William Kløverød Griffiths Policy and Information Intern, Dementia Carer Voices spoke at the event about the work of Dementia Carer Project and the emerging themes from the pledges that have been gathered. In this blog William writes about the You Can Make a Difference campaign and the importance of celebrating the kindness of people with dementia, their families and carers.
President of Institute for Healthcare Improvement, Don Berwick, has been credited with saying “The heart of improvement is not in controlling, it is in unleashing.” For me this really sums up the work of Dementia Carer Voices ‘You Can Make a Difference’ campaign. The work we do is about unleashing not in controlling what people do, their messages and their stories.
The campaign is about celebrating and unleashing the kindness and dedication of people with dementia, their families and carers. It is to emphasise that they are equal partners in the care they receive. To this end we collect the stories and experiences unpaid carers have in providing care to their loved ones. Dementia Carer Voices are building a range of multi medium case studies, asking people what matters to them. It is our hope that these will provide useful evidence about the lived experience of the lives of unpaid carers. In that regard, we hope to be a platform to unleash the messages of unpaid carers.
The project also shows the lived experiences of people with dementia, their families and carers to those who work in the health and social care system. It is a difficult and underappreciated role that health and social care staff do every single day, day in and day out, but it is essential to the health and wellbeing of millions of people. Thousands of people come into contact with NHS Scotland every day, an estimated 37,000 people living in care homes in Scotland, and many more receiving home care visits. If our campaign can unleash some compassion, care and consideration into every one of those human contacts, then we will make our health and social care system better.
So the work we do at Dementia Carer Voices is about unleashing the passion and kindness of unpaid carers. It is about those people who sit by our beds, knock on our front doors and who we speak to on the phone. It is about the people who treat us when we are unwell, about those who offer kindness when we are vulnerable and are able to make a difference in people’s lives. To all those who follow the five must dos of caring for someone, and place the person at the centre of their care.
When I first joined this project a little over two months ago, I took out a selection of the pledges we have received over the years. Just over 13,000 people have made a personal pledge to make a difference, giving people the opportunity to commit to, to share and celebrate the difference they and we can all make every time we meet someone. That is what this project is about, it is about unleashing the voice of people with dementia, their families and carers. These are people seldom heard, but with our project hopefully gives them the chance to express themselves and take this message to people who make policy.
Dementia is everyone’s business. It is not about buildings or organisations, it’s about the people within and the people we meet, on every occasion it’s about people and relationships. It’s about the life and love stories of families all across the county. So I truly hope the people the pledges, the life and the love stories are about unleashing what matters, who matters and about unleashing the parts we can all play in every moment, every day and every time.
On Monday 26th June, the Academy will be hosting Emphasising Humanity over Bureaucracy in Social Care, an interactive event that aims to explore what emphasising humanity looks like in practice, not just for those receiving care but for the care workers too. What would human rights look like if we focused on the human rights of the system?
Speaker Helen Sanderson poses the question of how we can work in ways that will enable everyone to flourish in this blog written ahead of the event:
The Guardian, in November last year tells the story of Jean. Jean works for a home care agency in the north of England. She starts work at 6.30 am, and completes 23 calls in 12 hours. She drives 20 miles between appointments, and is not paid for her travel time, and earns £64.80 before tax. Jean is on a zero hours contract. She does not know how many appointments she will have each week, and therefore how much she will be paid. Her list of appointments comes through on a Friday.
It is stressful work, she says, and she feels she has little support.
“It’s a lonely job…you are in the care on your own, you get to peoples houses and often face problems on your own. They tell you all of their worries and then you take them home. Often at night I’m tossing and turning worrying about them.” But Jean still loves her job.
Jean’s experience could explain why there is up to 40% turnover in home care. Yesterday I spoke to a manager of a large home care organisation in the south of England. She said that they lose 50% of their new recruits before their 6 month of employment. How close is Jean’s experience to Alan’s?
Michael Marmot, in his book ‘The Health Gap’ tells Alan’s story.
Alan was a picker in a warehouse, and Michael described in detail his daily experiences of work and ends the story with this statement.
“It was as if his employers had taken everything we know about the damaging aspects of work, concentrated them in a syringe and injected them into Alan.”
