Challenges of integrating service user and carer
experiences into the Health and Social Care curriculum:
reflections on a podcasting initiative
at the Open University in Scotland
Peter Blackledge and Mo McPhail, with Wendy Laird, Gráinne Smith and
Surinder Saroya
Peter Blackledge is an Associate Lecturer in the Faculty of Health and Social Care and Mo
McPhail is Head of Social Work, The Open University in Scotland.
Abstract
The involvement of people who use social work services and carers in the design and delivery
of professional programmes and qualifications has been identified as both good practice and
a professional requirement for a number of years (COSLA et al, 2003). A changing funding
climate raises potential difficulties for the sustainability of this practice. This paper will explore
an Open University project which produced a series of podcasts to incorporate service user
and carer experiences into the wider Health and Social Care curriculum delivery. This project
is then used as a springboard to consider wider debates on the purpose, and learning benefits,
of embedding direct service user and carer experiences in the curriculum.
1 Introduction
The value of involving service users and carers in the education and training of service
workers, once a radical notion, is now taken for granted in principle if not always in practice.
In particular, providers of social work degree programmes have been required since 2003 to
ensure that policies and procedures for the selection and assessment of students include
"effective and appropriate ways of involving [and] meeting the requirements of key
stakeholders", who are defined as including "people who use services [and] carers" (COSLA
et al, 2003). Similar requirements for user and carer involvement were introduced in
England, Wales and Northern Ireland by their respective Care Councils. This requirement is
now extending to a wider range of professional programmes including those for nurses and
child care practitioners.
From 2008 to 2012, the Scottish Social Services Council (SSSC) provided a modest grant to
social work degree programmes to facilitate the involvement of service users and carers.
The cessation of the grant in 2013 challenged the sustainability of practices that were
developed in a more benign funding climate; it challenged the Social Work programmes to
find more cost-effective approaches to continuing and indeed developing the participation of
service users and carers in the Social Work degree.
At the Open University in Scotland a small group of service users and carers and Health and
Social Care (HSC) staff have been working together since 2005 to develop the practice of
involving service users across the HSC curriculum. This is a cross faculty initiative, rather
than one which is exclusively focused on social work education. Despite the removal of
SSSC funding the OU is committed to continuing to enhance student learning by embedding
the voices of service users and carers in the HSC professional programmes. To achieve this
the OU is developing a series of podcasts of service users and carers talking about their
experiences of particular areas of health and social care services, to be available on-line to
1
OU students and perhaps eventually, to a much wider audience of users of open educational
resources.
The podcasts aim to enhance student’s learning by providing access to the voices of people
who use health and social care services and carers, talking about their experiences of health
and social care services. The project addresses a perceived gap in social work teaching, by
providing new resources that help students to prepare for the specific practice learning
placements they will undertake to enhance their learning.
This paper will consider the OU project in relation to discussions on the broader learning
implications of the inclusion of service-user and carer experience in the curriculum. It will
include reflection on what this means for curriculum development and student learning,
particularly through creating opportunities for authentic and critical enquiry based learning
(for definition of these terms see Lee et al 2007).
2 Literature review
An extensive literature of journal articles and published texts on service user involvement in
professional education is too large to detail here. A selection of studies specific to service
user and carer involvement in the social work education context include; Beresford (1994;
2000; 2001a; 2001b; 2006; 2008; 2012); Harris (2003); Levin (2004); Molyneux & Irvine
(2004) ; Ager et al (2005); Taylor et al. (2006); McPhail (2008); Warren (2008); Sadd (2011)
Wallcraft, et al. (2012), and Smith et al (2011) who consider the lingering barriers to
involvement of the most marginalized groups.
The Social Care Institute for Excellence (SCIE) has produced a series of Guides and
Position papers on service user involvement in both social care and social work education
around themes of inclusion, networking and involvement of under-represented groups, which
provide a backdrop to the current study. Glasby and Beresford (2006) present a case that
the generation of social work knowledge which does not include the views of people who use
and those who provide social work services is likely to produce a false and unsafe view of
the world. However a study in England by Branfield (2009) found that despite being a
requirement of the new social work degree, involvement of service users and carers remains
piecemeal and patchy. Obstacles included inadequate training for service users, negative
attitudes of students and staff, and practical barriers such as poor transport and slow
reimbursement of expenses.
