29 March Nesta Co Production Workshop Mc Manus


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Co-production of public services, NESTA seminar

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  • I am going to talk about our experience of trying to address issues as they arose In most emergencies issues arise you do not plan for In this flu pandemic, we had neither a slow rising tide nor a flash flood experience but a mix of different issues in different parts of the country and the city I think what comes out of this is the need to seek to predict what systems of the City’s life will be most affected given what we now know, and then seek to make those resilient My guesses are most cities will see schools, nurseries and social care very affected In delivering this I am focusing on Local Authority services because this is a local authority seminar. I will, inevitably, do injustice to NHS family colleagues because of this. Setting up out of hours flu centres, for example, was a valuable experience for us. And the work of BADGER in developing clinical good practice in assessment and response is just one important piece of work from Birmingham I won;’t be able to do justice to. I will also inecvitably underestimate the role of the Birmingham Resilience Team and the multi-agency Birmingham Resilience Group. These have been hugely important and positive experiences.
  • 29 March Nesta Co Production Workshop Mc Manus

    1. 1. Co production Roadshow 29 th March 2011 Jim McManus Joint Director of Public Health Making co-production central to improving health outcomes
    2. 2. What does it mean - SCIE <ul><li>Co-production is a potentially transformative way of thinking about power, resources, partnerships, risks and outcomes, </li></ul><ul><li>‘ Co-production means involving citizens in collaborative relationships with more empowered frontline staff who are able and confident to share power and accept user expertise. </li></ul><ul><li>Staff should be trained in the benefits of co-production, supported in positive risk-taking and encouraged to identify new opportunities for collaboration with people who use services. </li></ul><ul><li>The creation of new structures, regulatory and commissioning practices and financial streams is necessary to embed co-production as a long-term rather than ad hoc solution. </li></ul>
    3. 3. Homage to Ambrose Peirce The Devil’s Dictionary <ul><li>Another opportunity for both third sector and public sector to argue about services while continuing to ignore the voice of users and citizens </li></ul>
    4. 4. Is it Possible? <ul><li>Father Hudson’s Society </li></ul><ul><li>Primary Care Heart Services </li></ul>
    5. 5. Why is it necessary? <ul><li>Economic reasons </li></ul><ul><li>Diversity of Outcome Reasons </li></ul><ul><li>Intrapersonal reasons </li></ul><ul><li>Interpersonal Reasons </li></ul><ul><li>Outcomes – control, self-efficacy and empowerment </li></ul><ul><ul><li>Better implementation (org psychology) </li></ul></ul><ul><ul><li>Better and healthier living (health psychology) </li></ul></ul>
    6. 6. Why hasn’t it happened? <ul><li>Hard work in a very busy workload </li></ul><ul><li>Users “It’s your job, why should we tell you?” </li></ul><ul><li>Professionalisms </li></ul><ul><li>Risk </li></ul><ul><li>Cost </li></ul><ul><li>Time </li></ul><ul><li>Willingness </li></ul><ul><li>Commissioner timeframes – 1 year </li></ul>
    7. 7. How could it work or more reasons why it hasn’t happened? Collaborative Economy Co-produce JSNA Co-produce commissioning intentions Co-produce Pathways Co-produce Standards Co-produce Training Co-assess 4Es Co- implement Co-determine Outcomes
    8. 8. Levels of Co Production – why it hasn’t happened Macro Meso Micro What are our priorities for older people in Birmingham? What do we do about older people at higher risk of seasonal death? How does Mrs X choose and buy her care packages? Some work on JSNA Not a lot…better on falls Who does better
    9. 9. Getting to making it happen role distinction - Public Health Roles Macro Meso Micro What are our priorities for older people in Birmingham? What do we do about older people at higher risk of seasonal death? How does Mrs X choose and buy her care packages? Accessible information presented with clear priorities Evidence of what works Case finding Information to users about choosing their care
