Cerdic talks passionately about his experiences of coproduction in relation to Peer Workers in Camden and Islington, the highs and lows, and why it is of value. 

Yes. OK, then I'll just ask you to introduce yourself and, um, tell us a bit about an experience or experiences of coproduction that you've had no worries. So I am. I am a nurse consultant at the moment, working with Camdenton Foundation Trust

And I've been there about 78 years now. Um, and the experience uh, I wanted to tell you about was, um, the creation of the choice and control peer coaching team, which was done, uh, really solidly with, um, some really great, um, service users. I mean, they were much more than service users

They brought so much to the the programme itself and were real leaders and managers on the development of the programme. And I think, um, they were really core to it. So I guess just sort of thinking back to to what was involved

Um, so we we've done sort of consultation, sort of thinking about that kind of ladder of coproduction. We've done sort of consultation work with large group of primary care based service users. So people who use, um, mental services, but in primary care rather than in your secondary care hospitals and that kind of stuff and what came through really strongly were people were saying we want to be involved in the development of care and the not and the delivery as well and the design and we want to create programmes around stigma and we wanna just be involved in all parts of it as well

And so and peer working was one of the things that was really highlighted as wanted as well. And so when we came to, um the opportunity to create something as well we we kind of got a an amount of money, um from, uh, health education in England to just kind of do a very, quite a quite a quick pilot. It was like three or four months we had in order to to arrange it, um and then we followed that on after that that went in very quickly and we did that in quite a core produced way

But I think the real kind of gut to the programme came after that when it was picked up by the c c. G. In order to create a programme that involved meeting kind of personal health budgets for people who had long-term health conditions, particularly long-term mental health conditions as well

And so, um, we had a, um a kind of management team that had 22 people who live experience on that management team. And they were pretty much part of every decision. And it was a really positive experience, too, because, you know, the C C

G, in a way were really committed to co-production, but didn't necessarily have a lot of experience doing it. And so we had these 22 people on kind of every meeting, and they helped to create, um, a bid a grant funding bid. Charity bid

Um, that was successful, um, and helped to develop, like the the kind of in of the programme, including, Like, how we treated the clients, how we responded to them, the kind of language we used. Um, you know, every detail that was involved. And I think you know what What they really brought to the programme was just a real sensibility of what's this gonna be like when it's experienced at the other end? And so it was just, um yeah, they were just they were just really on point with everything, and they just thought of stuff that we hadn't really necessarily thought of or we just think, Oh, that's the usual process

But we didn't think How would that usual process be received at the other end? And that might be be as simple as, like, a kind of referral process. Or, um, you know how you greet people. And I guess they were also much more aware of some of the barriers to get in the way of people accessing as well

Um, so that was one side of it. The other thing is we had to train up a group of peer coaches in order to do this work as well. Um, and one of things I would just really remember about their involvement was they were really informally in the in the in the programme, particularly in the training

So rather than necessarily fronting the training, um, although they're kind of visible part of the team, they were also just in the background, kind of just checking the temperature of how it was going for people and what they thought was working or not working. And in a way, they brought a real kind of They just brought a realness to what was going on rather as deluded thinking everything was hunky dory when it wasn't they could really flag up problems really early. They were really tuned into things like benefits and some of the struggles people might have in trying to commit to work as well that, uh, you know, in some ways we kind of had this default of, like, we we'll give you go and get some advice and we'll facilitate

Are you getting advice? But we hadn't really thought through What are the realities for people trying to both kind of get out of the benefit system, but also stay safe and stay in a a situation that feels solid enough for them to, um as well. And I guess, Yeah, I mean, and in some ways, they're also really clear about, um, kind of standards expected as well. So they weren't like a soft touch either

You know, they had expectations of the peer coaches coming in to do things at a particular standard, and that actually shouldn't be compromised because I guess they really had their eye on what gets delivered at the end. So I think sometimes when we're we're working with peer workers, sometimes it can be sort of a bit patronising from US professionals and that we can be, like, you know, allow everything. But I think for our, uh, the two people on our management committee with live experience, they were very much like, you know, that person doesn't seem up for it

They don't They're not really managing. They're not getting this and so kind of worrying about that, looking at ways to really manage that in on that also, honour that per person's experience as well. So yeah, that that was some of what happened

