Montgomery Judgement

Bill Fulford speaks about a new legal departure towards co-production

 Bill Fulford (Click to download Slides) introduced the day’s proceedings at the second seminar of ESRC series Re-imagining professionalism: towards co-production with an overview of the work of the Collaborating Centre for Values-Based Practice at St. Catherine’s College, University of Oxford. Bill addressed the relationship between values-based practice (VBP) and co-production, pointing out that VBP is developing strongly in bastions of evidence-based practice (EBP), notably surgery. Bill emphasised that EBP and VBP are partners in clinical decision-making (VBP ‘links the science of EBP with people’). At the heart of values-based decision making is dissensus.  Dissensus is a decision-making strategy which respects and acknowledges people’s differing values. This contrasts with the usual organisational/institutional approach of attempting to enforce consensus. Bill referred to the recent (2015) Supreme Court Judgement on consent in the case of Montgomery v Lanarkshire Health Board. This strongly endorses co-production. It specifies that for consent to be legally valid: 1) clinicians (of any kind not just doctors) must engage in ‘dialogue’ with their patients, to the point that, 2) they have sufficient understanding of the risks and benefits of the options available such that, 3) their individual values are ‘taken into account’ in the decision made. This judgment marks and gives new legal weight to established principles of person-centred decision-making (as in the GMC’s ‘Good Medical Practice’ for example). It shows the extent to which principles of co-production are becoming more influential not just in mental health but across health and social care as a whole. The Collaborating Centre will shortly be announcing a conference on the Montgomery Judgment: Lady Hale, one of the Montgomery judges, is a Keynote speaker.  (Hold the date, Friday October 28th.)


Partner Organisations

The initiatives outlined below have informed the development of the seminar series:

vbp imageThe Collaborating Centre for Values-based Practice in Health and Social care has been set up to support the development of the field through shared learning. Based at St Catherine’s College in Oxford the Centre brings together a wide range of individuals and organisations working on different aspects of values-based practice around the world. Although originating primarily in mental health and social care a particular aim of the Collaborating Centre is to support extension of values-based approaches to other areas of health care such as surgery.

C-VBP-N.jpgThe critical values based practice network comprises of practitioners, people who use mental health services and academics from the statutory, private and voluntary sector working within mental health. It focuses on education, research and practice which attempts to critique and address the barriers to implementing values based practice in mental health in-patient settings. We have an explicit focus on exploring professional and organisational power structures which underpin these barriers. This position informs educational and practice based action research initiatives which attempt to acknowledge and work within legal and ethical constraints to improve collaborative practices.

Volition imageVolition is the network for third sector organisations working with people and their mental health and wellbeing. With 96 members organisations in Leeds, Volition support and bring together the strong and vibrant mental health third sector in Leeds as well as facilitating the mental health third sector voice at a strategic level. One of the core aims of Volition is to promote service user-led and recovery focused socially inclusive services. Volition is a strong advocate of people with lived experience being at the forefront of decisions around mental health, from mental health service design to co-production of a person’s own care and support. Within Leeds, one of the core principles of the redesign of the MH services in Leeds, which is a current 3 year project, is that people with lived experience are at the core of all of this work.


Lip imageLeeds Involving People (LIP) is a user-led organisation, connecting citizen insight with service redesign for 20 years. LIP is a recognised centre of expertise in the coproduction of health, social care and community service solutions, with 600 members representing a range of seldom heard communities. LIP’s Together We Can network is an active partner in mental health strategic development and co-author of the Leeds Mental Health Framework 2014-17.


co-creation, imageThe Co-Creation Network began on October 2014 establishing a network of Communities of Practice for anyone interested in improving health and social care. The Network brings together service users, academics, researchers, professionals and service provider staff from all sectors to share knowledge and experiences and develop new practice. The regional initiative which began in Yorkshire & the Humber now also hosts communities with national and international interests.

