Page 25 - WCEN Dr Rochelle Burgess evaluation report\ Baloon

The model identifies a series of key outcomes for both statutory bodies and communities as a result of
phase one. Statutory bodies achieve more authentic engagement with target communities, engage in
practices that are driven by community intelligence and begin to shift practices within the health sector
as a whole, particularly around how they engage with communities. On the side of communities,
individuals within community organisations become more empowered, through engagement in
transformative forms of participation. They also have increased trust and understandings of statutory
bodies, which feeds into their ability to act as bridges between their wider community networks and
formal health sectors and services. Detailed examples of all of these outputs are provided in the next
section of the report. The establishment of phase 2 resulted in coproduction activities in four key
dimensions in line with previous models. In areas of co-commissioning, in particular the issue of
prioritisation was established through the development of the coproduction reference group, and BME
mental health forum. These two bodies represent formalised processes where community organisations
who were previously absent, now drive and support agendas around health service development and
prioritisation. Co-design of services is embodied within two cases of activity in the WCEN network –
the establishment of the family therapy network for faith leaders within Wandsworth and the development
of a bespoke IAPT service at the Shree Ganapathy Temple (see box 1 and 2 for summaries). Co-delivery
of services, which is articulated as partnerships in the delivery of care, is also embodied in these cases.
One primary gap in the model is an absence of models of co-assessment, an issue that is addressed
further in section six of the report.

As suggested earlier, the mapping of stage 0 within the WCEN approach highlights a new contribution
to the literature on coproduction. The importance of attention to this phase and the theoretical processes
that underpin its operation is supported by calls to reconceptualise ideas of participation and social
change in relation to promoting health (Cornish, Montenegro, van Reisen, Zaka & Sevitt, 2014).
Ultimately, coproduction faces critiques over its inability to produce measureable outcomes and a
reliable evidence base. However, we suggest that such arguments are linked to the tendency to overlook
or minimise the small wins embodied within smaller shifts in understanding and practices that can
contribute to wide scale change later. By valuing change solely in terms of discrete health behaviour
changes (such as the outputs linked to individual level coproduction within health services), it is easy
to label programmes as ‘failed’ and overlook important processes. As such, it is critical to widen
definitions on what counts as meaningful change in spaces of health promotion.

This argument is supported by Catherine Campbell’s (2014) recent reconceptualization of social change
for health, which highlights the importance of acknowledgements of power in driving and valuing change.
Within mainstream community health improvement approaches, ideas of power are linked to materialist
views that position power as a zero-sum force used to allow one group to dominate over the other.
However, in doing so, community mobilisation efforts can be deemed satisfactory as long as they appear
to transfer power – often in one direction, from top-down. Examples of this are seen in the one directional
transfers of knowledge that typify community-based interventions, such as the training of community
health volunteers as peer-educators. More critical positions on materialist power may extend such
efforts to include the acknowledgement of the need to transfer political and economic power (Freire,
1973) as well. However, the processes related to this achievement are slow and often are rarely
achieved within the space of a single intervention.

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