The damaging effects that he refers to are high demand with no control over the work task, high effort and little reward, social isolation at work, job insecurity and working antisocial hours.
I am not suggesting that every carer who works in home care experiences these damaging aspects, but I am sure many do, and it does resonate with Jean’s experience. In changing home care most of the focus is on the experience of people using the service, or on making efficiencies. Both of these are important, however we must consider the experience of the staff. If we don’t not only will turnover continue to be very high, but we are also building health challenges for the future. The challenge therefore is to create a different way of delivering support for people at home, that is truly person-centred, where they have choice and control, and delivered by an engaged, happy workforce.
There is a lot of interest in happy workplaces. It almost sounds frivolous to talk about happiness in home care. Ron Friedman, in his book ‘The Best places to Work’ talks about how meeting psychological needs are at the heart of employee engagement and wellbeing.
The psychological needs that he refers to are autonomy and relationships. It is clear that having choice and control matters to staff as well as people using services, and that having friends at work is critical to productivity and happiness. Jean has no autonomy over her work – she is told where to go and when, and for how long. She describes the work as lonely.
We care trying to build choice, control, and relationships into the DNA of Wellbeing Teams. Wellbeing Teams are small, neighbourhood, self-managed teams inspired by Buurtzorg. (link: https://www.youtube.com/watch?v=MNJ3iTw0AXw)
For people who are supported at home
People choose what they want support with (their outcomes and priorities), how they want to be supported, when and where. We enable them to choose their team too, either through looking at the team’s one-page profiles or a 30 minute film of a team member introducing themselves. No more than four team members work with an individual, to provide consistency and to develop good relationships.
For team members
The team meets every week to share information, address any problems or issues and support teach other. Each team member has a buddy. The team shares the roles needed in a self-managed team together, and they choose the roles based on their strengths. Each person has a coach to support them to become confident in their role (for 3 – 4 months) and then the team has a coach to help them work well together. The team develops the rota/schedule together after the team meeting.
Michael Marmot is compelling that we need a radical change in the way we think about health and society. This means not only ensuring that older people are supported well at home, but that the health and happiness of staff is critical too.
If you are interested in attending Emphasising Humanity over Bureaucracy in Social Care please email email@example.com to register your place.
In this blog post Pat Tyrrell, Deputy Director of Nursing and Midwifery at NHS Highland continues our #EmphasisingHumanity theme and talks about the importance of this, not only for patients but staff working within the health and social care systems.
Our health and social care systems are full of those who care deeply about the people with whom they work – both their colleagues and the people for whom they provide care and support. Minute by minute, hour by hour, day by day, we see interactions and services which are designed to respect the rights and needs of our fellow humans. This design delivers time and time again the kind of care that supports and helps the most vulnerable in our communities meet their potential and flourish with love and compassion.
We also know that the experiences of many people, both working in the health and social care systems and those experiencing the services of these systems, is not always a fulfilling one. People are often left feeling dehumanised and devalued, on the receiving end of transactional processes which fail to recognise and respect their needs as human, sentient beings.
We cannot talk about emphasising humanity in health and social care systems without recognising that this must include everybody within that system – staff and patients are not separate entities when it comes to considering the basic needs which we all have for relationships that respect our rights and which are based on compassion and kindness.
In Reinventing Organisations, Frederic Laloux states that “Extraordinary things begin to happen when we dare to bring all of who we are to work.” He also recognises that “In a forest, there is no master tree that plans and dictates change when rain fails to fall or when the spring comes early. The whole ecosystem reacts creatively, in the moment.”
Here he recognises what we know to be important – that we respect and honour our individuality and diversity and that as individuals we interact with others in a way that enables each and everyone of us to develop and to adapt in ways that meet changing needs and contexts.
It was on many of Laloux’s principles that Jos de Blok, the founder of Buurtzorg, the Dutch community based nursing service, established his new organisation on in 2006. This was in order to address the problems which he identified within a fragmented and transactional health and social care system in Holland – a system which met neither the needs of the patients nor the staff.
‘Humanity beyond bureaucracy’ is the mantra of all the nurses who work within the self organised teams in Buurtzorg. They work in teams of no more than 12 people, where respect and dignity are at the heart of their approach towards each other and towards the communities with whom they work. 10,000 frontline staff are supported by an organisation of 45 backroom staff. And there is no hierarchy. Decisions are made and enacted by teams, based on the needs of their patients and staff.
