April 25, 2024
In this blog Co-Production Collective team member Vanessa Bennett, therapist and lived experience practitioner Jane Faulkner and Recovery Lead for North London Mental Health Partnership Cerdic Hall share their reflections and learnings from the Peer Community of Excellence project.
Over the past 2.5 years, Co-Production Collective have been supporting a range of partners including North London NHS Mental Health Partnership (Camden & Islington, Barnet, Enfield and Haringey), Central and North West London NHS Foundation Trusts, and other voluntary, community and social enterprise companies to co-produce a supportive Peer Working Community of Excellence. When we talk about peer work or peer workers in this context, we mean people who use their lived experience as well as their learnt experience of mental health challenges to support others.
We are now moving into a new phase in co-producing and building our ‘collective leadership’ and showcasing the broad impacts that Peer Working brings across many mental health contexts. This blog hopes to give you an insight into where we are heading.
From the get-go, the project aimed to evidence the benefits (or impacts) that greater investment in support and recognition, professional development and the integration of the peer working ethos can offer healthcare transformation plans in the UK. The peer workforce is growing rapidly across the NHS and partnering organisations in North London to support current national agendas, including the NHS Long-Term Plan and Transformation Plan.
There were two important aspects that came to give the Community of Excellence its name:
Community = recognising where expertise lies and power sit in this group
Excellence = an aspiration and a recognition of a direction
The meaning of these, and relevance to this Community representing Peer Working, have been further defined in the visuals below.
The journey started by presenting the ideas and needs we have just described to the Personalisation Oversight Board for the Integrated Care Board for North Central London for funding. This was followed by:
You can read a summary of the journey, and more about how we ran the workshops, and detailed outputs in our most recent report.
While the common principles of co-production may seem simple; in practice we often get a little stuck knowing how to apply them or are sidetracked and afraid of the tensions and challenges that may (or may not) arise. As we’ve learned from working with many co-producers who work across different contexts, these can also manifest as different things depending on the perspectives and experience, and also fears that individuals are holding. In the initial stages of working together it was important to try and define what these tensions and challenges are, reflect and recognise what individuals are bringing to the Community. The first stages of the workshop in April 2022 set out to dig deeper into how to define the community (see top half of illustration) and the second part looked more at how we could start working on some of these areas (1A, 1B and 1C in the diagram). Other impact aspects will be explored in a later phase once the Community is established.
Throughout our journey, we have heard an eagerness to find ways of coming together to work across a range of boundaries (e.g. different individual and professional roles, mental health contexts, structures, systems, sectors) and identify what will make a difference, develop a pathway to make it happen and measure the change.
While the focus has been on peer workers at all stages in their journey, the process has also included listening to those being supported by mental health recovery services and those in diverse roles across these organisations whose lives and work are touched by peer work.
Community members with lived experience have shared insights and experiences of entering, training and practising peer work, helping other community members to understand the potential mutual benefits and also challenges that come with their journey. For many there have been benefits purely from being ‘in the room’ and feeling heard and valued in a safe space:
“I don’t feel so isolated or as if there is something faulty about me.”
“Feel more confident and accepted as a peer – more knowledgeable and hopeful.”
“I feel more part of a community and connected to other peer workers”
This highlights the delicate balance between valuing peer work to improve healthcare provision and recovery for service users, while better supporting the communities of individuals who courageously apply their experience and wisdom from their own recovery to help others.
Essential to transforming healthcare, Michael West describes compassionate and collective leadership as essential ingredients to succeed in connecting and improving collaboration across boundaries to overcome challenges faced by the healthcare system (West, 2021, Chapter 9; and see NHS England page for additional resources). We brought this compassionate approach into our co-production, direction and facilitation of the workshops. The first steps are in providing safe spaces to enable some of these conversations to happen. In our April 2023 workshop, we brought a range of people across boundaries together. This included Peer Workers at different stages in their career journeys from the NHS and voluntary sector organisations, and other mental healthcare practitioners. Bringing such a diverse range of people together helped to broaden people’s perspectives around the value, potential and hopes for peer working within and across organisations and sectors. Our graphic summary (below) describes a summary of the values and purpose of the Peer Worker Community of Excellence, as well as the qualities of the environment and how members would like this to make a difference. Being involved in this process with the community, some members commented:
“A hope that this process will lead to more collaboration between the NHS and third sector for peer support.”
“Opened my eyes, helped me to widen the views of Peer Support Working and community.”
“I feel that as a community this has given me direction. Recognising that lived experience is an asset.”
At Co-Production Collective, we believe that co-production is about working together in equal partnership and striving for equal benefit. We work across boundaries all the time. Importantly working intentionally using Collective Leadership approaches creates the ideal foundation to explore change across boundaries with a range of people coming from different parts of the healthcare system. We believe in working together to identify what change looks like and value embracing that change.
