If you are a bit like me, you've certainly been wondering about the root cause that created our present problems of austerity, spiralling costs in health and social care, compassion crisis, burnout of professionals, neglected epidemic of chronic disease, dramatic rise in depression, and so on?
Even more importantly, what is a new level of thinking that could address the present turmoils, across all public services and allow us to feel hopeful and inspired when thinking of the future of our health and wellbeing?
Rather than pointlessly restructuring public services within each silo, what could a truly transformative perspective do for public service development? What would this mean for service users, professionals and traditional organisations?
There is no doubt that co-production is central to the future of public services. The good news is that we are doing some of it already as Kim McManus, Director of Public Health at Hertfordshire County Council recognises when he promotes co-production on a major scale.
However, I also agree with him that we have not been doing it as well and as effectively as we could.
What is co-production and how can it be achieved?
Co-production is happening whenever we co-design, co-implement, and co-evaluate public health and welfare interventions.
The New Economics Foundation defines co-production as "delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change". In the context of researching and delivering effective public health interventions, we would also add academic researchers to this equal and reciprocal relationship.
A key element of co-produced social welfare and health services is that the knowledge and experience of users are just as important as the professional knowledge and research-based evidence.
What if we challenged the traditional ethos of public services being 'done to' passive recipients...?
I suggest 3 key barriers to promote co-production are:
1. Small number of public service professionals capable and willing to question their professional identities.
2. The resistance of the system to truly empower users and user-led initiatives and organisations
3. The lack of know how in measuring and accounting for the value of the co-production approach.
The common view has been that service quality is guaranteed by the training and expertise of professionals. Public service co-production especially in the health service thus still remains a rather rare plant in the UK public sector.
Regarding successful co-production of welfare services, research by Johan Vamstad (2) shows that twenty-five years of co-producing childcare in Sweden has resulted in better service quality, both from a user/parent and staff perspective. This experience is yet to be applied in the structuring and wider provision of welfare services across other areas.
Professor Victor Pestoff (3) has an interdisciplinary focus that makes a unique contribution to the body of knowledge in this field, at the cross-roads of a number of disciplines - including business administration, policy studies, political science, public management, sociology, third sector studies, etc.
How can mindfulness practices improve the quality of co-production?
Practising mindfulness will allow the professional to be present to the patient as a whole person and receive him/her with compassion. When the patient feels seen and heard, his/her potential can unfold naturally. With the support of the health professional, health can be co-produced in an empowering and sustainable way.
Mindfulness makes us as service users feel more connected to ourselves, to our body sensations, and by feeling more connected within we connect with others more freely. Becoming more transparent and honest with ourselves has the wonderful side effect of becoming more visible and open to others.
The practice of mindfulness in my work in a busy dementia service has given me access to a more refined perception of my internal and external processes and helps me to notice and accept what I feel without needing to judge or fix it. Just giving myself permission to pause and connect to my breath creates enough space to align with the subtle information of that very moment. Out of an inner space of gratitude for having received this subtle information, emerges a coherent response which makes me feel whole. I feel I can intentionally move from inner chaos to coherence which is invaluable in my work. I no longer feel lost in a bubble of chaotic thoughts and emotions but feel empowered by using my senses to see more of reality and being able to hold space for myself and others with compassion.
At a recent session of the All-Party Parliamentary Group (APPG) in the House of Commons which focused on mindfulness and its potential applications in health and education, all 5 panelists stressed that mindfulness training should be part of the training of every health professional.
"The practice will fundamentally change peoples perspective on life as it naturally opens hearts to greater compassion and develops the desire to end the suffering of others.
We need not fear that mindfulness might become only a means and not an end because in mindfulness the means and the end are the same thing. There is no way to happiness; happiness is the way." (Thich Nhat Hanh)
Thus, we need not fear that mindfulness is the next sugar pill that lets us ignore social and health inequalities. Practised correctly, it opens us to compassion and engaged collective action to end unnecessary suffering caused by the obsolete social structures and processes at the root of those inequalities.
In the first 2 weeks of June, we are lucky to have 2 experienced Mindfulness teachers, Dr. Joel & Michelle Levey, Founders of Wisdom at Work with us in London. Over the past thirty plus years their programmes on Meditation and Medicine have inspired a diverse audience of thousands of physicians, researchers, nurses, pharmacists, and other health caring professionals from dozens of leading medical centres and schools to integrate mindfulness and contemplative practices into their work in integral/blended mindbody medicine.
If you want to learn more about their work and decide to make mindfulness part of your life and work you can find more information here
(1) 1 Boyle, D., Slay, J., Stephens, L. (2010). Public Services Inside Out. London: nef/NESTA
(2), (3) http://www.govint.org/our-services/co-production/