Edgar S. Cahn – Scotland taking the worldwide lead in co-production

Edgar S. Cahn, founder of TimeBanking, former counsel and speech writer to Robert F. Kennedy and co-founder of the David A. Clarke School of Law at the University of the District of Columbia celebrates Co-production Week Scotland in this special blog:


In devoting an entire week to promoting co-production, Scotland is taking the lead worldwide. Congratulations. You are transforming what it means ‘to help others’ from a well-intended service delivery role to being a catalyst that enlists those being helped as partners and co-producers of real change, for themselves and others.

TimeBanks USA is undertaking to bring co-production into our higher education system – both for undergraduates at the University of the District of Columbia and my law school. The law faculty will shortly authorise a course in Becoming a Changemaker which introduces law students to co-production that reframes providing legal services to clients from a service delivery role to a transaction that enlists those clients as co-producers advancing System Change.

This past week, at the Annual Conference of our National Legal Aid and Defender Association (NLADA), TimeBanks USA, my law school, and the NLADA conferred a formal Client Contribution award to clients who had advanced social justice.

As we look at the recent election, we can see that we may be learning that the well-meaning effort of all our NGO’s to ‘do good’ may have relegated those recipients to being passive and disenfranchised – a status they did not appreciate. This election may have been their expression of dissatisfaction with that role and status. My hope is that co-production will be the way to restore us to the core values on which this nation was founded. Empowering the disempowered and disenfranchise is the mission to which I have committed myself since 1963 when I served as a Special Counsel and speech writer for Attorney General Robert Kennedy. I’m  not turning back – and you in Scotland have provided a model for us all.

Edgar recently gave a special lecture at our event Health, Human Rights and Co-production. Read the #LetsCoPro Storify here.


Co-production Week Scotland

Co-production Week Scotland 2016, running from the 14th – 20th November, highlights the co-production approach, shares the vision for co-production in Scotland and celebrates examples of it in practice on a local and a national level.

This week Ashleigh de Verteuil, Policy and Information Intern – People Powered Health and Wellbeing and Dementia Carer Voices at the ALLIANCE, provides a snapshot of where we are with co-production in health and social care across Scotland.

Co-production. Either love the word, or hate the word, it is increasingly being recognised as the transformational change health and social care services need. Auditor General Caroline Gardner has backed the use of co-production at a local level across Scotland as a means to better recognising what works for people in health and social care.

Giving evidence to the Public Audit and Post-Legislative Scrutiny Committee on Audit Scotland’s recent NHS in Scotland 2016 report, Ms Gardner responded to questioning by Gail Ross MSP by noting that some NHS Boards were involving people by “not just consulting on plans but involving people in developing those plans.”  She also noted that the NHS in Scotland “can’t do too much of that”.

In an online survey which 60 health and social care professionals completed, we asked ‘how important should using a co-production approach in your role be?’

copro-ashPPHW Survey: Health and Social Care Staff’s response for the importance of using a co-production approach

The survey presented a situation where professionals at a strategic and frontline level are at the early stages of adopting co-production approaches, and feel as if they are making progress, but acknowledge that they face a number of barriers to developing their engagement further.

And that’s exactly what People Powered Health and Wellbeing want to tackle, to help embed co-production approaches across Health and Social Care Partnerships. This would result in shifting the balance of power, to enable people with long term conditions and disabilities to be recognised as experts in their own health.

Results from PPHW survey also showed that respondents identified access to online examples of good practice as a helpful means of support, as well as co-production masterclasses, training conferences and events. They also identified the potential for practical development and consultancy support. The ALLIANCE can, therefore, play a key role as a hub for co-production work; producing materials and tools, sharing information, news and good practice, and brokering and supporting links between practitioners.



Podcast: Ceding power – Participatory Budgeting

What does ceding power mean in practice?

In the latest Academy podcast we hear from Alistair Stoddart, Scotland Network Manager at the Democratic Society, about how participatory budgeting (PB), a practical tool to support community decision making in resource allocation, is progressing across Scotland.

Read More “Podcast: Ceding power – Participatory Budgeting”

The Roots of Democratic Culture – Lisa Curtice

The Roots of Democratic Culture

You know the feeling. The meeting feels stuck. One person keeps making the same point, only more vociferously, another insists on bringing up something else just as the Chair tries to move the agenda on.  The rest have switched off and stopped trying to participate. Decisions are postponed and power relationships are reinforced.

Read More “The Roots of Democratic Culture – Lisa Curtice”

Citizen Voices – What is the impact of using them? by Sophie Dishman

This year’s Creative Competition theme is ‘Voices of the Experts’ as we ask our entrants to tell us of their experiences, and what a healthier and fairer Scotland looks like to them. In this blog post, Sophie Dishman talks of the importance of citizens using their voice to improve health and social care and the impact it can have.

