Don't Forget The Preproduction When Carrying Out Coproduction

 If there is one thing that frustrates me, it is the lack of progression. In a personal capacity, the need to develop, learn, adapt just does not want to stop. Professionally, it frustrates me even more. Having worked in the public sector, I have seen the wheel of ideas come around a few times. I have a theory that a new idea gets recycled every ten years or so.

Involvement, inclusion, patient participation and my favourite co-production, get thrown around at every opportunity to show how people are involved in making decisions that affect the public sector. In reality, I have seen very little effective participation that makes the real changes needed for people to actually flourish.

One of the most regular pieces of feedback I hear is we invite people but it is the same faces going over the same things. What does this tell you? Firstly, they are not happy having to repeat themselves so they keep coming and repeating their stories. Secondly, these people are from your community. They go back and tell other people that they are not listened to. So why would others want to spend time and participate? Most people just feel like it's politics. It just is not effective. 

People will point towards politics and say that is the way our democracy works, we vote and choose a person who we think will represent us and be our voice. But in reality as we see over and over again, the people we vote in seem to be interested when in power to doing things as they seem fits. Is there another way that would work better? 

I think so and it is not that drastic, it has been around for a while. It is just not being utilised fully. This is where my theory of pre-production instead of co-production comes from. 

Over the years I have learnt that when looking at Equalities, there are two things with primary importance. Data and talking to people. Yes data, I know there is a huge movement in the NHS and Local authorities looking at the use of data. I guess this proves my point of the wheel coming around again. At that time and still today, people find that we do not have the real data needed to help us plan. 

The idea was that the public sector would look at the data particularly around protected characteristics (hard to reach groups) and then by working with the people to design services to meet local needs. The procedures built around these are mostly forgotten now. Remember the Joint Strategic Needs Assessment (also known these days as ICS) along with Equality data were supposed to be used to help to plan the path to meeting peoples needs. 

The main difficulty with this process (then and now) is the lack of data. The problem in the world  is that people are not static, things change. National Data simply cannot keep up, especially when we rely on the census; which due to  changes the figures soon become out of date. If you just look at the last lot of data austerity, Brexit, Covid the Ukraine war all have had major effects on the data. The other issue is that National data which is often used to try and describe effects, are not relevant locally. As an example; National data for disabilities suggests the disability level to be around 20%. Yet locally in our county I know for a fact that in a certain part of our county on the east coast because of the demographics and age, the disability statistic for a particular town is over 50%

In order to deal with this it is important to collect local data. A lot of authorities will often ask for this data. Yet from experience having worked as a manger in a local authority call centre, people who answer the phones often reply to customers that it is just what we are required to do. Instead of explaining the purpose of this data. Also even when it is collected, from experience is it really used or used to make things look better than they actually are? Another example would be a recent local authority who asked for data in a specific area. They then reported that 100% of local ethnic minorities who had responded had said they were happy. When I looked closer the 100% was one person from ethnic minorities who had responded. Guess who that was? 

The answer is simple, talk to the local people. Managers (especially seniors) as well as those in commissioning and equalities should be on the streets talking to people. At present it seems that authorities come up with an idea often shared by some other authority (remember local data is king) and people jump on the band waggon. The important thing here is when you talk to people you learn what works in one area and what does not equate or relate in another. You need local ideas and local solutions. 

Better still, the best people with the ideas and usually the solutions are the people who live with the issues, 24 hours a day. Their issues do not stop at 5pm or on a Friday evening. The question on my brain is: why are we not asking people with lived experience? As opposed to assuming what needs doing. 

I have seen lots of ‘co-produced’ ideas where officers of the services come up with ideas to try, usually influenced from somewhere across the country or the latest buzz. This is great but is it not better to ask first. Let the people suggest what is needed. Pre-produce instead of co-produce. Work with the people before the idea comes to life and spend time designing. 

Recently I have worked with a number of partner organisations who have come up with some good ideas, in the scope of things; as an example end of life services. One of the public partners mentioned that the Asian communities do not seem to want to engage in this area. My response is what if it is not an issue for them? From experience, I know that such communities have their own in-house services for end of life. If the question had been asked what is needed, the community would have saved them a lot of time and effort in trying to work out if the input was needed.

The other great thing is by pre-producing you will actually reduce the burden of having to consult. Not saying it is not necessary, but it does look better to say we did not come up with this, it is what the people asked for. 

This shift though simple in principle takes some serious changes to happen in public authorities. We need to change and put the needs of the people first. After all it is known as the National Health Service and Social Service. The emphasis in being the organisations are supposed to ‘service’ the people needs. So why not ask them how best to do this before you design or come up with solutions.