From Protest to Co-Production: a personal journey?

From Protest to Co-Production: a personal journey? Jack Evershed Sheep Farmer; Chair RHCW; Chair Public Patient Forum, MWJC

My Background • CHC – Community Health Council • aBer – campaign group for Bronglais hospital • MWHC – Mid Wales Healthcare Collaborative • PPF – Public Patient Forum • MWJC – Mid Wales Joint Committee for Health and Social Care

The Journey “At the most basic level, we co-produce a clean environment when we put out our correctly sorted rubbish on the allotted day, we co-produce our health when we take the medicine that our GP has prescribed for us…. At the intermediate level are good quality consultations or shared decision-making healthcare approaches. And at the transformative level citizens and professionals work as equal partners to commission, design, deliver and evaluate public services” Co-production Wales

Principles of Co-production Co-production is based on 5 principles: • Value all participants and build on their strengths • Develop networks of mutual support • Do what matters for all the people involved • Build relationships of trust; share power and responsibility • Public service organisations enable people to make change happen

The Start In many parts of the region we encountered a near-dysfunctional level of mistrust, misunderstanding and concern with Health Boards’ plans for the future of healthcare service….. Many people … felt ‘orphaned’ by the powers-that-be. It appeared to them that none of the bodies responsible for their care had either the willingness or the capability to bring about a solution that met their needs. Mid Wales Healthcare Study (Longley et al, 2014)

Basic Level • Develop networks of mutual support Barriers to Progress: • Value all participants and build on their strengths • Do what matters for all the people involved • Build relationships of trust; share power and responsibility • Public service organisations enable people to make change happen

Intermediate Level Health Board leadership changes Mid Wales Healthcare Collaborative formed (2015) • Value all participants and build on their strengths? • Do what matters for all the people involved? • Build relationships of trust; share power and responsibility? • Public service organisations enable people to make change happen?

Transformative Level Mid Wales Healthcare Collaborative Engagement Programme • Value all participants and build on their strengths • Do what matters for all the people involved • Build relationships of trust; share power and responsibility • Public service organisations enable people to make change happen

Lessons Learnt / Observations Different viewpoints lead to different perceptions: • “Not about beds”, “Not about money” Beware appearing deceptive • What is the difference between structured engagement and consultation? Beware appearing not to listen

Lessons Learnt / Observations Language: • Should I tup my ewes as tegs or gimmers? Beware talking in code • “Obese” “Chronic” “Pandemic” Beware confused communication

Lessons Learnt / Observations Risk: • There is an understandable level of risk aversion amongst health professionals • Health professionals need to feel more comfortable in less formal situations Attitudes to risk management need to be developed

“It can also be difficult for any professional to relinquish control and 'hand over the stick'; not only does this challenge occupational identities but it also confers a greater sense of risk – co-production can be 'messy' and is inimical to rigid control. If the hearts and minds of those delivering services on the ground cannot be changed, and if the necessary skills associated with relinquishing control are not embedded, co-production is likely to be constrained”. The Challenge of Co-production (NEF / NESTA, 2013)

Lessons Learnt / Observations Tradition: “Years of working to narrowly defined roles and job descriptions has understandably led to many public service professionals seeing their 'clients' through circumscribed lenses; as patients that need to be cared for, rather than people who could be enabled”. The Challenge of Co-production (NEF / NESTA, 2013)

Lessons Learnt / Observations Systems: • Emphasis on evidence-based commissioning • Outcomes not as easily measured as outputs • Target driven performance management All these conspire against co-production

“The obvious reason why many commissioning frameworks favour outputs over outcomes is that they are simply measured, making it deceptively easy to evaluate success or failure. But real success is not easily measurable. Nor are many of the preventative benefits of co-production easy to quantify. Making the case for co-production and capturing its complex and myriad benefits is a key challenge”. The Challenge of Co-production (NEF / NESTA, 2013)

Lessons Learnt / Observations Spreading Best Practice: • There is not a co-pro blue print • Needs a defined community to work • Small scale is easier Beware de-valuing the concept of co-production

“It is fair to say that the majority of examples where co-production is being successfully practiced take place at a local scale.…they are rooted in local realities, have grown organically from the ground based on local assets and ideas and emphasise the importance of face-to-face relationships”. The Challenge of Co-production (NEF / NESTA, 2013)

Lessons Learnt / Observations Trust and Respect: • Fundamentally, co-production is about trust and respect • Trust is easily destroyed and hard to build and maintain • Trust is built with transparent and honest communication and the availability of health professionals of all standing to meet with the public • Trust is maintained and reinforced by action Co-production is impossible without mutual trust and respect; Lack of action gives space for doubt and / or mistrust

“Trust is not simply a matter of truthfulness, or even constancy. It is also a matter of amity and goodwill. We trust those who have our best interests at heart, and mistrust those who seem deaf to our concerns”. Gary Hamel “When people honor each other, there is a trust established that leads to synergy, interdependence, and deep respect. Both parties make decisions and choices based on what is right, what is best, what is valued most highly”. Blaine Lee

“This study has proved to be oddly inspiring. In an era of public apathy and disengagement, we have been moved by people’s passion and commitment to a service which really matters to them, and by the seriousness with which they have thought about the issues..… In every quarter – among community and patient groups, clinicians and managers, right across Mid Wales - we have been lucky enough to work with people who care deeply about the future of their NHS, can see the real dangers facing it, and genuinely want to find new ways of addressing them”. Mid Wales Healthcare Study (Longley et al, 2014)

QUESTIONS? Jack Evershed Chair, Rural Health and Care Wales Chair, Public Patient Forum, Mid Wales Joint Committee for Health and Social Care (MWJC) Tel.: 01970-635918Email: contact@ruralhealthandcare.wales

From Protest to Co-Production: a personal journey?