The real reasons we still don’t co-produce

By Alex Fox. CEO of Shared Lives Plus and trustee at SCIE

It’s rare to hear senior public service and voluntary sector leaders talk openly against the idea of co-production. Some still confuse it with consultation. As I heard a senior leader say recently, “We will come up with ideas and then co-produce our plans with local people.” (If you’ve already come up with the plans, it’s not co-production.) Many still describe it as difficult, either in terms of the process (despite so many co-production toolkits out there from Think Local, Act Personal; the Coalition for Collaborative Care, SCIE and others), or in terms of it being risky and time consuming. 

It is risky: it involves placing trust in groups you do not normally work with, and being willing to take the first step forward, knowing that the other side may just take a step back. It also takes time, but how much time do we waste rushing headlong in the wrong direction, coming up with plans that never work, because the most important people were not part of the planning conversation? That’s why in my book, I argue for a slow policy movement.

But I always think that when something is talked about so positively, but done so rarely, there must be something else going on. Here are some reasons we don’t co-produce which we don’t talk about.

1. Heroic leadership. The news pages of a number of trade magazines/ websites remain dominated by stories of who is moving in and out of the big jobs. We remain hooked on the idea that the right leader will make or break a service. We see this happening: an inspirational leader comes in to a troubled organisation and galvanises the team around a new vision with great results. But for every example of a leader achieving this, there are dozens of it not happening, as well as some of leaders being key factors in toxic cultures. The culture of looking to powerful individuals is part of the problem: it creates the conditions for disempowerment, hopelessness and at times, bullying. But most people with any power in public service organisations are somewhere on a career path predicated on the value of the brilliant individual leader. It can be easier to be a leader than an ally. Co-production is the opposite of heroic leadership: believing in it is difficult if you aspire to be the hero.
2. When co-production is real, the group of people involved in decision-making doesn’t just grow, it diversifies. This means that co-production is at odds with monocultures. The gender imbalances and “snowy white peaks” of those at the top of the NHS and other public service organisations has been well documented, but there is also a less-frequently talked about class divide: those running public services and charities come from predominantly middle-class backgrounds; whilst health inequalities and the impact of the social determinants of health mean that those making most use of those services and charities are significantly more likely to be working class. Co-production is part of the effort to diversify decision makers, and those efforts are resisted by any number of conscious and unconscious biases.
3. Co-production can only work where there are people with lived experience in a position to co-produce. That usually means not only having their own lived experience, but also having the support, training and networks that anyone else needs to be an effective decision maker. No-one can be ‘representative’ of a large and diverse group of people who use services, unless they have been chosen by a number of those people, and ideally are in regular communication with them. This can only be achieved by investing in training and development for individuals, and more broadly investing in user-led and grassroots organisations. Our public services are reluctant to do that at the best of the times and these are not the best of times. User-led organisations are falling by the wayside in alarming numbers: our social capital and our co-production capacity is reducing just when the argument is being won for the value of co-production. This needs to be reversed.

The common theme running through these three problems is power: its unequal distribution and the discomfort those with it feel talking about it, let alone sharing it. I’d be interested to hear other barriers to co-production which you are seeing but which aren’t talked about. Naming these barriers is only a first step to changing them, but it is a start.

This blog was originally on Alex's own blog page, Escaping the Invisible Asylum. 

Co-production - could it apply to other aspects of our lives?

By Eleanor Mould, SCIE project coordinator

As someone new in the social care sector, I had hardly heard of co-production until I started at SCIE and I was assigned to the co-production team as a project coordinator. When talking to SCIE's Pete Fleischmann and Kate Pieroudis about their work, which they are so clearly passionate about, it’s hard for that passion not to rub off on you.

I started to research co-production; reading articles, watching YouTube videos, and reading the SCIE and TLAP webpages and available literature. ‘The principle that those who use a service are best placed to design it’ doesn’t sound like a revolutionary concept, yet it is.

Attending the different co-production meetings at SCIE has opened my eyes to new ways of working together, power-sharing, and the development of services. The respect, passion, hunger for change, and lack of hierarchy present at these meetings is an inspirational change. These meetings are a place where everyone and every opinion can be heard. A place to be respected, relax, discuss serious topics with a renewed sense of energy, and constructively challenge topics. These meetings and all those who are involved are a breath of fresh air.

It made me think why the notion of ‘nothing about us without us’ doesn’t apply to more aspects of our lives. Coming from a politics and security studies background the idea of power-sharing is, as you can imagine, rarely discussed. Seldom do politicians or those involved in security want to relinquish the power they hold. If only politicians could see that by power sharing and co-producing more policy on different topics, they are not losing anything, rather that they could gain a wealth of knowledge and experience, ‘don’t shift power, share it’.