I mean, what happened was the programme was great. I mean, it was just a really high quality programme that was just really embedded in a value system. That that I mean, it still runs the programme and it still holds that value system really strongly

Um, you know, I think where it became difficult around coproduction was, uh, around decision making and the limitations of decision making where it became like, this is the trust line of what decisions could be made jointly and which ones just sit with the most senior person who's employed by the trust. And in a way, you know, there was there was that part of it was really difficult, because what ended up was it felt like some decisions were unilaterally made, and in a way, they they were, but it felt like, um, there wasn't an easy way to untangle it. Um, but also, we hadn't spoken about it

So, you know, like I I think it became difficult around finances and, uh, accountability as well. Um, and I think we hadn't spent the time talking about it. So, you know, things fractured a bit towards the end of the programme as well

Um, the other thing that was really raised by them because we, you know, continue to have conversations after the end of that programme, which is really important, because in some ways, I think we both came away feeling a bit hurt and a bit like we had to lick our wounds a little bit and just go. I don't You know, that was hard. Um, but I guess we both came away with a kind of respect that we're still in trying to learn

You know, I think the fact we were both, um, you know, we were all there still going, OK, what did we do wrong And how could we do better? It was really important just to stay the course and not just go. Well, that's co-production. That didn't end well, you know, when actually so much good had come from it, it was quite sustainable

And I think, um I think also because what they brought was this sort of sensibility of, like, what was really authentically right for service users lent the s lent the service a real power of kind of doing things the right way. That meant that it just carried because it was a good quality service from the get go, uh, as well. One of the things that was really brought up that we didn't do so good was around just valuing the input of our lived experience kind of advisors managers throughout the programme and doing that really explicitly and kind of assuming that's understood

But I think when you're not necessarily in a paid position or the equivalent paid position, because I think ultimately, you you're not valued in the same way monetarily. Even if you're getting, you know, an amount paid per hour, it tends to be not really value your your sort of broad skill set as well. And so I think we didn't also spend the time going

Thanks. That was really amazing. And this is the impact of what you've done

And so I you know, I've really learned that I, you know, with co-production really need to do that quite explicitly, um, and regularly as well. And name that publicly to others rather than just kind of like, assuming that that's all understood as well. Um, yeah, yeah, that's that

That's a lot. There's there's there's so much in there. I mean, interesting, just what you were talking about there around, how how people's contribution was valued

Um, And it not just been about the money, but actually being valuing what they do bring and for who they are. And, um, and and working, you know, working more on that, um, I think, is something that a lot of people struggle with. Um yeah, and And I guess there's there's often quite different views on what's gonna be right for a person

So it's almost like having a really personalised approach to kind of valuing as well. And you know, often co-production money tends to be an afterthought. Rather than kind of like Central as well

And so often you're scrambling around and in a way it becomes a sort of strange tension around actually, you know, having people who are, like, equal on the team and yet not getting paid in an equal way. And so it becomes a bit like, Can I ask of this person again? Something Am I right to do that? And and in a way, I think it just makes the conversation really difficult around how how to to get it right. And yeah, so, I mean, that was it was really painful towards the end

But I think, you know, I think always since then is always naming those people as the programme develops and continues to develop that we name its history and say, you know, these people were involved at the beginning of developing this programme. Um, which also means that something about like, I think, often with co-production. Those histories aren't, uh, kind of honoured

And so it's like you're just sort of forgotten, and it's like you give and then you're forgotten and actually just to kind of continue to go Oh, you know, these two people, they are in the management committee. They helped create this as well. This is why this programme is so strong

Because they did set the tone for the programme as well and had a really high standard of expectation about how we should be and how decisions get made. It made things longer, but it also, you know, we had to just put in the time to come to to a good enough agreement. Um, as well, um wasn't always consensus, but, you know, I think it was It was good

It is good. Yeah, but we we can. I mean, consensus is one thing, isn't it? But actually, it it's that collective sense of doing things in a way that's better for people

I think that's often more important. Um, we we we can't get it right for everybody all of the time, so yeah, yeah, go on. You're gonna say something

