How the Care Review is challenging me
Claire Lightowler shares her reflections on power shifts and the work of the Independent Care Review
The Independent Care Review has deliberately been set-up to correct a power imbalance.
For years those whose lives are directly and most affected by the ‘care system’ have been unable to influence it on an individual basis, never mind at a strategic level.
This matters, because the design and delivery of care (and of other supports and services) is likely to be the best it can be if it draws from those with direct expertise; it also matters because having influence over your own life is important.
Of course, this form of direct experience, or ‘lived experience’, is one form of expertise and there are others.
For instance, there is:
- Practice wisdom/knowledge (knowing how to do)
- Policy or strategy knowledge (knowing how to navigate systems, process, bureaucracies)
- Research knowledge (knowing what has worked in other contexts, and why)
- And also conceptual knowledge (knowing what should work, based on logic and first principles)
My working hypothesis is that the dream team for any review, improvement process or service design should include people with the full range of knowledge, expertise and experience, as outlined above. Sometimes people in such a dream team will need to be involved in different ways through separate processes to enable everyone to contribute fully and safely.
My thinking on this is heavily influenced by Sandra Nutley and colleaguess’ (2007) work on different forms of evidence and the different ways of ‘knowing’, and Bovaird and Loeffler’s (2013) work on co-production, which they define as:
‘professionals and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes and/or improved efficiency’
This definition recognises that different people have different assets, resources and contributions to share and we need to make better use of them all, particularly ensuring the contributions of both professionals and citizens, if we wish to achieve something meaningful.
If we are to make better use of everyone’s contributions, in a fundamental way, that is beyond consultation, or engagement on a restricted set of issues (what colour should the room be, rather than whether there is a room) Needham and Carr (2009) argue there needs to be a significant shift in both power and control.
This involves embedding real power and decision-making authority permanently within and across organisations, rather than creating discrete opportunities for collaboration.
Such a fundamental power shift requires those who have power and influence to give some up, to be willing to share it more equally with all those who are affected. But, sometimes this proves hard to do.
Because the other side of the power imbalance are the people who have got used to being asked for their opinion, and are regularly invited to make a contribution (even if that is not always then listened to!). People like me.
This came to stark realisation following a conversation with the Independent Care Review’s Practice Support Manager Thomas Carlton (thanks Thomas) when explaining how delighted I was that care and justice was to be a major area of the work for the Care Review and that I was hoping the Centre for Youth and Criminal Justice (CYCJ) would be involved.
Thomas asked me if I’d offered to be involved and I realised I hadn’t.
I had arrogantly just expected that our expertise would be called upon.
The irony is not lost on me. Despite my work on co-production and long advocating the need for this power shift, here I was presuming that the type of contribution we would make would be recognised and called upon, when for years those with direct care experience have never had their expertise called on.
If we are to achieve a transformational shift of power and control then people like me need to actually tangibly commit to such change by acting differently. The power shift required will not always be about stopping power crazed individuals hanging onto influence for their own ego or personal benefit.
It will also sometimes need well-meaning people, who are eager to share their knowledge and expertise to help make a difference, to step back and create space for others. Of course, everyone’s contribution still needs to be made use of, but to do that properly others need to have influence as well.
This experience, this forced reflection, has really made me think about whether sometimes I am part of the problem, and I need to do something about that.
Bovaird, T., & Loeffler, E. (2013). The Role of Co-production for Better Health and Wellbeing. Retrieved from http://www.govint.org/good-practice/publications/co-production-of-health-and-wellbeing-in-scotland/
About the author
Claire Lightowler is the Director of the Centre for Youth and Criminal Justice (CYCJ) but is spending 2019 exploring what a rights-based response to children in conflict with the law looks like in Scotland.
CYCJ supports improvement and learning in youth justice, contributing to a reduction in crime and the realisation of better lives for individuals and communities.
Follow Claire on twitter @C_Lightowler