The opportunity for public services of truly engaged expert citizens

The World Wide Web was invented in 1989 and Google was incorporated as a company nearly a decade later, in 1998. AirBnB started in 2007 and Uber in 2009.

I wonder why there was such a big delay between the web and Google, and then Google and AirBnB, Uber etc., and then a subsequent delay in their reaching a tipping point in terms of awareness and use by the general public?

I ask this because there have been a very wide number of approaches and initiatives for improving public services, not least health and social care, through technology and particularly the web. For example, there have been care comparison sites a-plenty, much talk of open data and suggestions of location-based services to replace off- and online directories. And yet we see relatively little evidence of these approaching a tipping point, let alone being used regularly by local authorities, providers and the general public when it comes to health and social care.

The prompt for these thoughts is this excellent, detailed post at Policy Exchange about the rise of the citizen expert.

In it Beth Simone Noveck (former United States deputy chief technology officer and director of the White House Open Government Initiative) takes as a starting point another area of public policy – citizen engagement – and notes how the obvious opportunity to improve public services and local communities hasn’t been taken in the way it could have been.

Citizen engagement isn’t just the equivalent of technology: it’s clearly bigger than that. Beth makes clear this point by showing how better harnessing the interests and expertise of citizens can help both bridge the democratic divide and make the most of people in contributing to their local communities and society.

The internet is radically decreasing the costs of identifying diverse forms of expertise so that the person who has taken courses on an online learning platform can showcase those credentials with a searchable digital badge. The person who has answered thousands of questions on a question-and-answer website can demonstrate their practical ability and willingness to help. Ratings by other users further attest to the usefulness of their contributions. In short, it is becoming possible to discover what people know and can do in ever more finely tuned ways and match people to opportunities to participate that speak to their talents.

But she also notes the most significant barrier to this: the continued dominance / monopoly of policy- and service-elites in the work that they do:

[There is a] long-held belief, even among reformers, that only professional public servants or credentialed elites possess the requisite abilities to govern in a complex society.

Why? Because it is believed

Citizens are spectators who can express opinions but cognitive incapacity, laziness or simply the complexity of modern society limit participation to asking people what they feel by means of elections, opinion polls, or social media.

The shifting of the cause of the problem of a lack of engagement onto citizens themselves rather than the professionals asking the questions is a familiar refrain. We regularly hear laments about “the usual suspects”, limited response rates or adversarial consultation processes that create more problems than they solve.

But this characterisation of this situation only makes sense for one set of players: it suits both the technocratic elites who dominate public policy and services, and the other well-embedded elites with (vested) interests who can mobilise quickly to respond to consultation/engagement that affect their organisations.

It is, of course, a characterisation that doesn’t really stand up to scrutiny. For example, we know that (proper) co-production in health and social care has a solid evidence base in the difference it makes. But we also know it continues to be at best a nice-to-have rather than a must-have.

Thus we come back to the questions kicking about in my mind at the start of this post: if the ability to do this sort of thing exists (be it citizen engagement or technology), why hasn’t social care and the like made the most of this opportunity?

It’s largely because elites aren’t yet comfortable with distributing leadership and expertise.

One of the ways to overcome this discomfort, then, is to make it valuable and rational for the existing elites to engage in effective citizen engagement by ensuring a ‘good’ group of people are engaged and involved in public service reform in the first place.

Noveck rightly says:

To make all forms of engagement more effective, we need to increase the likelihood that the opportunity to participate will be known to those who need to participate. If a city really wants to improve the chances of crafting a workable plan for bike lanes, it should be able to reach out to urban planners, transportation engineers, cyclists, and cab drivers and offer them ways to participate meaningfully. When a public organisation needs hands on help from techies to build better websites or data crunching from data scientists, it needs to be able to connect.

To do this:

[I]nstitutions [must] begin to leverage such platforms to match the need for expertise to the demand for it and, in the process, increase engagement becoming more effective and more legitimate.

This is appealing. Citizen engagement may not be valued by elites because there hasn’t been adequate effort or ability to engage sufficient citizens to make it worthwhile enough.

As Noveck concludes:

This is about chances for civic participation; to be a member of a local community and to make a contribution based on this… It has everything to do with what it means to be a citizen in a contemporary democracy.

This is why I particularly like this: this isn’t just about technical changes around the edges of public service economies, but the broad meaningful difference it could make.



