Abstract
The recent special issue ‘Inside Co-production’ (edited by Bevir et al, 2019) of the journal Social Policy and Administration called for a ‘decentring of co-production’ (p.199) by focusing attention on elite narratives, local traditions and resistance, and meaningful practices. We continue the analysis of these themes in this chapter by highlighting what we view as important distinctions between co-production and Patient and Public Involvement (PPI) in applied health research. In introducing their editorial, Bevir et al (2019) acknowledge the rich and distinct tradition(s) of co-production around the ‘radical goal of challenging dominant interests and emancipating marginalised groups’ (p.197). But they also – in our view problematically – ascribe flaws found in PPI (e.g., widespread tokenism) to co-production. We argue that conflations of this kind arise from an uncritical acceptance of how proponents of the PPI agenda have adopted (at least in rhetoric) key principles distilled from the work of academic researchers and others associated with co-production, while neglecting or failing to comprehend its distinct and radical origins.
In this chapter we briefly outline the emergence of PPI in the English National Health Service (NHS) and explore the rationales for the promotion of PPI – and the more recent adoption of the label ‘co-production’ – by the National Institute for Health Research (NIHR). We then draw distinctions between PPI and co-production within the English healthcare and research contexts and assess their respective need for a decentred analysis. More specifically we examine whether the discourse of co-production itself requires decentring, or rather whether the co-option/corruption of co-production through a national mandate for PPI has perhaps inadvertently served to translate theory into practices that can only be mislabeled as co-production. Central to this analysis is understanding the networks (and associated traditions) through which co-production has become so closely aligned with PPI in English healthcare and research contexts, as well as competing ideas regarding the utility of different forms of involvement as a means to achieving better health(care) outcomes. In short, we suggest that many of the critiques levelled at co-production arise from a misrecognition of its origins, which are rooted less in grand or elite narratives, imposed from the top down, and more in practices that have been developed in multiplicitous locally driven exchanges, and shared through lateral networks. In this light, what is needed is less a decentred understanding of co-production itself, and more a critical analysis of the path by which a policy-driven and quite distinct set of practices (PPI) came to be associated with the term. This implies an approach to analysis that also accounts for structural influences on the practice of PPI – one that we commence in this chapter.
In this chapter we briefly outline the emergence of PPI in the English National Health Service (NHS) and explore the rationales for the promotion of PPI – and the more recent adoption of the label ‘co-production’ – by the National Institute for Health Research (NIHR). We then draw distinctions between PPI and co-production within the English healthcare and research contexts and assess their respective need for a decentred analysis. More specifically we examine whether the discourse of co-production itself requires decentring, or rather whether the co-option/corruption of co-production through a national mandate for PPI has perhaps inadvertently served to translate theory into practices that can only be mislabeled as co-production. Central to this analysis is understanding the networks (and associated traditions) through which co-production has become so closely aligned with PPI in English healthcare and research contexts, as well as competing ideas regarding the utility of different forms of involvement as a means to achieving better health(care) outcomes. In short, we suggest that many of the critiques levelled at co-production arise from a misrecognition of its origins, which are rooted less in grand or elite narratives, imposed from the top down, and more in practices that have been developed in multiplicitous locally driven exchanges, and shared through lateral networks. In this light, what is needed is less a decentred understanding of co-production itself, and more a critical analysis of the path by which a policy-driven and quite distinct set of practices (PPI) came to be associated with the term. This implies an approach to analysis that also accounts for structural influences on the practice of PPI – one that we commence in this chapter.
Original language | English |
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Title of host publication | Decentring Health and Care Networks |
Subtitle of host publication | Reshaping the organization and delivery of healthcare |
Editors | Mark Bevir, Justin Waring |
Publisher | Palgrave Macmillan |
Pages | 213-237 |
Number of pages | 25 |
ISBN (Electronic) | 978-3-030-40889-3 |
ISBN (Print) | 978-3-030-40888-6 |
DOIs | |
Publication status | Published - 12 Jul 2020 |
Keywords
- Co-production
- Patient and Public involvement
- Networks
- Health care