Modelling the change we want to see - how Making it Real was truly co-produced

Modelling the change we want to see - how Making it Real was truly co-produced

The launch of Making it Real has been a busy but energising week for both myself and the National Co-production Advisory Group, so it felt like a good time to reflect on how we have arrived at this point after a three year journey of user engagement.

It was June 2009 when I first took up the post of User Engagement manager, at the Department of Health with the Putting People First programme. One of the first agreements I made with the existing User Reference group was that if the purpose of our work was to embed personalisation into social care policy, it was important that we modelled person centred approaches in all our actions.

The meetings we organised with people who use services and carers needed to be built around what people wanted from the system rather than fitting them into existing structures. For example, one member who had autism would see personal success as being able to feedback from a workshop session to build their confidence in public speaking, or for a person who had vast years of expertise; success might be to see a legal framework being improved as a result of their input.

Shared and open decision making

One important aspect of building the co-production team was to ensure that the way people were recruited to specific roles was as open and transparent as possible. All role descriptions were visible to everyone and simple processes were put in place to ensure that every person who engaged with the group completed an application process and was interviewed by two members of the co-production group. This has created an environment where people are less likely to jockey for positions, or to be looking over their shoulders wondering if another group would have preferential treatment over them. To improve this approach, co-production group members have willingly subjected the group to regular scrutiny, with an annual equality screening of the group to constantly check that the group represents the whole user and carer sector.

Within a few months all co-production group meetings were chaired or facilitated by people who had been elected by the group themselves. As with any new group, the first period of development involved some disagreements and stormy discussions. Through this, a core set of values were agreed - we committed ourselves to honesty, openness and transparency, we decided that if we did not agree with one another we would take time to listen to another person's perspective. We also agreed that if everyone in the group voted for a particular decision, people would have to accept the decision. As one member said - "if we can live with the decision, we should accept the majority vote, if not we will keep talking until an agreement is reached".

Choosing the language we want to use.

During early discussions, group members took control of the language that was being used - and voted to use the term "people who use services, carers and citizens" to describe the group membership. They also disliked the concept of being a "User Reference group" which implied that they who would be referred to when needed, but preferred to be a "Co-production Group" which represented sharing of power. After a carefully facilitated session which allowed everyone to speak, the group voted to be called the Transforming Adult Social Care Co-production group.

Certainly we faced some challenges along the way. Some staff felt that people who use services and carers should be grateful to be involved even if they were consulted at the last minute or that the issues being developed were too complex for ordinary people to understand or that engaging people would slow down discussions at meeting. Often after a first meeting with the group, colleagues would quickly realise the huge amount of expertise that we had. People who use services have made it their business over many years to understand the detail of policies because the final publications would have a direct impact on their own lives, their families and their own well- being.

Knowing when to challenge and when to wait

On occasions I felt that I was sometimes walking a tightrope - balancing the perspectives of different teams of people but I soon began to find that the re-energised co-production group were a huge source of support. It also occurred to me that it was important for me not to jump in with a solution every time there was a problem, but to allow people to work together to find collective solutions.

Another milestone for the group came with the development of our "membership and fees group" who created a new participation fees policy. Most people who use services have long term expertise in managing very tight finances and balancing budgets. They also have a real awareness of public perceptions on how public money should be spent. Within the group, collective decisions would be made about how the co-production group budget would be spent. We have introduced a flat fee structure and a vote is taken each year on the level of the fee. Interestingly, the group has voted for three consecutive years that the participation fees for group members will not be increased.

Embedding co-production

In the second year of development (June 2010) Co-production group members were aware that the Putting People First programme was due to close in March 2011 and as our key host, this put continuation of the group at risk. By this time, many of the early obstacles to co-production had been overcome, and engaging people who use services at the earliest stages of policy development was becoming more of a normal way of working.

At this point the group decided to take a lead in managing the next phase of development. Sally Percival (now the chair of the group) and Alan Crone facilitated an inspiring session on the theme of "Planning Alternative Tomorrow's with Hope" and one section in particular focused on our Dream Service, highlighting aspirations such as:

"Professionals on tap, not on top"
"Services which achieve quality of life"
"Maximum choice and control"

As the Think Local Act Personal (TLAP) Partnership began to develop, it was clear that there was a clear role for citizens to play. This was an exciting time as the new collaborative approach to decision making fitted more closely with a culture where the co-production group could thrive. Thanks to leaders who were committed to co-production, the new structure included roles for co-production group members to chair the TLAP Partnership, places for people at the TLAP board and representation at Partnership meetings. Although we were continuously improving and still have more to do, co-production with people who use services was now becoming a normal way of working within the TLAP Partnership.

The moment at which the concept of Making it Real started to develop occurred in the early stages of TLAP during a round table where benchmarking was being discussed. There had been several weeks of discussion about how TLAP could measure progress around personalisation but difficulty getting partners to agree to a single model. The one issue that all partners had in common was the fact that everyone had "people who used their services". Thinking back to the Dream Service work, we began to suggest that the co-production group could come up with ideas about what the ideal outcomes might look like. We started with a small workshop, a flipchart and pens and asked members of the group to write statements about what they wanted and the programme grew from there. As soon as the statements began to appear on the page we had a feeling that this was something that might work. After many workshops, debates, disagreements and deliberations, 9 months later the Making it Real programme was born.......

National Co-production Advisory Group members:

TLAP Co-Chairs and board representatives: Bill Davidson and Sue Bott
NCAG Chair - Sally Percival
Making it Real sub group: Co-chairs: Clenton Farquharson and Tom Mcloughlin-Yip
Membership and Fees - Co-chairs : Alan Crone and Marjory Broughton
Communication sub group - Co-chairs: Janet Brandish and Andy Hopley
TLAP Partnership representatives - John Evans, Frances Singer, Sally Percival

Peter Beresford
Michelle Braithwaite
Janet Brandish
Bill Davidson
Marjory Broughton
Sue Bott
Alan Crone
Kevin Caulfield
John Evans
Andy Hopley
Joanne Hough
Ian Hubbard
Tom Mcloughlin-Yip
Sally Percival
Gerry Robinson
Philippa Russell
Frances Singer
Clenton Farquharson
Martin Yates

We are currently recruiting additional group members. If you would like further information, please contact Shahana.ramsden@scie.org.uk for further information.

Shahana Ramsden is the Making it Real Project Co-ordinator, Co-production and Equalities lead for Think Local Act Personal. She has previously been employed as User Engagement Manager for Social Care Policy within the Department of Health.