Looking at co-production as a key determinant of a culture favourable to self management.
Self management is about recognising that everyone has strengths, resources, skills and experience that supports their health and wellbeing and enables them to manage their long term condition(s) or caring role. At the heart of self management is a collaborative relationship between people and health and care practitioners, supporting the person and their family to feel empowered and in control of their lives and conditions
The learning in Scotland has clearly shown that people and communities hold the key to developing successful self management approaches. By building the system around this collaborative relationship we can transform the way in which the health and social care system supports people with long term conditions.
Transforming relationships is also at the heart of the New Economics Foundation (This link will take you away from our website) definition of co-production:
“Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.”
Seeing lived experience as an asset
The New Economics Foundation refers to assets and capacity as key components of coproduction: where the delivery model of public services recognises and grows people’s capabilities, recognising people as equal partners in designing and delivering services.
Scotland’s approach has been to learn about self management through the lived experience of people living with long term conditions and unpaid carers. This has been evident through the Transforming Self Management in Scotland Fund, and formed the core criteria of the Fund.
A central feature of all the projects has been the involvement of people with long term conditions and/or their unpaid carers in design, delivery and evaluation. This results in rapid growth in capacity as people’s skills and learning develop. People with long term conditions and their families are equally seen as crucial to service delivery. In this way self management challenges the perceptions of who we see as providers of health and social care; encompassing people and communities and their individual and collective strengths and assets.
Many self management projects identify peer support as the most powerful aspect of their work – enabling people to develop the confidence to assert their right to the support they need. This has been a key contribution of the third sector which has significant experience in facilitating and developing peer support.
Many self management projects utilise the power of personal experience and stories to raise awareness of self management and the role it plays in enhancing health and wellbeing.
A number of projects also work closely with, and encourage people to become, volunteers providing different opportunities tailored to individuals’ strengths and abilities. Particular benefits arise for all when the volunteer has a shared experience with people who are receiving support. This can help the person receiving support develop a sense of hope and inspiration from seeing someone at a different stage in their self management journey.
Staff as enablers rather than deliverers
Mutuality has been identified by New Economics Foundation as another key component of co-production. This involves providing a range of incentives for people to engage which enable reciprocal relationships and mutual responsibilities and expectations. Key to this is having shared roles by removing tightly defined boundaries between practitioners and people who use support and services.
Staff operating as enablers rather than traditional service deliverers is a central aspect of self management projects. This concept of being an enabler, empowering people to reach their full potential, is not simply a tool used by paid staff. It is a core professional and personal value within the projects that people and staff experience is given equal value.
A strong theme which has emerged is the way in which staff and volunteers operate to support, enable and empower participants to realise their personal potential and capacity for self management. The strong relationships that develop between all people involved in a project enable this sharing and blurring of roles.
People often need support to build their capacity to self manage – this can mean being supported to explore what self management means to them in an environment where they are able to take part in meaningful activity and build relationships with their peers.
The experience of the ALLIANCE has been that those who have been supported by volunteers often go on to volunteer themselves – showing that reciprocity is an important aspect of self management. There is often a blurring of the distinction between people and practitioners. The benefits to volunteers are many and varied including using the experience as part of their recovery, developing new skills, using their experience to positively impact on other people’s lives, and being able to give something back.
Self management projects are very careful to ensure the involvement of people with lived experience benefits the person before benefitting the project. For example, people will share their personal story out of a natural desire to celebrate their improved confidence and influence others, rather than simply to promote good practice by the project.
By being supported to find techniques to self manage, building confidence and seeing their strengths, people are inspired to share their experience so that others can benefit from their learning.
It is important to reach out to people who might want to share their lived experience and go the extra distance to support them to do so. It is equally important that where people volunteer with an organisation that they can continue to be able to utilise the support available as well.
A key aspect of self management projects has been the ability to regularly adapt to what people want. This is important as self management means so many different things to different people and the people the projects support regularly change as a result of them no longer requiring the same level of support. Balancing a degree of structure with people led ﬂexibility and responsive working, helps create a sense of ownership for people.
The ALLIANCE has learned that self management spreads through people sharing their lived experience, both with their peers and practitioners. At the heart of this agenda are strong, connected communities – brought together by a shared locality, interest or common bond – that have the ability to adapt and thrive.
With this in mind the ALLIANCE established the Self Management Network Scotland in October 2014 to build capacity in self management and share and spread knowledge inside and outside of the health and social care system.
The network currently brings together over 500 people with a passion for self management including people with lived experience of self management as well as people across sectors with a role in supporting self management.