The Chief Inspector writes...

By Kate Terroni, Chief Inspector of Adult Social Care at the Care Quality Commission

As I write this it has been six weeks since I began my new role and the time really has flown. I have had the chance to shadow inspections, meet with many external stakeholders and this week I had the pleasure of chairing my first coproduction meeting at CQC. It was great to spend time with so many people who are as passionate about coproduction as I am, and there were some very insightful comments made about how we can make the way we coproduce even more valuable.

Coproduction is something that I have always been passionate about – after all, how can anyone expect to get the best outcomes for people who use services if they don’t involve them? In my last role, as Director of Adult Social Care in Oxfordshire, I committed to embedding coproduction into all aspects of our work as we started on an ambitious journey to design, buy and evaluate the quality of all services with people who use them and their families. To ensure that we made coproduction meaningful and not tokenistic, we worked with SCIE and established a coproduction board which I co-chaired with a family carer and were joined by people with lived experience. We made really good progress with this work, but there was still lots more to do at the point I left.

True coproduction is about power sharing and working together as meaningful partners. In my role at CQC I want to involve people with lived experience as much as I can, which includes having Experts by Experience on as many inspections as possible. I plan to have a co-chair who is not from CQC at our coproduction meetings, these agendas will be coproduced from now on and I have asked that all future agenda items are co-presented with people with lived experience or family carers. I am also interested in how coproduction can help us within CQC think about how we regulate in the future.  

I am looking forward to SCIE National Co-production Week and the coproduction festival on 4 July, where I will be speaking more about coproduction and the importance of sharing power across the sector.

Seven reasons NOT to do coproduction

Warning: may contain satire

The National Coproduction Advisory Group. Written by Catriona Duncan-Rees.

One. Don’t do it if you already have great policies and procedures that provide all the answers.

If you don’t want to co-produce any new ones – be sure to lock yourself away and continue to write great policies, procedures, business cases, whatever else you like – and keep believing that they contain all the answers and will solve all the problems faced by the system. And be sure to make sure that everyone knows ‘there is no policy for that’ when suggesting new ways of doing things.

Two. Don’t do it if you are confident that it is possible to magically create the perfect systems and process to manage human beings.

If you are certain that productive solutions to human issues lies in ‘just finding’ the right IT system, process map, formula for processing ‘stuff’ more efficiently, then… well good luck. Please can you let us all know when you do – so that we can be sure to scale and spread it at pace.

Three. Don’t do it if you are convinced that people should not be trusted to do things for themselves.

Clearly people of ‘limited’ ability are not capable of making decisions for themselves, or for that matter do anything for themselves. The system is designed to fix people and care for people, therefore the responsibility for this is in the system, and your amazing management of it. 

Four. You know how much co-production costs.

Because of course coproduction is REALLY expensive. I mean getting all those people into a room to talk about things they really know nothing about – oh and the biscuits! The cost of all those biscuits!

You know it is so much better to spend that money on making sure that everything you do looks GREAT on paper. You have an amazing business case for change, a small army of programme managers, programme leads, a few consultants all running around asking questions, analysing this and that. And then starting the whole process again until you find the perfect formula. So much cheaper than asking real people what matters to them.

Five. You know how much time co-production takes.

It takes up far too much time. Time that needs to be spent writing policies and procedures, developing business cases, managing a small army of programme managers and consultants, reading all those reports and business cases, analysing them to make sure it all adds up, amending, adjusting, re-writing, re-calculating until it all looks right on paper.

We don’t have time to find all those hard to reach people and put on events that would help us to solve the problems we face.

Six. You understand the importance of keeping people safe and free from risk.

People with ‘limited’ abilities need to be kept safe from themselves and other people. They need to be ‘cared for’ in hospitals, care homes, even their own homes. You need to know where they are, and need to know that the people caring from them are able to ‘control’ them and keep them safe. The community is not a safe place for people, they might get mugged, or verbally abused, or taken advantage of. They might not be treated with respect and dignity.

Seven. You are the expert, and have been trained to be a very good expert.

You know everything there is to know about how to keep people safe and well. What time they need to get up, dressed, eat, sleep (repeat). What medicines they need and when. When to pee. Have a cup of tea. Places they want to go, things they want to do. You know what matters to people much more than they do, because you are the expert.

As soon as you ask people themselves what matters to them you run the risk of hearing things you don’t want to hear. They might not want to go to bed when you think they should, or eat or sleep or play (and repeat monotonously day in day out).

In fact the biggest problem we face is PEOPLE, if it weren’t for the people then the health and care systems and processes, policies and procedures would run like clockwork…

Post Script:         

Obviously this blog is tongue in cheek – but it does reflect some of the myths about coproduction. The National Coproduction Advisory Group believe there are NO reasons not to coproduce.