System design is important in enabling this. I have been fortunate enough to spend time with one of these teams in Rotterdam and know only that the positive visceral and emotive which I have experienced told me that emphasising humanity in everything that we do is a core essential of success in health and social care systems.
There is an urgency to redesign our health and social care systems in Scotland. As we advance with this redesign we must recognise both the individual and the system components that enable human flourishing. We can now make unprecedented decisions which challenge existing organisational paradigms and halt the perpetuation of poor experiences. We just need to be truly human and brave.
“Wherever the art of medicine is loved, there is also a love of humanity” – Hippocrates
In 1816 René Laennec, a 35-year-old French doctor, invented an instrument that would allow him to listen to a woman’s chest without having to place his ear against her chest, thereby preserving her modesty. “I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear,” he wrote in the preface to De l’Auscultation Médiate in 1819. The instrument, which he named the stethoscope, quickly became popular and in the words of medical historian, Stanley Reiser, “led to a seismic shift in how doctors evaluated illness and their relationship with the patient.” In his book Technological Medicine: The Changing World of Doctors and Patients, Reiser expresses concern that over-reliance on technology has replaced openness to the patient as a whole person. The new technology, he wrote, “made doctors more interested in the physical findings of disease than in the life of the patient.
Humanity in healthcare rests on an awareness of patients as human beings first, patients second. Sir William Osler (1849-1919), who is often called the father of modern medicine revolutionised the teaching of medicine by bringing students out of the lecture hall for bedside clinical. One of his most famous sayings was “the good physician treats the disease; the great physician treats the patient who has the disease”. This I believe is the essence of humanity in healthcare – the ability to see beyond the biomedical model of disease to the life into which the disease has intruded. “The foundation of healing”, believes Dr Adrienne Boissy MD, Chief Experience Officer of Cleveland Clinic Health, “begins with reassurance that [patients] have been seen and therefore valued and appreciated for the human that they are beyond the disease”.
I vividly remember the day I was diagnosed with breast cancer twelve years ago. The doctor who delivered the news ignored my tears, and while he spoke, didn’t make eye contact, reassure me or make any other effort to acknowledge my shock and distress. When I remarked on the doctor’s lack of empathy to a family member later that day, he asked me whether I would rather be cared for by a skilled surgeon with a poor bedside manner or a caring and compassionate surgeon with adequate but not exceptional surgical skills. Does it have to come down to a choice between compassion or competence? Can’t we have both?
Compassion and empathy should be at the core of any good therapeutic relationship, but as Dr Rita Charon, founder of the Program in Narrative Medicine at Columbia University, wrote in a 2001 paper for The Journal of the American Medical Association, “despite medicine’s recent dazzling technological progress in diagnosing and treating illnesses, physicians sometimes lack the capacities to recognize the plights of their patients, to extend empathy toward those who suffer, and to join honestly and courageously with patients in their illnesses.” Dr Charon believes that “a medicine practiced without a genuine awareness of what patients go through may fulfil its technical goals but it is an empty medicine, or at best, half a medicine.”
Clinical empathy has been defined as the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation. It means not just recognising that the patient is suffering, but acknowledging the distress and moving to address it. The ability to listen and empathize is central to establishing trust in the clinical encounter, and yet these skills are undervalued and often ignored in traditional medical education. In years past, clinical empathy was simply viewed as having a good bedside manner, a “nice to have” rather than a “must-have” trait in medicine, but a wave of recent scientific research has now shown positive correlations between empathy and improved patient outcomes, satisfaction and adherence. A study conducted with diabetic patients showed they had better control over their illness and fewer diabetes-related complications requiring hospitalisation if their doctor scored high on cognitive empathy. In another study, patients who rated their surgeons as highly caring during their stay in the hospital were 20 times more likely to rate their surgery outcome as positive. And empathy is not just beneficial to patients, a 2013 study suggests that doctors with higher empathy levels—meaning that they are aware of their patients’ emotional needs and respond appropriately to their concerns—experience less stress, cynicism, and burnout than those with less empathy.