Read More “Citizen Voices – What is the impact of using them? by Sophie Dishman”

A Sense of Belonging – Jo McFarlane

In this poem Jo highlights growing levels of inequality across Scotland. The recent Academy thinkpiece “The Right to Health” considered health inequalities across Scotland and how to tackle them.

In “A Sense of Belonging” Jo urges us all to not leave tackling inequalities to the politicians and managers. We all have a responsibility for social justice and we all have a stake in a healthy, flourishing Scotland.

Read More “A Sense of Belonging – Jo McFarlane”

People in Scotland at the forefront of change

“A social movement that only moves people is merely a revolt. A movement that changes both people and institutions is a revolution.”Martin Luther King Jr., Why We Can’t Wait

It seems extraordinary that it has been just 10 years since the birth of the ALLIANCE. A decade ago, the voice of the people who use health and social care services was muted. Now, people in Scotland are at the forefront of change. Read More “People in Scotland at the forefront of change”

The Courage to Cede Power

Has Scotland missed an enormous opportunity to have the expertise of some of the 2 million voices of users feed into the DNA of the new Health and Social Care Integrated Joint Boards?

In common, it appears, with most of Scotland’s national and local politicians, I had accepted that the obligation to have one third sector member, one carer member and one service user member on each of the new boards ensures the voice of the ‘customer’ is built into the new structure. Read More “The Courage to Cede Power”

“None of us is better than all of us”.

At the ‘2 Million Expert Voices’ ALLIANCE conference on 23rd May the afternoon brought a panel and Q&A session based on the Five Provocations for the Future of Health and Social Care. These have been generated through cross-sectoral discussion groups tasked to consider what is needed to transform Scottish society so that all citizens are able to thrive. The provocations are: courageous leadership; nurturing transformation; target culture; emphasising humanity and ceding power (see http://academy.alliance-scotland.org.uk/about-the-academy/five-provocations). The three panel members each focused on a different provocation in their talks.

Jackie Maceira, convener of the Scottish Disability Equality Forum, illustrated the importance of emphasising humanity when he described his experience of applying for self-directed support not for personal care but for a personal assistant so that he could remain involved and active in the community. He was taking an approach that was considered somewhat novel, trying to do things in a flexible way to achieve what was meaningful. Barriers that arose around which category to ‘put’ him in, or “but we don’t do it that way” were subsequently overcome, a social worker represented his request to the panel and ultimately he received the personal assistance. Jackie’s message of hope was that life-changing outcomes can be achieved when there is an emphasis on humanity.

Judith Robertson, Chair of the Scottish Human Rights Commission, addressed the issue of nurturing transformation, pointing out that people need to know what their rights are in order to assert them and hold duty bearers to account; something we need to work on in Scotland. Judith reflected that often there are individuals within services doing things as we want them to be done, but in order for this to spread and become the norm it is vital that those people and their positive practices are truly valued and nurtured. As Eleanor Roosevelt said “Where, after all, do universal human rights begin? In small places, close to home…”.

Oliver Escobar, Director of What Works Scotland, took both courageous leadership and ceding power as the prompts for his talk, although he highlighted that ‘ceding’ power might also be seen as ‘sharing’ power… or even creating power by involving 2 million experts. Oliver emphasised the need for a shift from an ethos of individual, ‘heroic’ leadership to recognition that the best leadership is collective, with facilitators bringing together people who need to have difficult conversations. Grassroots community work alone is not enough, he stressed; those at strategic level need to be engaged in order to influence investment, aid decision-making and effect transformational change on a large scale. Oliver advocated devolution to a local level and not only the participation of lobbies but actively seeking the voice of the seldom heard. An overarching theme was the need to move from seeing health and social care integration as a question of services to seeing it as a matter of power, politics and democracy.

Questions from the attendees stimulated discussion and comments about the politics of partnership, the importance of those providing a service having knowledge about human rights, and the view from Oliver that sometimes those collaborations which involve constructive conflict can actually be the most productive. The role of advocacy for individuals was a recurrent theme in people’s stories, with one person’s reminder that even those who are empowered and capable of defending their human rights can be just exhausted by it. Tokenism and overuse of jargon were cited as barriers to participation, while positive examples from as far afield as Melbourne and West Dunbartonshire were presented to illustrate willingness to cede power and do things in a different way.

Take-home messages for me? Particular challenges may include the necessary culture shift described by Judith – maintaining accountability but moving away from a culture of blame and defensive practice and towards a culture of looking for learning. I would argue that much work can be done in the early years, in schools and in parenting support to nurture such a culture. Opportunities for doing things differently are ripe in Scotland right now, with developments such as the new Mental Health Strategy and the work of the Integration Joint Boards. Above all, I was reminded of the power of collective action by Jackie’s “None of us is better than all of us”.