Some Thoughts on Seminar 5

Many Thanks to Helen Crimlisk for her contribution:

Reflections on attending the 5th ESRC-Co Leeds

I am familiar with the power of storytelling. It ought to be familiar to all doctors – we use the word “history” to indicate the nature of the dialogue between doctors and “patients” as they try to jointly make sense of the issues being discussed. The experience at its heart should be an act of co-production. It should lead to a collaborative effort to arrive at a place where joint understanding is arrived at and some thoughts on what (if anything) could or should be done next by either or both parties to alleviate or attenuate suffering (the origin of the word “patient”).

But how much do I really listen? Today, I was moved by hearing the stories of hope and challenge from Tricia Thorpe and Vanessa Findlay (delivered at their pace, without the opportunity to interrupt, question, comment or plan) who alluded to trauma, hopelessness and frankly poor quality of past services, but focussed on their own personal development and roles in helping others. Their testimonies had power, wit and value. The sense of having been heard and understood is a process which should have inherent worth, although all too often, the process is hijacked by other processes – administrative, artificial constraints and the need to make plans for the future.

I work as a psychiatrist. I am bound by professional, legal and regulatory processes which, despite benevolent intentions around care, safety, quality and governance can be stifling and frustrating (I’m not looking for sympathy, just relating the day to day experience of many of us). The focus on these issues is one of the reasons that I believe we have a health and social care system which is creaking and is why I am keen to look at ways of reconnecting with the reason most professionals are in the job – a desire to be compassionate – and nurture that quality in others, especially students and trainees. Hearing patient stories can help us understand the meaning of “quality” from the perspective of patient/service user as well as that understood and defined by professionals. Working together with patients or service users as an integral part of the teams is the most effective way of undertaking quality improvement or service redesign.

Co-production is the obvious answer isn’t it? And so I along with many other colleagues busy ourselves ensuring patient participation, peer worker involvement, service user engagement and experience based co-design methodologies, making co-production work.

“How much are you prepared to change your view?” was the challenge today.

“Because if you’re not, then there’s really little point in continuing”.

This is something we don’t talk enough about and I need continually reminding of. There is still a risk that we still behave as if co-production can be “added on” – an addendum to satisfy patient groups, grant giving bodies, commissioners, Boards. But – in co-production should expect an element of surprise, risk and paradigmic shifts of power. If it is too easy, we should question whether we are actually doing co-production or simply playing at it. There is a big risk of recreating a system based on familiar patterns and comfortable traditions. Today’s reminder about the inherently radical nature of true co-production in their exploration of the value of a truth and reconciliation process by Mick McKeown and Helen Spandler certainly raised my heckles. Also helpful and horrifying was Shirin Teifouri’s eloquent challenge that co-production as currently undertaken is infantilising and culturally exclusive. I intend to continue working within the system. I will be constrained. This does not mean that my actions are worthless or insignificant, but they will not be revolutionary. This means my attempts at co-production will be almost inevitably flawed.

Something which does not help is the artificial dichotomy between professionals and service users. Not only does it maintain power imbalances, but also fails to recognise the potential value of lived experience in staff members, who should be able to use their experience to enhance their professional roles. The recognition of the stories all of us have within it are one way of finding our common experiences and enabling us to bridge the gap and come closer to “the other”. We have started on this journey but have a long way to go. Engaging with and valuing this is work which will progress the story further, iteratively and painstakingly slowly, but nevertheless in the direction of the Utopia alluded to by Brendan Stone in the final inspiring talk of the day: an unachievable goal, but one still worth aspiring to.

A final reflection was how welcomed I felt at the meeting. I don’t recall previously having attended a meeting where several people checked in with me that I was feeling ok and not too “attacked”. Thank you.

 

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