The use of art for Co-production ( - in bringing users together with providers and commissioners on a 'level playing field')

(The following represents Nigel Fenner's personal views rather than those of Hertfordshire PASS.)

As part of Hertfordshire PASS’s involvement in the planning of a User Led Organisations (ULO) Conference in Hertfordshire, it was invited to prepare and lead the Art Workshop, given its experience of running similar with young disabled people through its Job Forum.

Having delivered the workshop I wrote the following report for members of the planning group, which is reproduced her – without the photos of the artwork, and names - to protect the identity of individuals. The report summarises what took place, and finishes with some reflections relevant to the overall aim of the conference: users taking control of their services in Hertfordshire.

2. What each conference delegate was expected to do.
After lunch the 100 or so delegates were split into groups of 10 made up of a random mixture of ‘users’, carers, providers, commissioners etc. Each group of 10 worked at a table with a range of arts and crafts materials, supported by a facilitator - mostly from Adult Care Services, briefed before the conference by Nigel Fenner using a briefing sheet (Appendix 1).
The Support Co-ordinator Senior Apprentice at Hertfordshire PASS introduced the Workshop by setting the following brief:
“Everyone is asked to pick the best or worst example of a service you know of which is led by a user or users, where for example users ‘have a say in what happens’ – and then use the arts and craft materials on your table to communicate this.”

3. Nigel Fenner’s experience of facilitating his group
As soon as the group started it was noticeable how all the ‘non-users’ worked with the ‘users’ to help them follow the brief, at which point, as the facilitator, I reminded everyone that we were ALL asked to work to the brief. This resulted in the manager sitting next to me declaring that ‘this was taking her outside her comfort zone’.
After about 30 minutes, when everyone had finished their art work I asked them:
“to reflect on the art work we have all created, and using only a few words or phrases, each describe what is important in terms of ‘users taking control of their services’ in Hertfordshire”.
In response each member of the group shared their art work and said the following ‘words or phrases’ ( - the numbering below being used in this report as a link to photographs of their artwork in appendix 2 - not reproduced in this blog):
1. “We have healthy lunches which we help to choose” (said by a user – as their best example)
2. “I lost my purse when on my way to the gym” (user – worst example)
3. “This shows me (pointing to his clay model) on the recruitment panel at the Daycentre. I ask them if they are good….if they will support us very well….. I get paid for this role” (user – best example)
4. “I went to a residential centre to lead a ‘pampering session’ but the residents were all sat in front of the TV” (provider – worst example)
5. “We discuss what we do for activities and my picture shows the Holiday Inn, Michael Jackson, using a spa….” (provider – best example)
6. “Public transport….; the drivers are rude and sometimes bully disabled people” (provider – worst example)
7. “The Sunnyside Trust…..” (provider – best example)
8. “The Learning Disability Parliament in Barnet is user-led” (provider – best example)
9. “Stop and listen” (provider – best example)
10. “’Mirror, mirror….’ kept in the pocket to check whether what we’re doing is user-driven”(Statutory sector manager)
11. “We need the tools for power…..to help us” (Statutory sector manager)
12. “A disabled person saying the truth in a group discussion, when no one else had the courage to do so” (provider – best example).

As facilitator I asked what all our art work, taken as a whole, was saying in terms of ‘users taking control of their services in Hertfordshire’, and together we spread the pictures across our table, in an order which told a composite story, which went something like:
“We get sat in front of the TV (4).... get our purses stolen by bad people (2)....and the buses are inaccessible and sometimes the drivers bully us because of our disability (6)...What is needed is for people to ‘stop and listen’ (9), and ‘look’ (using the mirror) (10), and appreciate that disabled people have wise things to offer (12)...so we can use the ‘tools and power to help us’ (11)....so we can choose our own healthy lunches (1), decide where to go on our outings (5), be involved (7), be on interview panels to select staff (3) and be part of the LD Parliament (8).”

Given this was too much to feed back in the plenary, the group was asked to
“decide as a group what is the most important word or phrase that will have the most impact on ‘users taking control of their services’ in Hertfordshire.
Also agree on who in the group will share this in the Plenary session.”
The group decided on ‘Stop and Listen’ (9) as the most important phrase, with a user from the group feeding this back in the plenary session.

