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Richard McCann

While co-production appears to peripheral observers to address many of the acknowledged weaknesses of service user involvement groups, Richard McCann believes there are fundamental dangers that will – unless addressed immediately – form the rocks upon which the ship of co-production will ultimately founder.

After a critical review of the two principle methods of design and delivery of mental health services and an examination of the perceived strengths and weaknesses of Service User Involvement (SUI) and Co-Production’s (CoP) attempt to offer a broader and reciprocal model of citizen engagement within the activities of providing services, communications specialist Richard McCann puts forward the suggestion that while each delivery method has its own strengths and weaknesses, scant regard has so far been made to the vital part that effective communications needs to play in their success, what the lack of effective communications played in any identified failures or weaknesses, and indeed the role of effective and sophisticated bespoke communications structures to ensure the success of an integrated model.

Investigating the effectiveness of current service user communications and influence and the potential requirement for different methods of communication if the alternative offered by co-production was to be successful, Dr McCann has identified a need for new strategies designed to facilitate better engagement between all stakeholders - including wider society – while resulting in ‘leaner’ provision of more effective and efficient services and ultimately assisting - for example - in breaking down the stigma and discrimination currently surrounding mental ill health.

“Service user involvement has accumulated some power since its inception 40 years ago” says McCann, “However, deeper study reveals that SU involvement has ultimately failed to deliver its promise of meaningful service provider change due, it appears, to communications difficulties presented by the very ‘voice out’ nature of the approach resulting in a range of reactions from service providers from genuine engagement to tokenistic interaction, patronisation or even – in the case of some GPs and consultants – fear.”

McCann believes there’s still a widespread belief that mental ill health suffers from stigma and discrimination, a majority dissatisfaction with SUL organisations and cynicism to the idea that service users could ever be effectively represented without the involvement of the wider society, coupled to a bias towards Co production away from SU led methods as a means of more effective service user communication ultimately leading to the breaking down of stigma and discrimination. McCann suggests that the service user movement has become confused, equating involvement with influence and influence with power. While that progression of thought is understandable it leads to an adversarial communications strategy of ‘service user out’ rather than ‘community in’ which intimidated rather than engaged.

While he readily acknowledges that the accumulation of service user power was initially effective and undoubtedly of more value than passive compliance or apathy, McCann says that what was laudable in the 1970 and acceptable in the 1980s is now in need of radical overhaul if it is to evolve, to continue to address the needs of service users, and address to wider challenges of the next decade. However – those 1970s and 1980s attitudes towards the power so hard-fought and hard-won by SUL organisations will not readily be disbanded. Indeed, McCann accepts that champions of SUL organisations are exhibiting understandable prudence, since it will be dangerous to disband and relinquish their power and influence until a new way is established of proven effectiveness.

Co-production is the method widely offered as the current means of achieving greater traction for service users. This apparent panacea is claimed by its champions to allow campaigning engagement with both service providers and the wider community but at an inclusive rather than adversarial level. While Co-production appears to peripheral observers to address many of the acknowledged weaknesses of service user involvement groups, McCann believes there are fundamental dangers that will – unless addressed immediately – ultimately form the rocks upon which the ship of co-production will ultimately founder.

If service user groups fail to embrace the opportunities that co-production represents – for example, if they pay ‘lip service’ to the co-production concept while failing to accept the fundamentally different communications requirements between the co-operative approach and the old adversarial system – co production will result in service user organisations losing the very ‘power’ and influence that was discussed with such protectionism during a recent meeting in London.

McCann suggests that the political messages put out describing co-production as a ‘delivery’ method triggers the immediate aggression and alienation of SU groups since it implies that service providers could trial co-production as a means of simply using SUs to assist in the delivery of existing services while excluding them from the very ‘design’ process that genuine co-production is intended to broker.

To borrow an example from the private sector, simple economics dictates that consumers’ needs should be examined at the design stage before production and sale. Would any business market a product without researching and involving its potential customers first? Yet the ‘delivery without design’ policy of some academics and service providers ignores these fundamental market principles as well as the ‘involvement and engagement’ concept at the very heart of co-production.

But as well as service provider misunderstandings, let’s not have a mirror of the worst of ‘80s service user adversarial approaches which simply resulted in the movement often being marginalised or ignored. The requirement for an embedded and radically new communications strategy has already failed to be identified by most – and certainly failed to be implemented by many. Co-production is falling at the first hurdle, not through any fundamental flaw in its concept but, rather, a flaw in its communication strategy, and the McCann uses the term ‘embedded’ to express the importance of recognising that bespoke stakeholder communication must be embraced as a fundamental part of the whole co-production model and not merely as a desirable add-on.

