The origins of West London Collaborative as a social enterprise dates back to 2013. It was recognised then that service user involvement at West London Mental Health NHS Trust was not working because of a lack of dedicated funding, fragmented organisation and an adversarial 'them and us' culture. Over a period of 18 months the Trust’s board, service users and carers agreed coproduction was the future and an open community meeting voted in favour of forming an independent social enterprise – more specifically a Community Interest Company or CIC limited by shares. As well as the important work we do with West London Mental Health Trust we began to work with other community organisations and providers across London to help them embed coproduction in their service design and delivery.
Highly Commended in Quality Improvement Category - #MHAwards18
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
The origins of West London Collaborative as a social enterprise dates back to 2013. It was recognised then that service user involvement at West London Mental Health NHS Trust was not working because of a lack of dedicated funding, fragmented organisation and an adversarial ‘them and us’ culture. Over a period of 18 months the Trust’s board, service users and carers agreed coproduction was the future and an open community meeting voted in favour of forming an independent social enterprise – more specifically a Community Interest Company or CIC limited by shares. As well as the important work we do with West London Mental Health Trust we began to work with other community organisations and providers across London to help them embed coproduction in their service design and delivery. As we attracted more partners outside of NWL London, we rebranded as We Coproduce. In 2016 we were invited by the head of local services at West London Mental Health NHS trust to work with her team on the transformation of local services. We have been collaborating beautifully ever since.
What makes your service stand out from others? Please provide an example of this.
Research has demonstrated the benefits of coproduction. Participants living with mental health issues have gained a greater sense of belonging, improved their connections with local groups and strengthened their relationships with peers, family and friends. In one case 90 per cent of participants reported reduced isolation. Participants also said they experienced less stigma from mental health professionals and the wider community. Coproduction also improved their skills and access to education and made them more employable. At a time of increasing financial pressures, coproduction can make services more effective and increase capacity to deliver. This in turn improves staff morale, building a happier workforce who are more likely to be retained, creating consistent care and so improving patient and carer experience. We do not agree that coproduction is about one off coproduction events where people are asked what they think and never hear back – we believe in building genuine partnerships where power is shared from the point of naming the issue to delivering the solution. We use Nesta’s 6 principles of coproduction because authentic co-production enables us to achieve more together. We Coproduce runs a number of workshops throughout the year to help local people and professionals explore the differences between co-production and user involvement and to begin to understand the impact this way of working together has on everyone. We work constructively to solve problems together, we use local people, the arts and – we don’t speak NHS.
How do you ensure an effective, safe, compassionate and sustainable workforce?
We work in partnership with people from across the community, we believe that all people have assets and gifts that they may want to share with the wider community – and if they do, we ask them to share them with us as collaborators. Sometimes people collaborate by volunteering, other times they are paid as part of permitted work and we pay people the market rate for the jobs we ask them to do. We offer training and support – with paid for opportunities with The Centre for Patient Leadership and The Kings Fund. We have employed over 20 local people with long term conditions or who care for others, some have gone on to work and some to other voluntary work. Our board has had front line staff, carers forensic patients, OT’s, and we support everyone to thrive. Without our community of collaborators we could not exist.
Who is in your team?
Jane McGrath – CE0 – We Coproduce Emer O Neil – Project Support Bea Devlin – Project Support Ivan Moore – community member 100 local people!! 30 front line staff
How do you work with the wider system?
We Coproduce works as a social consultancy. We provide consultancy services for organisations that want to work in genuine partnership with their wider community – not just patient leaders. We do this by working with collaborators, utilising ALL of their assets, not just their lived experience of health and social care organisations. We recognise the whole person – their history and colourful lives. People who have amazing gifts and stories to share and want to change things for the better. Our collaborators include, mothers, journalists, storytellers, photographers, film-makers, survivors, refugees, poets, call centre workers, airline pilots, writers, risk assessors, teachers, postmen, polygots, musicians, actors and more – a wealth of talent. Being curious We are curious about the problems organisations are trying to solve.