4. Plenary feedback from all groups( - as noted down by Nigel Fenner)
 ‘Stop and Listen to me to support me better’
 ‘Getting into my own flat; choice and control; working together is necessary’
 ‘Important to have 50 – 60% of users on the management committee to have a voice’
 ‘A Parliament; Direct Payments are important; awareness’
 ‘Working together with confidence and honesty…to include everyone’
 ‘Being heard…; support and understanding’
 ‘Change for the better’
 ‘Time; the clock….care and the clock; our picture shows a disabled person left in their hoist because the carer’s shift had ended’
 ‘There’s a lot of crap in our ‘life tunnel’, but once we got a PA our lives got brighter’
 ‘Power, listening, trust, obstacles….; users need to be listened to and empowered…’
(The written notes taken and recorded by each facilitator on their briefing sheet are listed as Appendix 3.)

5. Post conference reflections – to the Art Workshop, and the conference in general
5.1 Feedback from the facilitators
Nigel Fenner wrote to all the facilitators asking them for their post conference reflections and received 2 responses, one from an Adult Care Services (ACS) Manager, and the other from a Senior Apprentice at Hertfordshire PASS. The questions asked and their full replies may be found as Appendix 4 – reproduced with permission.
One suspects that their reflections represent the two extremes of views held by participants on the Workshop: The Apprentice reading much more into the art (ie assisted suicide) than the ACS Manager and her group who found the ‘brief confusing’.
Nevertheless the ACS Manager’s group produced an excellent piece of art on ‘time and time for change’ – see below.

5.2 Nigel Fenner’s reflections.
In planning the Art Workshop, facilitating a group, reviewing all the art work in depth with another Hertfordshire PASS Senior Apprentice, and getting feedback from facilitators (see above), the following personal reflections are made by Nigel Fenner:

a. The art workshop produced some important and creative insights
 The use of TV in residential or day care settings as the worst example of a user-led service (picture 4 in appendix 2). In another group someone had drawn a TV and next to it written ‘free from TV’.
 How the use of long words by professionals exclude many users. For example one picture included the words: ‘When the ULO do there workshop the peop who read the ULOs they make to many long words’. In addition a member of the planning group (for the ULO conference - presumably) also reported in their ‘art workshop group’, they found it difficult to take part.
 Some images told some sad stories:
- someone in a wheelchair being struck by lightning and being told ‘you can’t do that’…and falling into a shark infested sea
- a mass of wool stuck on the page and ‘aarghhhhh!’, and ‘tied up in knots!! cannot escape’ written beside it, also with a list of these words: ‘confusing, frustrating, emotional, upsetting, angry, bitter, restricting’, and
- a life size piece of ‘crap’ coming out of one end of the ‘life tunnel’ piece of art work created by one group.
 The importance of time as portrayed by one group, given their only art work was a very large sheet covered in clock faces, surrounding the central image of a disabled person suspended in a hoist above their bed and left by their carer, who had ‘clocked off’ ( - already referred to above).
This links to the discussions we regularly have at Hertfordshire PASS about the use and management of time given we believe ‘time is one thing that disabled people can begin to manage, compared with many other aspects of life’.
 The mirror (10 in Appendix 2) which because of its association with the Fairy Tale ‘Snow White’ (whether meant or not) raises all sorts of questions such as ‘who is the fairest of them all?’.....in terms of ‘Users taking control of their services in Hertfordshire.’

b. The ULO conference felt like ‘co-production in action’
Given the conference gave significant space and opportunity for users to
 lead ( - through AB introducing the conference),
 share ( - through the 4 stories delivered at the start of the conference by a range of different users regarding a range of different interpretations of what user-led means in practice), and
 work together ‘on a level playing field’ with commissioners and providers ( - through the art workshop) – see c below,
that the ULO conference felt like ‘co-production’ in action.

c. The importance of meeting users in a place they find ‘comfortable’...and that they understand.
Once during the conference and then immediately afterwards I was told separately by 2 senior managers ‘the art work session took me right outside my comfort zone’ which led to us discussing how important it is for commissioners and providers to perhaps experience such discomfort, if co-production is to work. This is set in the context of the discomfort that users probably experience when they attend our meetings and conferences – as communicated through a number of pieces of art.
Getting it right is not easy though, as the experience with the conference evaluation form demonstrated. Whilst the form was very ‘easy-read’ no one on our table filled it out because it was not possible to relate the symbols to the sessions in the conference.

