ESRC seminar ‘Enacting co-production’ at St. Catherine’s College, University of Oxford on 17 February 2016
First of all, many thanks to all participants for an interesting and stimulating day. Your level of engagement was great, and your commitment to co-production and social justice very evident. Thanks too to the Collaborating Centre for Values-Based Practice for providing us with such a lovely venue and lunch.
The programme was full – arguably too full – but, that said, I wouldn’t have wanted to have missed any of the papers which were all great. Throughout the day power was a theme that emerged time and time again. Addressing imbalances of power goes to the core of co-production, and space (in different forms) seems to be important for resisting power. I was heartened by a message I received from one of the participants who commented on our final discussion at the end of the seminar, ‘To me, it felt very much like the safe, shared space we were talking about towards the end’. This suggests that we were enacting co-production – not merely talking about it.
Here are some brief reflections on the presentations.
(Click the links to download presentations)
Bill Fulford introduced the day’s proceedings with an overview of the work of the Collaborating Centre for Values-Based Practice at St. Catherine’s. Bill addressed the relationship between values-based practice (VBP) and co-production, pointing out that VBP is now being applied in the traditional bastions of evidence-based practice (EBP), notably surgery. Bill suggested that a balance is required between EBP and VBP, highlighting that this involves dissensus. Dissensus is a decision-making strategy which respects and acknowledges people’s differing values. This contrasts with the usual organisational/institutional approach of seeking consensus. Bill explained the significance to co-production of the 2015 Supreme Court Judgement in the case of Montgomery v Lanarkshire Health Board. Following this ruling, doctors must now ensure that patients are fully aware of the risks (and alternatives) involved in any proposed treatment. This constitutes a new departure in how informed consent is implemented.
Following Bill’s contribution, I gave an overview of some of the salient points which arose in the first seminar. Perhaps the key message in this was that co-production involves blurring traditional boundaries which separate the personal from the professional, the sharp distinction in roles between professionals, service users, peer support workers and informal carers. Equally, co-production requires a new approach to research which is more tolerant of ambiguity and uncertainty. This view is expressed in the recently published N8/ESRC report N8/ESRC Knowledge That Matters: Realising the Potential of Co-Production.
Some really important raised here which reflect the need to embed co-production in a broader social/civil movement. Sarah Carr drew on Cahn’s work ‘No more throw-away people: the coproduction imperative’, eloquently highlighting the need for external pressure in bringing about reform in mental health care. Without external political pressure, organisations and institutions adopt or, more accurately, co-opt emancipatory terms such as co-production, applying them as an adroit strategy to perpetuate the status quo and existing power relations. The legacy of Goffman’s total institution is maintained, turning people into aliens and alienists. In brief, Sarah’s paper pointed to the necessity of not entrusting organisations to reform themselves, arguing that internal reform requires external pressure – hell-raising.
Peter Ryan followed Sarah by outlining the key principles and values of co-production based on power and control, reciprocity, an asset perspective, social capital, and redefining work. The values identified by Peter appeared to resonate with just about everybody. What Peter subsequently provided was a really well thought through systematic framework for promoting co-production. Peter’s model incorporated all levels of a system, from commissioning and organisational processes down to the micro level of everyday interaction. Partnership is key to the goal of creating a system which empowers people to look after themselves. Peter presented a detailed and really helpful action plan for implementation.
The last presentation of the morning was by Ruth Allen who spoke engagingly about the need to re-imagine professionalism with co-production at the centre. Emphasising that professionalism should be developed through a synergy of personal and professional learning, Ruth argued against the traditional model of detached professionalism. As Ruth put it (taken from the film ‘An ecology of mind’ by Nora Bateson), ‘A role is just a half-assed relationship’. This distinction between role and relationship summed up the views of many of us who believe that authentic relationships are central to co-production. Ruth’s presentation argued for systemic change and for greater sensitivity among professionals who can unwittingly inflict minor injuries in everyday interactions.
In the afternoon, Gemma Stacey’s and Philip Houghton’s paper (co-authored with James Shutt) representing the Critical Values Based Practice Network, was based on a study which investigated co-production or, more accurately, its tendency to be absent, in ward rounds. The paper critically interrogated how the exercise of power – a recurrent theme throughout the day – meant that patients were often not even routinely informed about their treatment and care. In co-production with patients Gemma and Philip have developed a guiding framework to enable busy professionals who may have their minds on target and efficiencies to enact shared-decision making/co-production. The model, developed by the Critical Values Based Practice Network, involves a practical step-by-step approach towards the three ‘i’s: being informed, being involved and being influential. Many commented on the usefulness of the model, suggesting that it might be adapted for contexts other than ward rounds. Lots of food for thought here.
The final presentation was by Ms Keeble who provided an insightful view of co-production in action by speaking about the development of the Bristol Co-production Group, initially formed to co-produce a change in mental health assessments. The Group, which was co-produced by Laurie Bryan (service user lead); Lu Duhig (carer lead) and Bill Fulford (academic lead) is based on ‘three keys’. These are: 1) active participation of the service user and carer; 2) a multidisciplinary approach and 3) strengths, resiliencies and aspirations of service users and carers. Among the valuable lessons that emerged from Ms Keeble’s presentation is the insight that the journey or the process of working towards co-production is an important as the destination. In other words, co-production is a learning process for everybody. The positive outputs achieved by the Bristol Group include publications and the development of educational materials for mental health nursing students. The Group evidences the productive power of dissensus.
Overall, the day provided an opportunity to share ideas both on and in the spirit of co-production and, once again, thanks to all participants.
In my next blog I’ll post a list of points which emerged as a result of your reflections in groups. These points will be used to develop a focus for future research collaborations and applications.