Co-production event: Teasing out the Tensions

This event was planned and delivered as a partnership between public contributors, INVOLVE; Centre for Public Engagement at Kingston University and St George’s, University of London; UCL Centre for Co-production in Health Research; Bridges Self-Management; Department of Design, and Brunel University.

With thanks to Journal Frontiers in Sociology who sponsored the event on 26 February 2020.

This blog is written by UCL Centre for Co-production co-producer and event team member Sarah Markham, thanks Sarah!

I arrived early at the NCVO building on the morning of 26 February ready to help Gary of INVOLVE, to distribute copies of the agenda and co-production materiel on the seats. This felt a good way to embed myself into the event; I had played a role in the design and organisation of the workshop and it felt important to me to be contributing on a practical level on the actual day. It was a beautifully sunny Wednesday morning and the event had sold out. The day felt full of co-production promise.

The term ‘co-production’ has many context dependent meanings, across a range of settings including clinical research and services management, but in general refers to the creation and implementation of projects in which members of all relevant stakeholder groups, especially members of the public, are involved as equals.

In line with the co-production principle of parity of involvement and contribution, when organising the Teasing Out the Tensions event, we had agreed that one of the principles of the day would be that everyone, attendees included, would be responsible for its implementation and success. How this democratic ideal would play out in practice, we had no idea.

The event began with a welcome from Scott Ballard-Ridley of Bridges Self-Management who explained what would happen throughout the day and how the it had all been put together. This was followed by a scene setting talk about the challenges of co-production by the key speaker Peter Beresford (University of Essex). The focus of Peter’s talk was strength in complex and difficult times in the context of national politics. Themes included progressive democratisation versus neo-liberal populism, the privileging of traditional forms of knowledge and continuing barriers to involving hard to reach populations. Peter asserted that this was creating distrust in service users regarding the feasibility of co-production. He celebrated the many people who were making robust efforts to actualise democratic involvement and co-production, and the expansion of associated research projects (both national and international). Peter exhorted us to be positive and assertive, and to keep moving forward in promoting the democratisation of policy and services.

Competing ideologies of patient public involvement (PPI) have evolved within the same terminology framework and Peter spoke about the impact of political power on co-production. He claimed that there are serious inequalities to resolve in the arena of co-production and a great need to empower service users and raise confidence in their agency to enact political and cultural change. Peter emphasised the inclusion of all forms of diversity at a level of equal power in participatory activities and this required community development and outreach. Co-production must run through this from the beginning to the end.

Peter concluded his talk by emphasising the need for co-production to include and generate new experiential knowledge and for people to continue to resist epistemic discrimination (prejudice, bias and discriminatory action suffered by individuals in their position as epistemic agents, that is, as individuals who can acquire knowledge, justified belief or understanding). The presentation was then thrown open to the audience for questions and discussion and there was further talk with regard to creation of shared knowledge and learning via the involvement of service users at every stage of social work post qualification and the power of co-production to change culture. The realities of trying to getting involved in co-production project was also discussed, including issue such as identity intersection and impressions of residual disregard for subjective experiential learning.

At this point attendees had a choice of five parallel sessions to attend, exploring respectively tensions in the co-production of publishing, commissioning of health and social care research, acting ethically within co-production, sharing power in a project and co-produced evaluation. There was a focus on discussion and interaction within all sessions (and no PowerPoint presentations allowed!)

Lunch was a fabulous range of sandwiches, rolls, hot wedges and fruit and was alive with vibrant conversation. After lunch a re-run of the five parallel sessions of the morning allowed everyone to engage in their second favourite option. As in the morning, I was co-facilitating the co-production in evaluation ’embracing messiness’ session led by Lizzie Cain (UCL Centre for Co-production in Health Research). Personally the notion of ‘mess’ unnerves me, conjuring notions of unmitigated and incomprehensible chaos. I was anticipating being one of the most challenged people in the session. At the same time I understood that discussing practical means of dealing with ‘mess’ would hopefully allow us all to at least begin to get a handle on the matter. This had the potential to help build confidence (and hope!)