Oh, I mean, I you know, I think the other thing, too. Um, yeah, I you know, I think tho, those those two people who were involved um I mean, we we had other bits of co-production where we had our kind of care plan co-produced with GPS and and a group of service users as well. And that also sort of continues on in a in a form as well

Um, I just there's something about like they just invested a lot of themselves in that and I think it takes, you know, it's really something to to go to an organisation that you've been both had good experiences and quite traumatised experience in and to come and be willing to enter into that or to relationships to that organisation with a positive head and go, we're gonna create something good and it's possible. Actually, that's a really hard thing to do, and I think we don't really name that very often. Um and it's actually quite an extraordinary thing to do because it takes quite a lot of resilience and so, you know, we assume vulnerability, but we don't assume resilience and that's that seems wrong

Somehow it doesn't seem and so I think that's one of the things I've really learnt from it. It going well and then not so well and then well again is that actually there's real resilience there and real com such commitment to the long-term change for the better within mental health services. And, um, that is gonna be the long game

So it's just Yeah, I feel really lucky to have worked. And and, you know, the other thing I guess they bought is right kind of an informality. Any humour that I think, you know, we can get so serious

And so there was just something about some irreverence and you're like, It's such a relief when you get people who have, like, you know, they can be silly and they can have fun And they can kind of name their own silliness because it gives us all permission to kind of just be ourselves and to be informal as well. So, you know, it's it was It's been a really positive experience overall, and one, that's yeah, that's a massive learning as well. So I I kind of like I now have the opportunity to kind of front load co-production and and I I do now, and in some ways I'm also watching some of the same people, also with other groups that are kind of I'm sort of involved

But I'm a bit more peripheral, and it's really interesting watching how how much is involved in just those conversations just to kind of come up with agreements, and it can take a long time, but people are really committed to it. Both professionals and people with lived experiences as well. So So, um, again, lot, Lots to kind of, um uh, explore in in that

But I'm I'm wondering what what are some of the things that you might sort of go to in your mind when you think about the impact of what you've done, not just on the people who, you know, were involved from that lived experience perspective. But maybe on some of the other people who work within the in the system and the difference that it made I mean, I think I mean, I just remember that the conversations with the C C. G, um, were great because, you know, there was a it was a particular programme because we worked in cooperation with the sort of department of the C C

G. So they would usually commission. But in this instance, because it was an early adopter programme, we kind of worked on it together

And, you know, we built such a strong relationship with that programme and the C C. G and I think so. Much of it was based on, you know, the many conversations we had about just really trying to get it right, labouring over a point till it was like, That's right, that's the right way to do it and right enough for us to continue on with

And I think, um so I think the impact I look look at them as well and think they became really committed to co-production through that process and they and I guess, real believers in, like the intelligence and the creativity and the worth of people who have experienced being central rather than kind of worrying that it's going to detract as well. Um, I mean, they they they were, like, completely on top of the the detail, you know, they weren't they weren't at all being carried by the programme. They were leading the programme and so um yeah, that I think I I think about those and I I'm just sort of thinking, um I mean, there's a few impacts, so there's the individuals who would be, um, then impacted by the programme and the way it's done

And so I think when you get an example of it really working. It's great because people go, Oh, that's inspiring. You know, How do you do it? You can also really sing the praises of Co-production

So there's that impact and there's the impact. When people are working with a client and that client gets a great treatment and they're like, Oh, you do it that way, that's great. We really love that

And you know, it just really sinks to people's values around how work gets done. It's really, um it's safe and, you know, it's I was gonna say trauma and reform, but it was kind of like predating the language of trauma reform. But, you know, it was, yeah, it It just really honours what people might need and what they need for safety and to be respected as well

And so I think they they really brought that that element to it as well. So the impacts are kind of in lots of different places and and in terms of people who now are supported through through that particular programme or through those um, services that have been impacted, the the experience is better now than it was before. Yeah, I mean, a couple of years after we started, we won a National award for positive practise, and, you know, that was a kind of moment of going Oh, yeah, that's that's that's really well done

And, you know, now there's I mean it. It led to a massive growth in peer working in our trust. Um, it's kind of those peer workers have gone on to work with other teams, and they bring a really autonomous sense of like, um that

