By Nick Andrews, City and Council of Swansea, at WCVA's Annual Conference.

1. ‘Adding Values’ – Moving
towards genuine co-production
in Social Services
Nick Andrews,
Planning Officer for
Older People,
City & County of Swansea

2. What went wrong with Preston?
• ‘Daddy created him
for good, but he’s
turned out evil’
(Wendolene
Ramsbottom, A
Close Shave, 2005)
• Let’s be truthful not
cynical - ‘The facts
are friendly’ (Carl
Rogers,1961)

3. Social Services - A current focus
on process, not people
• ‘Like the police service, adult social care is designed
as a bureaucracy to feed the regime, not a service to
meet older people’s needs. The regime constrains
method. It is a bureaucracy of call centres, functional
specialisation, activity targets, budget management,
form filling and counting, designed according to the
requirements of the regime. And the bureaucracy is
cemented with information technology, all of which
has been designed from the point of view of
electronic data management and reporting, not
solving people’s problems’ (John Seddon, 2007)

4. So called ‘personalisation’ in
England – yet more process!

5. Back to the future - a thought
from Lord of the Rings?
• ‘Much that was, is
lost, for none lived
who could remember
it. Some things that
should not have been
forgotten were lost.
History became
legend. Legend
became myth’

6. Learning from Two Welsh legends
– both a little non-conformist

7. ‘Tales of a Country Doctor’- in
the spirit of co-production
• ‘While playing with her sister, our
small daughter fell awkwardly and
dislocated her elbow… it was not
long before Dr. Davies arrived at
the home. In no time, the elbow had
been corrected – accompanied by
a sharp cry of pain! He told the girl,
the best kind of treatment for this
sort of problem was an ice cream
poultice applied internally. With that
diagnosis, he disappeared to the
village shop and was soon back
with the ‘prescription’ in hand.
Having helped himself to spoons
from the kitchen, he sat down with
all of us and shared the ice cream’
(Davies, et. al.,2009)

8. ‘All real living is meeting’ (Martin
Buber)
There are two ways of
relating to people and
the world:
• I-IT Implying
coolness, detachment
and instrumentality
• I-THOU Implying
attachment, self
disclosure and
vulnerability

9. A call to put relationships before
processes
‘A man or woman could be given the most
accurate diagnosis, subjected to the most
thorough assessment, provided with a
highly detailed care plan and given a
place in the most pleasant of surroundings
– without any meeting of the I-Thou kind
ever having taken place’ Kitwood (1997)

10. A call to restore humanity,
friendship and reciprocity in
Social Services
• ‘…and (the social worker)
came and you know, talked
to the kids about it that
evening… and when my
dad died, and my oldest
son was in a terrible state,
she came that night as
well, at 9 o’clock. So pretty
impressive support really.
And I am sure she would
do that for everyone…
that’s the person she is’
Service user quoted in
Beresford, P. et al. (2008)

11. No them and us – ‘Do you get it?’
‘As an organisation,
becoming person centred is
about creating a culture
where the service brings
out the best in individual
staff and those receiving
the service. This involves
enabling people living and
working together to develop
a feeling based service,
almost like a family or
community’ David Sheard,
Dementia Care Matters

12. But where are we now? - a word
of caution from the expenses
scandal
‘Compliance has
replaced
conscience’
Jonathan Aitken,
BBC Today
programme 3rd June
2009

13. Another word of caution on
individualistic consumerism
• ‘There is a need to replace
an individualistic view of
autonomy with one based on
‘interconnectedness and
partnership’ that recognises
the uniqueness of each
individual, but also the
interdependence that shapes
our lives’ Nolan et. al.(2006)

14. Creating ‘enriched environments’
through the Senses Framework
Service users, carers
and staff achieve:
•A sense of security
•A sense of continuity
•A sense of belonging
•A sense of purpose
Copyright Dementia Care Matters
•A sense of achievement
•A sense of significance

15. ‘Enriched environments’ in a
nutshell

16. Moving co-production from the
margins to the centre
• Time banking and ‘Not a one Way Street’ stuff
is great, but co-production mustn’t stop there!
• Older Peoples Services budget in City &
County of Swansea is approx. £32m:
• 10.3% on assessment & care management
(£3.3m)
• 42.5% on care homes (£13.6m)
• 42.8% on domiciliary care (£13.7m)
• If we can get co-production across all three,
we’re talking about 95.6%

17. But beware ‘passing the buck’
masquerading as co-production
• ‘The term co-production
itself dates from the
1970s, a time when
movements to challenge
professional power and
increase citizen
participation in
community affairs
coincided with efforts to
reduce public spending’.
Needham and Carr
(2009)

18. Co-production in social work
practice - rethinking our
approach to Unified Assessment

19. Co-production in care homes –
from ‘hotel’ to therapeutic
community
• Short term pleasures of
the kind elicited by the
senses, e.g. watching a
game of rugby
• Long term satisfactions
linked to meaning and
purpose in life – linked to
biological markers of
health (Ryff et al 2004)
• Ty Waunarlwydd care
home, Swansea

20. Co-production in domiciliary
care – from impersonal time task
care plans to flexible relationship
centred support
• ‘People who receive home care are frequently not satisfied with the way
that services are currently provided…. Many find the task-based approach
of the majority of councils insensitive to their needs, requiring particular
activities regardless of whether people want them done that day or at all.
People tell us that this inflexible approach means that services are more
accountable to councils than to them. It is also unsatisfactory for those
who provide care and support, as it inhibits the proper relationships that
should develop between care workers and the people they care for’.
Denise Platt (2006)
• ‘All Together Now’ pilot in Swansea in 2009
• Caring Support, Croydon – a multi-stakeholder co-op