A short film with Living Well volunteers and elderly discussing their personal highlights.
Coproduction lies at the heart of the Living Well programme. In Living Well the aim is to firmly position volunteers as integral to the coproduction of care for older people. In practice this is about volunteers having the power to: 1) shape how volunteers are trained and deployed; and, 2) be part of healthcare delivery through their involvement in the decision-making for their elderly clients.
To achieve these twin aims the Volunteers in Communities (VIC) team have produced this qualitative review of the coproduction of care model in the Living Well programme. This paper examines coproduction from two perspectives. Firstly the paper reviews the current spaces for coproduction in Living Well. Secondly it reviews the challenges and opportunities for delivering alternative models of coproduction. The paper concludes by making recommendations about how coproduction can be better delivered through Living Well.
1. Living Well recruitment and training should emphasise the maxim ‘medically aware, not medically trained’; emphasising the importance of risk identification, not necessarily action, and the process of how to escalate an issue.
2. Integration of volunteers into MDT should be trialled and reviewed and the lessons learnt embedded in the current Living Well areas before scaling up to a Cornwall-wide policy. The trials should happen at MDT where the GP chair is ‘on board’ with the coproduction model and, crucially, the meeting structure arranged to be accommodating for non-medical experts. If the trial is deemed successful an MDT protocol should be developed to guide MDT chairs in how to integrate volunteers without breaching confidentially.
3. Delivering the co-production model necessitates a change in approaches to volunteer management and deployment. The integration of volunteers into MDT will not suffice alone to deliver the co-production model. Lessons learned so far indicate the importance of: i) regular peer support opportunities for volunteers; ii) a system for non-medical referrals; iii) communication of ‘success stories’ back to volunteers.
4. Trial the attendance of medical staff to Living Well volunteer meetings; both formal and informal types. Review benefits of approach.
We presented our Co-production of Care in Living Well Report to West Cornwall’s Living Well Board in January (2016). In the spirit of coproduction the aim was to gather their professional feedback on our report and its recommendations. To try and gather partners thoughts in a fun way we asked Creative Data to transform the report into some engaging cards. The feedback we obtained is currently being used to update and improve the original report.
The final question we asked the Board was “how will you achieve coproduction in light of these recommendations?”
The responses were inspiring!
“By involving as many interested parties as possible” Age UK Cornwall
“More volunteer support” Kernow Clinical Commissioning Group
“Get feedback from volunteers as to what works well for them” GP
“Need to attend a volunteer meetings to hear views, concerns, successes and good news” GP
“Try and meet some of the volunteers working in our practice area” GP
“Be engaged to create, develop and deliver services” Volunteer Cornwall
“Acceptance and appreciation of a volunteer’s role and responsibility” Peninsula Community Health
“Constant and flexible management for volunteers across county” Age UK Cornwall
At the end of last year, Cornwall Voluntary Sector Forum held the ‘Brave New World’ conference on the topic “How do we ‘future proof’ the VCSE for the challenges ahead?”. A range of presentations, sessions and workshops focused on the issues, and potential solutions, facing the VCSE sector. Professor Catherine Leyshon, co-lead of the Volunteers in Communities team, presented on the topic of volunteer training, organisation, and retention. In Catherine’s presentation she discussed the transformational potential of working with volunteers, the usefulness of co-production in unleashing this potential, and the importance of an equal partnership between services; “so that the whole becomes more than the sum of its parts”. You can view the presentation slides below, please cite appropriately though if you use these ideas in your work.
Workshop Discussions: If they build it will you come?
After lunch (thanks VSF for a great spread!) four Open Space Sessions were run. We, the Volunteers in Communities team, ran a workshop titled ‘If they build it, will you come? Enabling volunteers in communities’. Our workshop was attended by seven representatives from Volunteer Cornwall, British Red Cross, Cornwall Rural Community Charity, Young People Cornwall, St Johns Ambulance inter alia. Based on our recent research (see our reports page) we structured the exercise around four key factors that encourage ‘enabled volunteers’: 1) competencies and know-how; 2) materials and infrastructure; 3) messages and images; 4) faithful carriers. Predictably, as human geographers, we brought some brightly coloured posters as the method to capture participants comments. In particular how they thought they could improve volunteer training, organisation, and retention under the four themes. Below, we discuss the key themes participants discussed in this exercise.