And in a way, they they recognise the importance of co-production in terms of their own work as well. So I mean, they are peer workers, so they've got a particular perspective on it That's maybe stronger than other, um, professionals. But actually, yeah, it's it's It's just kind of normal as well, in terms of what's there And, um yeah, so I guess it just becomes a bit more of the culture of the organisation when those examples really work well and becomes a bit of a template for others to do to do that work as well

And you know, like often, organisations have a strong value system that's spoken about, but it's not always played out. So When you get something that strongly reflects a value set, it just has a certain momentum that others can get on board with as well. And And I guess it just really needs co-production in order to to be true to those values, because otherwise it it doesn't

It doesn't. It's not in alignment when you create, so it does. It wouldn't make sense otherwise

Yeah, yeah, no again. Lots. There's lots of things running through my through my mind

You you talked a bit about, um, some of the specifics you talked a little bit about language and the impact on on language and and how that's changed. Are there any any specific examples of of how that's that's worked and the difference it's made, I suppose maybe mostly for people, but, um, I mean, we really laboured over language, we say. So I mean, I think there's an informality to the language we use for, like the service information that's a bit still a bit unusual, like I've looked at some others at recent services and to think it just sounds a bit jargony and, like, you know, like real jargon busting down to the nth degree kind of feels really important as well

Um, so yeah, just sort of stripping away the the kind of medical terminology, um, as well. And making a bit more of a kind of personal statement. Or, you know, like you're speaking to somebody rather than here's a form for you as well

And, um, yeah, I guess also, um, I mean, it's sort of putting an emphasis on relationships rather than necessarily kind of gathering information and an assessment period as well. It's a bit more like we'll just get some basic stuff so we can get you in the door, and then let's have a conversation and see what's really important to you. So it's kind of like, um, yeah, just just trusting People kind of know what they need in a way, um, and and I I guess the thing about co-production as well is that those with lived experience were on the management team

I guess brought that confidence that people know what they need, and we just need to make it really easy for them to get in the door. Um, and then the rest will kind of look after itself to an extent. And so I think? I think, Yeah, I think if they're if they're in the room going, Yeah, we can

We can trust this. This is enough. And this would be comfortable enough then

I think we don't then get dominated by other agendas of, like, professional agendas of like, you have to have this specific information or that specific information. So it just feels like it's Yeah, it's just easier. It creates an easier path in it

It sounds a lot. It sounds like a much more kind of human approach to to working with people who are, in essence, humans. So yeah

Yeah, And when you when you mention relationships, then that that resonates quite a lot in terms of, you know, my experience of of what, You know. Good, good, good co-production if if you like, and that focus on the conditions rather than the tangible outputs. Yeah, I guess that's another thing

Just when you say that reminds me, the other thing I think they brought to bear was a real understanding of like the societal and environmental factors that affect somebody as well and just the harshness of, like the benefit system and how housing can be so difficult. And I think in some ways, you know, this was like three years ago, four years ago. Um, trying to get the time is moving

Um uh and you know, it's become much more popular now in a way, in primary care to think about those kind of factors. But I think they were really aware of them from the get go and kind of raised our notion of like actually these will be priorities for people and priorities for the workers who come in, too. So if you're looking at peer workers, how how can we? Sure they're OK

They're being looked after their well-being is looked after as well. And certainly that's another thing they brought was a kind of a a mentality of like looking after people's wellness throughout as well. And being aware of that and having the conversations and being upfront about it as well, rather than kind of just like ignoring that side of stuff as well

There's a certain irony when I hear you say that I guess in terms of here are people that you've brought to work alongside you who know how to look out for other people's wellness. It's It's handy, isn't it? When you're, uh yeah, in the wellness business. Really? Yeah, yeah, yeah

Um, and and then you you did mention some of the kind of difficulties that that you you you had, particularly in terms of decisions. Um, certain decisions not being able to be influenced. It felt very top down

Um, is that is that something that you think might change? Or do you have any thoughts about how, um you know where you go next with this? I guess I I mean, I think I mean, one of the things that we are doing is I mean, we we we've really developed our peer workforce. And so I think that's a really strong voice that can be a real bridge, um, to really understanding what it's like to be at the really kind of pointy end of things as well. Um, and so one of the things we're trying to do is just communicate across a kind of whole geography as well