When presented with a ‘problem’ we investigate with our collaborators and if necessary we reimagine it until we are sure it’s the right one. We believe that local people will always have the answers to the problems that their communities face and collectively will be best placed to solve them. Data innovation and technology We are curious about data. Particularly its reliability. We are hopeful about the potential for innovation in the design of SMART data collection technology in health and social care settings. We wonder what is signal and what is noise and how can we use good data to create SMART communities. Dreaming our way out of stuck We want people to dream big, to re-imagine community and its pivotal role in health & wellbeing and social care. We are curious why with all the investment into transformation plans and strategies and in the provision of voluntary care services, so many people are unable to thrive. We believe its because the system is broken and stuck – but we also beleive that we can dream our way out of stuck if we dare to. Solving problems, not just finding them Because we explore peoples lived experience of using the institutions, systems and services that were designed to care for them it’s very easy to pick fault and find problems.
The difficulty facing those tasked with making things work is finding solutions that work. In the 21st century, with old infrastructure, limited investment and growing populations this has been a challenge. But a problem shared is a problem halved. Our collaborators could be in full-time work or unemployed, they may be getting older, have dementia or have been recently diagnosed with a life changing condition. They may have just got out of prison. They may have just had their first baby or be looking after their elderly parents. But they will know the local area and it’s issues, live in the community and will have used services or actively avoided them. They have the skills and expertise needed to work in partnership with professionals to find solutions. Creating new spaces and experiences To find those solutions, we create new community spaces that try to empower all those that pass through them by speaking in many voices and seeing with a kaleidoscope lens. To achieve that we work with artists, musicians, technologists, philosophers, disrupters and dreamers using tools that include poetry, film, comedy, drumming and debate. We do this because most people don’t want to or can’t sit in a board room during working hours – if you keep doing the same thing you get the same results. *As a CIC our profits are invested back to support people and communities to thrive. Reducing unnecessary reliance on the very institutions, systems and services we work to improve.
Do you use co-production approaches?
“Never doubt that a small group of thoughtful, committed citizens can change the world – indeed, it’s the only thing that ever has” Margaret Mead We are commissioned to work with local communities to coproduce better and braver solutions to their health and social care challenges – and we invest all of our profits into building resilient communities. Our national network of collaborators use authentic coproduction and radical disruptive innovation techniques to challenge systems that are not working. By creating genuine and equal partnerships with senior management, boards, policy consultants, academics and front line staff we build hope, we dream outside of what is…to a future of what could be. To do this effectively we use the arts, interactive technology and social media to facilitate democratic spaces for local people to collectively reimagine local health and social care outcomes. We believe in communicating in language that people respond to, be that spoken word poetry, stand-up comedy or tweeting – because most people don’t speak NHS.
Do you share your work with others? If so, please tell us how.
We love Nesta’s vision for SMART cities, ones where the people in them collaborate and support each other using collaborative technologies with open data and open platforms and there is investment in smart people – as well as smart technology*. (Nesta 2015) for that reason we share what we learn via Creative Commons. We recently shared graphics that we coproduced with the service users and staff at SLAM. We have spoken about our work in rural India, New Zealand, Australia, various cities in Europe and across the UK. We recently opened the conference for Nesta ( May 2018) People Powered Health. We have been featured on Radio 4 All in the Mind , Soho Radio and on TV’s on London Live. We have been featured by NHS Horizons – The Edge and published a blog ‘Coproduction an inconvenient truth’ for the Kings Fund – with one for Nesta due any day. We have been featured as a case study on coproduction by ImROC. Every year we host the new Darzi fellows as a demonstration site of excellent coproduction practice. You can tell we are proud of our work and love working with our partners!