We believe that coproduction is a Long Term Relationship with citizens, it takes time but can make a huge difference, making things easier for everyone in the long run.

Ultimately coproduction IS sharing power. If we have done it together from scratch it is coproduction… If we haven’t, it isn’t. The POWER of coproduction is great relationships. Get this right (the cultural conditions) – the rest will follow (not without continued effort mind!)

The theme of this year’s Co-production Week is ‘power’. How powerful to work together to smash this lot!

For more information about coproduction please visit:

https://www.thinklocalactpersonal.org.uk/Browse/Co-production/National_Co-production_Advisory_Group/

And to find out how people and organisations are making coproduction real check out:

www.thinklocalactpersonal.org.uk/makingitreal

Co-Production: Sing out for inclusive communication

            By Alix Lewer and Susi Barran, the Include Choir                            

The Include Choir 

There is a growing recognition of music’s amazing ability to heal and promote wellbeing– but wellbeing is only part of the story. Music is also a powerful agent for change. The well-timed protest song may do more to influence change than umpteen academic articles or committees.

Music is a powerful form of communication and we also know that communication is power!

We know how powerless we feel if we do not have a voice. But sometimes we forget the other half of the communication exchange - understanding is also power. If we do not understand what people are saying to us, we are as excluded as if we are not heard.

And this is what makes The Include Choir unique – not only does it harness the power of song to give a voice to people who don’t feel heard,  it also uses and teaches the inclusive communication techniques which make genuine co-production possible.

An average Include Choir rehearsal uses:

·  * Makaton signs, symbols and pictures to support understanding and expression

·  * Visual timetables / diaries to maximise autonomy

·  * Accessible information

·  * Talking Mats & iPad apps to make choices, discuss and reflect

·  * Objects of reference or sensory interaction to engage people with more profound communication needs.

Inclusive communication means power is shared in all aspects from running rehearsals to introducing performances, inducting new members to choosing songs. Together with song, it breaks down the barriers between people with communication needs and other members of the community, meaning everyone can be involved.

The Include Choir also embraces musical coproduction when writing its own songs about things that matter to its members.  Rehearsal and repetition increases learning and understanding –whether singing about complex legal issues in The Battle Hymn of the Mental Capacity Act, or singing about a curry! For support staff, repetition also builds confidence in using inclusive communication.

Pity is disempowering and is not a word associated with The Include Choir. The power of song grants  a voice and reminds people that coproduction means supporting communication.  There is no pity, but there is a shared song, laughter and a commitment to ‘sing till we are heard’.  

To find out more about: Accessing the Battle Hymn of The Mental Capacity Act e-learning in 2020; mental capacity and inclusive communication training; booking The Include Choir; setting up an Include Choir in your area; Or anything else - please email info@include.org

The Include Choir is a volunteer-led charity. If you would like to make a donation to help make the world more welcoming for people with understanding and speaking difficulties, go to https://wonderful.org/charity/theincludeproject

Website: www.include.org

Twitter: www.twitter.co.uk/includechoir

Facebook: www.facebook.com/IncludeChoir

YouTube: www.youtube.com/c/theincludechoir

Instagram: www.instagram.com/includechoir

Co-production at Mind

As part of SCIE’s Co-production week on 1-5th July 2019 we are holding a staff event on 3rd July at our head offices in Stratford to highlight the many positives and benefits of co-producing work and sharing power. It is a big part of our values and goals at Mind to involve people who experience mental health problems in all of our work and something that we aim to continuously develop.

Co-production is an increasingly common concept in the influence & participation work that we do at Mind, as well as for organisations that we work with. For us the difference between co-production and other methods of influence and participation that we use is that in co-production people with lived experience play an equal role in both designing and delivering work, rather than making suggestions that professionals are responsible for deciding upon and implementing. Here at Mind we would like to see this happening where ever possible in our work.

With this in mind we will be co-producing our co-production event aimed at the increasing number of staff at Mind head offices to attend. Seven people with lived experience are joining myself and three Mind Influence & Participation Coaches to design and deliver the event. As we work together we we are starting to see what we want the key outcomes to be, what the event will look like and how it will be delivered - so watch this space….

To help with our work around involving people Mind has created an Influence & Participation Toolkit which is a comprehensive resource designed to develop understanding and support the meaningful involvement of people with lived experience of a mental health problems in the development of organisations and their services. It is available publicly for anyone to use and can be found here.

 We are always looking for examples of good practise from different organisations including examples around co-production so if you have a piece of work that would make a good case study then please do get in touch with us at LivedExp@mind.org.uk

 Current case studies about co-production can be seen here.