d. ‘User-led’ operates at both individual and corporate levels
It may be stating the obvious but the art workshop and conference in general enabled me to better understand that ‘user-led-ness’ is as much about developing individual authority in users (in choosing menus, or activities, or whether to watch TV, or managing their own time), as in creating User Led Organisations (ULOs) – and that these are not mutually exclusive.
Therefore the challenge involves knowing how and when to move users who, having developed such individual authority, are ready and willing to develop a more ‘corporate authority’ in enhancing the ULO they are part of, or if necessary, creating a new one.
From answers to one of the ‘quiz-dom’ questions ( - the session which followed the Art Workshop), it would appear as though a significant number of disabled people are willing – see below.

e. A significant number of users want to develop their capacity to lead
I was astonished that 38 users expressed a wish to get involved in developing their leadership, with only 14 saying no in response to the ‘quiz-dom’ question. This was a question posed by KF (Hertfordshire PASS) who has attended the Leading Ability course run by the Essex Coalition of Disabled People as commissioned by the Department of Health earlier in 2010.

f. Disabled people’s stories are so important
I was very impressed with Mrs B’s story about her experience of Direct Payments, so much so that I asked her if we might publish it on Hertfordshire PASS’s website – to be featured on Hertfordshire PASS’s new ‘PASS experience’ page.


Appendix 1
User-led Organisation (ULO) Conference
16th September 2010
Art Workshop – FACILITATOR’s briefing sheet

Facilitator’s name: …………………………………………………………………………………………………………………

Thank you for agreeing to facilitate this Art Workshop session. There is no right or wrong way of facilitating the session however all facilitators need to account for
 the BRIEF given to each group,
 the OUTPUT we expect from each group,
 how the session will link to the PLENARY session, and
 that we have to finish the session by 3pm.
The BRIEF for each group
Each table of 10 or so people have the following brief to work to:
“Everyone is asked to pick the best or worst example of a service you know of which is led by a user or users, where for example users ‘have a say in what happens’ – and then use the arts and craft materials on your table to communicate this.”
The OUTPUT we want from each group
Towards the end of the session please ensure there is time to get your group “to reflect on the art work we have all created, and using only a few words or phrases, each describe what is important in terms of ‘users taking control of their services’ in Hertfordshire”.
Please list these words or phrases below ( - continue over page, if needed):

The link with the PLENARY session
Once everyone has shared their ‘words and phrases’ decide as a group what is the most important word or phrase that will have the most impact on ‘users taking control of their services’ in Hertfordshire.
Also agree on who in the group will share this in the Plenary session.
It should now be 3pm.
What to do with your group’s art work – by the end of the day
Please deliver this ‘filled out’ sheet and your art work to the Hertfordshire PASS stall. If you can, it would be very helpful to note on the back of each piece of art whether it was created by a user, provider, commissioner, or ‘other’, as well as describing what the creation represents.
Thank you.
Hertfordshire PASS
15 September 2010

Appendix 2
Pictures - not reproduced here.

Appendix 3.
The feedback from each group as written up by the facilitators

SS’s group
1. Empowerment. Enlightened; changing belief in our capabilities; enhance our lives; finding what suits you best; incentive to go out; raising awareness, passion, LOCAL
2. Democratic. Best interest heard; restoration of your self esteem
3. Awareness

CB’s group
Meaningful inclusion; choice; move forward; together
(Facilitator not identified)
Bad: confusing, tied up knots, bitter, angry, frustrating, emotional, professionals using long words and not explaining them.
Good: Path of meeting different people and organisations; different places; good to be involved and help each other; smiling; meeting people.
Confused about long words
Larger font size – use organisations which are expert at making easy read and pay for it!
Really hard for people for LD to take part
Difficult to be part of the planning group.
Working together with confidence and honesty to have a strong voice and to include everyone. Being honest; kiss; making it easier to understand; going forward together; working together with people; good support; be included; building confidence; good support

CS’s group
Hard work; more choice; listened to; organisations that are user lead have more power; if you don’t trust your committee you won’t get anywhere; only someone who has experienced it can really understand; obstacles can get in the way of people; it is good to listen.
5 pieces of art: power, listening, trust, experience, obstacles.
Users need to be listened to, they need support and funding to be empowered.

HDT’s group
Finding out things you never knew you could do
Opportunity – confidence building
Support
Social friendships
People come up with ideas themselves
Responsibility
Knowledge – sharing – parts make a whole
Opportunities
Being heard + support + understanding.

Appendix 4
Facilitators reflections on the Art Workshop.

