As an Allied Health Professional working for the NHS in Scotland I am extremely aware of how difficult it is to maintain services at a time of increased demand and decreased financial resources.
Part of the Scottish Government’s response to these pressures has been to develop policies that promote co-production approaches in health and social care. In June 2011 the Christie Commission Report on the Future Delivery of Public Services stressed the importance of services being “built around people and communities, their needs, aspirations, capacities and skills”, but are we really working closely enough with our service users to achieve this? Co-production relies on the skills, opinions and resources of individuals living in communities being afforded equal value with those of the professionals who deliver the services they use. It necessitates an on-going, active, equal dialogue between all parties and aims to share knowledge and understanding to find solutions. Ultimately, it should result in more collaborative relationships across communities and lead to more knowledgeable and empowered citizens.
However, I wonder:-
Are we investing enough time in co-production to make a cultural shift that will empower people to move away from being passive recipients of the services we provide?
What does it really take to actively engage people in co-designing, co-delivering, co-evaluating and co-commissioning the services they use?
Do people who are actively involved in co-production feel empowered to start managing their own health and social care needs more effectively?
The desire to answer these questions (among others) has been the driving force behind the work I am undertaking as part of my current AHP Careers Fellowship. I am spending my fellowship working closely with “Stepping Forward Together”, a mixed group of service users and health professionals whose mission is to raise awareness about falls prevention among older people in Aberdeen City. Initially the dialogue in our group focused on difficulties service users had finding out about falls prevention, getting a timely referral for assessment and concern that people don’t tend to talk about their falls.
However, after a few meetings, during which it was reinforced that everyone had a voice and everyone’s ideas were valued, the decision was made to take the falls prevention message to people “in their own spaces” (lunch clubs, coffee groups, fellowship groups and community clubs) and to co-deliver the sessions with health professionals and “experts by experience” (our service users) working together. Service users in the group were keen to share their stories as part of the session and subsequently elected to call themselves “Falls Ambassadors”.
So many insightful ideas were voiced; it was going to be hard trying to turn them all into reality. However, some of the highlights of the past six months have been:-
- Working in collaboration with students from the School of Creative and Cultural Business at the Robert Gordon University to design a logo for the project, create flyers to advertise our “Falls Ambassadors Recruitment Event”, setting up a Facebook page, designing a website and making information and teaching films for the project. All of this work was completed to a high standard as part of the student’s degree course and came at no cost to NHS Grampian. Seeing inter- generational collaboration in action is incredibly rewarding!
- Holding a successful recruitment event in collaboration with “Sport Aberdeen”, our local sports trust, who have supported the project by providing venues, promoting it among their exercise classes and being part of the co-production group
- Linking up with ROAR, a charity in Renfrewshire who have also been working with older people to raise awareness of falls prevention
- Stepping Forward Together Falls Ambassadors winning the “Hearing Others” award at the Aberdeen Health and Social Care Partnership heart awards ceremony in March 2019
- Carrying out co-production workshops with “Governance International”
Following our recruitment event in February we now have nine Falls Ambassadors all with different skills to bring to the project. The group meets regularly on a monthly basis and a news letter goes out to everyone keeping us all up to date. So far we have co-delivered falls prevention sessions to eight community groups. This amounts to over 200 participants who have heard about services, tried some strength and balance exercises, listened to their “peers” talk about the falls journey they have made and taken away resources to inform and educate them regarding falls prevention. We have groups booked to visit through until the New Year. Each group has a follow up session to revisit exercises, answer any questions and get feedback about changes participants have made regarding falls prevention. We encourage groups to embed a short exercise session into their meetings and to consider having a group Falls Ambassador who will keep falls prevention on the agenda and link with the project for any future advice.
What plans do we have for the future?
- We have made links with the Red Cross and colleagues in the acute hospital sector and are planning to support Red Cross volunteers working in our local acute hospital, Aberdeen Royal Infirmary, to deliver a similar falls prevention message to inpatients who have been admitted following a fall
- We are in the process of planning “Stepping Forward in the Park” which will celebrate the project’s success to date by inviting all the community groups who have taken part in the project sessions, people who have been involved in making the films and all those who have supported our work. We hope to have a “1km, 2km, 3km – run, walk, ride” event in the park, along with stalls/sessions delivered by our partners
- A joint event is planned with ROAR (Renfrewshire), Ageing Well (Midlothian) and Stepping Forward Together (Grampian) where we will share our work and run a facilitated focus group to create a submission to https://consult.gov.scot/health-and-social-care/falls-and-fracture-prevention-strategy/
- Research Project – As part of my AHP careers fellowship I am working on a small qualitative study into the “value of co-production in self management” with support from Professor Kaye Cooper at the Robert Gordon University
My key learning points from this project are:
- Never underestimate the knowledge and understanding of older people who use our services. By disregarding the wealth of skills that sit with our “retired” communities we make ourselves poorer in so many ways
- The impression I had, that older people struggle with technology, has been completely shattered. Many older people already can, or want to learn how to, use technology and in that respect they are no different to my own generation
- If we want to empower people to take a greater role in looking after their own health we need to work on a level playing field, where the experiences and ideas of people living in communities are heard and valued and a balance is struck between what communities need and what services can deliver
- If we invest time and energy co-producing services with service users, we may find a small army of people who are keen to get involved and who may, ultimately take some of the pressure off stretched services
A final note from the author, Janet Thompson, Senior Occupational Therapist, Aberdeen Health and Social Care Partnership:
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