Value of Copro - Adrian shares his understanding of coproduction and why it works

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