An extensive scientific literature review conducted by the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University demonstrates that “when patients are treated with kindness — when there is an effort made to get to know them, empathize with them, communicate with them, listen to them and respond to their needs — it can lead to faster healing of wounds, reduced pain, reduced anxiety, reduced blood pressure, and shorter hospital stays.” The research also shows that when doctors and nurses act compassionately, patients are more likely to be forthcoming in divulging medical information, which in turn leads to more accurate diagnoses. They are more likely to adhere to their prescribed treatments, which leads to fewer readmissions. The authors of the review conclude that “kindness shouldn’t be viewed as a warm and fuzzy afterthought, something nice to show after the “real” medicine is administered. Instead, kindness should be viewed as an indispensable part of the healing process.”
More recently, Mills and Chapman in an editorial published in the Australasian Medical Journal, go beyond kindness and empathy to a call for compassion in medicine. They draw a distinction between empathy, which relates to an awareness of another’s experience, and compassion which relates specifically to contexts of suffering and the alleviation of it. “Compassion is more than just kindness,” they write, “it involves cognition, affect, intention, and motivation; that in a context of suffering, relate to the alleviation of that suffering.” In an article in Modern Healthcare, Julie Rosen, executive director of the Schwartz Center for Compassionate Healthcare, writes that compassion is the foundation of good medical care “recognizing the concerns, distress and suffering of patients and their families and taking action to relieve them”.
I believe compassion in medicine is based on acknowledging the difference between illness as a diagnostic entity, and illness as the way in which the disease is perceived and responded to by a person. In limiting its focus to the physiological effects of illness, medicine often overlooks the human experience of illness and is in danger of losing sight of the person with the illness. The late neurologist, Oliver Sacks addressed this failing when he observed that “medicine has shifted its focus to getting to know and treat a disease instead of getting to know and treat the person with the disease”. This echoes Donald Evans in his book Values in Medicine: What are we Really Doing to Patients? who writes, “the contribution of science to the development of medicine has made remarkable strides in the delivery of effective health care, but it has also tended to remove the patient’s experience of illness from centre stage.”
The practice of medicine is both a science of knowledge and the art of humanity. For too long we have trained doctors and nurses to see illness through a bio-medical lens which reduces patients to a set of symptoms without taking into account the wider emotional and social aspects of illness. Attending to how patients experience their illness within the context of their lives, rather than the narrow confines of symptoms, provides a richer perspective within which to learn how to care for the person with the illness. Collectively we must learn to cultivate the skills that are essential for humane medical care – empathy, dignity, respect, caring, kindness, compassion, and above all, a willingness to see and understand the person behind the patient. Repeated cases of failure in health and social care have revealed a common failing – staff lost sight of the person and stopped responding to patients as people. Building a culture of compassion doesn’t involve any large capital outlay, but in reframing medicine through this human lens we will reap a greater reward in terms of meaning, context, and healing in healthcare.
To celebrate National Acts of Kindness Day, Dharmacarini Kuladharini of the Scottish Recovery Consortium makes the case for #EmphasisingHumanity and why we all need and should encourage kindness.
Try A Little Tenderness…
A week into the national kindness challenge, Kinder Scotland 2017, I find myself writing chalk messages of appreciation on the pavement outside the building that houses the Scottish Recovery Consortium. In the heart of the merchant city in Glasgow people stop and stare and smile.
Kindness is something we all need more of; its that connection, acceptance and loving regard that is part of what helps all humans feel well, alive and that life is worthwhile. Bruce Alexander in his seminal work, “ The Globalisation of Addiction”, calls this experience psychosocial integration. We know our place in the world and in the hearts of our loved ones; we are part of a real community.
Dislocation is when these connections, environments and those secure places in the community are broken. This can happen through war, economic upheaval, loss of family and nation as well as other aspects of the unrelenting march of hyper capitalism, from the mass indoctrination into self-interest and greed being the only interest worthy of attention to the loss of support services that kept you from falling off the edge.
This dislocation, he says is at the heart of the spread of addictions in the world. We use substances and behaviours that we feel will soothe us and reconnect us quickly with a sense of well-being. As Johan Hari points out in “ chasing the scream” humans and animals take substances to alter their experience of emotional pain as well as physical pain. This is normal.
