Power to the people!

By Steve Palmer, Communications Manager at the Social Care Institute for Excellence

A popular TV sitcom in the 1970s starred Robert Lindsay, playing Wolfie Smith, the self-proclaimed leader of the revolutionary Tooting Popular Front, the goals of which were to gain ‘Power to the People’. The show, called Citizen Smith, didn’t rock the establishment, because the chances of popular revolution in Tooting were fairly unlikely. In fact, people often like democracy because you don’t have to be the people with power. You can get on with your life, bringing up families, dealing with challenges and being aspirational, just because you delegate responsibility for bin-collection, having a decent local hospital and accessing social care, to others.

But could it be that we could look at the idea of power in a different light, forty years after Wolfie Smith was advocating it in South London? Co-production is a word that’s getting very popular in social care circles. It means seeing people who use services, and carers, being centrally involved with the design, delivery and evaluation of care services.

Power surge

But it’s also about power. As we approach Co-production Week, organised by the Social Care Institute for Excellence (SCIE), the theme for 2019 is “Power”. This might sound a bit pie-in-the-sky, but during the week we’ll be exploring how power can be shared more equally between professionals and people who use services - and carers. This is important stuff.

A board member at SCIE, Alex Fox, recently put it like this: Co-production is risky. You have to place trust in groups that you normally don’t work with. And it can take time. But he points out that much time is wasted because the most important people – people who use services and carers – were not part of the planning conversation.

Oxfordshire and Birmingham

Again and again we think, and the evidence suggests, that where you have this sort of input from experts-by-experience, then people’s experiences and outcomes can improve. SCIE has been working in Oxfordshire to embed co-production into their adult social care services. A group of Co-production Champions is made up of people who use services, carers, Council staff, professionals from health and social care, and voluntary sector organisations who are learning and working together to make change happen.

Birmingham City Council’s People Directorate is one of Think Local Act Personal’s Making it Real sites. It has developed a range of structures to support co-production work with citizens. These include: Two citizen-led quality boards that co-produce minimum standards for services; making sure that people who use services are involved as early as possible in specific projects and at all stages of service development; and allocating resources and staff time to supporting co-production.

I wonder what Wolfie Smith would make of this new demand to share power? There’s no storming of the barricades, but there is a hope that we are dismantling barriers to getting things done in the way that people who use services – and carers – know is more likely to work. And I think Wolfie would quietly agree that Co-production Week in July is a great place to embrace this.

From engagement to co-production – How we do things in Leicestershire

By Claire Cluer, Co-Production Officer for Adult Social Care within Leicestershire County Council.

I started in this role 3 ½ years ago and only now with the Engagement Advisory Panel do I feel like my role has come alive!

Whilst true co-production can and should be strived to achieve, and we do have some great pockets of success, we recognised the need to focus and improve on all the layers that build co-production as the concept that it is. 

What did we learn?
I started off with a small co-production planning group that co-developed some staff guidance around basic engagement. At its very first meeting I remember a carer saying to me, “this is all well and good but if people above you are not committed, what’s the point”. This comment stuck with me.

Lessons learnt over the first 3 years include:
• Senior governance is crucial for any advisory / working group 
• Building working relationships takes time
• Sharing power can feel like it is unwanted. As well as offer it, we need to support and nurture this skill and confidence in people

What are we doing now?  
We have launched our new Engagement Advisory Panel. The work is governed by our Departmental Management Team. The panels will have 9 members representing different areas of social care. Its purpose is to support the increase both quality and quantity of engagement related work when producing strategies and designing/reviewing services.

The panel will review engagement plans and provide constructive criticism, suggestions and support. Members will receive training to support them in this role and will be shaping the content of this.
They will also co-produce a one-page yearly plan. It will have clear actions to improve how the council works with people who use our services and their carers. 

This process will make the council more accountable in how we engage and work in partnerships with the people who use our services.

Staff Briefings

We are also holding two staff briefing sessions during co-production week. These are to inform staff about the panel and how they can work with them, as well as raising the profile of co-production and other good working practices.

You can keep updated about the development of the panel 

“Laura, I’ve got some good news.”

By Laura Wood, lived experience practitioner

I was perched on the stairs with the phone to my ear, and Suki Westmore at Mind was calling to tell me that I’d been selected as one of the lived experience facilitators on a project to develop quality assurance principles for maternal mental health peer support.

Once we had hung up and my victory dance was complete, I began to consider the practicalities – and, I suppose, to form my expectations. I had undertaken a fair amount of mental health involvement work already in various contexts and I thought I knew the drill. I was used to feeling, as a “service user” rather than someone from a third sector background or a clinician, that I was seen as a bit second-rate, less skilled, and only really useful for rehearsing my own story. 

Once someone genuinely patted me on the head. Decades of poor mental health meant that I hadn’t achieved the big dreams I’d always had and this, coupled with the fact that as a lived experience practitioner I was effectively patronised for a living, meant that I felt permanently frustrated and that my confidence was pretty low.

I anticipated that I would be helping to plan and deliver some consultation events and focus groups, which I did – but I was also treated as an equal partner in designing and delivering the project as a whole. This was totally unexpected and an absolute game-changer. It wasn’t true co-production, as the structure and timeline of the work was established before I came on board and we weren’t able to conduct the interviews or write the principles themselves, but staff intentionally gave us as much agency as they possibly could at every opportunity. This meant that we were invited to the table whenever there was a decision to be made. 

We met with the funders. We networked and promoted what we were doing. We designed and delivered every detail of those events and focus groups. We gave feedback on everything we couldn’t actually do ourselves within the parameters of the project, and changes were made accordingly. Budgets were managed so that we were paid fairly for our time, which made me feel valued and valuable, and enabled us to do the work justice.

The co-design process offered the perfect combination of autonomy and support. It showed me that I can make things happen, take the lead, that my expertise can be recognised and valued by others. I felt a powerful sense of ownership over the project, and I was encouraged further by enthusiasm amongst the wider maternal mental health community. 

Everyone who participated was so passionate and invested in good peer support for mums; many went above and beyond, emailing me resources to inform the work and checking in regularly to ask how it was going. It was a privilege – and very validating - to be their point of contact, to be associated with a piece of work which they recognised as so important and so needed. True co-production is rare, but I hope this example has demonstrated some of the benefits when we aspire toward and actively pursue that ideal.

Designing work rather than making suggestions

By Angela Slater, Senior Lived Experience Leadership Officer 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. 

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