Self Management: Why
Co-Production is Central

Background

logos.pngSelf management is critical to the Scottish Government’s 2020 vision for the future of health and social care in Scotland. The Christie Commission, Route Map to the 2020 Vision, health and social care integration and Scotland’s National Action Plan for Human Rights (SNAP) all form part of the backdrop for a fundamental shift in favour of asset based approaches, co-production and the desire for empowered citizens living in thriving communities.

The self management agenda provides an insight into how health and social care can work when this change takes place. Scotland’s approach to self management has been to learn from people’s experience of living with long term conditions and their unpaid carers.

Self management is a powerful example of an approach that gives people and communities more opportunities to shape the services they use based on their own experiences. With greater control over their own wellbeing, people are able to support and shape a focus on individual and community strengths.

This case study

The Health and Social Care Alliance Scotland and its members have been involved in supporting and developing practice and learning in self management since the launch of ‘Gaun Yersel!’, the Self Manangement Strategy for Scotland in 2008. Co-production is a central principle to the practice of self management. This case study reflects collective learning over the last 10 years – in particular the work of the self management projects within the Self Management Network Scotland and the Self Management Fund for Scotland - looking at the relationship between self management and co-production.

Image.jpgOver this period of time a number of key themes have emerged from our learning. These are concurrent with the core co-production components identified by the New Economics Foundation: assets, capacity, mutuality, shared roles, networks, catalysts.  This case study will map the learning in self management and how this relates to co-production.

To help illustrate this learning in practice, the work of two projects funded by the Self Management IMPACT Fund - Clydeside Action on Asbestos and Let’s Get On With It Together (LGOWIT) - will be highlighted. 

Read the LGOWIT case study here


 

Read the Clydeside Action on Asbestos case study here

Read more about Clydeside Action on Asbestos’ self management work.

Read more about Let’s Get On With It Together

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What we are learning about co-production through self management?

Boccia_photo.jpgCo-production is a key determinant of a culture favourable to self management. Self management is about recognising that everyone has strengths, resources, skills and experience that supports their health and wellbeing and enables them to manage their long term condition(s) or caring role. At the heart of self management is a collaborative relationship between people and health and care practitioners, supporting the person and their family to feel empowered and in control of their lives and conditions

The learning in Scotland has clearly shown that people and communities hold the key to developing successful self management approaches.

By building the system around this collaborative relationship we can transform the way in which the health and social care system supports people with long term conditions.

Transforming relationships is also at the heart of the New Economics Foundation definition of coproduction:

“Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.”

Seeing Lived Experience as an Asset

The New Economics Foundation refers to assets and capacity as key components of coproduction: where the delivery model of public services recognises and grows people’s capabilities, recognising people as equal partners in designing and delivering services.

Scotland’s approach has been to learn about self management through the lived experience of people living with long term conditions and unpaid carers. This has been evident through the Self Management Fund for Scotland, and formed the core criteria of the Fund.

A central feature of all the projects has been the involvement of people with long term conditions and/or their unpaid carers in design, delivery and evaluation. This results in rapid growth in capacity as people’s skills and learning develop. People with long term conditions and their families are equally seen as crucial to service delivery:

Clydeside Action on Asbestos has used people’s experience and knowledge of how they manage their own daily routines to develop a toolkit that contains information and hints and tips to help others diagnosed with an asbestos related disease.

 

“I would say it has been co-production on all levels, from the partnership down to local groups. Being able to say things that are welcomed and valued at the partnership group is good.” (Peter, partner and self management trainer at LGOWIT). “It has felt like a real partnership for me and that of course is about the members generally. There is real cohesion between the different partners and a good team in the project. As a trainer working with people, you always get a “sense check” about what’s important and what works.” (Ian, participant on self management training and team leader, community networkers, at LGOWIT).

In this way self management challenges the perceptions of who we see as providers of health and social care; encompassing people and communities and their individual and collective strengths and assets. 

Many self management projects identify peer support as the most powerful aspect of their work – enabling people to develop the confidence to assert their right to the support they need. This has been a key contribution of the third sector which has significant experience in facilitating and developing peer support.

A number of projects also work closely with, and encourage people to become, volunteers providing different opportunities tailored to individuals’ strengths and abilities. 

Particular benefits arise for all when the volunteer has a shared experience with people who are receiving support. This can help the person receiving support develop a sense of hope and inspiration from seeing someone at a different stage in their self management journey.

Staff as enablers rather than deliverers

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Many self management projects utilise the power of personal experience and stories to raise awareness of self management and the role it plays in enhancing health and wellbeing.

Mutuality has been identified by New Economics Foundation as another key component of co-production.  This involves providing a range of incentives for people to engage which enable reciprocal relationships  and mutual responsibilities and expectations.  Key to this is having shared roles by removing tightly defined boundaries between practitioners and people who use support and services.

Staff operating as enablers rather than traditional service deliverers is a central aspect of self management projects. This concept of being an enabler, empowering people to reach their full potential, is not simply a tool used by paid staff. It is a core professional and personal value within the projects that people and staff experience is given equal value.