Competencies and Know-How: There were three key points which emerged on this theme. First was the importance of good volunteer management. Participants explained that a ‘guided conversation’ with new volunteers was crucial. It was agreed that this should be initiated immediately in order to channel volunteers energy effectively from the beginning. By doing this, it was possible to find out what a volunteer is interested in and what skills they have to offer. Andy Brelsford (Volunteer Cornwall) emphasised how as mangers “it was important to encourage volunteers to reflect on their competencies”. This leads to the second key point, which is that a volunteer’s skills should then be matched to the needs and requirements of an organisation; if they are not then the volunteer should be ‘passed on’ a more appropriate organisation. Thirdly, and finally, it is expected that a volunteer will gain and build upon their existing experience and skills as they embark upon the role. As such getting volunteers to reflect on their own learning through the process is important. This is because if a sense of self-worth and personal achievement is enjoyed by a volunteer then they are more likely to continue.
Materials and Infrastructure: Participant discussions around materials and infrastructure revolved around three categories: physical restraints, the size of the organisation, and organisational procedures. Firstly, Cornwall’s population is widely dispersed. One participant discussed how they had encountered difficulties with meetings for staff training due to poor bus links and, when attempting a video call, problems with technology. The second point was the barrier, to enabled volunteers, of an organisation’s own capacity to take on and integrate fresh ideas and ways of working from the volunteers. While a co-productive approach might generate fantastic ideas an organisation has only so much capacity to deliver. The third, and main point, discussed was organisation procedures. The enabling factors, and barriers, discussed included things such as; a good volunteer induction process, quarterly volunteer meetings, individual feedback, and clarity in volunteer role descriptions. There was also a conversation about having a volunteer representative on the board of trustees, but it questioned by others as being too difficult to achieve in practice.
Messages and Images: Discussion around messages and images focused on the importance of maintaining positive communication between managers and volunteers. Participants explained how this can be done through communicating an organisations appreciation for volunteer’s achievements through volunteer awards, everyday feedback, or gaining their views and opinions about their management with volunteering surveys and exit questionnaires. Other successful methods of communication mentioned included handbooks, newsletters, workshops, regular conversations, and/or social events.
Faithful Carriers: There may be some volunteers who show particular keenness and energy; these are what the Volunteers in Communities team call ‘faithful carriers’. All participants recognised the importance of immediately harnessing the skills and enthusiasm of these faithful carriers. To do this, firstly, recognition is vital. It would be easy to miss these people. However, it was agreed that the ‘guided conversation’ is the best way to determine a volunteer’s skills and competencies. So, recognition is the first step. The second, our participants suggested, may be personal development. Guidance through coaching, council, volunteer buddies, and speakers can provide motivation and play a role in enabling volunteers to be their best in the time they volunteer, as it is likely that they may “fizzle out”, as one participant put it, with time. A darker side of faithful carriers was also discussed. This is the issue of ‘volunteer hierarchy’. A number of participants explained how hierarchies of power can build within a volunteer cohort. It was explained that these hierarchies were built on a number of factors, including; length of time volunteered, their skills, previous employment statuses, relationships with other staff, and familiarity and access to buildings. Participants saw this hierarchy and the process of power as a barrier to some volunteers reaching their potential.
