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Report transcript in: Value of Copro - Adrian shares his understanding of coproduction and why it works
Please Report the Errrors?
OK,
Ok,
so Hi, Adrian.
I'm just gonna ask you to introduce yourself briefly and, um,
share with me a bit about your experiences of coproduction.
Hi.
Yes.
Um, I'm Adrian Davis. I've been working,
um, over the last 40 years on sensory health, hearing and vision, things like that,
but also globally on developmental disability.
I've worked in,
uh, with
all sorts of stakeholders around hearing,
and it's important to listen to what they've got to say.
Um,
in terms of other areas of of, uh, research and and development.
I've worked with AAA whole range of people, um,
from Imperial College and U c L to look at
how we might represent hearing diff differently.
And in doing that, we came up with the idea of hearing birdsong.
Um, and that has been a great,
um, collaboration from people from very diverse fields.
And once you put together engineers, designers, uh,
poets and artists with scientists, and you start to talk freely,
it's amazing where you actually get to.
So so that is an example of a freewheeling type of collaborative.
I've also worked in, um the, uh a A more formal U C l, uh,
collective for collaboration.
Um, and
sometimes it feels a little bit slow getting all the all the
stakeholders in and listening to what they have to say forever,
Um, trying to frame what you're saying so that people with neuro diverse, um,
issues can understand
as well and participate as well.
So I think that there's got to be a better way to, um
for,
um this sort of collaboratives to to work that that gets the best of the four.
Very well organised and funded.
Um,
collaborative.
Um, together with that,
um, incredible thing
zest that you get when you bring people together in an ad hoc way.
Um, OK, there are risks with both of both ways
of doing things, but I think we need to be looking more strongly at at how we can
use the the great power of these tools to to
do better for our health and social care systems.
Yeah. No, thanks.
Adrian, You you you mentioned something there around the kind of, um,
spontaneity.
Um,
and your kind of approach to co-production.
Um what do you think?
The impact or the benefit of of being able to, you know, work more freely
in in our sense has been.
Yeah.
Well, being able to work more freely
means that the expectations that people have
can can be expressed much more readily.
Um,
and therefore,
you get you get outcomes that are aren't really
going down one line or,
uh, taking one community
forward rather than another. But you get the most incredible,
um,
views and outcomes being ex
views being expressed and outcomes,
um, being aspired to. And I and I think when we go
towards more formal,
um, co-production
our our aspirations are can be,
um, somewhat reduced.
And we need we need to keep in the health and care system.
Um, and in social justice, we need we need to let our aspiration shine
and for people to take the spark, um, from others
and say, Oh, yeah, OK, I've always done this. I get all the evidence I do
these randomised control trials, and I've got the evidence here.
Yeah, we we need that. But
on the other hand,
um,
you can't just say Oh, yeah, I think that
maybe that person needs a different insulin or a different treatment.
And let's just try that,
um,
so so you,
by bringing people together from
diverse groups.
We abolished the silos
and and we let the
the human aspirations. So I feel.
Hm.
And do you think there's a challenge in in evidencing
the impact of that?
Yes, there is.
Yeah.
So? So there. Um,
you can't evaluate that in the same way as you can
with the,
uh, system.
Um, it is much more difficult.
Um, it needs a mixed method approach
using both qualitative and quantitative work.
Um, you can't just dis the whole of the, uh, of the evidence, Uh, methodology,
um, in doing that, but
But you have to take more care around understanding
the
anthropological basis of what you're doing.
Sorry. I've got somebody playing basketball outside.
That's right. He's He's noticed. Carry on.
All right. Sorry.
Do
do
in my
let's go lunch.
Um,
so I think
if we if we're able to bring people together
and diverse groups
that works, if we put it in a form of framework,
I think sometimes it doesn't work so well,
um
what? What do you think that does to
people? I mean, I
you've clearly got evidence.
You've clearly got experience of doing co-production
in that much more open ended way,
um, which has had an impact on on the lives and the experiences of people.
Um,
so, yeah,
what have you had experience of when people have then tried to constrain that
and it and it's kind of
the time
and you can't possibly do that.
It's
it's not
the right thing.
So, yeah, I My reputation was greatly blackened
because
we went with what pregnant women once,
rather than what the evidence suggested they should have.
And, um,
I got I got into some trouble with this approach. Uh,
but it it's I I think it it's about listening to people,
um, from all different walks of life, and that's what co-production should be.
And the more you try to constrain it,
the less useful I think it might be because
you think Oh, yeah, that's, uh, gonna do it within those constraints,
but
people resist it. I mean, all of the
Oh, yeah, Adrian, um,
we'd have difficulty in court of law if you
just If you've just used people off the street
and and people who've got needs,
um,
we'd never be able to hold the case.
