How Early is Early?

By Kevin Minier. Independent carer.

Cost-effective co-production must ensure that we do the right things in the right way.

This means that the end-user of services must drive the need for change. We can no longer acquiesce and relinquish our responsibility to health and care managers.  Currently those managers can often determine what needs to change; and this might have to be based on the premise of short term finances. Under these circumstances, real change can be just too difficult. 

I believe this is because the authorities have limited influence and are only able to impact the services that they are directly responsible for. This means they are limited to dealing with symptoms and not the root problem.  What I also believe is that the end users and their carers are in a key position to highlight the root cause of the problems that they face. And we call this co-production.

Using co-production to contain costs

My proposal is that service user and carer groups are proactive in defining the root cause of system issues regarding integrated health and social care. Of course there is a need to contain costs and one way to do this is to work up proposals from lay people. This reduces the need to engage more expensive professionals, and it can also take them away from performing their desperately-needed duties. This is especially so if it means taking staff and clinicians from their front-line activities.

So, local patient and user groups can do things like: be proactive; get trained up in co-production facilitation; and create proposals for new integrated models of care. They can then get professionals, clinicians and other frontline staff to critique the proposals that they have come up with. These proposals, can, in turn, be presented to those ‘decision-makers’ and the proposals can be revised and given timescales so that they can be implemented.

It’s also important to create a co-production steering group of professionals and experts-by-experience to develop those things that can be delivered- and for them to monitor progress. Barriers and bottlenecks can be reviewed by all concerned.

Revolutionising models of care

I believe this process will facilitate programmes for change to address those root issues, thereby providing solutions that can revolutionise models of care rather than merely patching over symptoms. The latter adds cost to a process and rarely results in quality of care and customer satisfaction.

This process can surely be more cost-effective as it more effectively uses combined user / carer / professional /clinical resources when developing and implementing new integrated models of care.

Hammersmith and Fulham: leading the way with co-production

By Victoria Brignell. Member of Hammersmith and Fulham’s Disabled People’s Commission.

On June 20^th, Hammersmith and Fulham Disabled People’s Commission will officially launch its report calling for co-production in the way the council operates. If it’s implemented fully, it will have far-reaching consequences for how the council is run and how it delivers services to residents.

Entitled Nothing about Disabled People Without Disabled People, the report’s key aim is that disabled people should be actively involved in directing all aspects of the council’s work.

A cutting-edge initiative

The DPC was set up by the council in September 2016 and over the year that followed it carried out an extensive investigation into the experiences and views of local disabled people. Led by Tara Flood, who has been a disability rights activist for more than 20 years, the ten members of the DPC are all disabled and lived in Hammersmith and Fulham.

It was soon clear in the DPC’s research that not only do services need to be improved but local disabled people want to take part in making the decisions that affect their lives.

The way ahead

Now that the report has been published, the next stage, of course, is to put its recommendations into practice. No one is underestimating the scale of the challenge ahead. It could be argued that producing the report was the easy part. The real effort starts now.

What will undoubtedly help is that the report has the full backing of Steve Cowan, the council leader, and was approved unanimously by the council’s cabinet in December.

Disabled residents have already been closely involved in drawing up the plans for Hammersmith Town Hall’s refurbishment. More significantly, a implementation group is being established, made up of disabled residents and senior council officials, to drive forward the co-production agenda across the council.

Tara Flood comments: “Focusing on co-production was a risky move for the DPC, not because co-production is a bad idea – far from it – but because co-production has been much misunderstood. The DPC report recommendations set out all the strategic changes that need to be implemented by the council if real and lasting co-production is to become a reality. There is no doubt we’re doing ground-breaking things in Hammersmith and Fulham and it has been a privilege to be part of it.”

A trailblazer for other councils

Meanwhile, what’s becoming increasingly apparent is that councils elsewhere in London and beyond are starting to notice what’s happening in Hammersmith and Fulham. The pioneering changes underway in this West London borough are sending quiet ripples through local government.

The history of government is full of examples of reports which promise a great deal but deliver little. Members of Hammersmith and Fulham’s DPC hope that their report will be different and that co-production will soon be a reality in this part of the capital at least.

Fulfilling Lives South East - Creating our research together

By Kerry Dowding, Research and Evaluation Officer, BHT Fulfilling Lives 

In our project we have a team of peer researchers, who are volunteers and paid staff with lived experience of multiple and complex needs. They interview clients once a year, to gather feedback and input about the project. 

The problem? 

The researchers told us that some of the questions didn’t make sense to them or the clients, and as a result, the quality of feedback we were getting could be quite variable. We decided to co-produce a new version of the survey, with everyone’s input. 

The solution...

We started from scratch by asking staff and volunteers at all levels of the project what they would like to know from our clients. A selection of questions were drafted from these topics, reflecting everyone’s input equally, and covering a range of issues. We finally went back to the peer researchers (those in our project who have lived experiences and would be conducting the surveys) to ask about how to word the questions in a way that was clear, approachable and non-stigmatising. 

Co-produced survey

The feedback from clients, interviewers and staff has been incredibly positive since we co-produced the new survey as a team. Clients now understand all the questions properly, and interviewers feel much more confident using a survey they helped to create. From a research perspective, this means the depth and quality of information is much improved, and more useful to a wider range of people within the organisation. 

And it was all done using co-production. 

South East project 

Nothing About Us Without Us

Patrick Wood on the need to keep it real in co-production

Simple but revolutionary

Co-production is a simple but revolutionary idea. It’s about developing more equal partnerships between people who use services, carers and professionals with the aim of providing support and services that meet the needs and respond to the wishes of people who access health and social care provision.

Principled

I fully support SCIE’s approach to co-production, which is grounded in the principles of equality (everyone has assets), diversity, accessibility and reciprocity (or getting something back for putting something in).

More than a buzzword

There’s a lot of talk about co-production in statutory and voluntary sector organisations at the moment, which indicates that the concept is moving towards the mainstream. Whilst this trend can be broadly welcomed, we need to be aware of the associated dangers. Sadly, I’m aware of initiatives supported by large service providers that use co-production as a buzzword in the aggressive pursuit of funding, which ultimately works to the disadvantage of the communities they purport to serve.

We need to remain vigilant to ensure that co-production doesn’t end up as an empty word or co-opted approach to maintaining the status quo that has everything of real value stripped from it. As my old friend and fellow long-term survivor activist Terry Simpson says, mainstreaming has diluted the reach and potential of advocacy and peer support, and you can also see a similar limiting force at work in the history of the mental health recovery movement and the provision of talking treatments in this country.

From strategy to delivery

Sue Sibbald, the Sheffield based campaigner, trainer and activist for people with ‘Borderline Personality Disorder’ produced a couple of Tweets during last year’s National Co-production Week that get right to the heart of the matter:

“Co-production is not asking me to come along and tell my story nor is it asking me what you think of your great idea... It's about me being there from strategy to delivery and you need to be aware of the power imbalance...”

Patrick Wood: Mental health training, advocacy, influence and participation, peer support and co-production. Co-ordinator of SUST (Sheffield User Survivor Trainers).

Patrick Tweets @pwtc_wood