When the dislocation grows and gets more extreme some of us will turn to more substances, more shopping, more working, more video gaming, more overeating, more gambling, some of us will get very depressed, some will commit suicide.
The chronic health problems of the 21st century are resistant to public health strategies that focus exclusively on the individual as the source of the problem. Phil Hanlon, while he was Professor of Public Health at Glasgow University, called the problems of addiction, depression and obesity ‘diseases of modernity’, products of our market driven, highly materialist, individualized form of economy. He suggest that new forms of public health action are needed to stem the tide of pain.
At the SRC, we are all about the love, the human connection, the real community and so we have joined up with U lab Scotland and Carnegie Trust and surprising bodies like Visit Scotland to promote that spirit of Kindness, that will be part of helping us all heal. It’s not the only change we need but it’s a great contribution.
To celebrate the Kinder Scotland 2017 challenge, the SRC has made a PDF of its Scottish Recovery Workbook and is giving that away to anyone anywhere in the world that could use it to recover from addiction. It’s a gift from people in recovery in Scotland to people suffering from addiction anywhere in the world. Connected through kindness and our beautifully flawed humanity.
To me, to create true transformation in health and social care, transformation needs to be considered on an individual level as well as looking at the wider transformation landscape. This personal idea of transformation should be able to slot into the interactions people have with the health and social care professionals they come across throughout their life – but for this to happen there is a need for a shift in the way that the health and social care system across Scotland operates. The introduction of Health and Social Care integration was promising and in theory makes absolute sense – however in practice will this turn out how we imagine it and truly benefit the individuals that it needs to?
On a personal level I think of transformation as the ability for me to live well with a long term condition, but also to be able to learn, adapt and develop as a person in response to this, with the support of those around me including health care professionals. The support that I have received over the last two years from health professionals has been very hit and miss. I know I am very lucky to be receiving and have received the support I have thanks to our NHS – however this system is far from perfect and I have been victim to the postcode lottery which exists in mental health care support across Scotland. I did receive crisis support but not without a fight, but 9 months on from when I first presented to a GP in crisis I am still on a waiting list to see someone from the Primary Care Mental Health team. I have had to ensure that I am still on the correct waiting list as it seemed that one hand does not know what the other is doing. I am proactive and capable of advocating for myself which has prevented me falling through gaps – however, what about those who don’t, or those who like me have tried to advocate for themselves and seemed ‘too well’ to receive the appropriate support and treatment? It should not require an individual or their families and carers to have to fight and chase up services?
To be able to provide true transformation across health and social care in Scotland, there needs to be a shift in attitude towards person centred approaches – there is already evidence of this being demonstrated by the outcomes of projects funded through the Transforming Self Management in Scotland Fund. Approaches like those that funded projects provide need to become more common place – putting people at the centre and working with them to design, deliver and evaluate services. The true worth of Health and Social Care Integration won’t be clear for a while, but to get the most out of it there must be true partnerships between statutory and third sector agencies, there must be a trust placed in the third sector that they already are and can continue to develop and provide a kind of support for people that is not currently available through statutory agencies and must stay where it is to protect the true nature of this work. Strong partnerships supporting these approaches are needed to move away from a postcode lottery and ensure that everyone who needs support can access it in a way which suits them and in a timely manner. People are more likely to thrive, develop and therefore give more in return to society if approaches are person centred. There are partnerships forming across Scotland between statutory agencies and third sector organisations which are effectively providing services and support for people in a way which is right for them, precisely because it has been designed and developed in conjunction with them.
The first in our brand new for 2017 series on ‘What is transformation in health and social care?’ is from Cath Cooney, Scotland’s House of Care Programme Manager at the ALLIANCE.
What is transformation in health and social care?
A good question to reflect on at the start of a new year. The word ‘transformation’ is at risk of becoming another well used but ever more elusive concept as it becomes part of our everyday language in the world of health and social care. Somehow despite our best efforts the thing we seek to develop becomes harder to pin down.
This past year saw some of the pieces of the transformation jigsaw come a bit more into focus as I’ve grown in to my role within the Health and Social Care ALLIANCE and the House of Care programme in Scotland.
