Adult Social Care Glossary, v 0.6

Co-production is the word of the moment in local authorities, largely because the Care Quality Commission (CQC) assessment framework includes a commitment that ‘coproduction is embedded throughout the local authority’s work’[1].

The assessment framework is designed to help CQC assess how well local authorities are performing against their duties under the Care Act 2014. The Care Act 2014. Legislation that has been in place for almost a decade, based on principles of self-directed support and ‘nothing about us without us’ around for much longer. The Care Act statutory guidance states explicitly that “local authorities should ensure that individuals are not seen as passive recipients of support services, but are able to design care and support based around achievement of their goals”, that “local authorities should actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community”, and that “strengths-based approaches might include co-production of services with people who are receiving care and support to foster mutual support networks.”[2]

You may be surprised that the word ‘co-production’ isn’t on my long list of ‘hmmm’ words. The dictionary definition of the prefix ‘co-’ is “with : together : jointly”, and so “co- is used to form verbs or nouns that refer to people sharing things or doing things together”.[3][4] And ‘production’ means to make or create something. To cause something to happen.[5] So co-production = creating something together. Working alongside. Doing with.

But once we explore the language associated with co-production, it quickly becomes clear that while the meaning of the term couldn’t be more explicit, we’ve largely managed to miss the point in our interpretation.

Alex Fox recently wrote that “strengths-based working and coproduction are inextricably linked.”[6] Both terms refer to working alongside people, with a focus on what matters and a shared role in producing something valuable and valued. Shared power and shared decisions. Mutual trust and respect. A shift from providers and passive consumers – from saviors and ‘the saved’ – to reciprocity and interdependence. To seeing all people as equal human beings with ideas and talents and knowledge and passion and dreams. To creativity and possibility. Connections and relationships.

Working with, not doing to.

Nothing about us, without us.

But over twenty years ago, Edgar Cahn identified that “words like “strength-based” and “asset-based” had been turned into a mantra by social welfare professionals… an obligatory incantation recited to prove that one was in the know.” [7]

“Use of buzzwords certified one as morally pure and appropriately avant-garde. Behind the curtain, though, business was proceeding as usual: preserving one’s turf, creating dependencies, and protecting a livelihood earned by catering to people’s needs, deficiencies and problems.”

Edgar Cahn [8]
In my blog about the term ‘strengths-based’ I wrote that “we throw the term strengths-based around, drop it in to our narrative too easily to put a new shine on our practice, without realising very many of those key elements, without changing very much behind the scenes.”[9]

The words associated with ‘strengths-based’ expose our (mis)interpretation of the approach and reveal the same old power dynamics and divisions that exist ‘behind the ‘curtain’. And if we unpick the language relating to ‘co-production’, we find much the same.

Let me explain what I mean…

Professionals and service users
There are a lot of definitions of co-production out there, and many of them refer to ‘professionals and service users’. ‘Service providers and users’. ‘Professionals and people using services’.

The term ‘professionals’ suggests status and authority and expertise.

The term ‘providers’ refers to delivery, and – well, ‘production’

And the terms ‘users’ and ‘using’ imply an absence of power and agency. Passive receipt. And the inevitable association with exploitation and drugs.

‘Professional’ offers people working in organisations an identity, while ‘users’ remain an anonymous, dehumanised, ‘other’ group.

The powerful and the powerless.

So, we’ve already failed. Instead of working together as equals, our basic definitions imply and perpetuate difference and inequality. Us and them. Instead of a shared role as producers, we’ve built the separation of providers and consumers into our definitions of a term that means the opposite.

These definitions also reinforce stereotypes and stigma by implying that people who draw on care and support aren’t professionals, and that professionals aren’t people who draw on care and support.

And what if you can’t use a service? If you’re not allowed in? If you’re not eligible? Who is ‘engaging’ with you then?

Improving services
The purpose of co-production is invariably described in terms of better services, not better lives. This interpretation confines ideas of co-production – and indeed of social care – to the realm of serviceland and ‘the market’, where ‘care’ is a task delivered in a package, or a destination with no return. The realm of ‘providers’ and ‘users’. Assessments and eligibility criteria. Transactions and institutions.

Of course, there is plenty of room for improvement in services, but this narrow lens ignores the vital, every-day role of people and families and communities in caring for and about each other.

Most care and support is already ‘co-produced’ in our homes and our streets and our neighbourhoods.

People looking out for one another.

Nurturing. Tending. Loaning. Mending.

Webs of support and relationships in local communities.

So, if we’re serious about building better lives and stronger communities, our thinking about co-production must start with people and relationships, not services and institutions. We must recognise and value the love and compassion and energy and potential in individuals and families and communities, and work out together how we can be most useful – as public servants, not as masters – in support of local people and local places.

Engagement
“Engaging customers in coproduction.”

“Engaging people with services.”

“Engaging with users.”

‘Engagement is often described as a ‘stepping stone’ to co-production, a rung on the ladder. But if we’re thinking in terms of ‘engaging’ people, we’re stepping off on the wrong foot.

