1. CO-PRODUCTION: A CRITICAL REALIST
PERSPECTIVE ON CONNECTING
OLDER PERSONS WITH SERVICES
AND CHOICE
DR CHRISTINE STIRLING
UNIVERSITY OF TASMANIA

2. OVERVIEW
Co-Production
Critical Realist Concept
The More Things Change…
Benefits of Partnership and Choice

3. CO-PRODUCTION
Services produced in a reciprocal
relationship between professionals,
service users, families and neighbours.
Service users are resources
Services need to interact with neighbourhood level support
Family, neighbourhood, community and civil society are the ‘core economy’ – social capital
Services need to promote idea of equal partnership
Focus on effectiveness not efficiency
(Boyle and Harris 2010)

4. CO-PRODUCTION BENEFITS
‘Co-production changes all this. It makes the system more efficient,
more effective and more responsive to community needs. More
importantly, it makes social care altogether more humane, more
trustworthy, more valued – and altogether more transforming for
those who use it.’
Phil Hope – then Minister of State for Care Services UK 2009
‘Co-production shifts the balance of power, responsibility and
resources from professionals more to individuals, by involving
people in the delivery of their own services.’ (Boyle and Harris
2009).

5. THIS
PEOPLE GETTING
CARE THEY DON’T
WANT AND OTHERS
NOT GETTING CARE
THEY NEED.
“FELT NEED” PROVIDING
A BETTER INDICATOR
FOR DEMENTIA SUPPORT
SERVICES NEED THAN
EXPERT ASSESSMENT?

6. “Well there’s been five actual assessments and three interviews…
over the last four months…then there was the day care lady
came and assessed her and that was fruitless” Carer of
Person With Dementia
A simple one-item measure of carers’ felt need for more services was
significantly related to carer stress as measured on the GHQ-30.
65% of carers would like more help from services than they were
currently receiving (felt need). The statement- ‘I need more help
from services than I am given’ was positively related to carers’
GHQ-30 (Spearmans rho = 0.625, p = 0.01).
Qualitative data showed that there are many potential stressors for
carers, other than those related to the care-giving role.

7. AGENCY - VISION, SHARED IDEAS, AND SKILLS
Change is the result
of the Interplay
between
Agency and Context

8. CRITICAL REALIST PERSPECTIVE - ICT
AGENCY CONTEXT
Vision Silicon Valley a hub of
innovation
Skills
Life circumstances –
Power – as a group education and
New field – no existing freedom
power elites Venture capital
Consumers – voted Unknown potential –
with purchasing no plan
power

9. CRITICAL REALIST PERSPECTIVE – THE +VE FOR
CHANGE IN HEALTH
AGENCY CONTEXT
ICT technologies System breaking
helping link Baby boomers are
consumers – voice, ageing
new power elite Social media,
Purchasing Power for a connectivity
large group Vast potential from
healthy older
workforce

10. RISKS TO CHANGE
AGENCY CONTEXT
Existing groups try to Unwieldy, busy,
hang onto power entrenched health
system makes
change difficult
Many consumers lack
the skills to access
and engage

11. SERVICE REDESIGN

12. STRATEGIES TO DEVELOP AND MAINTAIN EQUAL
RELATIONSHIPS
Develop Agency for Consumers – able to
communicate as a collective, new vision, able to
be heard.
Listen - Continue to capture the experiences and
voices of consumers and use this to inform new
programs. Redefine experts.
Systems and Tools that facilitate agency and
partnerships

13. BUILD CONSUMER SKILLS TO NAVIGATE AND
USE THE SYSTEM
PROBLEM SOLUTION
ICT
A complex fractured Focus on skills
system Targeted information
Decision making assistance
How to make choices?

14. REMOVE BARRIERS FOR ACCESS TO SERVICES-
THE NURSE-LED MEMORY CLINIC
SOLUTION -
PROBLEM AGENCY
Difficult to get a diagnosis  Consumers able to self-
refer
Difficult to get information
 Free nurse-led cognitive
Referral onto other services assessments and
inconsistent
diagnosis
‘I'd say, "Mum's memory isn't too
good"; try and not make her look  Follow-up visit to facilitate
silly in front of them, but, she'd appropriate referrals to
say, "Oh, it's better than yours",
and they'd just laugh with her community supports such
and that would be the end of
that. You know, you couldn't get
as Alzheimer’s Australia,
anyone to take it very seriously.’ HACC

15. SERVICES NOT FITTING NEED
PROBLEM SOLUTION
• Assessment Not Capturing Power, voice, representation
Need  Australia – Consumer
• Rigid boundaries around Directed Care Packages
service provision –  Patients Know Best
“He’s had four [carers] website,
and this gentleman will be the fifth
www.patientsknowbest.co
today. So he gets very confused
about who is coming and I have to m
explain each week.”  Local Involvement
• Experts within narrow silos. Networks

16. In Conclusion
There is a lot of work to be done to change culture
so that we have more equal relationships with
a sharing of power.

17. REFERENCES
Boyle, D., & Harris, M. (2009). The Challenge of Co-Production: how equal partnerships between
professionals and the public are crucial to improving public services. London: NESTA.
Lloyd and Stirling (in Print Sep 2011). Ambiguous Gain: uncertain benefits of service use for
dementia carers. Sociology of Health and Illness
Stirling, C., Andrews, S., Croft, T., Vickers, J., Turner, P., & Robinson, A. (2010). Measuring dementia
carers' unmet need for services - an exploratory mixed method study. BMC Health Services
Research, 10(122), EJ.