Email to all facilitators
Subject: Reflections on the Art Workshop at the ULO conference
To all facilitators
Thank you for facilitating the Art Workshop at the recent ULO conference.
I am writing a report and have used the ‘words and phrases’ you recorded on your briefing sheet as well as had a long look at all the art work – with AB.
I was hoping to have a section in the report on the facilitators reflections after the conference so can you please answer the following questions?
1. When you look back at the Art Workshop what ‘piece of art’ comes to mind first? Can you describe the piece…..?
2. Can you say what you feel the link might between this ‘piece of art’ and the aim of the ULO conference: ‘users taking control of their services in Hertfordshire’?
3. Any other reflections…?
4. Finally can you indicate whether I can use your answers to the above questions + what you wrote on the facilitators sheet, with your name, or without your name, or not at all?
Thanks.

Response 1 – used with permission
I think the piece that really stood out for me was Andrew’s tunnel of life that he and his table made as it symbolized the way how disabled people see life and I have heard these stories about disabled people wanting to end their life and I am on a campaign list to stop assisted suicide happening so the tunnel of life reminded me of the campaign.
I think the link with this piece of art reflects how disabled people are with their carers and the services that they get from having personal assistance with day to day tasks and the services that they provide to get personal assistants to help them.

Response 2a - used with permission
Hi Nigel
Answers to your questions:
1. None
2. I don't believe there was a link - my group struggled with the concept - they thought the brief was confusing (And was a topic of conversation for some time) and could not relate this to how they could control services in Herts.
3. Although a bit of fun (my view only) - it is hard to ask people to conceptualise in art what are often no more than feelings..e.g. frustration etc
I am not sure the brief was appropriate - reading the questions here I can relate them to the exercise - but this was not apparent on the day.
4. These answers are taken from the day itself - from the comments made to me during this exercise (Apart from q 3)
I hope this is helpful

Nigel Fenner’s response
All feedback is helpful – however be useful to know in what way the brief was confusing…..?
Did your table produce the large picture focusing on ‘time’? If so I’m really pleased, because the management of time is one area of disabled people’s lives that they can start to manage, as a start to growing to independence…. We often discuss the management of time in meetings at PASS….
I want to use your answers in your email in my report. As I asked in my email, can I quote you? Thanks

Response 2b – used with permission
yes it was the piece about time or time for change
The briefing as we understood it was to relate to a poor experience that was user led? We produced the piece we did to reflect 'time for change' - being about an experience that wasn't necessarily user led but the remendy to the problem was user-led -
The group felt they could only talk about poor experiences - we were then able to talk about what happenned and what the remedy was - in each case the remedy was SU/Carer taking control..which for me did answer the question (Which was why we created what we did) but the group felt it didn't though they were pleased with the outcome (I hope this makes sense)..which was the dilemma or confusion
I have no problem with you using the comments and the comments here which are entirely factual - in terms of that's exactly what was said on the day..
I hope this all makes sense nigel

Social Impact Bonds and disability

(The following represents Nigel Fenner's personal views, rather than those of Hertfordshire PASS.)

There has been quite a lot of media coverage recently on social finance or social impact bonds:
"A Social Impact Bond is a contract with the public sector in which it commits to pay for improved social outcomes. On the back of this contract, investment is raised from socially-motivated investors. This investment is used to pay for a range of interventions to improve the social outcomes. The financial returns investors receive are dependent on the degree to which outcomes improve. By enabling non-government investment to be raised, Social Impact Bonds should lead to greater spending on services that prevent costly health and social problems.
Take, for example, re-offending by released prisoners, which costs government millions of pounds a year. A Social Impact Bond could be used to raise money to pay for the expansion and coordination of services to reduce re-offending.
The more effective these services are at achieving the target outcome, the higher the blended (social and financial) return investors would receive."
'Towards a new social economy'. Published by Social Finance Ltd. March 2010.

Because I believe disability might benefit from such investment I today emailed the MP responsible for leading a review on this with 4 questions:

1. Have you considered user-driven projects?
I currently manage Hertfordshire PASS, a charity which starts with the premise that the best people to solve the problem of unemployment amongst disabled people, are disabled people themselves. For example our WorkABILITY project is currently managed by 6 young disabled people employed as apprentices, providing work experience, apprenticeship and employment opportunities for their peers. We’ve not only written 2 books on the users experiences, but also 3 academic papers on the ‘user-driven’ methods we employ. Whilst I have spent the last 5 years in ‘disability’, I learnt the theory and practice of user-driven methods over 6 years with the Grubb Institute of Behavioural Studies where we developed a user-driven approach to relationships education in 7 Young Offender Institutions. From my experience these methods developed with young offenders apply equally well with disabled people......