The School of Healthcare at the University of Leeds has Service User and Carer Community who are actively engaged in the selection and education of mental health nurses and social work students and research studies. Having been informed by discussions with the above organisations, an early draft of the proposal was presented to the Involvement Advisory Group for their thoughts and input. A member of this group, Annie Dransfield will be a speaker at the first seminar.

comensusComensus (Community Engagement Service User Support) involves  service users and carers and the wider community in scholarly activity at the University of Central Lancashire (UCLan). Comensus emerged from a participatory action research process and has been developed to embed the voices and experiences of service users and carers within health and social care practice. Democratised ways of working and relating are central to our ethos and practice.

scie.jpgThe Social Care Institute for Excellence (SCIE) improves the lives of people who use care services by sharing knowledge about what works.

We are a leading improvement support agency and an independent charity working with adults’, families’ and children’s care and support services across the UK. We also work closely with related services such as health care and housing.

The School of Human and Health Sciences at the University of Huddersfield believes the involvement of a wide range of people experienced in health and social care is of great value to the education of its students. Their stories and history of experiences can help students to understand the needs and expectations of the individuals they will be working with. This also enables them to develop the right values, knowledge and attitudes to support their client group, ultimately putting the person at the centre of care.


Flexibility and co-production

Final Report – Co-Production – 2016-01-20

Co-production involves learning and flexibility. This is important for the responsiveness necessary in research as mutual understandings evolve. Traditional research approaches conceive of flexibility in research as an indicator of a poorly focused study. The tide may, however, be turning. Please read the report by N8/ESRC Research Programme, which suggests that it may be within fluid situations of co-production that the most important new insights emerge.

Pamela Fisher


Research Team

Pamela FisherPamela Fisher (principal investigator) is a sociologist at the University of Leeds. Her work focuses on critical understandings of ‘resilience’ and resistance amongst communities marginalised communities.  Pamela’s recent work has critically interrogated professional practices and values which reinforce marginalisation and on alternative approaches which contribute to professionalism based on power-sharing. Pamela sees professional practices as inherently political activities which are informed by and which inform understandings of citizenship.

Co-researchers are:

John Baker was appointed to Chair of Mental Health Nursing in 2015. John’s research focuses on developing complex clinical and psychological interventions in mental health settings.

Albert DzurAlbert Dzur, Professor of Political Science at Bowling Green State University, who has developed the concept of democratic professionalism. His work focuses on both the barriers to lay citizen participation in professional domains as well as the resources available for sharing power in typically hierarchical institutions.

Hannah Howe is Director of Volition, the network for the mental health third sector in Leeds. Prior to working at Volition, Hannah worked for a Leeds-based metal health and wellbeing charity leading a service for people with long term conditions which enabled people to cope, manage and live positively with LTC’s as well as managing a 1:1 outreach service for people with complex mental health needs, again empowering and supporting people to live independently.

Norman McClelland, Head of Collaborative Research between Leeds and York Partnership NHS Foundation Trust and the University of Leeds.

Elaine McNichol, academic lead for service users and carers in The School of Healthcare at the University of Leeds. Elaine’s current research and practice is grounded in Patient and Public Involvement, from engagement through to co-production within a context of knowledge transfer.

John Playe

John Playle is Professor of Mental Health Nursing & Dean of the School of Human and Health Sciences at the University of Huddersfield.  He has a long standing interest in working in partnership with service users and carers particularly in relation to their essential engagement in shaping and delivering pre and post qualifying education for mental health professionals.

M WebberMartin Webber is Professor of Social Work at the University of York where he leads the International Centre for Mental Health Social Research. His research focuses on the development and evaluation of social interventions alongside people with mental health problems. He is also the academic lead for Think Ahead, a fast-track training programme for mental health social workers.

Seminar 2 Format

Please note the second seminar is now full. Should you wish to be put on the waiting list for this seminar please email .