Care to Listen Podcast: A Co-pro Case Study

Care to Listen by Five Rivers

Produced by care experienced young people, Care to Listen is a powerful podcast series. We hear first-hand experiences of what it is like to live and work in the care system.

In a bid to dispel myths, reduce stigma and support positive change, the podcast series was created and led by members of the Five Rivers’ Youth Council. It was important that they led the agenda. They decided whom to interview, what to ask and, crucially, how to edit the series to ensure key themes and ideas were broadcast.

This creative project has the support of the Children’s Commissioner, which will help to support the change needed to address some of the issues faced by society’s most vulnerable people.

Read the full case study on the SCIE site

Listen to the podcast

Sharing Power at People First

By Gina Barrett and Jennifer Taylor from People First Lambeth

Gina: ‘Having power gives me a good boost. In my life I haven’t had power. I learned it step by step, going to People First Lambeth and going to different meetings about powering people with learning difficulties to have power. Having power is taking charge of different things I want to do, having a say over what to do in my life and taking charge in my life’.

Jen: ‘We do a project called Supporting Each Other Equals Power. People First Self-advocacy helps people to sort out their problems like benefits and housing and to find work. Our bit is supporting people to go and do socialising that they want to do in the community, like our dance or afternoon tea and morning coffee. But if they want to go to the theatre or the art gallery or anything that suits them we support them to do that. Sometimes they come in and see us if they want to have a chat or do art with us. SCIE helped us to raise the money for the project. They are partners in the project as well’.

Gina: ‘Basically, they help us to run the project and look after the money’.

Gina: ‘We share power with different organisations when we do projects together. We work with lots of different organisations and we like to have equal control from the very beginning, from the start to the end’.

Jen: ‘That means we plan everything together and we make decisions together and decide what should go on in the project. We look at what’s working well and what’s not working well. We do writing the reports about what goes on in the projects. We decide how we should spend the money on the projects, like the financial side of it’.

Gina: ‘They can’t do it without us because we know what it’s like to be a person with learning difficulties. We know better than people without learning difficulties what we need, what we want, what’s wrong with services, when we’re treated bad and what services are good for us.

Gina: ‘So it’s very important that people do listen to us, what we’ve got to say, and treat us with respect as a person and don’t look down on us, like some people do, who think they know it all, but they don’t.

Co-production and Quality Improvement – Camden & Islington Recovery College

By Ksenija Kadic & Anne Prouse

All Camden & Islington (C&I) Recovery College courses are co-produced and co-delivered by a peer tutor (expert by experience) and a C&I Trust staff professional tutor (expert by profession).  We have trained psychologists, social workers, nurses, researchers, and managers to co-produce with us as professional tutors. 

Fewer Trust staff teach with us, relatively speaking, than other UK Recovery Colleges.  Unfortunately, we struggle to have C&I staff released to co-produce with us, especially for longer courses. Over the last five years, the College has grown significantly but we can’t offer all the courses we would like to, as we do not have enough staff tutors. 

C&I staff who co-produce and teach with us tell us they do find it valuable. ‘[It] has taught me a lot and encouraged me to reflect on how I work with people’ and ‘[I now] approach work in a more collaborative way.’

In February 2019, we set up a Quality Improvement (QI) project to explore ways to encourage more C&I staff to co-produce recovery and wellbeing courses with us.

Our aims

• Promote co-production & teaching for personal & professional development
• Transform C&I Trust culture through co-production and recovery model
• Invest in staff skills & knowledge

Our SMART goal

To increase the number of C&I staff teaching at the Recovery College by 20% by October 2019.

Our team

We invited students and C&I staff tutors to join our QI team to co-produce  ideas.   Our team was two students, three C&I tutors and a research manager, led by the College Deputy Manager/Senior Tutor and with a C&I QI Hub member.

We shared our own stories, and discussed why the Recovery College is a place where C&I staff would want to co-produce and teach. We collected stories from C&I staff tutors and student stories on how our co-produced recovery courses had helped them.  We presented our project to C&I leaders and it was well-received.

What happens now

As senior C&I leaders have shown support for our project, we feel confident we will soon be welcoming more C&I Trust staff to co-produce with us.

Working well Together at National Collaborating Centre for Mental Health

By Steph de la Haye, National Advisor at NCCMH and Co-production Working Group

NCCMH have taken on the mantle of developing co-production in all its facets, and their genuine commitment to make it real has driven Working Well Together, the paper on co-production and mental health commissioning, which was published on 10th May.

The first thing to state is that the team was made up of more people with personal experience of mental health distress and using services than there were professionals, although many had both hats.

One area of discussion during the development of this paper was around establishing key principles for co-production, which came down to:

Click on the image for a larger version

Another central conversation in the development of this paper was about ensuring that we acknowledge the range of involvement and engagement - as well as acknowledging that co-production may not fix everything! Co-production should, however, run through all work streams as a ‘golden thread’, from the start.