So across north central London, and really have a sense of, like trying to have the conversations now so that we build a really strong infrastructure across the whole area for for peer workers, for instance. But I think the other thing, too that we've been talking about a lot lately, is kind of having like a co-production hub because, as I said, you know, like I've attended a lot of co-production events and they're great in themselves, But often they're like, disappear in the dust of time really quickly and yet have been really important and often a bit repetitious because we're talking about the same stuff often And you know, people are saying what they want again and again. And it's not that I think people then go away and ignore that

I think they then try and apply it, but they don't ever re reference it back again. And so there's something about like if we had a central place where we could put Co-production intelligence as gathered and who was involved in that into one place that we could then go on and search and go. I'm looking for, you know, urban Somali women who you know, experience of, you know, whatever of parenting

And then you can look up the various kind of domains and you can go OK, you know, two years ago, Somali women were asked about this. This is the group that were asked and you know, Then there's the potential to to go back to that group of women and go back Then you said this, you know, we we would like to use it for this purpose. Is this to still hold true? Um, this we're thinking this tells us this, you know, Can you elaborate or, you know, we can gather in lots of different bits of information and go, You know, the consensus is that we should be doing things in a particular way

So that's why we're designing it in this way. And we thank the people who have given their information beforehand. So I think just thinking about trying to join out with co-production and across social care, you know, NHS trust the voluntary sector

You know, I think there's so much good stuff happening and it just doesn't get joined up and doesn't get referred to again. And I I mean, I it it can I imagine it can Well, it feels a bit heartbreaking for me, and actually, you know, I think if you've been in this system, I think it must be even more heartbreaking. because it feels like you're repeating yourself again and again ask the same questions

It feels a bit disrespectful. So I'm I'm kind of keen for that. Yeah, and I think in terms of I feel like there's a greater acceptance that Co-production needs to happen

I think it's still a bit of lip certain. Well, I think there's a lot of lip servers still pay to co-production as a a thing. Yes, we all agree Co-production is good, but nobody's going OK

Well, let's allocate this portion of the budget to it. Or, you know, how do we support Co-production Instead? It's just something that we don't necessarily talk about, how to do it well and build the skill set and the the ability of people to copro produce. Because I also think, um, we've got amazing service users in our trust, and they're not given skills training opportunity in order to make best use of what they know as well

And so you know, I think, but my feeling is that I I feel like things like the Recovery College can play a big role in helping people, um, and trust as well and staff of trust to copro produce more and learn how to co produce more and and really reflect on what is good co-production as well. So that's that's a little bit. And I I I am gonna be changing jobs soon, and so I I believe that it will involve more of that opportunity

So I'm I'm kind of keen to to really push on that bunch of stuff. Yeah. Gosh, lots

Yeah. Sorry about that. I did warn you

Unpack it rather than bring it for concise. I I need I need grounding. No, no, it's fine

But this is what this is the beauty of being able to talk to people in this way because it it goes off in in in lots of different, um, directions. Um, I was gonna say the other thing. The other thing just to do that strikes me

Um, you know, I did work in, uh, Uganda. Um, around people work in development, and, you know, like I think what was really interesting about that? I mean, it's a big story of its own, but I think one thing that happened was that, you know, I shared I was learning about peer working at the time and I just shared papers that I had and information, and I was just talking it up because I was like, This is really interesting And they just picked it up and went, Oh, we're already doing this. But we can do more

And so they just kind of ran with it and they created their own peer working scheme and that took off. And then, you know, like they're now doing multi site research pieces around, You know, um, Uganda and peer working, which has been running several years now. And it's just like actually, it's given people the information that says this is what the latest is means

People aren't in this style of information going well, Just tell us about your lived experience and we're not gonna reference you to anything else. We're just gonna take this little bubble of information. It it just doesn't feel like we're really doing

We're really giving it every opportunity to allow that intelligence to flourish and for them to advise us in the context what we should be doing. Instead, it becomes like in this very small bubble of context, and I think it's it's not. I'm not sure it's doing it