Other studies relevant to the OU podcast project focus on the use of podcasts in distance
education. Lee et al (2011) for example, found that there were a number of benefits
stemming from use of podcasts and other digital learning resources such as: increasing
learner motivation and engagement; facilitating and enhancing learning outcomes and
establishing a sense of a learning community. In contrast to earlier uses of audio-visual
material in distance education, podcasts were preferred because they are file-based
downloads and supported mobile or portable learning.
Another area of research studies is focused on the involvement of service users and carer in
professional education via the medium of podcasts or similar digital materials. Fox et al
(2011) developed an interdisciplinary action learning set to develop an e- learning resource
to enhance students to work more effectively with service users and carers. Service users
were involved in the development of this resource. Within this there are case scenarios and
feedback from learners. They comment that the development work was curtailed by lack of
time and resource, which appears to be a familiar experience.
2
3 Project background
At the Open University in Scotland, service users and carers have worked with members of
the Health and Social Care faculty since 2005 to contribute to the development and delivery
of the curriculum. The contributions of service users and carers have included participation
in agency approval and student selection; quality assurance of student assessment and
practice learning; development of curriculum materials; management of the social work
programme; and writing and/or critiquing publications to document and develop practice.
A Service Users and Carers (SUC) management group of users, carers and staff has given
guidance and continuity of oversight as well as providing a venue for developing new
initiatives. Academic assumptions and practices have been challenged and changed in the
course of creating opportunities for meaningful engagement (and trying to avoid the traps of
token participation) by service users and carers.
4 Development of the project proposal
The loss of grant funding encouraged the SUC to look for new approaches to maintaining
and enhancing the commitment to service user and carer involvement. The SSSC’s rationale
for the funding cut to social work programmes included the notion that other health and
social care disciplines require to involve service users and carers in their programmes; so
social work should not receive financial support that could not be offered to the other
disciplines. Within the Open University in Scotland (OUiS), colleagues in the Health and
Social Care (HSC) faculty were already engaging with service users and carers, and the
latter were themselves advocating for their voices to be heard more consistently across all
the health and social care disciplines. Meantime, feedback on the social work programme
suggested that it might be desirable to develop additional resources to help students better
prepare for their practice learning placements.
The nature of distance learning programmes means that it is difficult if not impossible to
involve service users and carers in direct work with students on a consistent and equitable
basis. Users and carers do take part in face to face tutorials in the final year social work
practice learning module; but the experience of different tutor groups across the nation is
likely to vary considerably, depending on who is available locally to work with them, and on
the particular circumstances of their tutorials.
In this context, the deliberations of the OUiS service users and carers group resulted in a
proposal to develop a series of podcasts, in which users and carers talk about their
experiences of particular health and social care services, to be available on-line to OU
students (and perhaps eventually to a wider audience of users of open educational
resources). The intention was to produce learning resources that offer students relatively
direct and unmediated access to the experience and opinions of people who have used the
services in which the students will undertake their practical professional training. Relevant
service areas in health and social care include: Mental Health, Learning Disability, Disability,
Adult Care, Criminal Justice Social Work, Social Work with Children, Young People and
Families services. A further aim was to involve service users and carers whose voices are
seldom heard in professional education, such as black and minority ethnic service users and
carers, and involuntary service users such as people involved with criminal justice social
work services and people who misuse alcohol and substances (Smith 20011).
3
5 Process and progress to date
A bid was submitted to an OU Small Project Fund in July 2012, and initial funding of £2000
was confirmed in October 2012. A meeting of the OUiS SUC group in November 2012
agreed to proceed with the project. The SUC group constituted itself as the project
management group, and nominated one of its members as project manager. Neither the
project manager nor the members of the management group had any previous experience of
making audio recordings or creating podcasts.