2. Have you considered social enterprise?
Given many social challenges lend themselves to enterprising solutions we have published a major paper entitled ‘User-driven Social Enterprise’ – go to http://www.hertspass.com/2010/08/user-driven-social-enterprise/#more-356

3. Have you considered ‘disability’?
I understand the brief to your report focuses on crime, when I believe there is as much potential for social impact in disability, given the significant dependence on State Benefits for this group. Are we not ripe for investors to invest in our WorkABILITY project and secure a return for each of the young disabled people we get off benefits into employment? At the moment this stands at 2 of the 6 apprentices we employ.

The potential for saving the government money and generating a return for an investor is not just restricted to moving disabled people from benefits into employment. For example the whole Personalisation agenda endeavours to move disabled people from state provided care to care determined and managed by the individual, usually in their own homes. There are considered to be over 100,000 disabled people on Direct Payments in the UK; some evaluation studies claim Direct Payments (or personal budgets or self-directed support) are cost effective, other studies are not so convinced. "However, with government funding for councils expected to contract from 2011 onwards and the numbers of older and disabled people requiring care set to go on increasing, social care leaders will hope that self-directed support can definitely deliver more for less." Jeremy Dunning 12th Feb 2010. 'Are personal budgets more cost effective? Community Care.

4. Have you considered the ‘disabled £’ or ‘purple £’?
One advantage ‘disability’ has over ‘crime’ in terms of being an attractive investment for would-be investors is that the ‘disabled £’ or ‘purple £’ is worth £85billion / year. So, not only will an investor make a profit out of a programme which moves disabled people off benefits, but also increase the likelihood of selling their products / services to the 20% (and increasing) of the UK population who are disabled. Again we’ve written a paper on this area entitled ‘The relationship between disabled people and the commercial sector – moving on from ‘fight and flight’ to access the purple £’. This paper was presented at the Social Enterprise Research Conference in 2008 (Go to: http://www.lsbu.ac.uk/bus-cgcm/conferences/serc/2008/papers.shtml - and scroll down on the first page to the paper presented at 15:15.)


Whether I get a reply from the Minister or not I still see 'Social Impact Bonds' as being important for the sustainability of the work we (and many other innovative charities) do, given the current economic climate.

Users, and 'wounded healers' - and user-led organisations.

(The following represents Nigel Fenner's personal views, rather than those of Hertfordshire PASS.)

I went to an event recently with two of my staff and Chairman of Trustees, all of whom are disabled, to consider whether Hertfordshire might establish a User-Led-Organisation (ULO) network in support of disabled people, so following the example of some other counties. The meeting was set up and run by the County Council, and included a presentation by the Director of the National Council on Independent Living.

I'm not sure exactly who attended but from what was said in the welcome there were 5 commissioners from Social Services amongst an audience of about 30. As far as how well represented organisations who consider themselves to be user-led were, I can only share a conversation I had at the start of the meeting with one of my staff, who said "there aren't many users at this event" which during our chat about this, prompted me to ask the question "am I a user?", eliciting the answer (to my surprise) of "yes".

This begs the question 'who are the users in relation to user-led organisations?'.

There is no doubt in my mind the member of my staff who is disabled ticks all the boxes for a ULO, not only as a 'user', but now also as a 'leader' providing a professional service to other disabled people.

But what about the commissioners, and me? Are we 'users'?

In a roundabout way this was asked of me recently by a researcher from NIACE (National Institute of Adult Continuing Education) who visited us wanting to explore my management of a user-driven project (amongst many other issues), and I answered in terms of the aim or purpose of WorkABILITY, which I could identify with in terms of my own personal experience. The aim (originally agreed by users) is 'people with a learning or physical challenge overcoming barriers to work', and because I have experienced barriers to work over my working life, which have, and continue to challenge me, that I can work to this purpose statement from personal experience. I also pointed him in the direction of one of my blogs ('The framework that informs managing user-driven work' dated 18th September 2009), as well as an article I'd written in the first book published by WorkABILITY early in 2008. This article was in the 'My learning or physical challenge' chapter, where all contributing authors, disabled or not, were invited to write a piece. In mine I wrote:

