thoughts on co-production

Change is happening in the NI health system. We’ve had a report and a ‘vision’, and our Executive (government made of different parties) committed to the change.

As part of the transformation, our Department of Health have recently discovered the concept of co-production, and don’t quite seem to know what to do with it…

Step 1: Convene a working group and get them to agree on what co-production is. Good luck with that. Also, produce guidance on co-production to inform transformation throughout the health and social care system, across multiple organisations. In 4 weeks. Don’t forget to include some patients and carers on the group. Long days in pokey rooms are preferred. Watch how co-productive methods are modelled. Or not.

Step 2: Be sure to use words like ‘mutuality’ and ‘reciprocity’. Nobody knows what they mean, so you have the opportunity to seem very clever if you can explain them. This is not a form of excluding people and their possible contributions. Definitely not. (It is.)

Step 3:Thank the group for their contribution, and clarify that it was simply a first draft. Lots of other people need to be involved, starting from scratch again. No need to share that draft that patients, carers and staff actually co-produced in difficult circumstances.

Step 4: Give multiple presentations using the video The Parable of the Blobs and Squares. Patients and carers *love* being called blobs.

Step 5: Make sure the presentations refer to doing things differently. It is important at this point to continue to work in the same way.

Step 6: repeat step 2

Step 7: Patients and carers give up their time to participate in co-production and other Personal and Public Involvement activities. You should provide coffee, sandwiches, petrol expenses, and a lot of boredom. Make sure presentations are long, and largely irrelevant. That will make sure that you have a) supported patient & carer participation, while b) making sure that they will not want to ‘participate’ again. Tend towards providing all assistance short of actual help.

Step 8: When discussing principles of co-production, be sure to talk about use of language. (repeat Step 2 as required, for clarity.) At a push, ‘shared decision making’ may be referred to.

 

Guiding principle to be used in all stages of the process. Above all else, never refer to ‘power’. Never say anything like

Co-production is where power is shared, different expertise and experiences are valued and considered in the development and delivery of public services, and trust and partnership working are at the core to improve outcomes. It will only work if there is a fundamental recognition of the power relationships that accompany the process.

 

Given that our coalition Executive has fallen apart because of an unwillingness to share power, to trust or to work in genuine partnership, it is perhaps not surprising that some in the Department appear to be challenged by a new approach. The sad thing is that effective co-production is happening in pockets and projects at all levels in health & social care- it’s nothing to be afraid of, but it does need supported and resourced.

We need to do things differently. We need to share power and decisions. We need to listen & be heard.

We have some way to go.

 

 

 

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emptying

It came to pass that Handsome Husband went to live with his sisters. The house in the oakland was to be sold.

But first, the stuff. A house with a lot of storage space holds a lot. The Brother and I set to with the help of many black plastic bags, a huge car boot, and the wonderful St Vincent de Paul charity. SVP are long established and work  “to fight poverty in all its forms through the practical assistance to people in need.” What I didn’t grasp until a few weeks ago, is how easy they can make a challenging task. From the first phone call, to the lorry driving away  10 days later, and multiple donation trips to the shop, they gave us kindness, humour, gentleness, and quiet support. We just gave them stuff.

I’d been most concerned about the back bedroom. Boxes went in there when we cleared Herself’s room in the nursing home, and hadn’t been touched since. These boxes took on mythical proportions in my mind. They weren’t just literal boxes, they were metaphorical boxes. What mental chaos would be uncovered? Imagine my relief when they contained an awful lot of out of date toiletries and hangers. The biggest, scariest box held only hangers. Hundreds of them. Too many to count. Even SVP didn’t want them. I’d been wasting anxiety energy worrying about a box of hangers. I was on a roll for a day or so after that. I only laughed at the chest of drawers filled with wrapping paper and ornaments.

I made my way through the room to reach a trolley (recently pretending to be shelves) and pottered back and forth to the garage- wheeeling the bags, posing in a 70s hostess style on the way back. We remembered the glory days of the trolley, with pavlova and grey glass bowls. The trolley collapsed under the strain and expectation of movement before long, but I was glad to have had it, and to have recalled its prime.

Of course, the back bedroom wasn’t the worst. It was all the random, carefully packed, bits of paper filling the fitted wardrobe space in the main bedroom. Years of cards, letters, wedding invitations. 5 orders of service from the one wedding. A letter written to Herself in the weeks after the Omagh bomb. Lots of notes written by herslf as she tried to figure out whether living in Spain with a Dutchman was really for her. (You already know the answer to that.)

The auntie wondered what we’d do with the fire brasses. We hadn’t seen those in years. They got found eventually, in the bottom of the cloakroom, underneath the tennis racket, badminton racket, squash racket, golf practice sets, Nora’s bowls, vacuum cleaner, dusters and all the coats.

We’d donated the regular clothes some time ago, but held on to the good clothes. They still didn’t fit me. I looked at the tweed suit, the respectable going to wedding outfits, Herself’s style, and I phoned the fancy second hand shop. “Designer or top end of the high street only. Must be less than one year old.” Less than a year old? That’s not style, that’s just shopping. Decent style in a size too small for me may be found at Vincent’s.

The chaise lounge went to a cousin. One took chairs and a bookcase. Another, drawers and a lamp. Aunties have ornaments, or a table, or a  different lamp that had a whole other adventure. The Brother and I have the items we wanted. The enormous desk- an huge civil service item from the 50s- had to be dismantled, and then the door taken off, to get out of the back bedroom. SVP are holding on to that one.

This house was never home to the Brother or me. But Herself was so happy there, so full of plans. Plans to learn languages, computer skills, book keeping. We found all the text books. Handsome Husband moved in when they married; we found the actual plans they’d got drawn up for a new home for them both.

