Coproduction

We were warned at the beginning of the Darzi programme that the middle bit is stressful. It is. So instead of stressing about all the things that aren’t going right right now I’m going to talk about our fabulous coproduction workshop instead.

You can’t really kick around mental health for very long without hearing something about coproduction, When I did my training at Surrey I was the first intake where one of the selection tasks was coproduced by the Service Users* and Carers** group, they were actively involved in teaching and I was encouraged to have a service user supervisor for my major research – which was brilliant because she was a gifted researcher in her own right. Having had that start much of what I saw labelled as coproduction once I qualified seemed a little lacklustre – often tokenistic, ‘tickboxy’ and limited in scope but there were also pockets of good people doing good things in good services.

I’d assumed that mental health, as in many other areas, had been left behind by the better resourced physical health services, so I was really surprised to find that for most of my Darzi fellows coproduction was a new idea. The idea that services are best designed in partnership with the people that are going to be using them was a new and, in some cases, quite challenging idea. In particular worries about managing clinical risk evoked a lot of professional anxiety. It is to the complete credit of the patient leaders and other expert witnesses who attended the workshop that they treated these concerns with respect and engaged in constructive dialogue.

If you too are new to the idea of coproduction then you’ll have noticed no doubt that I’ve skirted around defining coproduction. This is because this blog post is in fact a shameless attempt to get the internet to help me write my homework. We have an essay on coproduction to do and although I’ll probably get into trouble if I try to coproduce the whole thing (I think that’s called plagiarism in academic circles 🙂 ) I thought it might be interesting to try to coproduce this bit:

“Develop a theoretical model for coproduction…”

I’m allowed to draw on (or even just use) other people’s models such as this one from one of the Daves (you don’t have to be a Dave to be an expert witness for coproduction, but it helps!) The Challenge of Co-Production but it’s going to be way more interesting to see what comes out of a dialogue.

So I would be eternally grateful and may even buy you a beer / irn-bru / beverage of your choice should I run into you if you could help me out by adding your ideas about what coproduction is and isn’t by commenting on this blog post. It doesn’t have to long or in fancy language, but it will help me if you can let me know what perspective you’re coming from (person who accesses a service, person who provides a service, academic etc etc – it’s your label it’s up to you) and if you want to be credited as an author of the final model (as I don’t think Harvard Referencing is at the stage where I can credit @skubakampa yet) then let me know your initials and surname.

If it doesn’t all go horribly wrong I’ll post the ‘Twitterati Manifesto for Coproduction’ (other names are available) back here.

* Yes I know – labels are a pig. This was the name of the group when I was there, so apologies if service users is not your preferred term – it probably isn’t mine either.

** I also know that it isn’t unproblematic to group in ‘and carers’ with service users. I’m sort of stuck with it because a lot of the people I work with can’t talk so involving them in anything coproduction related will usually mean working with the people that know them well, but it’s still a tricky one.

 

How do you know to get ‘there’ if you don’t know where ‘here’ is?

I passed a major milestone the other day – I managed to say that I was a Darzi Fellow working on respiratory care pathways without laughing out loud. I even sat in a meeting with a commissioner for respiratory services and sounded like I knew what I was talking about (at least some of the time!).

It’s been a busy couple of months getting to that stage and hugely enjoyable. Funnily enough the fact that this isn’t my clinical area was quite liberating and gave me permission to ask pretty much anything that popped into my head. I was also lucky in the range of people that I met – a CEO of an acute trust who gave me a lot of time and let me shadow them for a day, The Chief Exec of a county council who was open and honest about some of the challenges, clinicians passionate about the services that they work in and patients who couldn’t tell me enough about how much they appreciated the services (and also invited me to an over 50’s social club!) to name but a few.

