Talking about co-production…

At the second seminar at the Collaborating Centre for Values Based Practice (St. Catherine’s College, University of Oxford) on 17 February 2016 we recorded some ‘talking head’ interviews with Gemma Stacey & Phil Houghton from the  Critical Values Based Practice Network, Mick McKeown of Comensus, and Tina Coldham of The Social Care Institute for Excellence.

Some really interesting insights here.  We’d like to hear your thoughts, either by tweet using #esrccopro or by contributing to the blog.

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ESRC seminar ‘Enacting co-production’ at St. Catherine’s College, University of Oxford on 17 February 2016

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.

Introduction

(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. 

 The presentations

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.

And finally

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.

Pamela Fisher

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. https://www.bgsu.edu/arts-and-sciences/political-science/faculty-and-staff-directory/Albert-Dzur.html

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.