I believe co-production in the social care system and its progressive impact, can be a shining beacon for making co-production mainstream. We should use the example set by co-production to constructively challenge the status quo and make co-production a requirement by law.

What is power? Who has power? How do we share it?

By Roy Curtis  

“The use of the term ‘partnership’ does not mean that equality has been achieved.” Marian Barnes

Power in health and social care should reside with people who use services and other people with lived experience. But it doesn’t always. Services and support should be developed in accordance with the expressed needs and wishes of people with lived experience, but they’re not always.

Decision-making powers in some organisations are not always acquired through talent or knowledge that is useful to communities, but can be arbitrarily seized by individuals who are shameless enough to do so. It’s open to anyone to say what they want, represent what they want and project themselves however they want; they don’t have to be sincere, authentic and truthful. Shameless leaders take advantage of the good manners and fear of people who have been trained to think of themselves as deficient through a lifetime’s experience of having this message imposed on them.

I know that oppressed groups have access to accurate forms of knowledge about their oppression and the power relations that sustain it. I understand the idea and theoretical desirability of partnership working, but I don’t want to be a junior or token partner in initiatives and agendas that are grounded in and controlled by individuals and agencies who are distant from the issues that affect me.

I am interested in activity where people with lived experience play an instrumental role in:

·       Deciding what will be talked about

·       Guiding the discussion

·       Developing plans of action

·       Implementing plans and evaluating their effectiveness.

I reject rule by self-selecting elites who put the pursuit of their own interests above the needs of their neighbours and fellow citizens. I reject the fantasy of the ‘strong leader’ model promoted by these elites and their allies. I favour participatory democracy and collective working. I trust communities to define the issues that concern them and to find solutions to their problems through knowledge sharing and purposeful action.

Get active with co-production

By Leanne Wightman, coordinator of Get Yourself Active

How do you solve the problem of getting people to lead healthier lifestyles? Whilst the policy wonks scratch their heads, many of us continue to indulge in frowned-upon eating habits and stay resolutely on our sofas, instead of heading out for a brisk walk or a cycle ride after eating our five a day portions of fruit and veg.

Experts can help – from dieticians to fitness coaches, there are people who will assist us, when we are ready.

For some of us, of course, getting physically active may be more problematic and that’s certainly true for disabled people. A combination of inaccessible facilities, poor transport links and financial difficulties throw up what can seem like insurmountable barriers.

Co-production

Can the principles of co-production help with these sorts of problems? Of course they can, because disabled people know what the problems are and can help identify how to sort them out.

That’s what we found when we started working with disabled people’s user led organisations to help broker access to physical activities and sport for local disabled people, which included funding posts for local coordinators.

Having lived experience of disability meant they were able to bring new knowledge and resources to local sports providers, helping guide them on the best way to provide services to disabled customers.

They also helped providers build relationships with disabled people’s organisations, deepening understanding of the needs of local disabled people and encouraging providers to think about a long term approach.

Less need for support

We know co-production is not a quick fix, in the leisure sector or anywhere else. But we also know that disabled people are much less likely to get involved in physical activity than non-disabled people, and miss out on the benefits that brings. There’s improved fitness of course, and improved wellbeing and less social isolation. Our research also suggests there may be a positive impact in terms of people needing less support in the shape of social care or GP services.

Whilst the policy wonks continue to scratch their heads, maybe they should be looking at co-production as a tool to make things happen?

Get Yourself Active is a project run by Disability Rights UK with support from the National Lottery and Sport England. An evaluation of the project has been launched. Copies are available here.

The advantages of sharing power - from a football referee

By James Anthony, Communications Coordinator, Social Care Institute for Excellence 

At age 16, I had my first taste of having ‘power’. I had qualified to be a football referee, putting myself at the centre of the game I loved. 

When I first stepped onto the pitch, I assumed that being strict on the rules and never letting my authority be questioned was the right approach. Put simply, I didn’t want to share any of my power.

When games got tough, and the players turned against me, I guessed the poor attitudes were because they didn’t like what I was telling them.

Over time, I learned instead that paying attention to how the players wanted to play the game made them much happier. Rather than dictating to them, I began to ask players if they were happy with the pitch conditions and check with goalkeepers that they were ready before kick-off. I started asking whether a fouled team wanted to have a quick free kick or wanted to stop for longer, and restart again later with the whistle. 

There’s also a fantastic rule in football known as the ‘advantage’ rule, which allows a team to keep playing if they’ve been fouled but feel it hasn’t affected them. I’d often shout “play on – advantage!” following a foul and let the players continue going forward, or call it back for the free kick if they weren’t happy. These ‘advantages’ are a great way of giving some decision-making power to the players, working together, and keeping them content.