The dictionary definition of ‘engagement’ is “an arrangement to meet or be present at a specified time and place”[10].

On other words, when can you – over there in your ‘marginalised group’ or your ‘vulnerable population’ – show up (at a time and place convenient for us) to help us?

Not how can we step in to be most effective? How can we step up to ensure sufficient connections and relationships and resources are in place for you to live the life you choose to lead? How can we step back and get out of the way?

‘Engagement’ is something we do to people, at a fixed time, for a fixed purpose. There’s no sense of an evolving, organic, long-term relationship, where trust is built and where genuine, human connections are made.

And if you choose not to show up when we tell you to, we’re quick to slap on a ‘refuses to engage’ label and move on.

There’s also the association of the term ‘engagement’ with battles – “a hostile encounter between military forces”[11] – which may be apt given the language of war that threads through our practice (frontline, duty, officers…) and the exhausting reality of fighting for support – but is obviously not the intention.

Empowerment
“We want to empower our customers…”

“We empower people with lived experience to use their own voice”

“We want to empower our service users to work as equal partners with us.”

Argh.

We – the ‘professionals’ – give you – the ‘users’ – power. If we feel like it. Maybe. Sometimes. Or maybe not.

We see power as ours to give away.

And, by default, to take away.

And you are ‘ours’. We own you. We control you. We’re in charge.

“Empowerment: An illusory gift from professional to a not quite human.”

Mark Neary[12]
We absolutely need to talk about power. We need to be aware of – and honest about – the power we hold in different roles and remove the obstacles to power being shared (including by paying attention to the way our policies and our practice and our language divide and exclude). But by talking about ‘empowering people’ and ‘giving power to people’ we’re further embedding the very power dynamic we are (in theory) aiming to remove.

Voice
The way we talk about ‘voice’ really makes me go hmmm.

There are the dehumanising references to ‘voice’ detached from any sense of a person. “We will actively recruit or involve diverse voices in a meaningful way.” “Advocating for a lived experience voice to be involved…”

There’s the noble act of ‘giving people a voice’. “We will be running events to give disabled people a voice.” “Giving voice to those who often aren’t heard or often don’t engage.”

There’s the generous act of people speaking on behalf of a collective group of ‘others’. “The voice of lived experience”, and – squirm – “the voice of the voiceless”.

And there’s the super kind ‘lifting up the voice of’. “Amplifying the voice of service users”. “We’re strengthening the voice of people who use services.”

Like engaging and empowering, the way we talk about ‘voice’ reveals and perpetuates deep divisions, a sense of superiority and a paternalistic approach.

The focus on voice implies meaningful contributions can only be made by people who can communicate verbally, and also retains the focus on ‘talking’ rather than actually producing something together.

You said we did
“We will empower our residents, listen to their voices and act on what they say.”

You told us some things and we went away and did stuff without you.

Erm – so much for co-production.

Managing expectations
“Managing expectations is crucial.”

“We need to be realistic about what we can offer.”

“We can’t promise the world because we can’t do everything.”

“We need to be careful not to promise too much.”

Ooof. This is not co-production. Where is the trust? Where is the transparency? Where is the connection? Where is the shared vision? ‘Managing expectations’ is a term I’d happily bin – and it certainly has no place anywhere near co-production.

Also – ‘what we can offer’… ‘we can’t do everything’?? Point entirely missed.

Co-production leads, strategies, frameworks, policies etc…
We’re approaching co-production in the way we approach strengths-based working. Recruiting a lead, writing a strategy, sending workers off on a half-day training course and expecting the world to change – without making any effort to change our world.

We’re viewing co-production as an add on. A nice to have, over there, located in a meeting room, led by someone else, while we keep doing ‘the day job’.

But co-production isn’t extra work, it is the work. It’s not something to be confined to the remit of a lead or a board, or constrained by a strategy or a framework or a policy. It’s an ethos and a value-base that should run through everything we do.

It’s “a different imagining of the world we know”.[13]

The core elements of co-production are the very same elements of a better, brighter social care future.

Seeing people with gifts and potential, not problems and needs. As resourceful human beings – not ‘non-human’ resources.

Recognising and appreciating ‘care’ as caring about and supporting each other, not ‘looking after our most vulnerable’. Nurturing relationships and connections, not delivering services.

Promoting reciprocity so people have a chance to ‘give’ as well as ‘get’ support. So people feel needed and valued, not needy and devalued.

And building and sustaining communities and better lives, not institutions and better services.

As I said at the start of this blog, the term ‘co-production’ doesn’t make me go hmmm, but – like the term ‘strengths-based’ – it is too widely misinterpreted and too easily misused.

I think we’re spending too much time talking about the future of co-production, and not enough time co-producing the future.

So, I’m tempted to suggest that we drop both these ‘buzzwords’ from our vocabulary and, as I proposed at the end of my ‘strengths-based’ blog, we focus instead on making sure that one simple question underpins everything we do.

‘What does a good life look like to you and your family, and how can we work together to achieve it’?