Rock Lobster was the first ever single by new wave band the B52's, released in 1979 and is lauded by critics as one of the top 500 singles of all time. Fred Schneider of The B-52s stopped eating crustaceans at the age of four after going crabbing with his family in New Jersey and watching the crabs get boiled alive.
When Fred wrote Rock Lobster he was sticking up for the lobsters.
Whats that got to do with Coproduction?
We need to more firmly unify our voices in a strong and vocal ethical base, one located in social justice, democracy and active citizenship. Where together we *demand* to change the relationship we have as citizens with our public health systems. We have waited long enough.
We can get so caught up explaining coproduction, arguing its principles and theories vs consultation and how we evaluate and measure it, that as citizens we risk forgetting why we seized it as our tool. We wanted change. We wanted to shape our public systems so they delivered what we want and need, on our terms.
Coproduction must not be an academic theory, it shouldn't only gain traction in the hallowed halls of academia or around the boardroom table when we have been invited to take a seat. Nor in pockets of excellence created by the most innovate and brave of our systems leaders. And never centralised in the hands of any one culturally homogenous organisation. It must be located at the heart of our diverse local communities, in groups of citizens who have a democratic right to shape their local and national health & social care systems on equal terms. We need to demand this new equal relationship between citizens and state. For too long we have been only allowed in when our CCG's and health and social care providers allow us.
I think that the statutory right to involve is currently located as a requirement within the NHS and its commissioners as something they must do, not that the community has a right to. The community can only challenge the lack of, not drive the doing of. So it appears to fall on system benevolence in how they actually go about it. They may have a few regular people that are easy to contact or work with, representatives of voluntary sector organisations, they may run a couple of events or work with organisations like We Coproduce. But the wider community is usually blissfully unaware of what's going on and what should be going on.
So genuine question...which body scrutinises the quality of statutory involvement? I'd love to know.
See here what NHSE says is supposed to happen
This is helpful. But we know this isn't always delivered authentically. Because yes, leaders hold events...they listen...but how often do they implement the changes we ask for? Where is the "you said/we did report?" Many won't share budgets or technical details so we are all working blind. For that reason I call for a we said - we did approach. Until then, I imagine a dark room, full of thousands of festering flip-charts - our passion, our lived experience and best citizen thinking staring out forlornly. I think it's time we addressed this. We must promote our right to be fairly involved BUT also demand more health democracy, we must affect change. Coproduction calls out for it. The wider community must be equal and equitable partners in local decision making. It is time to change the law.
If more citizens got involved... what would they find? A system and structure far from how they might have imagined it. The liberal ideals the NHS was founded on have morphed. There was a seismic shift caused by the introduction of the Health and Social Care Bill in 2011 which saw the NHS shaped into a buyers and sellers market. With GP's (who many people are surprised to learn are private businesses) as commissioners and now mostly in the driving seat. There are a few hand selected 'lay' voices here and there, many of whom are amazing - but they are vastly outnumbered.
It's confusing and alienating landscape. It has an historically fast staff turnover and short freelance contracts. Decision making often does not sit with providers or communities but with a short-term and transient freelance senior workforce, project managers and a few extraordinarily powerful characters at the top.
Where are we, the local people? Waiting for the crumbs off the table? The long term plan, the community framework and other more visionary NHS documents seek to address this - but how can we enforce implementation if we have no teeth?
How do we reclaim our power as citizens in this paternalistic landscape? The low level of wider participation that we see in many CCG's and patient participation groups is symptomatic; these spaces are owned by the system and predicated on power-over. Senior leadership is mostly a white middle class voice. It's a privileged, disempowering and fragmented space, sometimes misogynistic and discriminatory, often hyper-defensive. But peppered with the most amazing committed visionaries who bend over backwards to let us in.
If coproduction is a route to social justice, a route to a new relationship between citizens and the state, it must be located with the citizens themselves. It can’t be something that we are invited to do. We must come banging at the door. Those who sit round the table must look like the people in the local community and be free to speak in their own voices - not coerced into permission seeking and humble pie.
As a result, coproduction is being colonised. It's in danger of becoming seen as an almost benevolent act. Something that we have to be thankful for. Some institutions still use terms like, the hard to reach as if wider participation is an act of their determined altruism. As if local people haven't been shouting and waving to be seen and heard for decades.
Is it time to regroup, to think about coproduction in terms of a new wave?
What could that look like?
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The Art of Coproduction - A Guerrilla Guide, our pocket sized fold out guide (and gorgeous one stop shop) for all things coproduction. Designed to generate conversation, ideas and debate with people who coproduce regularly as well as providing an easy access starting point for those looking to learn. It was produced in collaboration with NHS England and coproduced with a team of amazing people from across the country.
Looking to own your very own copy? Please visit our shop.