Start with the first conversation and focus on step-by-step improvements
By Shahana Ramsden
Since the launch of Making it Real last week, I have had a number of useful conversations with organisations who are thinking about what "co-production with people" involves in practice and how to make the experience genuine and meaningful.
My biggest piece of advice is to recognise that every person using a service - either independently or supported by an advocate - can contribute in an effective way. The most important aspect is the quality of the conversation, how well you listen and to what extent you are prepared to share decision making power!
At Tuesday's National Care Forum conference, David Behan (Director General for Social Care, Department of Health) was a keynote speaker. I thought I would borrow a word of advice from his presentation which was to "learn by doing". When people from organisations ask how to co-produce priorities with people who use services, then I would say simply start with the first conversation.
We know within the TLAP National Co-production Advisory Group that genuine co-production is hard to achieve. One group member described co-production as "people working together and sharing power". Although this is a concept that everyone can understand, a huge shift in organisational culture is needed to create an environment that promotes these important approaches. But you have to start somewhere and get people involved at the earliest opportunity.
I took a call this morning from someone who had just registered their details with the Making it Real website. They were concerned that while their organisation wanted to engage with people, it would take too much time. My sense was that they felt there was pressure to get priorities and action plans onto the Making it Real website quickly. I explained that many of the organisations that tested Making it Real for us in its early stages of development found it can take several weeks to set up a conversation with people who use services. But they reported after that it was worth the wait.
The Making it Real process has worked best when people who use services are involved at the very beginning and where the organisation has the confidence to be honest about the fact that they are learning too. We have also found that, where there has been investment in co-producing the three priorities with local people, organisations have felt that they have a strong mandate to implement the agreed improvements. This mandate, combined with a board level commitment to the three priorities, can accelerate the change process.
At a recent TLAP event, we had a question from the manager of a care home who works with older people about what she should do if people have very low expectations about how their lives can be improved. Would engaging them to agree personalisation priorities actually lead to very modest or uninspiring priorities being agreed? Shouldn't people have higher expectations about the lives they want to lead?
My learning from the work with the National Co-production Group is that it is not always up to the "professionals" to intervene or to impose solutions. In fact, humility is important, combined with an acknowledgement from professionals that they may not have all the answers. During the Making it Real launch, Vanessa Keen from Action on Hearing Loss, who worked with us on testing out the Making it Real process, spoke passionately about how important those early conversations with people who use services had been, clarifying that "what is important to us is not always the priority for the person in the service."
I also reflected on one of our "seldom heard"group discussions held in a care home for people living with dementia. The discussion was facilitated by a member of the co-production group and we could see from the openness and frankness of the conversations recorded that having a peer facilitating the discussion made a huge difference to what people were prepared to say and how open they felt they could be.
My advice on co-production is that:
Leaders and managers should
• Champion co-production at every level - create an expectation that people who use services, carers and citizens will be involved
• Give permission for teams to be flexible to achieve the outcomes that people want
• Acknowledge the complexity of skills needed for co-production and recruit the right people for these roles.
Engagement / participation leads should
• Start the first conversation at the earliest opportunity, before plans and programmes are developed
• Don't take responsibility for solving every problem - allow the group to find their own collective solutions
• Work with the group to support a clear set of values and a collective sense of direction.
People who use services, carers and citizens should
• Use Making it Real as a lever for the changes you want to see
• Be clear about what they want and be fully engaged in the process
• Acknowledge perspectives which may be different from their own.
Over the next few weeks, I will be working with the National Co-production Advisory group to finalise a web based guide called "Ten top tips for co-production". If you have read this blog and feel that you can contribute with further ideas or good practice case studies, please do get in touch. I would love to hear your thoughts and suggestions. Please use the comments box below, or send me an email at email@example.com.
Shahana Ramsden is the Making it Real Project Co-ordinator and Senior Co-production and Equalities Lead for TLAP.