Justice. Really? So, like, research input feels really lacking we And that was gonna be my probably hopefully finally question around, um, the impact in in terms of Canton and Islington, if you like, and the work that you've done. And I think you you you may have in part, illustrated this through the Uganda example

But do you think that that that proliferates out or do you think it It's really hard to get it beyond the boundaries and the constraints of the particular programme or area of work that it's been a been applied, Um, or do you think it's heard elsewhere? And people act on that? If you make any sense of that, you're doing really well. I'm trying. I'm trying because I'm I'm trying trying to Well, I guess I'm just trying to understand the question

So glad you said that, Um, I it's I suppose it's when when you said about the, um, example in Uganda, you gave them information and they went, Yeah, we're doing that. And they went off and did more of it. Yeah, you're doing that in in Camden

Islington, you know, and you talk about a specific programme are all the people then able to see that and go Oh, yeah, we're doing that. Or we'd like to do that and then just go off and do it Or does it stop within the constraints of Yeah, I I think it's an interesting one because I think if you are somebody who is kind of into co-production as a health professional, you kind of if you're waiting for a kind of invitation is never gonna come, So you kind of just got to get on with it, and that means you can be a bit of an outlier. And so I think I don't think staff are necessarily very empowered to kind of run with ideas in a co-produced way

I think they've probably got the commitment to it on a kind of values based and level. But I think I'm not sure they feel supported to really run with it and feel like I've got people supporting me to do this. I'm hoping to change

That really would be my my real hope as well. Um, so I think the proliferation happens through the delivery of really good quality work and kind of highlighting that, But I think it's kind of limited. It is to be insular

Um and I think the way to bring it out is through education and stuff like we've just done a co-production module that's gonna be mandatory for all stuff, just to kind of go. This is co-production. This is what good quality is

This is you know, these are something important bits like, you know, being curious. And, um, you know, and in terms of what it can offer, we also talk about that. So in some ways, I think it's like we we need to drip feed as well as kind of have programmes that we can really celebrate

But I guess what I think also trust, perhaps need to do is go out to people and go Where is the good coproduction happening and highlight and celebrate it and extend it so that we can really, um yeah, kind of honour that work and and make more of it happen, Really? Otherwise, I think staff feel like it's a bit of an extra that they probably feel it. It's all a bit relentless. I don't know if I have time or if it's worth it, or if it's professionally risky to do that

So, you know, we want to encourage the the go getters to go get them. Really? So and I I guess like I said, I think we also need to be treating those who are in service user involvement to be considered like employees in terms of skills, development and opportunity, so that they can also develop their range of ability to input into it and see the wider context as well. Yeah

No, that that makes that makes a lot of sense. Um, thank you. Is there anything else you want to add before I stop the recording? Yeah

I mean, I guess just the thing is, you know, at different points, I would have said, Oh, I hate co-production because it was It was It was really difficult when it went badly, you know? And I think, um, being able to, you know, maybe the other thing trust can do is to really make space to reflect on co-production in a kind of non sanitised way and kind of accept mistakes and what we get wrong with a kind of like a a generosity of spirit and a bit of a kind of a a learning framework because it just feels a bit like, you know, it feels like you failed when you get it wrong, because it's like like it's value based. And so if you get it wrong, you're like, Oh, I'm no good at CO-PRODUCTION or I You know, I'm not a good nurse or I'm not whatever. So I guess something about, um, just really building in a sensibility within the trust to make co-production a learning exercise that we'll get wrong and learn from, and that we take that learning and go, OK, this is what I take from and it's OK to get it wrong because that's also part of the process

Um, and then maybe we can come back a bit quicker around that circle of doing it again and maybe the Q y kind of stuff. The quality improvement stuff can help with that, because it kind of it. It does that, too, and holds the frame for mistakes that happen and to be to be OK, um, as well, so so stopping and pausing and reflecting and thinking about actually what has gone well, what hasn't gone well, how can we do this better and actually building that in to to what you're doing? Yeah

Could make quite a big difference. Yeah, absolutely. And almost like, um, yeah

Just making that kind of requirement of of co-production is to to do the reflection so that we were learning as we're going and sharing it with others as well without fear that we failed. Yeah. Excellent

Thank you. I'm gonna I'm gonna stop this before I say.

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