V – So what’s been going on with your mental health group?  Any lessons for partnership working?

A – in a way, yes, but one specific aspect of it, co-production.

V – and what happened in the group to generate those lessons?

A – well you remember there was supposed to be a multi-organisational review of care for people in a state of mental health crisis?

M – it had already been put off a few times, much to your displeasure hadn’t it?

A – yes, well, now it’s been put off a fourth, or is it fifth, time.

M – I bet you’re stamping your little feet aren’t you?

A – Hmm, thank you for that.  My question is, ‘why is it not being done?’  I think most, if not all, of those on the group are genuinely committed to the idea of co-production, and the need for the review has been clearly made.  So what’s going on?

V – what did they say at the meeting?  Why was it put off again?

A – I’m not really sure.  I don’t know if they just hadn’t got round to sorting anything, or if they were trying to put it off because they don’t want it done.  What they did say is that the Mental Health Trust’s crisis service was doing its own review, despite us suggesting a review with lots of other statutory and voluntary bodies.

M – what, you’re saying a service shouldn’t review and improve itself?!

A – No, but .. I don’t know, when they’ve had an offer of help from other bodies, including the voluntary sector, it’s a bit of a snub if they just ignore that.  The other thing that was said at the meeting, by someone new to the CCG was that they were thinking of having a review, through the Crisis Care Concordat, but on a wider geography, across the whole county, not just our local authority area.

V – well that sounds like progress, the kind of thing you were asking for?

A – Maybe.  It depends how it’s done.  I did suggest in the meeting that we could have a local review which could dovetail with and feed into the county review.

V – OK, so it’s not a perfect situation, but it does seem as though there’s been progress, so what are these lessons you say could be learned from it.

A – I was thinking not just about the decision, but the process by which this had all been conducted.  Which is that the statutory bodies just said they would go away to sort it.

M – I thought that’s what you wanted, for them to sort it out?  You can’t win with you, can you.

A – I wanted the situation to be resolved.  But reflecting on how it’s been done, it’s not been addressed in a spirit of co-production.  That would have meant the various partner bodies (or representatives of them) getting together and working out what could be done.  The fact that that wasn’t done, suggests co-production isn’t embedded in the way we do things.

V – that’s not really a lesson is it?  You just haven’t got embedded co-production yet.

A – the first lesson is that co-production should apply to all aspects of your work together – not just co-design, co-delivery etc. but all the other sorts of thing that go on like, in this case problem solving and trouble shooting.

I think there’s a bigger, more important lesson though.

V – which is?

A – it’s not enough to be committed to co-production in general terms: you have to have a clear concept of what it means in practice and what should be done in any particular situation.  That should include conscious awareness of what needs to be done but also natural, intuitive decision making.  In this case, ‘taking away the problem to sort it’ is counter to co-production.

V – fair enough.  Not exactly earth shattering, but fair point.  Anything else?

A – well this is getting more speculative, but I think there were other reasons why they didn’t follow a co-production approach apart from not recognising the need.  I think there are prevailing tendencies towards doing things in your own organisation (or yourself as an individual) rather than in partnership, particularly not in partnership with the public.

V – I think most people would probably agree with you there.  Do you want to give some examples of those countervailing tendencies?

A – People may try to take control for a number of reasons.  It may be to get things done.  It may be fear of what would happen if it were left to others; a fear that aims and interests might not be met.  It could be a wish for greater certainty.  Or a desire to ‘take the glory’.

M – and have you got evidence or examples of all these tendencies.

A – well, no, but …

M – but this is what your imagination tells you, so that’s good enough for you.

A – point taken.  But at least it’s a hypothesis and one based on many years of experience.  And actually there is one example.  Co-production is one possible response to austerity and cuts, an approach which the council has sort of suggested.  But now it’s cutting funding for voluntary organisations and public health prevention.

M – That’s not really unique to your council.

A – no, but they’re trying to raise income by investing in property, whereas investing in the community and in prevention would produce direct benefits for people as well as reducing costs in future.  Maybe some of those political tendencies seep, unconsciously into the approach and actions of officers.

V – OK, anything else?

A – Well I suppose my conclusion is that being generally in favour of co-production, even if that’s genuinely meant, isn’t enough.  There are (possibly) countervailing tendencies which mitigate against it.  So you need to know what it looks like, develop an intuitive understanding of when to apply it and keep the pressure on.

M – oh well, not very profound, but harmless I suppose.

A – and happy New Year to you to.

V – and to all our readers!