Pete Fleischmann, Head of Co-production at the Social Care Institute for Excellence (SCIE) shares how co-production is happening at SCIE.
In the meeting rooms of think tanks, in the oak panelled corridors of power, in town halls and community meeting rooms from Lambeth to Doncaster – everyone is talking about co-production. What is co-production? Will it cost money or save money? Does it mean less power for people who use services or more? Is co-production merely a distraction from the seemingly endless cuts in services and welfare benefits that are making people’s lives so difficult? Or does co-production offer something new and different?
When Helen asked me to contribute a blog, it got me thinking about co-production. I wanted to talk about what SCIE is doing on co-production. But I also wanted to give a personal view of what co-production means to me.
My interest in co-production was shaped by my experience of mental health issues and psychiatric services. In my late teens and early twenties, I experienced a series of mental breakdowns. In the early eighties, there was no advocacy, no personalisation, no talking treatments and certainly no co-production – so I was treated with drugs and electric convulsive therapy. I had very little say in how I was treated. Though in some ways things have improved, sadly the mental health system still has a long way to go. In the nineties, I was lucky enough to get involved in the mental health user/survivor movement. I owe an enormous amount to the extraordinary bunch of people that came together to share their experiences of the psychiatric system and to challenge conventional approaches to mental health. I forged friendships, met my wife and developed personally; and I was lucky enough to work for several user-controlled organisations and projects.
In the early days, many of us in the user/survivor movement thought that user-only services or self-help was the ideal way to support people. We looked forward to an ideal future when all mental health provision would be delivered by people who had experience of mental health issues. But almost all our work involved professionals and people who use services working together. At the time, we called this user involvement or participation; these days, we might call this sort of thing co-production. The big difference between co-production and these earlier forms of engagement is that co-production indicates a much greater degree of equality between people who use services and professionals. It also involves acknowledging that professionals usually have more power and resources than people who use services. Co-production is about trying to equalise the difference in power between users and professionals. Now, I believe that all provision should be delivered in co-production.
Over the last few decades, the disability and mental health user/survivor movements and other groups, such as care-experienced young people and people with learning difficulties, have built up an enormous amount of expertise around how to work together in user-only spaces and also how to work with professionals. I believe it is really important that the development of co-production puts at its centre the lived experiences of people who use services and carers. That is why I have titled this blog ‘Co-producing Co-production’. It is vital that we apply the principles of co-production to the development of co-production. This might sound like it is not even worth mentioning – but as with all ideas, as co-production becomes more mainstream, it is in danger of becoming diluted. We cannot assume that co-production will not become tokenistic and watered down. One protection against this happening is to make sure that disabled people, older people, people with learning difficulties and care leavers are driving the development of co-production in genuinely equal and meaningful partnerships with professionals.
The Social Care Institute of Excellence (SCIE) has a turnover of over £5 million, was established by the government as an independent charity in 2002 and is a respected provider of good practice information and improvement services. So how does co-production fit into the work of an organisation like SCIE? At SCIE, we have always had a strong tradition of making sure that people are at the heart of everything we do. This was symbolised by the appointment of SCIE’s first chair, the well-known disability activist Baroness Jane Campbell. Back then, SCIE had a participation team and used the word ‘participation’ to describe how we involved people in our work. Now, SCIE uses co-production to describe how we aim to work in equal partnership with people who use services and carers.
SCIE covers all of social care, so we need to involve a wider range of people, including disabled people, mental health users/survivors, people with learning difficulties, older people and care-experienced young people. We have a co-production network which includes representatives of all these groups; it is chaired by Tina Coldham, a member of the SCIE’s Board and mental health user/survivor.
Over the past year, 50 people have been involved in over 25 different projects. People are involved on interview panels for staff and board members, on advisory groups and on NICE guideline committees, as well as supporting projects as writers, consultants, video contributors, conference speakers, media spokespeople, bloggers and trainers. Members of our network have recently trained all staff in both co-production and equality, diversity and human rights. On a more practical level, we have a well-established system of paying people fees and expenses, and making sure that this does not affect welfare benefit payments.
You might say we are living the dream – but of course, we’re not. There is always more to do. In co-production, it’s not yet possible to sit back and say we’ve cracked it. At the moment, we are working out a system so that staff members who have experience as service users or carers can also make a contribution to our co-production work in a safe way. We are also looking at how we can make our co-production work less reactive – trying to get people involved at the very earliest point possible in projects, supporting them to influence the strategic direction of SCIE and working with user and carer groups to promote ideas and projects that they generate themselves. We are also starting to look more closely at how we can evaluate co-production in SCIE.
We are slowly changing the culture of SCIE and moving to a situation where co-production is not a bolt-on extra, but is intrinsic to the way we work. So when we look at a new project, we automatically consider co-production in the same way as we think about the budget, a communications plan and how we will manage the project.
SCIE has recently appointed three disabled people to join our Board. Our new Trustees are John Evans and Ossie Stuart, who are leading disability activists, as well as Rachel Wallach, who is the Vice Chair of Scope and an experienced public manager. They join Tina Coldham on the Board, so that four out of our fifteen Trustees have lived experience of disability and using services. This is the highest ratio of Board members with lived experience in SCIE’s history and something to be celebrated.
I hope that one day in health and social care, we will look back to the time when users and carers weren’t involved in developing and delivering services as a sort of Dark Age which now seems strange and irrational. Then co-production won’t be something special; it will just be the way things are done, and it will be hard to imagine doing things differently.
SCIE’s NHS accredited Guide to co-production includes 16 new and updated practice examples: http://bit.ly/1xEpWA3