Co-production is a bit of an old buzzword in the health and social care sector. Put simply, it means that people who receive a service – such as healthcare, care and support, or even education – work alongside the people who deliver that service. If you are receiving a service, you can help to shape it. You have real control. Your experiences and feedback are valued.
As a model of practice, it has been shown to have various positive outcomes in social care settings, including health benefits, development of practical skills, investment in social capital, and value for money (Needham and Carr, 2009), and positive contributions to physical and mental health, including through development of social networks (Boyle et al, 2006 – RSA Fellow).
It’s fundamentally about a shift in power, though – and that’s not easy. In order for co-production to truly work, people who make decisions and people who run services need to give up some of that power, by understanding that their ideas do not always come first and are not always best. It is also about trust: trusting that the people who use services know what will work for them.
I have been talking about co-production in my work for several years, but recently I was reminded of how that relinquishing of control feels – and more importantly, how it works.
I work for the Grace Eyre Foundation - a fantastic charity that supports people with learning disabilities – which runs a monthly club night. It’s what you’d expect of any club – there are DJs (who are learning disabled), dancing (lots of it), a well-stocked bar (of course). The club is co-produced, meaning that it’s organised each month by a committee of people with learning disabilities alongside someone without a learning disability. They all work together to plan it and to ensure that everything goes smoothly on the night.
My colleague recently moved jobs and I was asked to help run the club night with the committee. I took the responsibility of running this club night very seriously, and I worried about everything that could possibly go wrong. I felt that the responsibility and control lay with me, and I didn’t want to let anyone down.
But the point of co-production is that responsibility and control are shared. My instinctive reaction to assume all of the responsibility and control was, I believe, a reflection of how deep-seated the power dynamics are between staff and beneficiaries of services. Indeed, the dynamic is inherent in the often-used term ‘service users’: people who use the services but don’t traditionally have an active part to play in designing or delivering them.
Worrying about my role in running the club was completely unnecessary. The committee were happy to share responsibility and control, and indeed took this as a given. It was apparent from the get go that they all knew what needed to be done, and together we divided up set-up tasks, I shared delivering the pre-club briefing with another member of the committee, and we worked out who would be responsible for what during the night, from cleaning up at the end of the night to helping sort when someone’s taxi hadn’t turned up. The night was a resounding success and we all went home happy that we had put on a great night.
I have long been an advocate for co-production, but my instinctive reaction to assume the responsibility and control gave me pause to think. As with many things, perhaps true co-production is easier said than done. While I know of many newer projects that have been co-created and co-produced brilliantly, many social care services and organisations that have been around for a longer time still operate with the traditional power imbalance tipped towards staff, management and trustees, and commissioners. At the Grace Eyre Foundation, we have committed to embedding co-production in our organisation, and while we know it won’t be straightforward, but I think that having open, honest conversations about our experiences can only help us on our journey.
I’m interested to hear about others’ experiences of these conversations. How have you changed yourself, or your organisation, to share power and to convince others to, too? How do we, as a health and social care sector, tell compelling and honest stories about how we really learned to trust the people we support?