The legal case
for procuring that stuff. Um
I think, Uh,
come on, this is 2020. Whatever it is
2022 even.
Um,
yeah, that we've got to listen to people.
And
we should count that
as another part of this evidence base. Um,
and yeah, it can be difficult. Legally, I guess,
um,
if you think
that you just want to do
what people feel they want
or need.
Um,
but my view sorry
is that that's what we should be doing.
We we shouldn't be saying Oh, yeah, there's a medical need here
or a social need.
We should be bringing people on board and saying,
OK, what is it that you want? What do you aspire to do?
Mhm
and
not my field, You know, in terms of hearing and communication,
Um, what is it that constrains you now?
And what do you actually want?
If if we did something spent the money,
spent some money
next year, what would you be able to want to do?
That's different.
What do you think? That?
And that's the way that we should be doing it. And I think that there is a sort of
from the hierarchy down there is a sort of yeah, That's just what people want there.
We can't do that.
Um, it's too expensive. We never afford it. Um,
OK. And And so I get quite annoyed.
Um,
what do you think the difference is for those people who are, you know,
who you work with who get involved from a co-production perspective.
So you know, those those the pregnant women,
the older people that you've worked with, What difference does it make to them
they feel they feel listened to?
Hm?
They, um,
their partners feel that it's worthwhile.
Hm.
Does it? Does it change something for them in terms of their experience,
Um, beyond just being listened to.
Not usually. Sometimes it does.
Mm.
Something
that's not what we aim to do.
Hm.
But
it can happen.
Yeah,
Um
I mean, um, a small instance. For instance, if I give you an example,
So, um,
we
we provide 1.2 million hearing aids for people here
in England.
And if I've got 20
people sitting around the table over 65
Oh, you mean you can get hearing aids on the health service?
I didn't know that.
And
and and so they go off and they get
they get, uh, their hearing tested.
They get hearing aids or
some other aid to
to, um, hearing.
And
they're much happier. But
it's not what we set out to do
with co-production.
Um, but it can.
There is a sort of a hard moment, you know, that like that that people say, Oh,
you mean you can do that?
Um,
and and and people's lives have changed.
Um,
but it's not what we aim to do
and not what I
aim to do.
No, it's more of a kind of spinoff of
kind of.
Yeah. Yeah.
And And how much do you think? Um
how much do you think the conditions, um, are are important? So what?
What I've heard you describe in terms of
education,
it it feels to me that you're kind of more interested in getting the conditions right
and the relationships and, you know,
the the the stuff that we would describe as the soft and fluffy bits, I guess
which then leads to a
different
outcome
rather than focusing on that hard process, Um, stuff.
I'm more interested in
getting people that will stand up and say,
Oh, yeah,
I'll be a champion for you.
Hm.
And people do that. You know, women do that.
The men
in the East End will do that.
And once they understand
the issues,
I
will do that. So
it's important, um,
to make sure
with coproduction that
people don't come to do it because they want
to sort something out for themselves. So if you get, um, my friends used to say
all the monos,
then you'll get a particular type of thing.
So membership organisations like, well,
National Institute of Deaf People and National Deaf Children's Society
maybe 75% of their members are people for whom
something has gone wrong and they want to complain.
So we don't want all of those in our co-production.
Hey, yeah, You want some of them,
um, people that know that what, what can go wrong.
And sometimes
when you listen to mothers and you hear
the service that they get
during their pregnancy and during their delivery and straight after,
and they're really thankful for what they've got And you think, My God, dreadful,
you've got to actually be very careful in working with people that you don't.
You don't, um,
get them to regret what they've done,
but yeah, because it it's it's a difficult world out there.
And what people think is good
may not be,
um,
and that's and that's worrying for me.
Um,
I can't remember, but, you know, there may be
There may be parliamentary questions, but
may be a three quarters of a million people
are waiting for
an outpatient appointment for their eyes.
And what do you do with that number of people?
It's just It's amazing, isn't it?
So co-production
I must say something about that.
Um
hm.
Understanding the experience
of things.
Yes, understand? Yeah. And and and quite often they don't.
The people providing the service
don't understand. They don't walk in those shoes.
Um, they just see people shuffling in and out of their rooms,
and but they don't see it. Oh, yeah.
This is an elder person that's also being treated for cancer
and has,
um, a partner who's
needs other supports.
And, um
so I think that's quite hard.