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
We set out our measurement tools when we begin specific projects. Often these are around culture change and process and the NHS provider will measure the hard outcomes that the project seeks to achieve – as we don’t deliver services we don’t measure them. However, in our work on local services transformation ” 24 Hours in A& E” the head of local services was able to identify a significant financial saving by providing a recovery house and changing the places of safety that patients were returned to. Inpatients beds cost £417 per night vs Recovery House at £144. Liaison Psychiatrist intervention cost £460 and the Crisis Cafe less than £200. This was coproduced with the community. We use a PDSA cycle to review and improve – this was developed in collaboration with NWL CLAHRC.
Has your service been evaluated (by peer or academic review)?
However, this is what people say Thank you so much for all the trouble you took to arrange such a full, varied and very interesting day for and Helen and I yesterday. I learnt so much about what is possible when a group of people who want to influence NHS services get organised and start knocking on the right doors seeking genuine partnership. The extent and range of the influence of WLC is truly impressive. – David McNally, Head of Experience of Care, NHS England Jane and the team are leading some of the most interesting and impactful co-production work in the country. I told her about your presentation last Friday in Jönköping and I hope you might send her a copy of your slides. – Helen Bevan, Chief Transformation Officer NHS Horizons I was so pleased that I managed to get back to The Lyric on the night of your party. I found it truly inspiring and very moving and really want to hang onto the things that so affected me. In fact beginning to attend your forums has given me a hope for the future in general and a realization that my experiences and feelings are valid and that I am not wrong all of the time.
The power in the words and delivery of those performance poets really spoke to me. – local service user Many thanks for inviting me last week – I found it mind-blowing (in the best of ways) and has completely changed my approach to my new role and made me re-think how NWL should approach the health and wellbeing strategy. – Thirza Sawtell. Director of Strategy & Transformation at NHS NWL Collaboration of CCGs (2012-2015.) Greetings WLC. Worldwide we are witnessing distrust of government, of officials, of experts. Coproduction is the way to build a world where each and every one of us can define himself or herself as a contributor, as an asset, as a builder, as a stakeholder and a shareholder. Native Americans have a saying, “We did not inherit the world from our ancestors. We borrowed it from our descendants.” Through coproduction you now lead the way in honouring that trust owed to our children and their children. Thank you for what you do and what you stand for. – Edgar S Cahn, distinguished American legal professor, former counsel and speechwriter to Robert F Kennedy. We have just put in a bid with Kings College Prof Glen Roberts to have our work formally evaluated. Small grass roots organisations cannot always evaluate in the way that is required – but that doesn’t mean we aren’t doing great things.
How will you ensure that your service continues to deliver good mental health care?
We see things a little differently Our team is built of people who have lived experience of health and social care systems, either themselves or as carers. We also have amazing gifts and talents as well as professional expertise. Our shared gift is that we are brave enough to dream of a better, fairer world. While we are small and sweet – we have collaborators across the globe and networks that can find solutions you may never have imagined. We use our network to create a kaleidoscope and we shift the lens to see the world in a myriad of colours and ways and our collaborators help open our eyes wider so we are forever learning. We curate Our thinking is based on a long period of curating ideas that inspire; from Walter Benjamin, Guy Debord and Bertolt Brecht to Foucault’s work on power relations. We travel the world looking for ideas – like magpies we pick up the shiny things that catch our eye and bring them back to our nest. Curating like this gives us tools that help us dream our way out of stuck. We learn We tip our hat unashamedly to thinkers like John Holloway whose book “Change The World With Out Taking Power” made us dream that change is possible. Our great friend and constant inspiration, Cormac Russel taught us that we were not ‘service users’ from day one. We would also be lost without the amazing publications that have been produced by Nesta, whose 6 Principles of Coproduction guide us every single day. You will see these inspirations and many others throughout much of our work.
What aspects of your service would you share with people who want to learn from you?
