1. to culturing co- production Nigel Monaghan From needs assessment

2. Warning! This is still thinking in development for me I am not an expert on: complex systems thinking co-production needs assessment Hence I teach the latter on local MPH courses

3. Inspired by... Complexity in primary care – understanding its value (Keiran Sweeney) Co-producing services – co- creating health (1,000 lives) Years of experience of open and participative approaches to needs assessment

4. Needs assessment 3 rd party or expert led Epidemiological Corporate Comparative Traditional Secondary Care Approach – typified by Stevens and Raftery (1994)

5. Needs Assessment in Primary Care Primary care problems are less well defined Thus a spectrum of both aims and of approaches to select from is more appropriate Scottish Needs Assessment Programme – Needs Assessment in Primary Care A Rough Guide (1998)

6. SNAP Rough Guide offers... Global needs assessment (to identify priorities) Focused needs assessment (need, evidenced interventions and current practice) Guideline based needs assessment Community development (participative) Healthy alliances approach (to generate health) Advocacy approach (Work with vulnerable) Economic approach (Costing of options)

7. I have encouraged students... To blend the best elements of these approaches – making needs assessment participative Thus we have been on a journey from 3 rd party decisions through participative working towards...?

8. A journey along a spectrum Expert led decision making – Traditional third party needs assessment Participative decision making – Participative needs assessment Community and individual empowerment – What do we do here?

9. Needs assessment and complexity Looked at through a complexity lens I am wondering... A. What should needs assessment look like? B. What should the role of public health be?

10. What should needs assessment look like? Enabling people to effect change, rather than engaging them within a change process or making decisions on their behalf Bringing people together to share knowledge, and understanding and to develop concensus and motivation to act Be an ongoing sustainable process/agenda rather than a one-off action

11. What is a complex adaptive system? Agents Environment Rules (formal/informal, manmade/natural) Interactions Self-organising Properties emerge

12. Examples of CAS’s Family School Workplace Community Note an individual agent may be nested within a number of these

13. Change Note that the interactions between agents and environments can lead to changes in: Agents Environments Rules What emerges

14. Complex Receptive Process (Stacey 2001) Basic unit of activity is communication between individuals through which individuals co-create and in the process make sense of the system Interaction of this type produces coherence and from this potential transformation These processes are unpredictable (Sweeney 2006)

15. Creating Conditions for Change (Sweeney 2006) Create a framework for change Reconfiguring a Bank IT system to prepare for the euro Mechanism used – series of monthly meeting of system developers, IT staff, managers and operational staff plus weekly info updates Cross-dependencies were identified, new communication emerged as did new groups

16. Receptive Context for Change (Sweeney 2006) Recognising things are not working well Leaders committed to aspirational goals including visible behaviour change Creation of new staff and staff/patient relationships Encouragement of experimentation and risk taking

17. Receptive Context for Change (Sweeney 2006) Accepting different ways of working will be better for patients Genuine and meaningful patient involvement Importance of language/communicating (beware jargon) Accept all above as a new way of working (Pursuing Perfection)

18. What are the implications? Can we help to develop a shared view where we could do better? Do we lead by example? Are we fostering better relations with our staff, with partners and within the community? Do we encourage experimentation & risk taking?

19. What are the implications? Accept that different ways of working will be better for health and well-being? Undertake meaningful and genuine public involvement? Avoid jargon and ensure good communication?

20. If we could do all of the above Then in addition to creating conditions where transformational change is more likely Are we increasing the likelihood of co-production Are we more likely to maximise use of community assets?

21. Working with a CAS Change environments to increase interaction Change rules to ensure that discussions occur, that voices are heard and unsayables are said Introduce new agents As a result of all of the above we can change interactions and communication

22. Working with a CAS In addition we can then inform conversations (bring information into discussions) Allow coherence, self-organisation and emergence Advocate for what emerges

23. What can public health bring Besides data?

24. Implications for Public Health We need to flex our approaches. If we have to do a third party needs assessment and we suspect complexity For a focused topic Undertaken with active participation And we should include consideration of networks, rules etc.

25. Implications for needs assessment Not 3 rd party knows best Nor 3 rd party leading/co-ordinating action Rather – catalyst for interactions – negotiating new rules of engagement, – facilitator of discussion/communications, – public health resource for local people – when asked to advocate and facilitator for community priorities

26. Create Conditions for Co-production? Environment (can seek to ensure people meet/ communicate in the right environment) Negotiate rules (formal/informal, manmade/ natural) Agents (can bring others) Interactions Public Health knowledge/analysis

27. Can we apply this? Health Social Care and Well-being Strategies from 2015? What does a “Prudent” approach to well- being” look like? Would a “Prudent” approach focus on what we (so-called experts) think matters most or on what local people think?