Um, but if we had, if we had better co-production
of health services and I think it would
be much more efficient and much more effective,
do you think do you think then there's something around? Um,
a a more human experience for people
at
the heart of coproduction, then. Yeah. Absolutely.
Absolutely.
Yeah.
And and it's no more complicated than that. Really?
Yeah. I have a, um,
nephew who's got a rare genetic syndromes
in Gap one.
And he was there last week.
Is
he is, um, on the spectrum?
Not in this, but I would say,
Can't
stand. Anybody coming close
had to go to A&E.
I still we got to do lots of tests, but they couldn't actually get near him.
You wouldn't let them.
You think? Yeah. Nobody's actually taught.
How do we get for Reuben?
A service that any other kid that went in there
who hadn't been able to hold damn food for four days
would have been able to get?
Is it fair that
OK, you can't do those tests because this chap has autism?
No.
So you gotta think about you gotta think about these things.
I don't say you have to involve
everybody with every
spectrum,
but But you have to have people in the room.
I understand that
and can
and can advocate for them
to remind people
doing that. I Am I doing that right? No. Yeah, I am doing that right.
So I think
some of, um
is is about advocacy.
Um,
it is about understanding people's communication needs, um, letting them express
what they want.
Um,
I'm thinking, What
what reasonable adjustment can I make
to enable it to happen?
Sorry.
No, no, no. It's
no, no, it's fine.
But it just makes me think and and what I'm loving about doing
these interviews is the the kind of those moments for me as well That
it it's that uniqueness, isn't it of like, you want a more human approach.
But there isn't one way
to be more human about what you're doing.
So, um, yeah, we want a question there for
for
neuro diverse people
that will tell us exactly what their personal requirements are.
I say, yes. That's great. Yeah.
So how do we standardise that? And now
for this group in West Yorkshire and this group in East Sussex?
Yeah. Have they got similar needs? Do we have?
Do we have the same approach here as we do there?
It's it's it's quite difficult getting that
right between the personal
and the general
and yeah, that's
that's
last few days I've been, uh
yeah, I've just done a, uh, interviewing questionnaire with the Lancer.
They sent me a paper to review
from Oh, God, Japan.
They tested almost a million people
and then made huge generalisations from that.
Hm.
About a million people were all
from the clinic.
They were making generalisations about
Japan, Asia, the world.
And it only took me five minutes to reject the paper and say
they've got no idea what they're doing,
because it it just doesn't work.
I think it's that
it's that sort of, um,
ability to be able to
generalise what I do in Gloucestershire or London.
And so, yeah, that will also work in Belfast or in Glasgow or in Cardiff or in
Newcastle. That might be more of a challenge.
Um, where where are you based
at
Manchester,
Right that way.
OK?
Yeah,
yeah. And and that's that's
That's interesting. Isn't it again? Because then then you know
the challenge you often get back is that you're not involving enough people.
Well, a million is quite a big sample size.
Yeah, and
the editors view Oh, yeah, they They've done a good job, haven't they?
Yeah, but it's the wrong. It's the wrong group.
And so the same with co
pro is that Yeah, it should be involved people from all seven regions of England,
just so that we don't
get accused of not
involving enough areas.
So that's what we've had to do with our autism project
and go to two schools in each region
and understand what they do differently, which they do a lot differently.
Um,
and we've been doing We've been doing that with the cop
pro collector for U. C.
Um, it doesn't move very quickly, but it it it's it's moving.
But then there's something in that isn't there.
I mean, I think because there's there's this thing, isn't it?
We have to do everything at scale and pace.
But actually, if you can take time over it,
then
I think,
particularly at the beginning, you know, taking a bit of time
means that you move faster. Nicer?
Um,
yeah.
So,
um,
I think he is good.
It brings
diverse views together
and enables you to get a greater insight into
what actually needs to be
thought about and done.
Um,
but when you go to formalise, I think it is quite difficult to work with.
And
that's people, isn't it? I mean,
even me. An elderly retired person.
I can't find a gap in my diary till late September.
Um,
so some of that is my Yeah. I want to play table tennis. I want to,
um, go out to discussions in the Labour Party and at church,
and, um,
yeah, why not?
That's what retirement's for.
But when people said, But can you manage this co-production meeting?
No, I can't. But I've got one now.
It's just about to start, I think. Hold on.
Let me just look at my diary.
That's what I did with you. I I was to a working group a
u C.
I accepted. Apparently. Yeah. Yeah, at two o'clock.
Where am I? Um, I'm back with you there.
Yeah, So I've got to move on to my two o'clock co-production meeting.
That's great. I've got to move on to my two o'clock meeting as well, so I will stop the
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