At LGOWIT, the partners have deliberately not led but facilitated and helped others to take the lead in developing the partnership’s activities – examples of this have been the development of the boccia groups and peer support groups so that they can become self-sustaining.

 

During the process of developing factsheets for their self management toolkit, CAA established working parties in Ayr, Forth Valley, Edinburgh and Aberdeen consisting of health care professionals and members of CAA support groups. The working parties were established to assist with the content and development of the factsheets and provided a forum for CAA members to share their experience of being diagnosed with, and living with an asbestos related condition on an equal basis with healthcare care professionals.

A strong theme which has emerged is the way in which staff and volunteers operate to support, enable and empower participants to realise their personal potential and capacity for self management.  The strong relationships that develop between all people involved in a project enable this sharing and blurring of roles.

People often need support to build their capacity to self manage – this can mean being supported to explore what self management means to them in an environment where they are able to take part in meaningful activity and build relationships with their peers.

The experience of the ALLIANCE has been that those who have been supported by volunteers often go on to volunteer themselves – showing that reciprocity is an important aspect of self management.There is often a blurring of the distinction between people and practitioners.  The benefits to volunteers are many and varied including using the experience as part of their recovery, developing new skills, using their experience to positively impact on other people’s lives, and being able to give something back.  

Avoiding tokenism

Self management projects are very careful to ensure the involvement of people with lived experience benefits the person before benefitting the project. For example, people will share their personal story out of a natural desire to celebrate their improved confidence and  influence others, rather than simply  to promote  good practice by the project.

By being supported to find techniques to self manage, building confidence and seeing their strengths, people are inspired to share their experience so that others can benefit from their learning. 

At LGOWIT people with long term conditions and their carers have been at the centre of what the partnership and project have done by:

  • Contributing to the partnership’s meetings and deliberations. 
  • Leading peer mentoring support sessions. 
  • Delivering self management training. 
  • Contributing to health care staff training.
  • Contributing to the overall Self Management strategy and Self Management plan.

 

The Self Management Toolkit developed by Clydeside Action on Asbestos was planned, developed and evaluated by people who are living with an asbestos related condition. This ensured the information contained was useful, relevant and reflected the experiences of their members.

It is important to reach out to people who might want to share their lived experience and go the extra distance to support them to do so.  It is equally important that where  people  volunteer with an organisation that they can continue to be able to utilise the support available as well. 

Flexibility

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A key aspect of self management projects has been the ability to regularly adapt to what people want. This is important as self management  means so many different things to different people and the people the projects support regularly change as a result of them no longer requiring the same level of support. Balancing a degree of structure with people led flexibility and responsive working, helps create a sense of ownership for people.

Networks

The ALLIANCE has learned that self management spreads through people sharing their lived experience, both with their peers and practitioners. At the heart of this agenda are strong, connected communities – brought together by a shared locality, interest or common bond – that have the ability to adapt and thrive.

An important outcome from self management support has been an increase in people’s social networks and/or decrease in feelings of social isolation – building people’s social capital has been a critical aspect of self management which in turn contributes to both individual and collective wellbeing.

The LGOWIT partnership worked through a variety of local networks across the Highlands to spread information about self-awareness and to help people take up new support opportunities. A key partner in this were the 11 community networkers who were key local representatives across Highland. Each networker highlights and signposts to services and events in local areas. Engagement with them has ensured that the asset mapping work is embedded in a process of relationship building with local communities. Read the story of this process here.

 

Clydeside Action on Asbestos operate a successful network of 8 local support groups where local members lead the planning and implementation of their activities.

With this in mind the ALLIANCE established the Self Management Network Scotland in October 2014 to build capacity in self management and share and spread knowledge inside and outside of the health and social care system.

The network currently brings together around 400 people with a passion for self management including people with lived experience of self management as well as people across sectors with a role in supporting self management. 

The principles underpinning the network are that people’s lived experience has equal value to the experience of practitioners and other practice based evidence. It is in this way that the network models a way of working together that underpins a self management approach.

Natural progression

The people with lived experience, who are involved in the projects that this case study has focused on, follow a natural progression towards increased confidence, assertiveness and self-esteem. The flexibility which the projects have means that there are no time limits placed on this capacity building work. Working in a person centred way, the projects recognise that everyone should progress in their own time and by working within the principles of self management, this progression becomes inevitable.

The new economics foundation has identified that public services operate as catalysts and become facilitators of action rather than central providers themselves, thereby creating the conditions for change within wider systems. 

As mentioned above, people who are successfully managing their long term conditions often become champions of self management and share their success with others. In this respect, the self management agenda has been truly led by people’s lived experience. The best ideas come from people’s lived experience and this is where self management projects can play an important role as catalysts in supporting change within the health and social care system.

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If you would like more information about the Scottish Co-production Network, please contact:

Scottish Co-production Network

Tel: 0141 222 4839

email: olivia.hanley@scdc.org.uk

For further information about People Powered Health and Wellbeing or Self Management Network Scotland, please contact:

The ALLIANCE
349 Bath Street, Glasgow

G2 4AA 0141 404 0231

Email: pphwadmin@alliance-scotland.org.uk
smns@alliance-scotland.org.uk
www.alliance-scotland.org.uk