I attended an event in a sodden Cardiff yesterday hosted by the city’s Life Sciences Hub at which PR agency Claremont were outlining some of their work to around co-production and nudge theory to inform behavioural change campaigns (such as smoking cessation or 5 A Day campaigns). Search for #BehaviourChangeWales on Twitter for further comment.

My friend Andy Green from Grow Social Capital, and who has a PR background himself, tipped me off about it at the last minute and with its reference to co-production I wandered along with my usual healthy scepticism whenever I see whether the term is being employed.

It was essentially a glorified sales pitch by Claremont to increase its footprint and activity in Wales. I have no problem with that and its people’s values came through loud and clear; there is clearly a social purpose and strong moral compass at Claremont’s heart. And certainly their suggestion that people need to be more involved in the drawing up of campaigns, such as public health campaigns, is a convincing one. Claremont’s founder Ben Caspersz worked on the 5 A Day but told us that despite the campaign’s fantastically high recognition among the public (in excess of 90% of the population if I recall correctly), the proportion of people who consume their 5 a day remains stubbornly around the 20% mark.

As a campaign it’s success was modest indeed. It was a sober reminder of, firstly, how difficult mass behaviour change is to achieve. And secondly, of the limitations of campaigns about people, to people, for people – unless or until they are devised with people.

Noreen Blanuet from the Co-production Network Wales was first up to provide a conceptual overview of co-production, to discuss the Network’s work and outline the policy and legal context in Wales in respect of the two groundbreaking acts passed in Wales recently: The Wellbeing of Future Generations Act and The Social Services and Wellbeing Act.

I was among the people that began to coalesce around the idea of more citizen engagement in services in the late 2000s. In the way that the Communities First programme in Wales provided for proximity to and a degree of trust among disadvantaged communities, it seemed an obvious pool from which to draw advocates and champions of a different, less didactic, more empowering way to not merely deliver services, but conceive and design them.

I’ll be honest, it got a bit too evangelistic for my liking. I am not alone in feeling it had become a bit of a cult so stepped away, but continued to cheerlead from the sidelines. What the Network (that evolved from those initial hustings and discussions) wants to achieve is the right thing; but I guess there’s more ways to skin a cat, as the saying goes.

I have maintained a fundamental concern all along that too often co-production advocates do not adequately articulate the value of, and need for, community development activity to be laying the bedrock upon which genuine co-design and co-production can happen. Noreen illustrated the value of co-production with a quick anecdote about an older woman who had moved to west Wales but was alone and isolated and burdening the local GP surgery daily because it was where she could have meaningful contact with someone. What Noreen described was, to my mind, low-level community connecting activity that is done daily in communities the length and breadth of the land. Providing the means for the woman to identify the sorts of activities she wanted to do and connections she wanted to have might well be co-productive but it is part of a more fundamental process, underpinned by particular values and principles, that seeks to empower that woman so that she overcomes some of the challenges she faces.

Neither am I persuaded that a residual pool of willing, informed, time-rich people exist across the wide spectrum of community, third sector, public (and private?) services who can be called upon when a co-production exercise is given an institutional green light. Co-production’s theory of change is robust – and Noreen was wholly right to emphasise the non-linear nature of co-production in practice – but there is a wealth of work that needs to be done to get your co-producers in the room (literally or metaphorically).

That work is done upstream, is not always obvious and invariably isn’t shouted about. And it’s more often than not community development activity that has organised people around what they want to address and achieve; has earned trust; has felt the ‘burn’ from working on what matters to these people, while irritating one’s paymaster and employing body in the process. It’s the hard graft upon which a co-production exercise can occur. The co-production lobby is not being honest enough when they fail to pay credit to the necessity of this work. It is rare that a genuinely co-production process can occur in isolation from what else has happened before or is happening elsewhere on that institutional/community canvas.

Ian Fannon from Claremont stepped up next and provided a whistle-stop tour of the tools, techniques and approaches Claremont adopts. A flurry of complicated diagrams flashed across the screen like a movie’s end-credits; it wasn’t a presentation for the reflectors, like me, in the audience. It would have been more impactful in a longer agenda. The cynic in me suspects that when jargon, models and diagrams are employed in this way they are there to dazzle and impress, to obfuscate and avoid interrogation. Ian also referred to ‘customers’. With a largely non-profit, academic, public and third sector audience that’s a red rag. Sorry Ian, it was a ‘No’ from me.

The highlight was without question Claremont’s Lucy Proudfoot’s presentation of a case study about co-designing a campaign with mums in east Belfast about encouraging parents to verbalise with their babies. The presentation was full of goo-goo and ga-ga, yet still more meaningful than Ian’s disorientating mirrorball of conceptual terminologies, lines and arrows.

In essence, Lucy was commissioned by Save The Children to work with a group of mums out of a Sure Start facility to develop key prompts that would prompt – nudge – parents to speak more with their babies and toddlers thus increasing the sheer volume of words, sounds and noises that a pre-school child absorbs. What made it more impactful for me was that Lucy acknowledged the work that had been done with the mums beforehand by Save The Children and Sure Start. In this way the campaign co-design was downstream from previous organising and empowerment work. We could see why it worked in a human sense, rather than in abstract theoretical terms. A constructive criticism is that it would have been nice to hear more detail about the nature of this work and what else it had achieved. It was not clear that the verbal deficit that disadvantaged children have in comparison to their more affluent peers was an issue that the mums themselves had raised.

It was particularly resonant given our recent podcast with Jonny Currie who works that same patch of East Belfast and where I had visited less than a month before; indeed, I recall walking past the very same Sure Start facility on Albertbridge Road that the co-design workshops took place. Lucy should also be credited in acknowledging those elements that haven’t been co-productive; self-reflection and critique is important in these processes as part of the overall evaluation. It appeared that the (co?) design of the overall evaluation of the impact of the campaign is still ongoing but it strikes me that the co-designing mums are well-placed – with sufficient support and capacity-building – to be the evaluators and researchers to help with the evaluation. They, after all, will be immersed in their own social and community networks of parents and have their confidences to ask the necessary questions. Might the mums uncover rich data that ‘traditional’ external, parachuted-in researchers cannot? In this way I am reminded of some of the co-production of research that Cardiff University’s WISERD department has undertaken with communities in south Cardiff and in Merthyr Tydfil.

Julian Tudor Hart Memorial Lecture 2019

The event also came hot on the heels of the annual Julian Tudor Hart Memorial Lecture at Cardiff University in which a range of academics across different clinical and social health disciplines came together to celebrate Hart’s life and pioneering work and research as a GP in Glyncorrwg in the Afan valley of south Wales. One of the speakers referred to Hart’s iconic belief that though initial consultations might be face-to-face, gradually he’d shift to working with patients side-by-side. Hart intuitively, fundamentally recognised that they were as much experts in their own health, if not more, than he ever could be. And that’s the other key thing for me: co-production only feels new to people because they have closed themselves off to the work of the pioneers, disrupters and innovators of the past who started not with the campaign, the service, the organisation, but with the people.