We would share our spirit of curious and willingness to learn. We aways wonder why… and why not. We ask who is in the room and who is not – and we wonder why. We wonder about peoples hopes and dreams and how the wealth of their gifts might be realised. We wonder what force blocks an organisations potential. What stops change happening – what scares people? And every morning we wake up wondering.. what if? We disrupt Because the butterfly is not a better version of a caterpillar. We don’t always know where we are headed We know where we want to get to…but we are not too sure how we will get there. That’s OK. The world is moving at pace and things change in the twinkling of an eye. So we will hold on to our dream and ask for direction from our collaborators along the way. We know this isn’t how the NHS usually works, with their love of PIDS and process and KPI’s PROMS and PREMS – we get that. But this different approach is what we bring – even this application probably looks and feels a bit different. That’s what we bring and share. We are not afraid to have a go and fail 🙂
How many people do you see?
Over 1,000 per year.
How do people access the service?
Monthly community forum workshops, emails, mail outs, events, in local cafes and on wards – including PICU and forensic.
What is your service doing to identify mental health inequalities that exist in your local area?
We have run special forums with our members of LGBT and BME inequalities. We provided training with The Kings Fund where one of our projects specifically taste out to tackle BME inequality at WLMHT.
What is your service doing to address and advance equality?
We are coproducing a programme and we are seeking to work more closely with Black Thrive in Lambeth. We have attended 3 scoping meetings.
How do you identify the needs of a person using the service ?
For us we look at peoples assets first –what´s right not just what´s wrong. And then we say – how can we help? 🙂
How do you meet the needs of people using the service and how could you improve on this?
We work on as assets based approach that means that we identify what people can do and we work closely to build on what they are good at. In 2015 we hosted a two day event at Chelsea Football club with Cormac Russell to discuss how we might work with peoples needs differently using the assets of the whole community. 125 people turned up. We coproduced the development of a Wellbeing Network in Hounslow and this supports local people to stay connected. As a group of local people working with commissioners and providers we make sure that local people coproduce the services that meet their needs. I have attached drawings that describe how we coproduced 21 Quality Standards for 11 MH acute wards. This is what patients wanted and needed. We used theatre and the arts to get to the final 21 standards – taking part in the process connected people and helped the to be heard as equal partners. Our outcomes and our process meets the needs of local people. We could improve if we had more partners to work with, if we developed our social media presence and were able to work with a wider community.
What support do you offer families and carers?
We run monthly community forums that carers attend, we have staged a big event at The Lyric in Hammersmith – ” Who cares for our Carers’ Over 8o local carers turned up AND (yes) we gave them wine and cheese and made a social evening of the theatre performance that we staged. This was a play written with us and local carers that described their plight to convince the CCG to fund the carers properly. In 2016 we completed a 60 page review of carer involvement in WLMHT. This has led to the Triangle of Care being adopted.
It has been very hard to complete this as a user led organisation working in partnership with an NHS MH trust. We really think that we do amazing work (sorry to boast) but we are struggling to fit into a category – so Im squeezing us in…. We thought that its not just the brilliant NHS services that should be awarded (AND THEY SHOULD BE !) but the small user groups and networks that bring local people to the NHS table so that coproduction can take place that develops those services. Its a partnership. So, I have uploaded two examples of work we delivered to transform 11 acute wards – we worked in equal partnership with amazing staff – Pauline Mason in particular from WLMHT and I would like to celebrate that. They are preparing for an imminent CQC inspection and haven’t got the opportunity to apply. They were amazing to work with and we have produced a fantastic set of quality standards that we think need to be highlighted. Why we chose QI Our work in coproduction across WLMHT continues to improve quality across the board – 7 x QI projects are on going with us and The Kings Fund – Leading Collaboratively. We have just finished an Action learning set over 6 months on improving care plans and we are working in data research in restraint to eliminate the need and working with the Medical Director in supported decision making in medication – we are about to publish our first paper – all 8 of us are authors. We think we deserve at least a mention 🙂 Thank you
Brief description of population
Size of population and localities covered:
Hammersmith & Fulham,
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
West London Health NHS Trust
Provided by (e.g. name of NHS trust) or your organisation: *