Working together vital to finding health service solutions

It came up time after time as health chiefs debated crucial decisions about the future of local community hospitals, maternity and children’s services – but begged the question, what does it actually mean?

When asked to translate, David Rogers, medical director of NHS Cumbria Clinical Commissioning Group (CCG), said it is effectively “working together”, with the community and staff, to find joint solutions.

Charged with making decisions about the Success Regime’s controversial proposals, the CCG governing body last week gave the green light to bed closures at cottage hospitals in Wigton, Alston and Maryport (click here to read about that) and the possible downgrading of maternity in Whitehaven (click here to read about that) .

However there were key caveats. Firstly that current maternity services would be secured for 12 months while bosses work with the wider community to tackle recruitment. If successful, the threat will be withdrawn – if not, services will be centralised in Carlisle.

Community hospital campaigners were also given further time to develop, alongside the NHS, alternative plans that could potentially save beds – though whether these could be medical beds remains unclear.

But the CCG was adamant that, for either of these scenarios to be a success, “co-production” would be crucial.

After the meeting, bosses called for an end to the protests and the start of a new dawn, but many campaigners – who had hoped for more than a year-long reprieve – were sceptical.

Helen DavisonHelen Davison , of Cumbria Health Campaigns Together , said just the term co-production is enough to alienate people.

“It’s being used, as I understand it, to mean working with the community. But if you’re trying to engage with everyday people you need to talk in language they understand, not jargon.

“All that does is create a hierarchy – those who know what they are talking about and those that don’t. If you are serious about engaging, there must be a level playing field,” she said.

Community activist Hazel Graham is also wary. “Co-production is one of several buzz words that have cropped up in the age of austerity to make cuts sound good. In this context it means communities being invited to take part, so decision makers are let off the hook. If we could co-produce the budget, that would be another matter.

“The term ‘co-production’ is as cynically deceptive as the term ‘Success Regime’. If co-production is supposed to mean involving the community, then why have they ignored the mass of people who voted to reject the entire consultation process?” she said.

Prof John Howarth But John Howarth , deputy chief executive of the Cumbria Partnership NHS Foundation Trust , which runs community hospitals, said co-production helped to save health services in Millom – where a few years ago there were high profile protests against bed closures.

Anger was high and trust was low, but Dr Howarth said they were able to channel the local passion by shifting the balance of power.

He understands the cynicism, but said if done properly, true co-production does work – and that means the community and NHS working as equal partners, even when it comes to budgets.

He used a comment from a member of the Millom action group, on the way into a high-level meeting, as an example. “She said ‘I used to think you were the most important person in the room, now I’ve realised that we are’. That is the real essence of co-production,” he said.

Dr Howarth believes it is possible to replicate what happened in Millom elsewhere, but said the NHS also needs to play its part.

“I’m a bit of a radical but what I’d like to see is a resetting of this idea of who we are accountable to. In the NHS we are under so much pressure from regulators, finances, national targets that we seem to look upward all the time when we should be looking outwards to the communities we serve,” he said.

“The public pay the taxes, they pay for all of this. But those taxes go up to the Treasury and come back through multiple layers. By the time it gets down again people seem to have forgotten that we are public servants.”

He said rebuilding trust will be vital. The recruitment challenge will be difficult, but he is optimistic. And if it succeeds we could set a national example.

“For it to really work it’s got to be completely open and transparent, even if that’s uncomfortable for us sometimes,” he added.

“But we have to change the story. If the story is about conflict, protest and the health service not being seen to listen nobody will want to come and work here. The starting point is that the CCG has, both for community hospitals and maternity, bought us some time.”

Yet just when some people were warming to the co-production mantra, bosses at North Cumbria University Hospitals NHS Trust came under fire after it emerged midwife Bernadette Bowness had been threatened with disciplinary action for speaking to the media (click here to read about that) .

Mahesh Dhebar Retired consultant and health campaigner Mahesh Dhebar said it was an own goal, fuelling the anger and distrust that already existed.

“They are sending out the wrong signals. If they are genuine about co-production then it could work, but it has to be very open. Consultants and staff should be allowed to participate freely without fear of reprisals or harassment. That is the only way to regain the trust,” he said.

The initial 12-month deadline also sounded alarm bells for local campaigners, however the CCG did agree that, if enough progress was being made, that could be extended.

Dr Rogers stressed that the milestones of what success looks like would be drawn up with the community, through co-production.

He said it was a genuine attempt to work together. “We have already heard from the public that they do not believe recruitment has been good enough. Let’s now get together and do everything we can to attract and retain staff,” he said.

“It’s not just about listening to the public but also staff. How can we make the best of this? Is it possible?”

Kate Whitmarsh Kate Whitmarsh, part of the Maryport Alliance, is positive but said the community needs to know where it stands.

“One of the problems throughout the Success Regime process was that it was unclear where the goalposts were. We now need to know absolutely where those goalposts are,” she said.

And she added that discussions cannot be led by a panel of NHS leaders. New ways must be found.

Alston hospital campaigner Jane Mayes said for co-production to continue, the option of medical beds must remain on the table. “It will only mean something if it brings together medical and care beds under the care of nurses and GPs.”