Co-production can be viewed as a disruptive innovation and challenge people to work differently. Lizzie and I had thought it would be useful to mention the potential benefits of ‘tensions’ in the co-production of evaluation. A mutually respectful difference of opinions/ideas/priorities could lead to productive and inspiring debate, possibly leading to the generation of new (shared) understandings and appreciation. I was personally aware of work done (in Tanzania) co-produced with peer workers in which it had been highlighted in interviews that the data collection specification for a service evaluation hadn’t really provided the funders with any meaningful information and had been in effect experienced as a burden and not a meaningful exercise for the programme. We used a discussion of this and similar issues to segue into a discussion of the value of evidence.

The notion that tensions could have a positive effect and play a valuable or even necessary role in co-produced evaluation proved popular and creatively provocative for the attendees. Of particular interest was the role that those tensions can play in working towards culture change. Both the traditional research and funding world, and co-producers need to understand each other’s needs and come to some sort of compromise around how and what is evaluated and reported. This is happening – responsible funders are becoming much more aware of the burden their reporting requirements can place on staff.

There was a general discussion about what evaluation is in the context of co-production and the value that tensions can bring; enabling productive discussions which may generate shared understandings. This discussion segued well into consideration of the role of evidence in co-produced research and the importance of context in assessing what kind of evidence is important to collect. We also considered the different reasons why you would evaluate a co-produced project, which audiences would it be relevant to reach, the kind of evidence needed and the extent to which you could co-produce the evidence collection. One participant raised the excellent point that evaluation is only of value if the findings are used and it leads to actionable points and this can be sued to guide the design of the evaluation.

There was recognition that we do need more evidence of the ‘traditional’ impact co-production can have on projects rather than just assuming it does make things better and the complexity of iterative, participatory evaluation. Angela who is also involved with the UCL Centre for Co-production in Health Research shared her experience of co-developing the Hearing Birdsong Pilot Project to raise awareness of hearing deficits with the use of birdsong funded first by Imperial College and more recently UCL. The project had essentially been user-led with professionals becoming drawn in as the project evolved. The entire process had been very organic.

Lizzie gave a clear and comprehensive description of how the UCL Centre for Co-Production in Health Research evaluate the projects they fund with an emphasis on drawing out reflection and learning from the projects including their relations with the Centre for Co-Production and their experience of the evaluation process. Within this there is also the awareness of the need to include more traditional quantitative measures of impact.

At the end of our session I shared my experiences of participating in a co-creation session at the UCL Centre for Co-Production in which we had shared positive experiences of co-production. What had been remarkable was the richness and diversity of experiences of how co-production had impacted on ourselves, the changes it had caused and the actions it had led to as a consequence. Common emergent themes being the importance of connectedness, of learning to understand each other better and the almost infectious nature of co-production.

Tina Coldham (INVOLVE) chaired the final session of the day commenting on the positivity and liveliness of the event and the importance of bringing new (and possibly radically disruptive) ideas to the table. She reflected on Peter Beresford’s presentation; on the multiple uses of terminology and framing co-production in research as collective advocacy. The leaders of the parallel sessions were then invited to come up to the front and give their reflections. Thoughts were expressed regarding the value of lay summaries in academic publications, the importance of addressing issues in co-production due to power imbalances, the need for commissioners to be more flexible in order to allow co-production to actually happen, the need for sufficient time to be allowed within projects for co-production to be done properly, the need to create an open and inclusive culture of evaluation in co-production, and the ethics and practicalities of paying lay people for their involvement in research. Hopefully the vibrant co-production conversations initiated during the day will be continued on Twitter and elsewhere. Check out the hashtag from the day #CoProToTT

More photo’s coming soon!

This event planned as a partnership between public contributors, INVOLVE; Centre for Public Engagement at Kingston University and St George’s, University of London; UCL Centre for Co-production in Health Research; Bridges Self-Management; Department of Design, and Brunel University.

The event was sponsored by the Journal Frontiers in Sociology.