"I have learning and physical challenges but in order to 'get on' in the world of work I have learnt to manage them so they are presented to employers and work colleagues either in a positive light, or not all. Since becoming involved with WorkABILITY and its aim......it is no surprise I have had opportunity to reflect on my own, and others challenges. From my experience with WorkABILITY, I don't believe some people have learning or physical challenges, and others haven't - as if certain types of people are better at driving WorkABILITY forwards than others. Given the opportunity, everyone has contributed their skills, insights, wisdom, perceptiveness, passion, honesty and understanding. Sometimes this has been because of our learning or physical challenges, and sometimes not; whatever, it has not mattered - as far as driving WorkABILITY forward is concerned."

Not only do I still stand by this (2 years after I wrote it) but I can also claim to "have learnt much from the disabled people I have worked with" ( - see my 4th October 09 blog: 'Boppi's song and Darwin's survival of the fittest' and 19th Aug 09 blog: 'Giants and foxes that 'eat you up' - and the world of work').

But does this make me a user? I'm not sure, but what might help in answering this question is to try to uncover where my identification with, and appreciation of disabled people comes from. I think it all surfaced when I attended a L'Arche conference about 15 years ago. I was working for the YMCA at the time and setting up a mentoring / befriending scheme with disabled people ( - which was my first professional involvement with disabled people), so L'Arche, which has over 130 communities across the world where people with learning disabilities and their assistants live and work together, felt a good place to start.

At the conference we were all attending a communion service, which was no surprise given L'Arche and the YMCA are both Christian organisations. I was in a circle made up of disabled people and their assistants where we took it in turns to wash each others feet. At the time I could not understand why it had such a penetrating and unsettling effect on me but many months later I realized that having my feet washed by a severely disabled person was not what made me want to leave the conference, instead it had exposed the previously hidden 'disabled' person inside me I wanted to run away from.

I felt this was an embarrassing revelation that needed to be kept private, however what helped in the process of coming to terms with this, was reading Henri Nouwen's bestselling book 'The Wounded Healer' ( - which interestingly he wrote having had 7 years in a L'Arche community). Nouwen was convinced that

"for the minister ( - perhaps all of us in the caring professions?) is called to recognize the sufferings of his time in his own heart and make that recognition the starting point of his service. Whether he tries to enter into a dislocated world, relate to a convulsive generation, or speak to a dying man, his service will not be perceived as authentic unless it comes from a heart wounded by the suffering about which he speaks".

It's important to say here that the 'wounded healer' is much more widespread than you might think, being found in mythology, alchemy, eastern religion (ie the 'rainmaker'), shamanistic healing, psychoanalysis as first identified by Carl Jung, and in the caring professions where it is understood to be "a normal response to care giving...a normal human response" (Irene Ens, 2004. 'The lived experience of countertransference in psychiatric / mental health nurses.')

So what is the 'wounded healer'; where does it come from? Carl Jung believed it grows out of the countertransference or usually hidden impact the 'patient' has on the 'doctor'. The best practical definition I've found which explains not only my reaction at the L'Arche conference but also why I've worked for over 20 years in the caring professions, is from Richard Tillett (2003). He said "our urge to care for others is to some extent driven by our hidden identification with the patient role, based on projection of our own unmet emotional needs. We have an internal relationship with our own personal vulnerability ( - to be ill, frail, helpless, afraid etc) and our external professional behaviour is driven partly by this". (Tillett's article is called 'the patient within - psychopathology in the helping profession'.)

And maybe because I have faced this, and endeavored to understand how it informs my work, and that somehow this is demonstrated to those around me, that my staff member said at the ULO event that he believed me to be a user.....?

But what about the commissioners? A recent development that endeavours to bring commissioners (and providers of caring services) closer to users is that of

"co-production which rejects the traditional understanding of service users as dependents of public services, and instead redefines the service:user (or government:citizen) relationship as one of co-dependency and collaboration. Just like users need the support from public services, so service providers need the insights and expertise of its users in order to make the right decisions and build effective services" (People and Participation website).

This is good news but can, or will commissioners and service providers including myself, work on our own frailties, as 'wounded healers' for true co-dependency? This is an enormous challenge because "it is easier to live through someone else than to become complete yourself" (Betty Friedan (1963), The Feminine Mystique).

However if we 'live through someone else' are we not users of them......?