Against ‘Involvement’ and Towards ‘Co-Production’.

Several weeks ago whilst taking part in some discussions on service-user involvement on Twitter that were, in fact, generally positive about this idea I had to profess that lately I have become ‘against involvement’. It’s tricky when you are limited to 140 characters to express nuanced ideas without oversimplifying what it is that you are endeavouring to express. I don’t wish to sound as if I am against ‘inclusion’ or embracing the ideas of service users. As an ex-service user myself that would be somewhat strange – I would have to censor and exclude myself!  So I’ve resorted to expressing these ideas at more length here in this blog post. It’s particularly pertinent I think to reflect on this now given the recent thought provoking Guardian article by Peter Beresford in the wake of the DOH’s (Department of Health’s, 2014) project to extend user involvement and live up to the policy pledge (rhetoric?) of “nothing about me without me”.

My problems with ‘involvement’ are that it is an ill-considered idea in the first place. It seems like something initially that is highly laudible and worthwhile. However my difficulties with it stem from what is implicit in setting up programmes with an ‘involvement’ agenda and from having being ‘involved’ in the running of such programmes in organisations in the past.  My experience as a professional in educational, healthcare and research organisations is that when ‘involvement’ is raised it’s at the point when most of the work in developing the educational, service or research project has already been done within the organisation itself.  “Involvement” can all too typically devolve down to inviting a service-user or outsider of the host organisation to participate in some pre-determined aspect or element of the service or programme that has already been committed to. They might have their expenses provided or receive some form of token payment for their activity. They might participate in the evaluation of a project as participants in a focus-group. My point here is that this is very much a form of “involvement” that stands to maintain the status-quo of the user as an “outsider” to the programme, project and host organisation. To put it in a nutshell “involvement” as has initially been developed is at risk of being “othering”.

If not “involvement” then, because of this “othering” risk, what instead? I would like to see the development of projects that aim instead from the outset to be collaborative and co-productive. Seek out and employ service users on an equal footing as participants in developing, designing, implementing and evaluating programmes across organisational settings as co-producers. Developing from this co-production I would then envisage programmes that head towards service-users leading and developing services/programmes in their own right.

The potential advantages of co-production and service-user leadership are, amongst other things, in the expressed values and diversity of the project. This is reflected in the Writing for Recovery research project of Taylor et al. (2014) who employed a service-user/writer to lead their project group.  Group members in this project reflected on the difference this made, and one reflected that:

‘Undertaking a service user led group gave me the courage to speak out, as I knew we had all faced major life challenges at some stage’ (WfR member). (Taylor et al., 2014, p 6).

References

Beresford, P. (2014), How Can Social Care Providers Involve Service-Users?, http://www.theguardian.com/social-care-network/2014/may/22/social-care-providers-involve-service-users [Accessed 28/05/2014].

Taylor, S. , Leigh-Pippard, H. and Grant, A. (2014), Writing for recovery: a practice development project for mental health service users, carers and survivors, International Practice Development Journal, 4(1) , pp. 1-13.

Further Reading and Watching

Check out the SCIE’s (Social Care’s Institute for Excellence) guide to co-production: http://www.scie.org.uk/publications/guides/guide51/

And a great little explanatory video: http://www.scie.org.uk/publications/guides/guide51/resources.asp

2 Replies to “Against ‘Involvement’ and Towards ‘Co-Production’.”

  1. Hi Stephen
    Equity and parity to joint collaboration in Mental Health services an research is better understood and developed than other conditions that effect patients.
    As you known the NMC in awarding AEI status to HEI’s to deliver nursing courses expect service user/carers input, once qualified the experience of registrants maybe different in terms of Involvement depending on the commissioners and providers understanding of what is required.
    In Bristol all MH services (not in patient services) has been retendered there has been SU & carers input from the start of the process, there will be a SU & Carer Board along with reference panels to oversee development of care pathways.
    This approach is a first in UK as a lay evaluator to the process and carer I aim to support cultural change to the delivery of services and ensure that co-production/co-design is taken to the next level. Below I provide a link which went public to-day, much to do between now and October.

    https://www.bristolccg.nhs.uk/news/go-ahead-mental-health-services/

  2. Hi Francesco,
    Thanks for your thoughts. It’s exciting to think that the perhaps over-looked consequence of the partial privatisation of the NHS courtesy of the coalition government is the opportunity to seriously rethink the development of service provision. Involving service-user organisations and expertise in partnership in such processes and as partners in collaboration it seems clear to me is one of the more promising aspects of recovery-oriented approaches. (See: http://www.imroc.org/what-is-recovery/10-key-challenges/).

    There are no cast-iron guarantees however that new service developments across organisations will necessarily move towards co-production however. No doubt we will here of tokenistic ‘shifts’ towards recovery that is little more than the old rhetoric heavily disguised in the new. Hopefully as more progressive changes are made and evidence emerges of the advantages that this (hopefully) engenders we’ll see a snowball of such changes.

    However, for me, one major caveat remains – and that’s the use of compulsory treatment. It’s the elephant in the recovery room.

    Best regards and thanks for the useful link, Steve.

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