To bring the workshop together we asked participants to write down the key ‘take home’ point from the exercise onto a post card. The aim was to ensure that the learning and shared ‘best practice’ from this workshop lasted longer than the session. To achieve this we the posted the post cards back to the participants place of work. We hope that this enabled the key points and learning to stick; in turn making a small step forward in ‘future proofing’ the voluntary sector. This considered, it’s definitely worth listing these ‘take home’ points:
“I found out that volunteers are not often spoken to about their aspirations and expectation. Because of this I will create an interactive session to find out more about our volunteers” Young People Cornwall
“I found that the Volunteers in Communities team research reflects the identified development needs in the VSCE Strategy and my organisation. Because of this I will explore the research as an evidence base and progress with planned developments” A R Consultancy
“I found out that volunteer competencies and aspirations need to be recognised in order to improve matching their skills with our roles in order to retain them. Because of this I will include new questions in our interview process and review existing volunteers to identify our faithful carriers” St Johns Ambulance
“I will introduce a volunteer development plan for each and every volunteer” Volunteer Cornwall
“I found out that co-production should be more that a word. I will reflect on my own practice with volunteers and speak to management about structures” Cornwall Rural Community Council
“I learned today that volunteers should be asked about their skills and experience at the interview. Also that we should participate in learning and training with other organisations” British Red Cross
“I found out about the University of Exeter Volunteers in Communities project, I will look at the their website and share their ideas” Cornwall Rural Community Council
As I continue my dissertation research, I will be continuing this series of blogs on co-production to discuss my findings. Following on from my previous post, ‘What is Co-Production?’, this entry is all about the opportunities that co-production presents to the healthcare sector. My literature review revealed some interesting points which are particularly relevant to elderly care and Living Well. Firstly, a lot of research has found co-production to improve the quality and efficiency of services. More specifically, though, there are studies to suggest that co-production is better able to deal with recent challenges in the area of healthcare, as well as being really beneficial for vulnerable groups.
This increase in quality and efficiency is largely down to the recognition of individuals’ voices and knowledge. This means that services can be much better tailored to each person. Whilst the user is encouraged to participate in the production of services, and their individual experiences, thoughts and knowledge are taken into account, they are not the only ones who participate in co-production. The unique, valuable experience of frontline professionals is also acknowledged, therefore frontline staff have more freedom to act as they believe to be most beneficial in each different circumstance. This overall contribution of previously unrecognised knowledge has been found to lead to better quality services than in the traditional context of more rigid, ‘one-size-fits-all’ service delivery.
Whilst the 19th century population suffered with infectious disease, we now face problems associated more with lifestyle and chronic disease. As well as this, life expectancy has increased so there are more and more elderly people relying heavily on social and health care services. The sustainability of this is a key issue; the NHS and government-provided health and social care services are lacking resources and funding. But, the increased quality of healthcare provision achieved through co-production provides a more sustainable option, not just economically but socially, too. Due to the complex, social causes of these issues, we must approach them with solutions that are equally socially oriented, as opposed to treating medical complaints as mere physical abnormalities. Co-production is more likely to delve into, recognise, and holistically address the wider needs of patients, and therefore provides one solution to new healthcare problems.
Closely related to this, is the opportunity for co-production to improve the efficiency of services for more vulnerable members of society. Under conventional forms of healthcare delivery, citizens become reliant on doctors and other healthcare professionals. Health and social care are treated as two separate realms. Medical treatment could almost be seen as superficial, as their social needs may be overlooked. They are likely to return for medical help again and again. But, if co-production is utilised effectively, there are likely to be increases in feelings of self-efficacy and the development of trust networks. Living Well’s focus on using volunteers and co-ordinators to reintegrate elderly members of the community who may have become lonely, isolated, or lacking in confidence, has been shown to have massive benefits. They are not just happier with greater feelings of wellbeing; they are better able to manage their conditions by themselves and/or with the help of their social networks, avoiding the need for hospital treatment and GP visits.
So, co-production in healthcare is a particularly useful method of improving services, addressing recent health challenges, and providing a service that works on a deeper, less superficial level for vulnerable groups. The value of co-production is widely visible, but it would be wrong to assume that this all happens smoothly, without encountering any obstacles. My next post, then, will address the barriers that have been identified and any methods of overcoming them.