I don’t wish to perceived as a ‘heretic’, despite people’s open and settled views in not labelling people. But please give me permission, oh thou people who say we shouldn’t ask for permission, to stray away from the song sheet for a moment.
One or two individuals like Kate Swaffer and Alison Cameron really ‘get it’, so the discussion below is not to do with them.
‘Co-production’ is a handy concept of designing and implementing services together with the ‘end users’ from the start. I have no wish to embrace a ‘status quo’ argument but it is a fact that there are many professionals and practitioners who are determined to get to the bottom of the beliefs, concerns and expectations of patients, clients, or howeverso called. The narrative about this is often confused by a moral panic whipped up from people involved in commissioning, some who are brokers, and journalists, and others.
I do not perceive myself as a doctor, even though I have received a medical degree, and am a registered medical professional. I do not perceive myself as a ‘patient’ despite living with a number of chronic long term conditions, going about my life and work, and having survived a six week stint unconscious on the intensive care unit of the Royal Free Hospital. So when others talk of ‘conversations between doctors and patients’, it is for me like talking to myself.
I think the work of the Royal College of Physicians in ‘Future Hospitals’ is brilliant – but it is driven by people with clear leadership skills, common sense, and a clear sense of crowdsourcing good ideas wherever they come from.
But at the other extreme there are quite aggressive egos who give co-production a bad name. I am reliably told that ‘co-production’ does not refer to rebranding of tokenistic engagement designed as a ‘tick box exercise’ to get funding.
And this is worth bearing in mind by Alison?
We surely all agree, whatever our starting points, that it’d be disastrous to throw the baby out with the bathwater, as Alison too rightly advises. The issue that real change is required, even if the change is more attractive than the activities of some of the ‘change activists’.
For all the talk of ‘inclusivity’, the norm is that I am never asked for my opinion in these discussions.
I think there is an advantage of listening carefully, rather than merely hearing and loudly boasting about hearing, to patients and users of services, as that is where you can glean often the most direct information about how things are failing. But if I were take a chip out of the motherboard of a LCD TV set it would not necessarily mean that the function of that chip is to make a picture on the TV set. Listening to patients and users tends to be badly done in the NHS, as evidenced by the sheer volume of complaints which never get acted upon. The NHS and social care have a generic problem in not valuing feedback, good or bad, and this fundamental issue needs to be addressed together with ‘co-production’.
I haven’t defined co-production as it means different things to different people, which is a facet of it which many find intrinsically attractive as ‘motherhood and apple pie’. But the definition does matter.
The co-production of public services has been defined, as cited in Wikipedia, in a variety of ways – e.g. “Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours” (new economics foundation) or “the public sector and citizens making better use of each other’s assets and resources to achieve better outcomes and improved efficiency” (Governance International).
This from Wikipedia also caught my eye:
“The term ‘co-production’ was originally coined in the late 1970s by Elinor Ostrom and colleagues at Indiana University to explain why neighbourhood crime rates went up in Chicago when the city’s police officers retreated from the beat into cars. Similarly to Jane Jacobs’ assessment of the importance of long-time residents to the safety and vitality of New Yorks old neighbourhoods, Ostrom noted that by becoming detached from people and their everyday lives on the streets, Chicago’s police force lost an essential source of insider information, making it harder for them to do their work as effectively.”
My Twitter stream is currently littered with people trying to sell products and services to do with co-production. This brokerage into the NHS and social care, whilst potentially adding value, is also adding costs, typical of private markets. Because of the sheer volume of these products and services, it is difficult to discern those who are offering something useful or those who are selling snake oil (yet again).
I, as it happens, am co-designing a MSc in dementia, so that it speaks to the needs of those people currently living with dementia and carers. I am not doing so as a source of competitive advantage. I am not doing it so some part of NHS England 0r a CCG can buy it.
I’ve already been dead once in 2007 – but successfully resuscitated from my asystolic cardiac arrest. Please don’t let me die, this time, by #deathbyhashtag?
I do applaud people who are using co-producing, wisely, I should emphasise
I’ll leave you with the wise words of Alison Cameron, speaking at the King’s Fund at their annual conference 2015, recently if I may?