Wicked issues and constructive conversations in health and social care

Image via Screenrant

The Social Care Institute for Excellence is working with the Health Foundation and Institute for Government on a fascinating project about how “constructive conversations” can help with “wicked issues” in health and social care.

I was lucky enough to be invited to a discussion about the project and hear a wonderful summary of the literature on both constructive conversations and wicked issues from ICFI, and wanted to quickly reflect here two key parts of the useful information that was shared.

(I stress that the information below is taken directly from the really excellent work by ICFI, to whom all plaudits should absolutely go!)

First, what is a wicked issue?

The concept is taken from social planning (Rittel and Webber, 1973) referring to problematic social situations where: there is no obvious solution; many individuals and organisations are involved; there is disagreement amongst the stakeholders and there are desired behavioural changes. Public policy problems are ‘wicked’ (Clarke and Stewart, 1997) where they go beyond the scope of any one agency (e.g. health promotion strategies) and intervention by one actor not aligned with other actors may be counter productive. They require a broad response, working across boundaries and engaging stakeholders and citizens in policy making and implementation (Australian Public Services Commission, 2007).

Wicked issues therefore have the following typical characteristics:

  • Are multi-causal with connections to many other issues
  • Are difficult to define – so that “stakeholders understand the problem in different ways and emphasise different causal factors… The way the problem is approached and tackled depends on how it is framed, so there may be disagreement about problem definition and solution.”
  • Are socially complex – “Decisions about how to tackle them are unavoidably political, values based and may raise moral dilemmas. They cannot be tackled as technical challenges with scientific solutions; there is no point at which sufficient evidence will be gathered to make a decision.”
  • Require a whole system, multi-agency response – they do not sit within the control or authority of a single organisation, making it difficult to position responsibility.
  • Have no clear or optimal solution – they are not right or wrong, but better, worse or good enough
  • Have no immediate or ultimate test of ‘success’.

Against these characteristics, questions of social care, health, promoting disability equality, and public service reform are all obvious wicked issues.

Second, what is a constructive conversation?

The phrase “constructive conversation” itself is perhaps not well known, but its attributes are becoming increasingly familiar since they reflect much of what the approach to system leadership calls for.

A constructive conversation engages in what area known as “clumsy solutions”:

  • Questions not answers: seeking a deep understanding of the problem
  • Relationships not structures: engagement as the primary vehicle of change
  • Reflection not reaction: resisting the pressure for decisive action at too early a stage
  • Positive deviance not negative acquiescence: ignore, or look beyond, conventional culture and wisdom
  • Negative capability: the ability to remain comfortable with uncertainty
  • Constructive dissent not destructive consent: seeking consent is often destructive and illusory
  • Collective intelligence not individual genius: WPs are not susceptible to individual resolution
  • Community of fate not a fatalistic community: collective responsibility to underpin action which is likely to involve risk-taking
  • Empathy not egoism: seeking to understanding how other people see the problem, and the wider context”

As a result, a conversation is constructive if the following are in place:

  • A commitment to be open and honest
  • A conscious effort to foster and maintain trust
  • Clear information, provided at the right time
  • A focus on relationships not methods, underpinned by the goal of collaboration
  • Well-defined roles and clear expectations
  • The involvement of all stakeholders, fostering a whole-system approach
  • The ability and willingness to be flexible, wherever possible”

What a wonderful though subtle rejection of “heroic leadership” or CEO-itis this is, and what an obvious parallel with co-production it produces!

As I read through the slides of the summary on wicked issues and constructive conversations I found myself scribbling “YES!” and “Absolutely!” all the way through, so well did the findings tally with my feelings about what’s needed for change, especially in health and social care, and disability equality. They clearly tally with the ideas of system leadership and collective impact we’ve written about here before on many occasions (1, 2, 3). Though I could understand it if people were to tire of yet another set of terms that could be used and abused, for me the value of the above is in having something further to point to, consistent with what we’ve been talking about before, that further articulates the how I feel we need to go about change.

Engaging people in adult social care and co-production: what’s the best evidence?

The voice and experience of people who use services in shaping and delivering adult social care has long been a preoccupation of mine. It’s so obvious a way of working and understanding to me that even now I’m bemused and confuddled more than I should be by how ubiquitous good engagement and co-production isn’t.