9.30 Registration (with tea and coffee available)
10.00 Bill Fulford, welcome and introduction to the collaboration between the Centre for Values Based Practice, St Catherine’s College and the Leeds University initiative on co-production. Pamela Fisher, summary of key points arising from seminar one. Housekeeping and scene setting

10.30 Presentation by Sarah Carr and Peter Ryan of the University of Middlesex. Sarah is an Associate Professor of Mental Health Research, Middlesex University and an independent mental health and social care consultant and researcher. Sarah is Co-Chair of the National Survivor User Network (NSUN) and uses her lived experience of mental distress and service use in all her work. Peter Ryan is an expert in mental health. He is currently establishing a research centre for co-production in collaboration with Sarah Carr at the University of Middlesex.

11.15 Café style discussion based on presentation
11.45 Facilitated feedback, questions and discussion of arising themes
12.15 LUNCH
1.00 Presentation by Ruth Allen followed by questions and comments

Ruth is Director of Social Work for South West London and St George’s Mental Health Trust and a Research Fellow at St George’s University of London. She is Chair of the national Social Care Strategic Network for mental health which promotes effective social work leadership in mental health and former Chair of the Mental Health Faculty of the College of Social Work.

Presentation by Philip Houghton, Gemma Stacey and James Shutt
Philip Houghton is a clinical psychologist with a particular interest in the impact of power on individuals and systems, both within and outside of the mental health systems.
Gemma is the Academic lead of the Critical Values Based Management Centre, University of Nottingham. Philip is a Clinical Psychologist and Practice Leader of the Critical Values Based Management Centre, Nottinghamshire Healthcare Foundation Trust.
James Shutt is the service manager of POhWER. Coming from an advocacy and voluntary sector perspective, he is interested in the lived experiences of people with mental disabilities.

2.00 Identification and discussion of key points arising from presentations and discussions

2.30 Round table discussion introduced by presentation (10 mins) by Ms Keeble.  Ms Keeble uses mental health services. She is a founder member of the ‘Bristol co-production group’ which has grown from its original brief to produce many collaborations, including the partnership teaching of mental health nursing students

3.30 Summary of key points and emerging focus for research applications and outputs

4.00 Additional Networking opportunity

First Seminar Recap

Many thanks to all of you who participated in the first seminar of the ESRC series Re-imagining professionalism in mental health: towards co-production on 5 January 2016 at the University of Leeds.

Thanks so much for the lively and interesting discussions which generated so many ideas and raised such intriguing questions.  I’d initially been worried that the conversation might dry up prematurely – but there was definitely no danger of that!

I think we all realise all too well that establishing co-production (as authentic power-sharing) in mental health will not be achieved over night. The challenges are considerable but, although daunted, I’m feeling enthusiastic and determined.  Last week’s conversations definitely energised my commitment.

Here are just a few observations from the first seminar.

Albert Dzur started off the day’s proceedings with an exposition of his theory of Democratic Professionalism (DP). DP requires a fundamental shift in power relations between ‘service users’ and ‘service providers’, and may be allied to a participatory (rather than representative) form of citizenship. Experts by experience, for example, are demanding that professional practices in mental health be opened up to democratic deliberation.

In their talks both Albert and Michael Guthrie emphasised the importance of role models, but a key challenge seems to be how to embed democratic professionalism into organisational cultures. After Michael’s and Annie Dransfield’s talks, we started to ask some interesting questions about what should constitute professionalism and whether the definition should be expanded to include service users, informal carers and peer support workers. On the other hand, it was mooted that we should perhaps dispense with the term ‘professional’ and talk instead about appropriate behaviour and judgement.

At one point there was an interesting discussion on whether co-production is aided or hindered by regulation. If it is regulated from above, does it then cease to be about democratic power-sharing? On the other hand, how can it become established without being endorsed by policy-makers and managers? I’m sure this is a point we’ll return to…

Scott Bell led a workshop which again generated lots of interest. He emphasised that co-productive relationships should be about mutuality and reciprocity. Scott pointed out that this is not reflected in the term ‘user-led’ which arguably places all the responsibility for recovery on the service user. Others pointed out that terms such as ‘service user’ need re-thinking as they perpetuate the arguably oppressive binary between service user and service provider. A model of ‘recovery together’ was suggested as an alternative.

Pamela Fisher