Gavin writes about co-production and how power imbalances can be a barrier.
What does co-production and washing your hands after using the toilet have in common? They are both things that many people claim to do, but not many people actually do, or do properly. Toilet hygiene aside, rhetoric vs reality has been slowing the co-production movement for many years.
To truly co-produce services, organisations and their employees transfer a significant portion of power. Power often equals control, leading to a feeling of safety in a risk averse culture. If it is something you can control, then you can (as far as possible) make sure it is safe.
The desire to retain power is not, in most cases, an egotistical issue. In our desire to ‘fix’ people or improve lives, we often feel that we should be making the decisions. That we are in a better place to make these decisions and that we know what’s best for people. That’s fine if you are a surgeon. I don’t think anyone has co-produced open heart surgery, yet. Sometimes it is appropriate for health and social care professionals to make the decisions, but most decisions should be shared and they are not. But, who decides which decisions should be shared…? I have often said that such a decision is the equivalent of announcing ‘We are going to empower you now’. As soon as that happens, it’s not co-production.
Education should play a significant role in this cultural change. I was a student only 5 years ago and learned that I would be a ‘professional’ who would make people better and do things to people, rather than with. That vulnerable people were passive recipients of care. Thankfully, education has been changing. Courses such as the BA Integrated Care at UWS equips students with a solid understanding and belief in empowerment, self-management and co-production. If all health and social care courses had these principles as a core element, we would begin to see real transformational change.
The rewards of co-producing services are vast. So too are the challenges. If your service, or organisation has only been consulting with people to date (honesty is important here), it is a very big ask to suddenly create a culture of co-production. There must be a cohesive, strategic plan to move towards co-production, with the understanding that this movement will likely be low pace and long term. Alternatively, if you are prepared to decommission services and start again from a blank page then you could move to co-production quickly, although even this would take a few years. Surrey County Council famously saw significant social and economic benefits from doing just that through the transformation of their youth services. If there is not such radical change planned, then the move must be made gradually.
We often disconnect engagement, consultation, involvement, co-design, empowerment and co-production. They are all part of the same family and although co-production is certainly the pinnacle, with (arguably) the most benefits, it should be the final phase of a lengthy plan.
North Ayrshire Health and Social Care Partnership have adopted a long term vision for co-production, which is shared across all structures and levels of the organisation. Like many other HSCPs we have a desire to realise a future whereby staff work alongside people with lived experience, sharing an equal balance of power. We have some excellent examples of projects and groups which have been truly co-produced, but as an organisation we can currently only claim to be consulting. Our immediate plan is to move the organisation towards engagement on the ladder of participation, whilst retaining our longer term goal of co-production. The challenge is to take both the organisation and the public through a journey of cultural change, in the midst of a financial crisis. Sadly, this is a challenge every HSCP is facing.
It is true that most of us are resistant to change and transferring power to communities is as significant a change as any organisation will ever go through. The devolution of power to communities must happen. Within health and social care, it is everyone’s role to make sure we are ready for it. Now, go and get yourself some hand gel.