    10. 10. Why a 3 rd sector based offer doesn’t engage with LA/NHS <ul><li>We each take a deficit model to the other’s capabilities </li></ul><ul><li>3 rd sector doesn’t have all the answers or the capabilities </li></ul><ul><li>Poor negotiation positioning </li></ul><ul><li>Access to decision making </li></ul><ul><li>Different styles and foci </li></ul><ul><li>Policy document fatigue – vs – showing clearly the links </li></ul><ul><li>Quoting Aristotle does not help! </li></ul>
    11. 11. An example RABBIT MEETS HEADLIGHTS <ul><li>“ We want to co-produce a service” </li></ul><ul><li>How can we explore this </li></ul><ul><li>What resources are available? </li></ul><ul><li>Lovely to meet you again.. </li></ul><ul><li>“ Oh ****, the latest buzzword…and I have piles to do…I haven’t got time to explore my in-tray let alone this, go away </li></ul><ul><li>Well we can do nothing without…Board approval, the strategy, a cheese sandwich </li></ul><ul><li>Money? for this pile of old rope? Get real! I haven’t a clue….say anything to get them out of here </li></ul>
    12. 12. How can we change things? <ul><li>What outcomes do you want? We want to consider where we can contribute </li></ul><ul><li>We think co-production could result in </li></ul><ul><ul><li>Better pathways for x…. </li></ul></ul><ul><ul><li>Less costs for y…. </li></ul></ul><ul><ul><li>Better outcomes in this area…… </li></ul></ul><ul><li>Can we explore together how existing resources and systems can be aligned to achieve this? </li></ul>
    13. 13. Quoting Aristotle does not help <ul><li>NEF document – Aristotle </li></ul><ul><li>Dialogues of mission </li></ul><ul><ul><ul><li>Catholic Church </li></ul></ul></ul><ul><ul><ul><li>Evangelical Alliance </li></ul></ul></ul><ul><ul><ul><li>Sikhs </li></ul></ul></ul>
    14. 14. Mapping capabilities across a pathway Low Increasing levels of need High Residential care and supported living (St John of God, Don Orione, and many others) for those at high levels of need. Currently have specialist experience in this across age, learning disability, mental health, behavioural problems and some drug misuse CURRENT PROVISION SPECTRUM Low level support which can keep people self-managing and functioning. Currently not well systematised but does exist POSSIBLE FUTURE PROVISION SPECTRUM Spiritual Care which evidence shows can and does bring psychological and other benefits to service users and carers A more formal offer for carers using church resources of support etc Practical support e.g St Vincent de Paul Society More systematised programmes of low level self management support across psychological wellbeing, physical conditions, elderly etc More systematised enablement work to help people get back on their feet after a crisis Home from hospital packages Continue residential care and supported living Informal care groups providing support around people coming out of hospital etc Spiritual Care which evidence shows can and does bring psychological and other benefits to service users and carers Practical support e.g St Vincent de Paul Society
    15. 15. Which Stakeholders Influence Money DsPH HWBB GP Consortia LA PHE NHSCB Scrutiny Healthwatch?
    16. 16. Starting Again <ul><li>Obstacles </li></ul><ul><li>Workload in NHS Commissioners </li></ul><ul><li>Commissioning Structures and Systems </li></ul><ul><li>Professionalisation </li></ul><ul><li>Complexity Confused structures and pathways to commission </li></ul><ul><li>Styles of working </li></ul><ul><li>Opportunities </li></ul><ul><li>New GP Consortia </li></ul><ul><li>New Outcomes Framework </li></ul><ul><li>Interface Work </li></ul><ul><li>Culture change at small level and major level </li></ul><ul><li>Clarify roles and contributions </li></ul><ul><li>Re-think the business </li></ul>
    17. 17. Some tips <ul><li>Start a conversation about shared interests </li></ul><ul><li>Skills and knowledge exchange </li></ul><ul><li>Knowledge and outcome co-production </li></ul><ul><li>Incremental disseminated change </li></ul><ul><li>Get GPs engaged and interested through consortia </li></ul><ul><li>Business cases (short, pithy) </li></ul>
    18. 18. Areas Ripe for Co-production <ul><li>Long term conditions </li></ul><ul><li>Behavioural pathways for prevention </li></ul><ul><li>Carer Support </li></ul><ul><li>Post operative care </li></ul><ul><li>Cardiovascular event rehabilitation </li></ul><ul><li>Primary care mental health </li></ul>
    19. 19. Timeframes of impact/yield Years 0 1 5 10 15 Planning Frameworks and Core Strategies Education Vitamin Supplements Decent Homes Air Pollution Primary Care Air Pollution Decent Homes Reducing Worklessness Primary Care
    20. 20. Thank you! Jim.mcmanus@birmingham.gov.uk