Anyway, I’ve been lucky enough to be asked to write a bit about this for research in practice for adults (ripfa) as part of a forthcoming collection they’re producing. The focus is on what the evidence says about how properly involving people in the design and delivery of adult social care makes a difference (in whatever way and at whatever level).

As something of a geek I have a pretty good sense of what the best bits and sources of evidence are, but one person’s approach for this type of thing is never as good as that of the crowd. I was therefore hoping colleagues might share with me any evidence or practice they think it’s worth highlighting on engagement / co-production.

Any information is useful; if people could share any evidence in particular about the following, though, then that would be particularly great!

  • How do different groups want to be involved in social care delivery and design?
  • Which groups are at most risk of not having their voices heard, and how can we ensure they are included?
  • What should we do when people can’t, or don’t want to be involved in their own social care?
  • What’s the best evidence around on the involvement of individuals in their own care planning or assessment and general person-centred planning approaches?

Though the focus of the work is on adult social care, evidence is limited to just this area: stuff from the world of health is as useful as anything from social care.

Feel free to share via the comments here, via Twitter (I’m @rich_w) or via email (rich DOT watts AT ndti DOT org DOT uk).

Thanks in advance for anything anyone is able to share. As always, I’ll share back what is produced as a result of this work, as well as a collection of the best resources found and shared on this topic.

Infinite series, remarkable results, and personalisation in social care

There are many astounding things to be found in maths. One of my current favourites (brought to popular attention by Kottke) is:

1 + 2 + 3 + 4 + 5 + … (to infinity) = -1/12

That’s right. Adding all of the positive integers to infinity equals a small, minus fraction (and thus the joke of the tweet at the start of this post).

If you’re interested in how/why, the video below is a good starter [1].

So what?

Without wishing to make too much of a leap, I think this has two contradictory lessons when it comes to personalisation in adult social care.

  1. If you follow rules and/or processes absolutely rigorously then what you might end up with could confound nearly everyone and what they would sensibly or understandably expect. In some cases, it would be reasonable to suggest things like Resource Allocation Systems could also fall into this category.
  2. If you pursue something in an open-minded way, trusting the way in which you go about it and where the process takes you, then you might end up with a surprising, unexpected, but still wonderful and valid result. Again, in some cases, it’s reasonable to say things like co-production fall into this category.

[1] – Note the word starter. For a brief overview of why the video isn’t rigorous read this excellent article at Bad Astronomy. If you want the maths try this from John Baez (pdf) or read up on the Riemann Zeta function. But be warned: it’s a rabbit hole.

Survey update what next for mental health and co-production

Mind and nef have recently published a literature review on how coproduction is being applied in mental health settings, which you can find here.

The natural question that follows from this publication is: “What next?” To help answer that question, a survey was put together by some folks* with a real interest in this and a little bit of time.

This post briefly gives an updated on the types of responses received so far.

In total, there have been 83 responses so far, which is pretty good going. Just over a third of responses are from people who identify as having a mental health problem. The next biggest response comes from mental health providers in the voluntary and community sector (15%) and then User-Led Organisations (12%).

The biggest barriers to coproduction in mental health are felt so far to be the following:

  • Lack of engagement from people who deliver services (24%)
  • Lack of understanding of the concept of coproduction (23%)
  • Lack of commissioner support (12%)
  • Other answers regularly mention lack of resources, including both time and money and insufficient recognition of people’s contributions/resources.

To take forward coproduction in mental health, the following so far were felt to be the most useful:

  • A network of people specifically interested in mental health and coproduction (25%)
  • Training to help understand what coproduction is, the difference it makes and how to do it (13%)
  • A campaign to promote coproduction in mental health (13%).

Other than a notable number of respondents who think all policy areas should be prioritised, people who have completed the questionnaire so far think that health (46%) is the policy area that should be prioritised for mental health and coproduction, followed by social care (16%). Very few have mentioned, for example, employment (4%), welfare (0%) or criminal justice (3%).

This is all really useful information so far, and want to make sure there are as many views shared as possible. As such, the survey will be open until the end of January. If you, an organisation or someone / an organisation you know might be interested in completing the survey, please do pass it on.