Through a process of listening and investment in understanding different perspectives at a deeper level, the potential areas that this programme could, or needed to, have impact on, evolved. These were not only at an individual level but also at team, organisational and cultural levels (see earlier illustration for different areas that were identified).
We are often asked, “How do we address the challenges, the ‘thorny issues’ and the power structures by using co-production?”. In itself, there is no foolproof framework or guidance only our thoughtfulness and experience. Every context, issue, experience and human mind adds a layer of complexity. But through co-production we notice, acknowledge and invite people to reflect and think it through together and consider how equality and equity exists within the power dynamic! We consider what we could do to change the ways we work together to bring about benefits for all. Bringing people together in compassionate spaces that enable people to communicate in accessible and safe ways and feel heard is what the Community hopes to achieve.
“We should focus more on the community of excellence, then on the work relations on power structures. Probably for most people is the severe isolation and not being heard at an organisational level.”
“It has opened my eyes to the fact that stigma is still a big problem and needs to be addressed through co-production.”
What is clear from the outputs of the Community of Excellence programme so far is an agenda for change with many thorny issues to address.
Now that we have established a vision for the Community, how could co-production and collective leadership develop mutual benefits and deliver wider impacts through the Community of Excellence supporting the workforce and leading transformational change in cross-sector working?
Christopher Fox, who directs operations across the North London Mental Health Partnership, describes how he sees the Community of Excellence supporting change that is already underway to create continued impacts to benefit patients.
“As the North London Mental Health Partnership moves towards a potential merger. The organisation has been developing a patient’s benefits case reviewing three clinical areas (working age inpatient adults, crisis, and emergency care and older adults). From this work there has been clear identification of possible benefits to patients by merging and how we can build best practice to ensure equitable service provision. The interesting part is the clear impact peer coaching can have on supporting the delivery of the main change objectives within the organisation.
There remains a commitment to developing the peer coaching, using the Community of Excellence to develop co-production within the new organisation with the opportunity to support and develop new peer coaching roles over the course of any agreed implementation plans. This is particularly true for the crisis and emergency pathway that I have been working on that wants to develop a supportive approach to prevention of unplanned care (crisis) by engaging with communities. Based on the work that has already been completed, I see the Community of Excellence as pivotal in shaping the model, but also the delivery going forward.”
Jane Faulkner, a therapist and lived experience practitioner, has recently joined the Community of Excellence work to support co-ordination of this next co-production phase.
“It’s an exciting opportunity for the peer workforce to really shout about their achievements. Of which there are many! As a workforce, peer workers are able to use their lived experience to support the wider community. In this project we can use our lived experience to support each other.
Every profession evolves, and to do that we have to reflect on how we got to where we are, and what we want to head towards. The Community of Excellence is not only highlighting and showcasing the diversity of experiences that are being brought into the profession but also the wide abilities and skills that individuals have.
Yes, a peer coach is bringing and disclosing awareness of mental health challenges, but they are also bringing their abilities as an artist, photographer, singer, playwright. We often talk about holistic and person-centred care for the community; where we work with people in their whole capacity. It’s important that we extend that to ourselves as professionals.
Already there has been such an interest, and so many amazing and talented people reaching out to be involved. It’s dazzling!”
At this point in the journey, the Community has identified a direction and co-produced action plans that now need implementing. In the first instance these focussed on three areas (see graphic representation of the outputs and the full report for more):
We are encouraged that these areas of need identified by the Community so far also align with some of the findings from a recent systematic review by academic and lived experience researchers (Collins et al. 2024).
On Thursday 9 May 2024 - the Community of Excellence will be attending a celebration for the North Central London peer workforce. There will be the chance for those attending to participate in a workshop that will look at the many ways people get involved in peer working. There will be a panel discussion on the values identified in the previous Community of Excellence workshops, as well as the sharing of Peer Working stories.
The event is open to anyone interested in finding more about peer work in mental healthcare from any sector.
After the May event, we are planning to create some podcasts as well as a library of peer and lived-experience professional stories. These can be expressed in text, art, music and other materials.
If you have an idea, want to share, or have the opportunity to collaborate with us, please sign up to get involved or receive updates from the Community of Excellence (or email cerdic.hall@candi.nhs.uk)
Thank you to our working group lived experience member, Alexandra Lima Dimitrijevic for reviewing and commenting on this blog.
West MA. Compassionate Leadership. Sustaining wisdom, humanity and presence in social care. Chapter 9. Compassionate Leadership Across Boundaries. 2021.
The British Psychological Society: Leadership and teamwork: Collective and compassionate leadership
NHS England. What does compassionate and inclusive leadership mean to us?
West MA. The King’s Fund. Developing collective leadership for health care. 2014.
Cooper RE, et al. The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review. 2024. (Open Access Publication)
Photo credit to Brett Jordan from Unsplash.
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