Just to make sure that I didn’t get too complacent about my achievements there have been regular workshops at LSBU that seem to have the sole aim of making me think that everything that I thought I knew was, in fact, completely wrong and that the only thing to do was to rip everything up and start again – even if what I thought I knew came from a previous workshop. These did give me some useful principles that I think will stick for the long-term. In particular the idea that ‘the NHS is obsessed with treating symptoms not causes’ (to shamelessly plagiarise Prof Becky Malby who also provided the title of this post) is an idea that I’ve found really useful when I’m wondering why systems are designed the way they are and what could and should be done to change them.

I’ve also got a much better understanding of how the health and social care context works and in particular how decisions are made and how to influence that – worth a year out just for that. And I haven’t completely abandoned being a psychologist – getting on with people, being curious about who they are and what they care about and coming up with joint ways of understanding complicated issues are all hard core psychology skills that are also essential to being influential in systems.

So now all I have to do is change the world…

So who do you work for, exactly?

I’m so glad you asked – KSS AHSN. Just on the off-chance you’ve not come across this before –

KSS – ‘Kent Surrey and Sussex’. So in other words – the bit of South East England that isn’t London. Now as a Londoner I can see that it makes sense to classify pretty much the whole world into ‘London’ and ‘Somewhere Else’. However having worked in the KSS area in various guises over the years I’m not so sure. In fact matching up Kent, Surrey and Sussex on the grounds that they’re not London seems to me to make as much sense as choosing your life partner on the grounds that neither of you are Lithuanian, but perhaps that’s just me. It does mean that I have the deep joy of trying to understand the Health and Social Care context over an incredibly wide range of services all with different ways of doing things.

AHSN – ‘Academic Health Sciences Network’. As I’ve been working in a dark hole for the past couple of years I have to admit that I hadn’t heard about the AHSNs. Which is a shame because they are amazing. They are relatively new and are membership-led organisations aimed at promoting innovation and improvement by fostering partnership working. Membership comes from Academia, such as Universities, Health and Social Care organisations, such as NHS trusts and industry. I’m impressed with what I’ve seen so far – KSS AHSN delivers a lot of bangs for your bucks and for a relatively small organisation is doing some impressive work. You might imagine that my colleagues here, tasked with the job of getting different organisations to network together to deliver innovation  and improvement in the current lean times might spend their entire time hiding under their desks sobbing – but not a bit of it. There are some really exciting projects going on that are making a real difference to frontline services. No pressure there then.

More info at: www.kssahsn.net – and there’s currently a Darzi page there as well!

Workshop or workhouse?

The thing is – everyone in Health and Social Care loves a CPD (continuing professional development) event. It’s a chance to catch up with old friends, there will usually be free food and you might learn something useful and / or interesting. In short it’s a bit of a jolly and a welcome break from the day job.

To be fair our first workshop at LSBU (London South Bank University) for the fellowship did tick many of those boxes. Although we didn’t really qualify as ‘old’ friends the new KSS fellows had had the odd meet up and had all come together for the rather swish launch event, so we at least could recognise a few faces. We even had lunch provided, although I suspect that was to stop us escaping into the wild and to make sure that we had our noses to the grindstone the entire day. And I definitely can’t complain on the learning something useful and interesting – the entire three days were spent ramming so much information into my head that I’m surprised that I could fit it out of the door on the way out. We then had to inspect, analyse, dissect, critique and generally dismantle all of the this and ourselves as well. To give you some idea of how exhausting it was the KSS Darzi Fellows ‘Whatsapp’ chat went entirely silent for an unprecedented 36 hours whilst we all tried to remember what our names were and which way was up. So definitely not a jolly, but probably the most intense learning I’ve ever done in my entire life.

Just on the off-chance that you’re reading this with the view to finding out whether you should apply to be a Darzi fellow (you should by the way) I don’t want to give away too many spoilers about content. However highlights included expert witnesses you would kill your own granny to be caught in a lift with, a better understanding of who you are and what you bring to your role and – the best bit of all – knowing that you are part of an amazing group of people who really are going to change health and social care for the better. Watch this space.