When you experience sharing some of your power, and realise it makes the experience better for all involved, you begin to wonder ‘why can’t we deal with other situations like this?’

As I moved to working in the social care sector – I realised this approach could be applied there, too. Co-production, working in equal partnership with people who use services and carers in the development of their services, is based on that idea of sharing decision-making power. 

There ought to be more opportunities of empowerment in social care just as the ‘advantage’ rule in football helps keep things fair. Perhaps the sector could learn something from the footballing world and realise – like I had to – that sharing a little power can go a long way to improving things for everyone.

SCIE's Co-production Week 2019 

Co-producing Research: How do we share power?

By Dr Gary Hickey, Senior Public Involvement Manager, INVOLVE (INVOLVE supports service user and carer involvement research) 

Gary Hickey 

Co-production, as an approach to research, is gaining traction.  At INVOLVE, in an effort to move toward clarity on what co-production means to research, we led on the development of some guidance (See here - pdf file) identifying some key principles and features involved in co-producing research.  The key principle is the ‘sharing of power’.  

The idea is that ‘the research is jointly owned and people work together to achieve a joint understanding.’  Easily said - but how do we achieve this in practice?  Research teams are often, and with all best intentions, hierarchical; with a chief investigator leading a team made up of researchers of various grades.  And how do we ensure that public members truly have a voice in decision making?  How do we also ensure that the knowledge of public members is respected and valued?

We will explore these issues in our second #How2CoPro event, Co-producing Research:  How do we share power? on 12th March. Last year the same event was such a success that we are back again with a bigger event and looking forward to learning together once more!  

Our key aim for the event is that we all share experiences, and provide practical examples, of how power can be shared in a co-produced project. We will also update you on various co-production initiatives and opportunities that we know of.  

At the event we have a range of quality speakers including Simon Denegri (National Director for Patients, Carers and the Public, National Institute for Health Research), who will update on co-production in the National Institute for Health Research; as well as a range of speakers (public members and researchers) who will share their experiences of, and techniques for, sharing power.  The event will end with a panel discussion on sharing power and will include SCIE’s Head of Co-production, Pete Fleischmann.

This event is sponsored by: Centre for Public Engagement, Kingston University and St George’s, University of London; INVOLVE; University College London Centre for Co-production in Health Research.

You can register for the event and see the agenda here. Twitter Hash Tag: #howtocopro   

Making it Real – something wonderful this way comes?

By Caroline Speirs - discussing power, which is the theme of Co-production Week 2019. Caroline is Head of Think Local Act Personal (TLAP). A longer version of this blog is on the TLAP website

‘Don’t shift power. Share it’. This sums up the thoughts of Halima Khan, from the innovation foundation Nesta. Halima believes that sharing power can open up new solutions. That’s TLAP’s intention with Making it Real. It’s our new approach to what good citizen-focused care and support should look like. It’s a framework that creates space for a different model of power – a shared power.

By virtue of a great partnership, TLAP holds a privileged position that provides us with a multi-dimensional perspective. We get to speak to national leaders and decision makers. We meet regularly with practitioners and we work up close and personal with people with lived experience via our work with the National Co-production Advisory Group. Viewed through that lens, we get to see up close the gap between the rhetoric of what ought to be supportive policy and legislation and the reality of what’s happening on the ground.

The view isn’t always a good one. We see an exhausted colleague who accesses care and support questioning what he needs to do to live his life. We see a parent who worries about a system that cannot see what her grown up daughter has to offer society, only how much she costs.

What does any of this have to do with power?

Quite a bit I think. Clearly the impact of unprecedented cuts has some role in creating a harsh gate keeping system but it would be wrong to apportion all blame at the door of austerity. We have, after all, lived through financially healthier times but processes were no less harsh and stifling when we had a bit more money in the back pocket.

The beauty and the power of Making it Real is that, applied properly, it gently encourages a shift in relations. It generates a change in focus and supports a new outlook, one that is far more about relationships than transactions. An approach focused on a conversation, on what matters, on a life not a service.

Making it Real in Manchester

I began to see what a turbo charged version of this could look like in Manchester TLAP ran a session on Making it Real at the annual conference for Directors of Adult and Children’s Social Services. Something interesting happened Some barriers were dismantled and a few roadblocks removed. Not only did the world continue to spin on its axis but it did so with gusto. The challenge now is to harness that energy and that optimism to go further and deeper and create the transformational system change we’ve spoken about for so long. I am hopeful that with the arrival of the long-awaited social care green paper, we will see a clear commitment to working in this way.

Think Local Act Personal will do everything it can to support that.