Instead, illness happened. Herself is gone a while now, nearly 6 years. I still find that remarkable. The space we’ve been allowed between her death and the house clearing was undoubtedly helpful. We laughed more than we cried. We grumbled without guilt.

And now that house belongs to other people. Sale agreed and completed much more quickly than we had any right to expect. A huge task finished promptly and efficiently.When does that ever happen?

It just feels weird.

pesky pets

Pah!

It’s not been a good day.

The grumpy old chap who had such a large part of all our hearts died  today. All of a sudden. He wasn’t in form- he had no oomph- and we were going to phone the vet for an appointment, when he just keeled over.

Spurs Fan demonstrated heretofore hidden agressive driving techniques, but it was too late. Jake didn’t make it to the vet. He was gone by the time we got there; he was undoubtedly gone before his head hit the floor, but we didn’t want to believe that.

We came home empty handed.

As with all things, it could have been worse. He could have been home alone. I could have been the only person here. Our friends who looked after him on Monday night and Tuesday morning could have found him. Instead, because it’s half term, we were all at home. We were able to satisfy the urge to do something, however pointless. We were able to pet him and hold him and talk to him.

He’s never been in great health, but when he was checked out last week, all he needed was an antibiotic, which cleared up his tum issues. We expected him to keep on pottering about for a good while yet.

My days at home will be longer and lonely.

I just made a toasted cheese sandwich and had no gentle nudge on my leg. No shake, stretch, or pitter patter when the fridge door was opened. When I leave the house in a little while I’ll not say “Bye, Jake. You’re in charge.”  I’ll not need to check on him first thing, or wonder where the poo is, or forget to let him in. He won’t knock over the footballer gnome (doesn’t everybody have one?) or stand in exactly the wrong place in the teeny kitchen. He won’t choose the bits of newspaper for the fire, or complain about the  television. He won’t or sniff every leaf, or grumble at each passing dog.

He came to us when he was about 8, a lifetime behind him. He needed a quiet house, with somebody about most of the time. He didn’t like fuss or noise or contact he didn’t initiate.

He was our wee old man, who got the blame for all the random smells.

He was one of us.

The wee pet.

talking to ‘our own’ politics

I spent Monday afternoon and early evening watching news and social media, and doing a bit of ranting. Then I stepped away from the screens and read my book. But the family, going to beds, didn’t turn off the TV, the news came on… Cue lots of fuming and little sleeping.

We’re having a ‘crisis’. The astonishing chaos, unwillingness to take responsibilty and arrogance at the heart of our political system was laid bare before Christmas. I was agog as I watched our First Minister react appalingly to claims about incompetence made by her former friend and colleague. A ‘car crash TV’ / ‘fetch the popcorn’ current affairs programme.

Arlene Foster was the Minister who oversaw the introduction of the Renewable Heat Incentive. Largely copied from England, the key difference was that there was no upper limit to the amount to be paid out. Since people are being encouraged to use renewable fuel by being reimbursed £1.60 for every £1 spent, the more they spend, the more they will earn. Heating empty sheds can make for a great income, costing the UK approx £1 BILLION over the next 20 years. Ah, sure never mind, £600 million of that is coming from GB, NI only has to spend £400million. Cash for ash indeed.

A series of unconnected facts:

The First Minister is from Co Fermanagh.

The largest supplier of renewable wood pellets is from Co Fermanagh.

No member of the First Minister’s immediate family is benefiting from this scheme.

There was a fire in a shed in Fermanagh this week. It contained 8 of the biomass boilers.

The green area on this spoof map from@LADFLEG equates to Co Fermanagh.

lad-snow

It was suggested that Arlene step aside for a while so there could be an inquiry. No. No. And, again no. People concerned about competence and possible corruption were accused of misogyny. By a political party known to ‘Moo’ at women politicians. One of the party said, in support, that the First Minister was doing a good job, considering her domestic responsibilites. There is plenty of misogyny in local politics, most of it from the First Minister’s own party. The public are not aware of any attempts she’s ever made to challenge it.

Due to the complexities of our political system, the First Minister holds position along with the the leader of the second largest party. It’s a cross community post. Two people. Equal authority. One can’t act without the other. When Arlene tried to speak to the Assembly as First Minister without the support of the ‘deputy’, on the RHI scheme, all the MLAs of every other party left the chamber. She was speaking without authority and up with it they would not put.

Nothing calmed down during the holiday recess, and local politics hit the fan on Monday when the deputy First Minister resigned, citing the RHI mess, other areas of disagreement and ‘deep seated arrogance’ of the largest party.. His party refused to nominate a successor. Unless a whole lot gets resolved in the next few days, we’re heading for another election. Joy untold.

arlene-firepla

Countering claims of arrogance and incompetence, Arlene released a video in the style of the Queen’s speech, talking to her subjects the voters in front of a large fireplace. Cash for ash being flaunted. This was not a mis-step from a PR junior, but a clear statement of what she feels to be important. Arlene. Arlene’s mates. Everybody else can go and jump. She also said that any election would be ‘brutal’, setting exactly that tone. She doesn’t care. She doesn’t care what anybody thinks if they’re not a natural DUP voter. She speaks only to those she thinks she knows. The rest of us are irrelevant or a block to the return of majority unionist rule in the region. There is no desire to explore commonalities, or to consider notions of good governance, leadership or equality to be desirable.

I read an article recently, which I now can’t find to re read/ consider/ credit, about the suggestion that we replace all our politicians by other members of the public. No parties, no elections, but selected members of the public, a bit like jury duty. A decent salary (but no expenses) for 5 years while you develop policies which benefit the public of the area governed. In this muddle, I could be convinced.

I want politics to be about community building, society, working together for the good of us all. Why does that make me feel like a naive fool?