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Tokenism to Co-production: what's the difference?

I've been meaning to post this manifesto on the blog for quite a while, and here it finally is! The exerpt below is from Ruth Marsden, who was standing for the role of National Director of Patient Insight with the NHS Commissioning Board. I've included her full manifesto, which I think it a helpful reminder of what the difference between tokenistic engagement and genuine co-production is.

 

Manifesto for the post of National Director of Patient Insight with the NHS Commissioning Board


The principles that will guide me if appointed:
• I will press for power to be given to communities in all decisions about the
commissioning of health services – for local, specialist and national services.
• I will not align myself with the disingenuous euphemisms of government which
claim to be putting patients at the ‘heart of’, ‘centre of’ and in the ‘driving seat
of’ of services. I am in support of real power and influence for patients, carers
and the public in the commissioning of services.
• I will challenge the empty ritual of participation. I support communities having
the real clout needed to affect the outcome of all commissioning processes in
health care.
• I am against participation without redistribution of power and the similar empty
and frustrating processes currently promoted by the government in the name
of public participation.
• I believe that public participation in commissioning decisions must be about
real influence, not a series of exercises dressed-up as 'participation in the
process' and 'citizen consultation'.
• I espouse citizen control to empower communities to have genuine influence
in the configuration and accessibility of their local services.
• I will work to embed pro-active measures to include those presently excluded
from the political and economic processes in relation to the commissioning of
health care.
• I will promote the inclusion of all communities in commissioning through a
strategy of information sharing, and the shared determination of
commissioning goals and policies.
• I will press for shared decision-making in relation to the allocation of NHS
resources and contracts.
• I will exert active and determined pressure to persuade the ‘power holders' –
the NHSCB and the CCGs, to promote diversity and inclusion of all
communities and to oppose paternalism, and resistance to power
redistribution.
• I will fight for the development of representative and accountable Local
Healthwatch organisations, in the face of alienation, distrust and conflict of
interest which the government’s current model for LHW presents.
• I will oppose attempts by the CCGs to co-opt and ‘use’ patients, e.g. utilizing
their special skills and insights but denying them real power in decision
making.

If appointed to the post of National Director of Patient Insight
with the NHS Commissioning Board I will specifically:
1) Promote citizen participation – but eschew the disempowering
approaches in which people are placed on ‘rubberstamp’ advisory
committees or admitted to advisory boards for the express purpose of
"educating" them or engineering their support.
2) Support genuine citizen participation, and oppose the distortion of
participation into a mere public relations vehicle - information-gathering,
and ‘letterheads’ - trotted out at appropriate times to legitimise service
commissioning that benefits the commissioners at the expense of the
public they serve.
3) Oppose the establishment of bodies that pretend that the "grassroots"
are involved in commissioning, in order to tick boxes for the NHSCB and
local Health and Wellbeing Boards.
4) Expose the sham of involvement in commissioning that causes deep-
seated exasperation and hostility toward the ‘powerholders’. Ensure that
resources are made available to local people to enable them fully to
participate in complex decision making in relation to the investment of the
heath budget in local services, e.g. access to technical expertise, to
adequate expenses, to advisors and other support mechanisms.
5) Ensure that mechanisms are in place to inform citizens of their legal
rights to participate, engage and influence, and the options available to
achieve genuine and legitimate citizen participation. Direct resources to
enable citizens to articulate their priorities alongside the increasingly
sophisticated commissioning organisations.
6) Oppose the tradition of sham/token participation that gives people
information about commissioning decisions at a late stage in planning,
resulting in them having little opportunity to influence the commissioning
processes said to be designed "for their benefit” - e.g. patronage, one-way
communication, superficial information, discouraging questions, irrelevant
answers , bland or obscure information, lack of feedback, absence of
outcomes.
7) Oppose the use of sham local and national public consultations that are
clearly decided in advance, and which are not open to any real participation
and the enduring engagement of the public. I support participation in
decisions not ‘participation in participation’.
8) Oppose the increasing use of eternal simplistic, deterministic surveys of
patient attitude and satisfaction that diminish public participation and
patronise and limit service users.
9) Support the development of commissioning bodies (CCGs) which are
elected by and accountable to local people and which have 50% lay
membership. I will oppose the increasing use of the placement of a few
hand-picked "token" people on Boards and GP practice groups.
10) Support citizen engagement and involvement that includes genuine
parity of influence and has a significant impact on the comprehensive
planning of services and where local people have direct, shared
responsibility with clinicians and planners for commissioning plans and
their outcomes.
11) Support the redistribution of power in commissioning through genuine
negotiation between accountable citizens and accountable powerholders –
the CCGs and the NHSCB. This will mean sharing planning and decision-
making responsibilities through structures such as joint (50:50 citizens and
professionals) policy boards, planning committees and mechanisms for
resolving impasses.
12) Support people locally, regionally and nationally having power and
control which guarantees they share in the leadership and governance of
the development of commissioning plans.

Ruth Marsden,
Vice Chair, NALM

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