In the House of Care programme, we use the T word a lot as well as coherence, person centredness, self management and sometimes even compassion. It’s a funny word – sometimes people move towards it in conversation and sometimes not. For me it’s a very important and fundamental jigsaw piece and I like the definition of compassion from Dr John Gillies, co-director of the Global Compassion Initiative and former chair of the Royal College of General Practitioners,
“an acknowledgement that a person or individual is suffering or unhappy and having the intention to take action to address that”.
Sometimes compassion gets a bad press as soft and fluffy – a luxury if you like in the real world of health and care but I don’t agree. It’s at the heart of the care and support planning conversations in the House of Care adopter sites across Scotland where prepared people and prepared staff develop a different kind of conversation.
It works best when there is a shift of intention towards sharing the power in the relationship and really supporting the person to be in the driving seat of their care and support.
It was heartening to read the recent social work report ‘It’s no longer them and us –it’s just us’, which also echoes the importance of co-production within a good conversation:
‘The relationship between the assessor and the assessed person is the foundations – it’s so important. It needs good communication – especially good listening – and honesty. Processes and systems should be built around this and enable it, rather than getting in the way.’
Hopeful signs perhaps that policy and practice in health and social care integration really are beginning to converge with the person at the centre.
We say we want a more human compassionate approach but when budgets are perceived as tight, services like this, which have high levels of support and satisfaction from people and their families are often cut; struggle to survive on short term funding; or are perhaps not even funded in the first place. Those services and staff are often judged against a reductionist effectiveness model, leaving the third sector to be the fertile ground for more person centred approaches and services that are informed by the voice of lived experience. We need a third sector that is truly an equal partner in health and social care.
But how can this shift in relational care be more clearly measured and evidenced? Sir Harry Burns is chairing a national review of indicators and targets. We must measure the process and the day to day business of the effectiveness of the systems but we need to include the voice of lived experience if we really want to understand what good care and support means. I hope that what emerges will also include the language of human, relational care in support of transformational change.
There’s a growing body of evidence to show that compassion is good for us all. Whether you’re a person living with a long term condition, an unpaid carer or a staff member, I’m hoping that in 2017 we openly move towards a kinder, more compassionate approach in support of transformation in health and social care.
There was an excellent piece in a recent Sunday newspaper where Dr John Gillies spoke bravely and clearly about the need for compassion and Dr James Doty, the neurosurgeon who founded the Centre for Compassion and Altruism Research at Stanford University, quoted the Dalai Llama:
“If we say the practice of compassion is something holy, nobody will listen. If we say, warm-heartedness really reduces your blood pressure, your anxiety, your stress and improves your health, then people pay attention.”
It is an inevitable fact of life, often met with apprehension, reluctance and even tactical avoidance but awkward or difficult conversations are something we will have recurring experience of during our lifetime. Be it in our personal lives, or the workplace, as the recipient or the initiator, navigating how to handle these conversations can be a complex and intimidating affair.
The issue with awkward conversations is that they are often needed to be had, and when done right they can be informative, lead to a greater understanding, expanded perspectives…and dare I say it, even a resolution. When done right, they can move us forward.
But there are often a lot of variables at play – differing ideas and opinions, negative attitudes, defensiveness and fear of judgement are just a few of the causations that mean we approach these conversations with trepidation, and can all too often result in heads butting, voices not being heard and communication breaking down. The question is then, how do we handle these conversations? If there are so many potential benefits that can be reaped from an awkward or challenging conversation gone well, what can we do to make this a reality?
On the 24th January, the Health and Social Care Academy, in partnership with COPE Scotland will explore how to hold challenging conversations without them breaking down. As part of Workforce Scotland’s Firestarter Festival, a weeklong festival aimed to shake up and transform the way we work through a series of creative, disruptive and innovative collaborative learning events, Awkward Conversations will tackle the proverbial elephant in the room and explore how to create a psychologically safe space that will facilitate the opportunity for people to share some challenging issues without fear of being mocked or judged.
In health and social care, especially in the pursuit of transformational change in health and social care, awkward conversations will be an unavoidable part of the process. But if we can create the space to have these conversations in a purposeful, open and respectful way, then perhaps awkward won’t be something to be feared.
For further information on Awkward Conversations, and to book your place at this free event visit the Eventbrite page. Follow @HandSCAcademy on Twitter for updates.
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 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?’
PPHW 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.