5.1 Laying the foundations
Before anyone could be approached for an interview, it was necessary to establish project
procedures and documentation and to acquire recording equipment. It took four months from
the decision to proceed in November 2012 until these foundations were established by late
March 2013. The first step was to draft an action plan and to seek advice best practice and
legal requirements in relation to data protection, informed consent and copyright. The
management group held three telephone conferences to discuss and revise project
documentation. Interview questions were pilot tested, the project manager and a carer
member of the group participated in a training day on interviewing and audio recording, and
the loan of a digital recorder was obtained.
5.2 Contribution of service users and carers to consideration of content,
confidentiality and copyright
The views of the service user and carer members of the project management group
significantly shaped the development of the project. As the project manager began to unpack
the project proposal and to draft an action plan, the service user and professional members
of the group brought different assumptions and perspectives to discussions about
recruitment of interviewees, content and editing of interviews, copyright and control of the
final product.
The management group determined that a "partnership approach" should be the primary
principle guiding the implementation of the project, and our relationships with interviewees in
particular. In order for the project to make respectful relationships with participants, and to
represent their views meaningfully, it must offer people real choice about involvement, based
on informed consent, and it must be open to feedback about participants' experience of the
project.
Group members began to articulate an understanding of the project within a wider context of
social policy and principles, for instance as an effort at co-production: "…a relationship
between service provider and service user that draws on the knowledge, ability and
resources of both to develop solutions to issues … changing the balance of power from the
professional towards the service user" (Scottish Community Development Centre). The
commitment to a partnership approach was described by a service user member of
management group as evidence of "understanding of my basic human rights and needs".
Academic vocabulary was challenged where it might be obscure or obfuscating. A draft
copyright agreement based on a standard Open University document that asked
interviewees to "waive all moral rights… (including, but without limitation) any of my rights
under Sections 77 and 80 of the Copyright, Designs and Patents Act 1988, or similar laws of
jurisdiction" was thought to be unduly onerous as well as obscure in its implications. So at
4
this preliminary stage, the project action plan, information sheets and consent forms were
revised and reviewed several times until they were acceptable to all members of the
management group.
The need to edit recordings - to modify an interviewee’s account to fit a pre-determined
podcast format - was questioned. The transcription of interviews was advocated, so that
interviewees would be able to identify what might be missing from the edited audio, and then
decide whether they would approve the publication of the edited version of the interview.
All members of the management group were venturing into unknown territory in this project,
and as the commitment to partnership with participants was explored, the project began to
develop an "action research" quality. Reflections offered by members of the management
group during this period indicate both the challenge and stimulation they experienced:
"… completely outside my comfort zone… have developed a whole new set of skills"
"An interesting and thought provoking journey - I have got a lot out of it"
"… challenges of co-production - learning as we go along"
"How long it all takes!"
5.3 Pilot interviews
At the time of writing, three interviews have been recorded with members of the Service
Users and Carers group. They all challenge one of the core aims and assumptions of the
project, i.e. that podcasts should be short and focused. Participants have been informed that
the interview is an opportunity to talk about their experience of a specific service, and to
identify what a student, as a prospective service provider, should know in order to be helpful.
Although they seem to understand the purpose of the interview, people want - or perhaps
need - to tell their story in their own way and in their own time. Recordings are 40 to 60
minutes long.
Having asked the initial question to set the ball rolling, the interviewer has felt that it would
be disrespectful and probably counter-productive to be over-directive about what should be
said and how. The experiences the interviewees describe are very personal, often very
challenging and emotionally charged; they may be in the past or they may be very recent. So
far at least, the stories told do not fit into simple, easily-labelled boxes. They do, however,
have the potential to communicate the pain, confusion and distress that have entered and
sometimes taken up residence in the lives of the speakers; while their darkness throws into
vivid relief people's resilience and their appreciation of meaningful help when it is given.
5.4 Next steps
To complete the first stage of the project, it is intended to undertake three more interviews;
to prepare the interviews for publication online; and to offer a small number of students
access to the podcasts for initial user testing and feedback.