Mental health and coproduction survey:

*Paola Pierri (Mind), Julia Slay and Lucie Stephens (nef), Shahana Ramsden (National Coproduction Advisory Group), Rich Watts (NDTi)


Examples of not #coproduction

In what is an otherwise good document, the latest version of the Adult Social Care Outcomes Framework drops a bit of a clanger:

Its content has been co-produced by the Department of Health, the Association of Directors of Adult Social Services (ADASS) and the Local Government Association

Producing something between a central government department and two representative umbrella bodies – maybe a few meetings, each organisation drafting bits, commenting on each other’s drafts, and then jointly publishing – is not an example of the coproduction I’m familiar with.

Whilst recognising its importance, I’ve never been one for getting too bogged down in language and definitions. I’ve suggested previously that, when it comes to coproduction, it’s better to say what it isn’t than what it is (see point 1 here).

To help things along, here are some other circumstances which I’d suggest are not coproduction.

  • I was driving to the tip the other day and the person behind bumped into my car. Despite what he said, we didn’t coproduce an insurance claim
  • I got home from a long day at work to discover my wife had doubled the number of cushions on the sofa. Even though she claimed we’d talked about it, I don’t think this counts as coproduction
  • I’d started off with the intention of coproducing what clothes my kids would wear last week. In the end, though, I had to tell them it wasn’t appropriate to wear only their pants and swimming goggles to school, and that I didn’t care if their socks were “itchy”
  • My energy company wrote to me the other day and said that it was basically colluding with the other energy companies to raise prices well above inflation. They can call this coproduction with each other all they like, but it’s bloody not.
  • (There are, of course, more serious cases where things masquerade, or just plain aren’t, coproduction)

I hope this is useful. Do please add your own examples of what isn’t coproduction, either in the comments or using #notcoproduction.

#Coproduction = win (and Bill Shankly)

It was great to be at the launch of SCIE’s excellent new resources on coproduction today.  The resources are here and well worth a look through (including two great videos in Have I Got News For You style – 1, 2).

Here are 5 thoughts/reflections from the day and wider conversations on Twitter.

1. Quite a lot of people get hung up on the definition of coproduction. I find this takes up valuable time that could be used figuring out how coproduction can be a very effective means by which we change public services and the role real people play in this. It may be easier to agree on what coproduction isn’t (clue: two public sector professionals from different organisations meeting together isn’t coproduction)

2. The following question was posed by none other than Lord Michael Bichard (see point 3): What do we need to do to get those people/organisations who don’t get coproduction to see its value and use it? Of all the things that can be done, I think the best is to equip real people with (a) the drive/expectation that they can be part of the way in which public services are designed and delivered; and (b) the evidence that coproduction works with which to convince intransigent others. Creating this demand won’t be sufficient, but it is absolutely necessary.

3. Both SCIE’s Chair (Lord Michael Bichard) and Chief Executive (Tony Hunter – who hasn’t even officially started yet) were there today – a fine indication of both SCIE’s commitment to coproduction and the importance of coproduction more generally.

4. It was noted there wasn’t a session dedicated to coproduction at NCASC (notwithstanding the excellent way TLAP presented their work). There should have been.

5. Coproduction has come a long way, but we all have to work together to ensure it goes much, much further. There is great evidence and practice that coproduction works and is a means by which the immense challenges facing public services – not just in social care and health, but all services – can be collectively approached and solved (see, for example, the excellent Coproduction Practitioners Network for lots of case studies etc.).

As a final thought, I hope you won’t mind me paraphrasing Bill Shankly. Some people believe coproduction is a matter of life and death. I can assure you it’s much, much more important than that.

WiltshireCIL: a #dpulo following local people’s prioirities

WiltshireCIL was supported through the Facilitation Fund of the Strengthening DPULOs Programme to explore the issues local disabled people wanted to focus on, and so enhance their sustainability. Below, Clare Evans – the Chair of WiltshireCIL – shares some reflections on their recent work.

The best thing about a strengthening DPULO grant is that you can apply for funding to meet disabled peoples’ agenda and not have to fit into funders’ agenda.

WiltshireCIL got a grant to reach more disabled people by involving members as volunteers in meeting the needs of others.

We started by inviting any disabled people from our mailing list of several hundred to come and discuss how the project should develop.

Four areas came up as priorities:

  • Informing disabled people about social policy to enable them to influence it
  • To provide disabled people with learning IT opportunities
  • Investigating how to assist self funders on social care
  • Supporting disabled people influence locally and gain skills targeting Salisbury area of Wiltshire

As we draw to the end of our year long project we can see that some areas have been followed through successfully while others not so.