Recognising power is fundamental and something that everyone within teams, services and organisations needs to do, and support the equalisation of. Accessibility is another key factor that can create a level playing field for all people, while recognising the equalities and inequities that people experience.

NCCMH already models what we want commissioners to do. By being open to improvements and individual requests, they have made the process of co-production more inclusive while being aware that more can be done. This is the mindset we hope others will take on. 

A member of the co-production working group said:
“I couldn’t have got to the meetings at all without taxis and 2 nights in a hotel, for a 2-hour meeting. This commitment of resource meant someone who would otherwise not have been at the table at all was able to attend.”

Another person reflected on the support they were given so that they could continue to access benefits while being involved in co-production: 
“Being on Employment and Support Allowance was also a barrier to being able to take part. While I worked hard and earned my payments, the flexibility of expectations, the low frequency of meetings and the level of support I needed to engage with the process couldn't really be reproduced in a job. Involvement in work like this shouldn't be used to assess capacity to work. Even though they had no experience doing this before, NCCMH agreed to write a supporting letter to be sent in with my permitted work form.

"This flexible approach of listening to what I needed is a vital part of working well together, inclusively.”

Creating the space for effective co-production based, power sharing

By Richard Field and Clive Miller – Independent consultants

Co-production is more than a practice innovation. It’s a total shift in the way the world is understood to work. This is the bedrock on which the new set of working relationships, with power-sharing at its centre, will be built.

Co-production understands that services do not produce outcomes. Instead it is what people and communities do alongside organisations that together produce outcomes. This has always been the case but has either not been recognised or taken into account in conventional practice. Hence the opportunity for people and community to be effective co-producers with practitioners continues to be missed. The result has been both the ineffective and inefficient use of the collective assets of people, communities and organisations.

What is now needed is large scale change that uses the learning from the many examples of innovative co-productive practices to completely transform all conventional practice to being co-production based. This is not a theoretical musing. Wholesale ‘re-imagining of social care’ is already starting to happen in places as diverse as Somerset, Thurrock and Wigan.

It works by devolving power:

·       A new relationship - ‘re-defining the relationship between councils and residents. For example, the Wigan Deal.

·       Community anchored support - ‘A clear sighted commitment to foster development of services and support, often small-scale, which is anchored in the community’.

·       Permission - ‘Senior managers creating a permissive framework that creates the expectation and provides support for practitioners to work in imaginative person and community-centred ways’.

At whatever scale co-production is being introduced, if power sharing is to become a reality it will also require a new ways of exercising power, including a new model of leadership with its own unique set of terms and conditions. SCIE trustee Alex Fox identifies some of them:

·       What. Stop believing in ‘heroic leadership’ the ‘inspirational leader who turns around a troubled organisation’. This is the opposite of the power sharing culture that underpins co-production.

·       Who. No diversity, no power sharing

·       What. ‘Co-production can only work where there are people with lived experience in a position to co-produce’.

The context within which power sharing takes place has a major impact on its outcomes. Hence the commissioning process also requires wholesale change. The many different individual innovations that comprise asset-based commissioning show what is needed.

Now is the time to bring them together as a connected set to deliver the new model of power sharing, at scale.  

Three key shifts will be:

Focus and how outcomes are perceived to be produced

Collaborate with people and communities as equal decision makers.

A fundamental shift in the relationship between commissioners, people, communities and suppliers.  

None of the above will happen unless there is system-wide change in both practice and commissioning. True co-production.

Sharing Power through Sharing Stories

By Flexible Films, a video production group working with SCIE

Sharing the power in filming creates interesting and captivating content. We would highly recommend it!

When we first started filmmaking in 2002, we were a bit nervous about doing this as we thought that things had to be exact and technical. There was an element of us wanting to take full control to make sure that the filming sessions were focussed and thorough. We learnt a lot through our mental health filmmaking group, which was a collective made up of people using mental health services. They helped us realise that it's better to include all those involved and to give them as much control as feasible.

We have since learnt that:

• Those being filmed should hold the power as it is their story.
• By sharing the power, this makes for honest and open footage.
• Taking ideas from others makes the films richer and more interesting.
• A collective process means that people have more ownership.
• The completed films are more real and engaging as a result.

We are learning all the time and at the start of each project, we leave ourselves open to new possibilities. Because of changing technologies, this can make sharing of power in film easier to achieve. For example, in this year's SCIE co-production festival, there are five volunteers who will be filming interviews with their Smart phones. We will train them how to do this as it is important that technical needs are met. Having co-production members interview delegates will give the interviews a new look and feel. It will also mean that the content is different because members are asking the questions. We are excited at this new prospect and look forward to the festival.