Page 45 - WCEN Dr Rochelle Burgess evaluation report\ Baloon

Risk Adversity

During the focus group with statutory agencies it was evident that coproduction may become locked at
certain levels due to institutional risk adversity. The greatest risk was not associated to clinical-safety
but instead financial risk; it was a common view in the interviews that coproduction is considered a risky
venture due to the lack of scientific evidence base for individual health outcomes. Conversely, it was
highlighted in the focus group with statutory agencies that other government initiatives such as the
‘health trainers’, with relatively weak evidence bases, were still commissioned and scaled up across
the country. This highlights that whilst risk is an issue for statutory agencies there may be other dynamics
that play a role, such as the reluctance for statutory agencies to shift power to the communities.

Risk was also linked to a lack of governance and formal processes of accountability. It was made clear
in the majority of interviews with statutory agencies that WCEN need to formalize processes of
accountability to minimize this risk.

…this is what we’ve done, this is how we work and it’s getting them to understand that they’ve
got to work in that governance, in a framework that has some accountabilities, it has clear lines
of delegation, it has clear lines of accountability around what happens, so for me that’s the big
thing that we need to get going… - statutory agency interview.

This quote, amongst other evidence from interviews, suggests that WCEN can address this barrier with
capacity building across the community organisations and the implementation of systems of
accountability. Some of these steps will be outlined in the recommendations section.

Professional views of coproduction

Despite the significant work that has been carried out in Wandsworth, there will still be individuals within
institutions who have a different conceptualization of coproduction and this will continue to pose barriers
to the work. This barrier is even more difficult to challenge, when the institutions themselves define
coproduction in alternative ways. So for example, in one interview a senior manager discussed the
process they had used to define what successful coproduction is as part of their strategy development:

‘…Yes, it’s a range, so we’ve been, we’ve discussed it as a board, we’ve discussed it with senior
managers, we’ve discussed it with some stakeholders and we’ve discussed it with service users,
but we will go back and test it with service users ultimately because the definition of how we’ve
succeeded needs to be one that our service users have significantly had input into, not one that
we as, we as senior managers sit down and think oh, we think it’s that…’

This conceptualization of coproduction is limited to the individual level and only requires nominal
participation from the community. This approach maintains the divides and boundaries between statutory
agencies and community, and further demarcates the imbalance of power between them. This view
surfaces in a number of other ways and it raises concerns about professional perspectives of
coproduction and their potential to hinder a mutually beneficial coproduction process.

The redistribution of financial resources

Whilst there had been some evidence of shifting of financial resources, according to interviews with
statutory agencies still remained on a less formalized level than other financial exchanges – there was
minimal evidence that the redistribution of resources was an institutional practice and instead relied
upon the cooperation of key decision makers. Furthermore, there was no evidence to suggest that the
specific health services that were being provided by individuals in community groups, e.g. IAPT and
Family Therapy, were being paid for their labor.
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