On 29th January, our CMO Ruth Hussey chaired a co-production seminar to consider how co-production might become a reality in Wales. Here’s an overview of the discussions…
Ruth Hussey’s introduction:
Why is this workshop about co-production taking place? Partly because the Minister has asked for it, and suggested creating a Co-production Implementation Group. But rather than just go ahead and do that, this event is about taking wider advice, thinking through the issues with others and, in a spirit of co-production, determining how best government can play a role.
The topic also chimes with my interest in health inequalities, the principles of Health for All, and the concept of community participation. The evidence base for the health benefits of people being in control of their lives, of concentrating on assets and strengths in communities is also now overwhelming.
The Welsh Government is taking an interest in this partly due to the Williams report on public services in Wales: resources are limited, effectiveness is patchy, services need to be more holistic and developed with communities. How can we help people live their lives? ‘Co-production’ is woven into many speeches. People say ‘we’re doing it already’. But it’s different from partnership working and consultation. It’s about power. The Social Services Bill, citizens panels, and other interesting work is in progress to find ways in which government can adapt what it does in order to build on these principles.
What do I want out of today? Co-production is not going to happen through project management. It is not a programme but a movement, which we are all involved in.
We need to clarify two things:
- What is the goal? What is it that we are going to do – so that anyone we meet can understand it? We need to unpack the co-production story so that it makes sense to people.
- How will we measure success? How will we know that we are getting there, five or ten years from now?
And after that, can we develop a sense of what we can do next, what is our job together – and how can government facilitate that? Are there things that government should be doing, or other ways in which government should be working, that could help?
Group discussion: we looked at co-production under four headings – purpose, urgency, goal and methods of achieving that goal. These are some of the responses:
Purpose: Why are we interested in co-production?
[RH. Ministerial instruction / reduce health inequalities / encourage community participation]
- Reform capitalism – why not?
- Mutuality not markets – create real value. Shift towards a human economy of relationship and abundance.
- Reconstruct the system – this is not about individual failings.
- What is ‘co-production’ carrying for our collective desires as a culture?
- What motivates people to participate in co-production? How can we feed that?
- Moral imperative – we must value people
- Transform relationships – not just improve the existing system.
Urgency: Why are we interested in it now?
[RH. Growing evidence about assets and people in control improving health / Williams report says ‘we can’t go on like this’ – we need to change public services]
- Frustration at the complexity of engaging with health services, lack of human engagement, waste of resources.
- Wales is a public sector economy – now under strain. State feeling the squeeze – drawing in the third sector, starving the fringes.
- Facing a perfect storm: economy and ecology, climate change – huge challenges ahead.
- Is this the right time? A time of opportunity?
- ‘We have no money, but we do have our hands.’ (Rousseau)
- Beware: short-termism is likely in an ‘urgency’ framing… we want long-term culture change.
Goal: Where do we want co-production to take us?
[RH. this is about power – not just partnership and consultation / every person in contact with a clinician is treated with respect / every person feels listened to by local public services.
- People are valuable, not throw-away (asset-based approach).
- Sharing expertise, making it widely available as a public resource.
- People are enabled and supported to live the lives they desire.
- Power no longer locked-down – more flexibility, flow and innovation.
- A different culture, reflected at all levels (individual, group, organisation, society).
- People really engaging with public services, and changing their direction.
- Civil society organisations supporting each other to generate change.
Success Paths: How do we think that can be achieved?
[RH. work in a co-productive way / work with communities / help people to live their lives rather than deliver services / identify what we mean by co-production / clarify the goal / determine the measures we should set, so that we know we are winning – over 5-10 years / determine how government needs to change in order to facilitate the new way of working]
- Mainstream this as a whole system way of working, embedded across the public sector. Set policy, performance framework, pattern of incentives etc to encourage innovation.
- Use a personal outcomes approach (eg like Talking Points) to generate a bottom up appreciation of outcomes, rather than top down accountability by results framework. See WCVA and Health Board work on outcomes based on asking people what they want: we have a good sense of what ‘a good life’ means for people. Use that as a performance framework for active citizenship, not gaming statistics.
- There is a long history of values-based approaches in Wales – eg cooperatives & mutuals. Use all of our assets.
- Develop a new language to talk about all of this, including about economy.
- Promote systemic evaluation and understanding - use the Most Significant Change technique to capture stories and patterns of change.
- Use time banking in health contexts.
- Provide central source of support for new community start-up initiatives. Encourage behaviour change. Encourage grass roots activity without programming it top down . Person-centred planning and Planning for Real are already in existence – use them!
- Free up locked-down systems & pay attention to the political context . How we are organised now to suppress co-production and what is at risk in freeing up the existing system ? Create the freedom to take risks at all levels. Cultural leadership is needed – break the (implicit) cultural rules.
Summary & what’s next: Chris Riley (DHSS)
Ruth Hussey asked how we unlock our potential. It is clear that this is a huge agenda – we are talking about a completely different system. So 10 years is a good timescale to be thinking of – but that will mean at least two elections, many Ministers, a turnover of staff at every level in the system.
Ruth asked us to think about goals, measurement, the role of an implementation team and the role of government. The session has given us some insights, even if no firm answers at this stage.
The next issue is how to engage people in the ongoing conversation – probably by establishing some form of network.
And Government itself needs to start thinking through answers to Ruth’s initial questions, to formulate proposals and feed them back to the group. The process of developing co-production needs to be collectively owned in a way that leads not to stasis but to progress. Hopefully a broad network will help government identify what it needs to do, what is missing from what it is proposing to do, where joins can be made, and possibly help scrutinise whether we are making sufficient progress.
Within DHSS we need to start thinking about what to do as a Department, to reflect what the Minister wants, what Ruth is inquiring into, and what the general expectations, aspirations and reality is outside.
Ultimately co-production cannot be done just for health and social services. But this is the starting point: it is the Health Minister who has asked for this. So what’s needed is to think in terms of creating a momentum which future-proofs the approach. Is this the Rosa Parks moment? Will this happen because the time is right, with the right people behind it? Or will it not happen because the crisis is not deep enough, or the public expectation is not right, or for all sorts of other reasons?
There is only one way to find out – working together to build on a good conversation today.
Attendees: 37 people (53 invitees) from: Welsh Government, Health Boards, Public Health Wales, Wales Audit Office, WCVA, WLGA, NWIS, CaST Cymru, Community Lives Consortium, Disability Wales, Macmillan, Spice, Taith, United Welsh Housing, Co-production Wales, Working with not to.
Please add your voice and experience to the on-going discussions: if we work together we might just discover that we do indeed have the preconditions for revolution!