CO-PRODUCTION: A CRITICAL REALIST PERSPECTIVE ON CONNECTING OLDER PERSONS WITH SERVICES AND CHOICE DR CHRISTINE STIRLING UNIVERSITY OF TASMANIA
OVERVIEWCo-ProductionCritical Realist ConceptThe More Things Change…Benefits of Partnership and Choice
CO-PRODUCTIONServices produced in a reciprocal relationship between professionals, service users, families and neighbours.Service users are resourcesServices need to interact with neighbourhood level supportFamily, neighbourhood, community and civil society are the ‘core economy’ – social capitalServices need to promote idea of equal partnershipFocus on effectiveness not efficiency(Boyle and Harris 2010)
CO-PRODUCTION BENEFITS‘Co-production changes all this. It makes the system more efficient, more effective and more responsive to community needs. More importantly, it makes social care altogether more humane, more trustworthy, more valued – and altogether more transforming for those who use it.’Phil Hope – then Minister of State for Care Services UK 2009‘Co-production shifts the balance of power, responsibility and resources from professionals more to individuals, by involving people in the delivery of their own services.’ (Boyle and Harris 2009).
THISPEOPLE GETTINGCARE THEY DON’TWANT AND OTHERSNOT GETTING CARETHEY NEED.“FELT NEED” PROVIDINGA BETTER INDICATORFOR DEMENTIA SUPPORTSERVICES NEED THANEXPERT ASSESSMENT?
“Well there’s been five actual assessments and three interviews… over the last four months…then there was the day care lady came and assessed her and that was fruitless” Carer of Person With DementiaA simple one-item measure of carers’ felt need for more services was significantly related to carer stress as measured on the GHQ-30.65% of carers would like more help from services than they were currently receiving (felt need). The statement- ‘I need more help from services than I am given’ was positively related to carers’ GHQ-30 (Spearmans rho = 0.625, p = 0.01).Qualitative data showed that there are many potential stressors for carers, other than those related to the care-giving role.
AGENCY - VISION, SHARED IDEAS, AND SKILLS Change is the result of the Interplay between Agency and Context
CRITICAL REALIST PERSPECTIVE - ICTAGENCY CONTEXTVision Silicon Valley a hub of innovationSkills Life circumstances –Power – as a group education andNew field – no existing freedom power elites Venture capitalConsumers – voted Unknown potential – with purchasing no plan power
CRITICAL REALIST PERSPECTIVE – THE +VE FOR CHANGE IN HEALTHAGENCY CONTEXTICT technologies System breaking helping link Baby boomers are consumers – voice, ageing new power elite Social media,Purchasing Power for a connectivity large group Vast potential from healthy older workforce
RISKS TO CHANGEAGENCY CONTEXTExisting groups try to Unwieldy, busy, hang onto power entrenched health system makes change difficultMany consumers lack the skills to access and engage
STRATEGIES TO DEVELOP AND MAINTAIN EQUAL RELATIONSHIPSDevelop Agency for Consumers – able to communicate as a collective, new vision, able to be heard.Listen - Continue to capture the experiences and voices of consumers and use this to inform new programs. Redefine experts.Systems and Tools that facilitate agency and partnerships
BUILD CONSUMER SKILLS TO NAVIGATE ANDUSE THE SYSTEMPROBLEM SOLUTION ICTA complex fractured Focus on skills system Targeted information Decision making assistanceHow to make choices?
REMOVE BARRIERS FOR ACCESS TO SERVICES-THE NURSE-LED MEMORY CLINIC SOLUTION -PROBLEM AGENCYDifficult to get a diagnosis Consumers able to self- referDifficult to get information Free nurse-led cognitiveReferral onto other services assessments and inconsistent diagnosis‘Id say, "Mums memory isnt too good"; try and not make her look Follow-up visit to facilitate silly in front of them, but, shed appropriate referrals to say, "Oh, its better than yours", and theyd just laugh with her community supports such and that would be the end of that. You know, you couldnt get as Alzheimer’s Australia, anyone to take it very seriously.’ HACC
SERVICES NOT FITTING NEED PROBLEM SOLUTION• Assessment Not Capturing Power, voice, representation Need Australia – Consumer• Rigid boundaries around Directed Care Packages service provision – Patients Know Best “He’s had four [carers] website,and this gentleman will be the fifth www.patientsknowbest.cotoday. So he gets very confusedabout who is coming and I have to mexplain each week.” Local Involvement• Experts within narrow silos. Networks
In ConclusionThere is a lot of work to be done to change culture so that we have more equal relationships with a sharing of power.
REFERENCES Boyle, D., & Harris, M. (2009). The Challenge of Co-Production: how equal partnerships between professionals and the public are crucial to improving public services. London: NESTA. Lloyd and Stirling (in Print Sep 2011). Ambiguous Gain: uncertain benefits of service use for dementia carers. Sociology of Health and Illness Stirling, C., Andrews, S., Croft, T., Vickers, J., Turner, P., & Robinson, A. (2010). Measuring dementia carers unmet need for services - an exploratory mixed method study. BMC Health Services Research, 10(122), EJ.