“I enjoyed the opportunity given in the NHS Redditch & Bromsgrove CCG workshop to engage in a discussion with others, as an equal partner with the views of all participants being respected, demonstrating the shared humility, humanity and responsibility, now required for genuine co-production”.
Tony D, HACW Big Recovery Newsletter Editor, Service User Researcher/Consultant
At present, we are two thirds of the way forward to complete a project partnering with Arden Commissioning Support to service redesign through coproduction with service users and patients:
- Services tackling multiple Long Term Conditions in Worcestershire.
- Children and Adolescent Mental Health Services (CAMHS) in Coventry & Warwickshire;
We launched both processes by listening to patients and carers, ensuring the outputs were rooted in the lives and experiences of patients.
From late 2014 to June 2015 we ran a series of workshops to:
- Help commissioners understand problems faced by citizens and communities; design and test potential solutions and co-produce outcomes;
- Provoke discussion, disrupt and challenge current perceptions, cultures, systems, processes and practices to catalyse new and improved ways of working;
- Develop improved Long Term Conditions and Child and Adolescent Mental Health Services (CAMHS) pathways and/or systems; and
- Share the learning with key partners to help generate further ideas for innovation, exploring a very different understanding of where power and resource exists in the system.
Key learning that arose earlier this year from both programmes programme earlier this year included the following;
Professionals, providers, children, parents and carers articulated a vision for, a person centred, relevant and responsive service which really does have the capability to prevent escalation. To enable this vision to become reality, there was a near consensus and heartfelt call for radical transformation of the system. This means dismantling the NHS Tiered System, and replacing it with a person-centred system that:
- Places most effort and resources in preventing poor mental health and well-being, and in so doing engages a far wider range of actors in delivery – health professionals, staff in other public services and community based organisations (incl schools), citizens – as volunteers and co-producers of services;
- Fundamentally re-thinks how Mental Health specialists (i.e. professionals typically delivering intensive interventions) deploy their expertise in the design of such services and support non-specialists in delivering them, and are on-call in a much more responsive way to prevent problems escalating.
If resources were shifted to prevention, an inversion of mental health expenditure could be created.
Coproduction with people with Long Term Conditions
That there was a groundswell of support that co-production could help patients manage Long Term Conditions (LTCs) as a vital, innovative and creative approach to foster effective management of LTCs. The support for co-production broadly fell into three interconnected elements:
- Empowerment – requiring services to shift their approach from ‘doing to’ to truly ‘working with’ treating patients and carers as equals by co-designing and co-delivering solutions, helping commissioners and service providers understand the problems faced by citizens and communities.
- Integration – building bridges between and across providers in:
- Health and Social care;
- Primary and Secondary care;
- Formal and informal care;
- NHS providers and VCS providers.
The importance of integration and building bridges between and across providers lies in the opportunity that they become irrelevant for the service user. Organisations are silos by their very nature, and often for good reason. What is important is that they become irrelevant for the service user. For this to happen in reality, organisations need to work together towards a wider common aim and support staff in understanding what this means in practice. Integration in this context is not structural, but crucially a way of working across boundaries.
For example, integration can be accelerated by building new alliances, collaborations and networks, (in the recognition that no one provider has all the answers), to develop a deliverable solution that will support patients with multiple LTCs to access a 24/7, person centred, integrated offer with one care plan.
3. Relationships & Mutuality
Supporting a shift in the dynamics between those delivering care and those receiving care, brokering a true partnership and shared responsibility between professionals and users. In practice this is a participative process where new relationships and attitudes are developed and by such, cultures are changed in an evolutionary way with respect and decision making shifting from one group with the service user at the centre.