Posted by: ayrshirehealth | December 14, 2012

Giving something back by @maidenturret

‘Giving something back’


PCHCI attended the launch of the Person-Centred Health and Care Programme a couple of weeks ago. This exciting development is a key element of the delivery of the NHS Scotland Quality Strategy.

The aim of the programme is that, by 2015, health and care services in Scotland will be person-centred as demonstrated by improvements in care experience, staff experience and co-production. This is quite an ambition!

I wish to focus on the co-production element of the programme, which sets out a bold aim to ensure that health and care services support peoples right to independent living and wellbeing; by working in partnership with people and communities assets to design, deliver and improve support and services.

It’s broken so let’s fix it

The established approach to delivering public services has been based mainly on meeting people’s needs. People are labeled and communities are described in terms of their problems and their deficiencies.  Public services set out to fix problems for individuals and communities and, in doing so; they take away control (and you could argue hope, meaning and purpose!) from people by making them passive recipients of services.  Evidence suggests that a sense of control over one’s life is associated with better health and a greater likelihood of espousing healthy behaviours.

Every person is an asset, with something to offer and every community contains a range of assets. ‘Asset thinking’ challenges the predominant framing of health as the prevention of illness and injury, instead, looking at it as the promotion of wellness. It is possible to ‘get ill better’ because good wellbeing tends to mean that people seek help sooner and recover quicker.

Rose tinted spectacles

The concepts of co-production are not new. Indeed, I remember my late father-in-law (who lived in an Ayrshire mining community) talking fondly of co-production in action including skills exchange, support networks, community participation  and a real sense of solidarity during the post-war era he grew up in. It is a shame that we have lost much of what my father-in-law used to vividly describe as we now tussle to live with the consequences of modernity.

We are already on the journey

Despite the struggle many of us face with what Professor Phil Hanlon describes in his recent article in the Scotsman[1] as ‘dis-ease’, I bet you wouldn’t have to look all that hard to find co-production alive and well in your community.  Individuals, community groups and third sector organisations have been facilitating positive change in the lives of the vulnerable and disadvantaged for years. Public services are playing ‘catch up’ from a co-production perspective and public sector reforms, unsustainable models of service delivery and the economic/demographic environment is driving the cultural change that is required.  However, I would argue that the change is slow, particularly within the NHS where I work. Paternalism is still alive and well in many parts of the NHS!  Co-production and asset-based approaches will only flourish if clinicians and managers relinquish power to become catalysts of change rather than the central providers of services.

Within my own organization there is some excellent work being delivered in partnership to enable people with long-term conditions, mental health issues or learning disabilities to take control of their wellbeing. This work is being delivered in the spirit of mutuality and reciprocity. The challenge is to test these approaches further using improvement methodology to achieve scale and spread.

Giving Something Back

Are there bold steps that public sector organisations can take on this co-production journey? I think the answer is “Yes”.

A few weeks ago I was privileged to attend a meeting of Irvine community leaders, who had come together to discuss the impact of the UK Governments welfare reforms. The negative impact of the forthcoming reforms was evident (the group highlighted that a food bank is starting in North Ayrshire, such is the need). I was struck by the positive attitude and commitment of those who attended. They articulated a plan to build on the asset base that already exists within Irvine to encourage public, private and third sector institutions to ‘Give something back’, for the benefit of the community as a whole.

screen-capture-8I reflected on what I had heard and asked myself how could I personally and my organization as a whole ‘giving something back’. What if every member of staff was enabled to give 2hrs per month (pro-rata) to ‘Give something back’ to the communities we serve. Given that there is 10,500 staff in my organisation this could potentially mean 20,000hrs of ‘person power’ per month.

Now, I know your thinking I must be mad! (especially when so many staff don’t have enough hours in a working day to complete core business).

However, I have seen such a crazy idea in action. I was fortunate enough to visit the Holy Cross Centre in London, which delivers services using the co-productive method of time banking.  As part of the contract of employment every member of staff must give 2hrs per week to the time bank. So, I wasn’t surprised to learn that Chief Executive regularly cleans the toilets!

I believe that such a bold step would realize a number of benefits including:

  • Supporting the cultural change required for healthcare professionals to relinquish power, sending out a powerful message.
  • Building mutuality, reciprocity and a shared understanding with the communities we serve.
  • Giving staff the time to reflect and rebuild capacity to care and achieve fulfillment for their efforts and the positive psychological benefits of ‘giving’
  • Blurring distinctions between professionals and recipients

In conclusion, co-production is key to driving the design and sustainable delivery of person-centred support and services. As Margaret Hannah from IFF highlights[2] at this time of fundamental change ‘we have to be both hospice workers for the dying system and midwives for the new’.

I’m ‘up for it’, are you?


  1. Not as dull as it first seems! If you have time it is an interesting concept. x

    Julie Hannah

    Resuscitation Officer

    Resuscitation Training Department

    Clinical Improvement Unit

    NHS Ayrshire and Arran

    01563 825750

    Extension 25752

    Page 3508

    For further information about the Resuscitation training Department, please select resuscitation from the Clinical Improvement Functions on the Athena Site http://athena/pdu/Pages/Default.aspx

  2. […] Giving something back by Andrew Moore […]

  3. […] it is whoever the best person for that patient is. We really like Andrew Moore’s proposal in Giving something back where he suggests a time bank of co-production to help improve patient care and to support the […]

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