A Blog entry by Nick Andrews: N.d.andrews@swansea.ac.uk
I have been working in education and social care for thirty
years, and have seen various new initiatives and buzz words come and go, whilst
the fundamental principles of humanity remain the same. ‘Co-production’ in its
truest senses is grounded in these principles. However, as with the concepts of
‘personalisation’ and ‘reablement’, there is a real danger that the term ‘co-production’ is misused for hegemonic
purposes to cover up what is essentially a cost cutting exercise. Under this
scenario, individuals and their communities are expected to take on more
responsibility for their own well-being whilst the machine of impersonal and ‘professionalised’
public services carries on as it always has done, albeit it with a few less
staff employed. In my opinion, this would be a travesty and missed opportunity
to restore warm humanity as the driving force for public services, not
compliance with increasingly centralised and de-personalised processes and
systems.
One of my favourite quotes by the theologian Martin Buber is
‘all real living is meeting’. Please
note that Buber’s understanding of the term ‘meeting’ is much richer than the
idea of putting a group of people together in a room or placing nurses and
social workers in the same office, which is commonly assumed to result in
integrated practice. I am sure many people will share my experience of being in
meetings where no one actually met, where each person had their own agenda and
the purpose of the meeting was to get this across – to win the argument. For Buber, ‘meeting’ is about genuinely
connecting with other people and being changed
in some way by the process. In order to explain this process, he talks about
two ways of relating to people and the world, which he calls ‘I-It’ and ‘I-Thou’.
In ‘I-it’ relationships,
the person is detached and unaffected. In ‘I-Thou’
relationships, the person is attached and vulnerable. Tom Kitwood, in his
seminal book ‘Dementia Reconsidered – The
Person Comes First’ talks about his experience of seeing how people living
with dementia were dehumanised through receiving emotionally detached task
based care:
‘A man or woman could
be given the most accurate diagnosis, subjected to the most thorough
assessment, provided with a highly detailed care plan and given a place in the
most pleasant of surroundings – without any meeting of the I-Thou kind ever
having taken place’ (Kitwood, 1997)
By contrast, I believe that genuine co-production
facilitates and nurtures the development of ‘I-Thou’
relationships between all parties, which in so doing begins to challenge the
prevailing understanding of professionalism and professional boundaries. In relation to this, I am currently
co-ordinating a NISCHR and Joseph Rowntree Foundation (JRF) funded project in
Wales, which is focused on the use of evidence from their ‘A Better Life – for
older people with high support needs’ programme, along with other forms of
evidence in social care service and workforce development.
The ‘A Better Life’ programme has identified that
relationships are key and ‘Often it is the
simple things that bring the most pleasure (and the lack of them can bring a
sense of sadness and loss) and services do not always seem to be very good at
delivering ‘the ordinary’’. (Blood, 2013 p13)
The research challenges also call for a different way of
working, which is often alien to the world of emotionally detached and
compliance focussed task based care, which is summed up nicely in the following
quote by Edgar Cahn:
‘The world of helping
others in need is now built around one-way transactions…. and with the best of
intentions, one-way transactions often send two messages unintentionally. They
say: “We have something you need – but you have nothing we need or want or
value.”’ (Cahn, 2004).
In a series of recent focus groups and learning events
involving older people, carers and frontline staff, I have been struck how many
people feel that current regulation and guidance is risk averse restrictive and
at worst destructive of human relationships. For example, workforce regulation
states ‘the inappropriate use of touch is
not permissible’, rather than ‘the
appropriate use of touch is fabulous and to be encouraged’.
This is a
particular issue for people living with dementia, who often have to express
themselves and connect with others through feelings and emotions. Frontline staff
talk have talked about feeling guilty when they do little kind things that are
not written in the Care Plan or receiving small gifts of appreciation, older
people have been ‘told off’ (in the name of health and safety) for pouring tea
for others in day services, and carers have been made to feel that they no
longer have a role when the person they love goes into a care home.
At the heart of co-production, is an understanding that everyone has something to contribute and
that exchanging these contributions is enriching for everyone concerned. I am reminded of the work of Jean Vanier, who
established the L’Arche Communities in learning disability services. Vanier did
not see his role as caring for people with learning difficulties, but rather
sharing his life with them and being open to receive and learn from them as
much as to offer them support.
I am reminded of one of my earliest experience of working in
social care services. It was 1984 and I had started my first job as a
residential support worker in a children’s home. I thought I was the ‘sorted
one’ who was employed to help others. I worked hard to form good working
relationships with staff and children in the home, but one boy, who had experienced
a lot of hurt in his life, kept his emotional distance. As anyone who knows me
well can tell you, I am not gifted in DIY or anything that involves fixing
something mechanical. One day, I was trying to repair my bicycle (I did not
drive at the time) and was getting nowhere fast. The boy walked past me and
said ‘I’ve got a book about repairing bikes,
do you want to borrow it?’. I am pleased to say that I took up his offer
and our friendship took off from that day. He is now a happily married 43 years
old who lives on the other side of the country, but we still keep in contact
via Facebook and phone and offer each other support and encouragement whenever
we can.
Jean Vanier once said, ‘I
am struck by how sharing our weakness and difficulties is more nourishing to
others than sharing our qualities and successes’. This is an important
message for social care practitioners and agencies. We need to open our ears, our
eyes and our hearts to the people we work with, which might involve sharing our
vulnerabilities and concerns and allowing ourselves to be changed by genuinely ‘meeting’
with them in truly co-productive relationships.
References
Blood, I. A Better
Life – Valuing Our Later Years, York, Joseph Rowntree Foundation, available at: http://www.jrf.org.uk/publications/better-life-valuing-our-later-years
Cahn, E. (2004), No
more throw away people – the co-production imperative, Washington,
Essential Books