The need for effective communication extends beyond service users and providers; it must engage all stakeholders. If co-production is to engage with the community as a whole – as surely it must – the messages of both users and providers must be firstly defined and then jointly communicated to a wider audience.

The current UK Administration has embarked upon a radical rethink of public service delivery, and while this presents those involved in the provision of public services in general, and mental health services in particular with both threats and opportunities there is no doubt that service users will be the ultimate losers if the new methods are allowed to fail. Conversely, if new strategies of effective communications, effective monitoring and effective evaluation allow the new co-produced methods to be successful then the beneficiaries will extend throughout society to encompass not simply SUs and service providers but also the wider society encompassing local and national government and citizens as a whole.

Co-production is parked on the edge of a cliff. It may be rescued. Or it may be pushed over. But McCann concludes that the worst fate of all is currently the most likely if unaddressed – that co-production will simply be hijacked as a re-badged version of old ideas and nothing will fundamentally change.

Recommendations – medium term:
‘LeanCo-production’, early adopters and ‘The Third Way’

So if not SU led organisations or conventional co production models, what hope for the future? Could there be a ‘Third Way’?

At the level of the individual, there appears to be significant number – if not a majority – of persons within the UK who wish for greater engagement with society as a whole and – by some means - to ‘give more back’ to ‘their society’; to ‘take ownership’ of society in some way as a participant rather than as an observer.

However, initial enthusiasm generated by citizenship interest in the Big Society concept should be tempered with pragmatism; while three quarters of respondents in a survey conducted this year told pollsters that ‘’local people should have more influence over local decision-making’, fewer than a quarter said they were ‘prepared to participate in community activity themselves’. McCann suggests that it is reasonable to presume that polls after the October 2010 UK chancellor’s spending review are likely to find these findings reinforced with perhaps even greater numbers being categorised by the author as ‘advocates’ but not ‘participants’.

The Big Society’s co production concept thus needs to find a method of releasing this asset of ‘advocacy’ by making it easier, more enjoyable and more powerful for people to ‘upgrade’ and engage as ‘participants’, while initially also seeking to leverage the small section of individuals who are society’s ‘early adopters’ so as to achieve some concept momentum.

One thing is clear – outmoded adversarial power-based philosophies of SU-led groups have no place in what McCann terms ‘LeanCo-production’ (Copyright) fuelled by ‘early adopters’.

Battle lines drawn between service user organisations and service providers while both outwardly proclaim allegiance to a common flag in order to secure government patronage is both dishonest and cynical.

Service users and the citizens of wider society as a whole will not be fooled for long and, when discovered, the perpetrators of the lie will have set back the movement decades and laid the foundations of citizen mistrust that will lead to even greater cynicism, stigma and discrimination than exists currently.

Accordingly, McCann advocates the establishment of a small collection of regional organisations with a brief to act as ‘co production champions’ - becoming mediators, facilitators and ultimately the implementors of internal and external communications strategies that will ensure co-production’s success. These ‘champions’ will not be mere toothless attendees at co-production meetings, they will have the teeth to allow ruthless policing of co production partnerships, ensuring genuine common purpose, and ‘buy in’ to lean co production principles of true engagement with service users, providers and early adopter citizens allied to top-to-toe influencer-communications with the wider society in order to achieve three objectives:

1. The provision of more effective and efficient services
2. Greater understanding of service production and use by wider society, and
3. Leverage of that understanding to combat and ultimately destroy stigma and discrimination of persons suffering from mental ill health

If co-production is allowed to fail, the messages to stakeholders at all levels of society will be stark, and the current disharmony and mistrust between current SU led champions, service providers and advocates of co production – and by implication the broader ‘Big Society’ concept - will surely escalate.

This must not be allowed to happen. The movement needs communicators to ensure lean co production’ fuelled by ‘early adopters’. By taking existing organisations already attempting a communications brief between service users and service providers, and by simply extending that brief, advocates of co-production would be safeguarding their concept while ‘doing more for less’.

Ultimately, one small decision to extend the brief of communications organisations to act as co-production champions could turn co-production’s certain failure into a resounding success. This is now happening; Partnership Trusts are already seeking how to extend service delivery monitoring and evaluation into effective co-production methods by devising a communications interface between service user led organisations and service providers, from grass roots service design through to delivery and encompassing vital metrics based on SROI against KPIs . And while some SULs may initially perceive the new ‘Big Society’ philosophy, the new method of co-production, and even the involvement of LeanCo-production facilitators and communicators as threats to their power, “the communication methods identified and developed in this document” says McCann, “will ultimately allow SULs even more power to ensure that SUs receive the services they both need and deserve.”

'LeanCo-production' is UK copyright registered number 330796.

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