First the “not so” ones! We advertised widely an opportunity to learn IT skills from scratch and had 5 people enrol but only 2 finished the 4 sessions and there’s been no demand for more despite extensive advertising. It’s a bit worrying when you know the Welfare Reform changes are based on everyone getting online to fill in forms, but somehow people don’t perceive local organisations as being able to support them with this.

Secondly we had plans with a local access group to develop some sessions in Salisbury but their leader became hospitalised and plans are on hold.

However what did work beyond our expectations was putting on an information session about the Welfare Reform changes – we are now planning our third conference; also similarly for ILF users.  A combination of speakers, presenting the facts clearly and an opportunity to discuss in groups in a safe place has met peoples’ needs though they remain anxious about the future. For self funders, we first contacted those who attended our Self Funders Forum for their ideas and then carried out a survey. We are now producing a signposting guide and Wiltshire Council has asked us to work with them on the issue to ensure we’re both as effective as possible.

We’re in touch with many more disabled people and are building systems to ensure we can publicise ourselves to them and others again.

Look out for the formal evaluation we’re preparing for the spring!

The case for coproduction – made in March 1788

Karl Wilding – a brilliant and ridiculously nice man – recently tweeted:

Karl’s is such a straightforward observation that belies how odd thinking about public services and the quest for innovation or newness is.

This reflection was further proven by this brief part of the Federalist Paper 73, where Publius (actually Alexander Hamilton) wrote the following in his discussion of the Executive branch’s powers over the Legislature:

The oftener the measure is brought under examination, the greater the diversity in the situations of those who are to examine it, the less must be the danger of those errors which flow from want of due deliberation, or of those missteps which proceed from the contagion of some common passion or interest.

It is far less probable, that culpable views of any kind should infect all the parts of the government at the same moment and in relation to the same object[.]

I’ve read many justifications and reasons for coproduction in public services. Hamilton’s two sentences above serve as one of the best there is, and was written in March 1788.

#DPULO resources and policy documents

This post is one for the policy geeks: you have been warned!

There is a pretty good existing amount of resources available for Disabled People’s User-Led Organisations (DPULOs) to support them in their development. Part of the issue, though, is that people don’t know where they are, how to access them or what to do with them.

One of the aims of the Strengthening DPULOs Programme is to both establish a repository of all such information that is as comprehensive as possible and to develop new resources that significantly complement and add value to existing information.

As such, the programme aims to capture, aggregate and share any relevant information that can support the development of DPULOs.

In the meantime, below is a full overview of the resources and information available on the topic of DPULOs that I’m aware of. It covers:

  • DPULOs and policy – the documents that form the framework for the role of Disabled People’s User-Led Organisations within policy
  • Broader Civil Society resources with a disability/personalisation perspective – a selection of resources that focus on building the capacity of organisations within the fields of disability and personalisation
  • Learning resources for DPULOs – full details of the resources focused specifically on building the capacity of user-led organisations

Inevitably this won’t be fully comprehensive, and will be updated over time. Thus, if you know of any other relevant resources, please do let me know about them.

DPULOs  and policy

A number of documents form the framework for the role of Disabled People’s User-Led Organisations within policy. The following are documents specific to DPULOs, their role in this policy environment and ways in which they can develop their work in order to positively respond:

The following are documents that establish the policy environment specifically in social care and health to which DPULOs contribute:

Broader Civil Society resources with a disability / personalisation perspective

There is a significant amount of information available to support Civil Society organisations to build their capacity and/or respond to the personalisation agenda in social care. However, capacity building support dedicated to disability and Disabled People’s User-Led Organisations is not as well developed. The resources below are a selection of better quality resources with more of a focus on disability and DPULOs.

Learning resources for DPULOs

There are a number of resources focused specifically on building the capacity of disabled people’s user-led organisations. The first two capture learning drawn specifically from the Department of Health’s DPULO Development Fund work between 2008-10. The rest are resources dedicated specifically to DPULOs from other strands of work and include a number of DPULO case studies or the work commissioners are doing to support DPULOs.

Both the Department of Health and ecdp (a DPULO based in Essex) have produced short videos demonstrating the work being done to build the capacity of DPULOs, as well as the work some DPULOs are doing in their local community. These are embedded below:

Social Care TV also has a dedicated video on personalisation and User-Led Organisations, available here. There are also a considerable number of videos about DPULOs that use the “DPULO hashtag” on YouTube.