The real reasons we still don’t co-produce

It’s rare to hear senior public service and voluntary sector leaders talk openly against the idea of co-production. Some still confuse it with consultation. As I heard a senior leader say recently, “We will come up with ideas and then co-produce our plans with local people.” (If you’ve already come up with the plans, it’s not co-production.) Many still describe it as difficult, either in terms of the process (despite so many co-production toolkits out there from Think Local, Act Personal; the Coalition for Collaborative Care, SCIE and others), or in terms of it being risky and time consuming. It is risky: it involves placing trust in groups you do not normally work with, and being willing to take the first step forward, knowing that the other side may just take a step back. It also takes time, but how much time do we waste rushing headlong in the wrong direction, coming up with plans that never work, because the most important people were not part of the planning conversation? That’s why in my book, I argue for a slow policy movement.

But I always think that when something is talked about so positively, but done so rarely, there must be something else going on. Here are some reasons we don’t co-produce which we don’t talk about.

  1. Heroic leadership. The news pages of a number of trade magazines/ websites remain dominated by stories of who is moving in and out of the big jobs. We remain hooked on the idea that the right leader will make or break a service. We see this happening: an inspirational leader comes in to a troubled organisation and galvanises the team around a new vision with great results. But for every example of a leader achieving this, there are dozens of it not happening, as well as some of leaders being key factors in toxic cultures. The culture of looking to powerful individuals is part of the problem: it creates the conditions for disempowerment, hopelessness and at times, bullying. But most people with any power in public service organisations are somewhere on a career path predicated on the value of the brilliant individual leader. It can be easier to be a leader than an ally. Co-production is the opposite of heroic leadership: believing in it is difficult if you aspire to be the hero.
  2. When co-production is real, the group of people involved in decision-making doesn’t just grow, it diversifies. This means that co-production is at odds with monocultures. The gender imbalances and “snowy white peaks” of those at the top of the NHS and other public service organisations has been well documented, but there is also a less-frequently talked about class divide: those running public services and charities come from predominantly middle-class backgrounds; whilst health inequalities and the impact of the social determinants of health mean that those making most use of those services and charities are significantly more likely to be working class. Co-production is part of the effort to diversify decision makers, and those efforts are resisted by any number of conscious and unconscious biases.
  3. Co-production an only work where there are people with lived experience in a position to co-produce. That usually means not only having their own lived experience, but also having the support, training and networks that anyone else needs to be an effective decision maker. No-one can be ‘representative’ of a large and diverse group of people who use services, unless they have been chosen by a number of those people, and ideally are in regular communication with them. This can only be achieved by investing in training and development for individuals, and more broadly investing in user-led and grassroots organisations. Our public services are reluctant to that at the best of the times and these are not the best of times. User-led organisations are falling by the wayside in alarming numbers: our social capital and our co-production capacity is reducing just when the argument is being won for the value of co-production. This needs to be reversed.

The common theme running through these three problems is power: its unequal distribution and the discomfort those with it feel talking about it, let alone sharing it. I’d be interested to hear other barriers to co-production which you are seeing but which aren’t talked about. Naming these barriers is only a first step to changing them, but it is a start.

Keep on co-producing

At the back of the social care White Paper is a note on how the vision will be implemented. Two new committees are announced: a transformation group, which sounds like it will be quite broad in membership, and a transformation board, which will be for representatives of those bodies with a responsibility to deliver the white paper. Who does have the responsibility to deliver the White Paper. I’m guessing that the board’s membership will include the association of directors of social services and other similar bodies. But if we take the co-production messages of the White Paper at face value, the messages of the paper attempts to reflect the views of people who use services and carers. The paper sets out a vision for a social care system which is co-designed and co-produced with service users and families at every stage. So, to my mind, it is essential that that board does not meet without service user representatives in the room, sharing that responsibility. There is always a risk of tokenism when that happens, but the risks of not co-producing at every level are much more serious.

Five questions with one answer.

On Friday, a group of senior leaders from council social services departments got together with colleagues from the Department of Health team writing the social care White Paper due later in the Spring. Sue Bott from Disability Rights UK and I did our best to keep order in a passionate debate about how to tackle a question as old as social care: what role should the state play in helping people to help themselves and each other? Peter Hay, this year’s ADASS President and social services Director for Birmingham, opened and closed the discussion and outlined a situation common to lots of areas: demand for services increasing whilst budgets shrink, coupled with recognition that even the best services cannot meet some of the most pressing needs, like isolation or exclusion from community life or employment opportunities.

I felt privileged to listen to the risks which local leaders are taking to turn a dysfunctional system on its head: it’s so very easy to panic and take a short term view when faced with a crisis in funding, but there are places around the country who have refused that easy option. There will soon be an open call for examples of citizen-led approaches to care and support, to which I’d encourage anyone with knowledge of promising local work to respond. But in the meantime, by way of processing some of what I heard and hopefully widening the debate, this blog and one or two following will set out some of the questions we kept returning to.

My first observation is that Continue reading

User-led organisations: endangered species?

I do my best to remain optimistic during these too-frequently grim times. One of the determining factors of what the sector achieves on much diminished resources, will be what we continued to believe was possible. Our public finances perhaps haven’t been this bad since about 1948. But in that year our grandparents looked around at the post-war wreckage and decided that a National Health Service was possible.

Of course, those were the days of when big national infrastructures were created from Whitehall (casual observers may be surprised to hear that the current NHS Bill, with its thousand amendments, is an example of ‘bottom up’ change). Social care has been re-shaped to give more control at the level of the council, the community and the individual.

So User-Led Organisations (ULOs) should be a key part of ‘personalising’ social care. After all, they embody the idea of individuals who use services being in control, and their work is often about people having a voice in local decisions, or being able to shape their own care package. They are also typically small and local, forming a bridge between councils and the people who are most affected by their decisions.

So I couldn’t help my heart sinking when, on the same day, I heard about two areas which were planning sweeping cuts to their ULOs. Had those areas completely misunderstood the basics of personalisation? Apparently not: at least one was an area with leaders who are advocates of personalisation. So what was going on?

It’s always risky to comment on local changes from a distance, but my impression is Continue reading