With regard to publishing the interviews online, the intention is to present the complete
interview both as a single recording, and also broken into a set of shorter recordings,
annotated and labelled to inform the potential listener of the topics included in each
individual item. The recordings will be packaged with a context-setting introduction and
questions for consideration when listening.
5
6 Reflections
The impacts on the project manager of interviewing and recording carers and service users
may indicate the potential impacts on the intended audience of listening to the podcasts.
Giving people time to speak about their lives encourages awareness of the burdens of living
with long-term illness or disability, and the burdens of caring for a relative with such illness or
disability. There is no doubt that everyday life is hard work, physically and emotionally. For
some, there may be little or no prospect of improvement or relief, so it is painful to hear
about the callousness of professionals and services when they forget or ignore the reality of
people's lives. Being reminded of our common humanity may lead to the understanding that
“there but for the grace of God go me."
6.1 Reflections on the process
As the work has proceeded, management group members have had to recognise and work
with tensions between project aims ("short, focused podcasts"), respect for participants
("giving people time to tell their stories") and the limitations of resources and expertise
currently available to us. There has though been a willingness to learn together, valuing the
distinctive contributions of the professionals and the experts-by-experience. The challenge of
managing differences in status and experience, in order to share power and decision making
in the management group, has mirrored a firm intention to respect and give meaningful
choice to project participants.
An interviewee who is also a member of the management group tells of a case conference
on her newly-disabled adult son, when she refused to allow the meeting to start until he was
brought to sit at the table. Our work on the podcast project has confirmed for us that
"…partnership is about managing power; it requires constant attention and is always 'work in
progress'." (Taylor et al, 2006, p. xiv)
6.2 Reflections on the implications
This project stemmed from the need for a more cost effective means to deliver service user
and carer perspectives on professional education programmes, without losing the
authenticity of the input from service users and carers. The project addresses concerns of
service users and carers having to repeat their personal experience year after year to new
cohorts of students on professional programmes of study. An additional feature of this
project is that management members are keen to avoid reliance of individual case study
experiences and to include more collective voices of service user or carers.
Involvement of service user and carers’ experiences in the curriculum raises pedagogical
questions about the place of authentic personal and collective experience in the HSC
curriculum. Should it always be tied to learning outcomes, as Fox et al (2011) and others
state, or does this approach open the way for a more direct and unmediated learning? How
does this project relate to the issues and discussions regarding the basis of open learning,
for example as supporting self-determination and independence of learners with guided
learning? Key features of an open learning approach are; informal learning, student selfdirection, authentic learning using real life situations, access to rich resources versus
approaches using written materials, and acknowledgement of what the learner brings to the
learning situation (after Dewey 1997). How much guidance and support do students need to
structure their learning? What is the role of individual and collective service user and carer
narratives in the production of health and social care knowledge? The next phase of the
6
project, evaluating the podcasts as learning resources, should enable some fruitful enquiry
into the possibility of differential learning from the podcasts as students move through
sequential stages of the social work degree.
The greatest learning so far from this project is that the co-production of podcasts with
service users challenges assumptions about the production and the creation of a rich and
valuable source of learning and knowledge; in particular, that it is indeed costly in time and
resources if it is to be carried out as a respectful co-learning activity.
7 Conclusion
At this relatively early stage in its implementation, the project has already shown that it can
engage service users and carers in both managing the process and in providing content.
There are clear indications that it can involve and challenge academics and professionals.
We look forward to presenting and testing the podcasts with students. If this pilot stage
proves successful, it will both strengthen the voices of people who are seldom heard and will
give students a deeper understanding of their professional responsibilities.
References
Ager, W., Dow, J. and Gee, M. (2005) ‘Grassroots Networks: A Model for promoting the
Influence of Social Work Users and Carers in Social Work Education’, Social Work
Education, Vol. 24, No 4.
Beresford, P. (2000) ‘Service users' knowledges and social work theory: conflict or
collaboration’, British Journal of Social Work, Vol. 30, No 4
Beresford, P. (2001a) ‘Service users’ knowledge and the construction of social work’ Journal
of Social Work, Vol. 13, No. 3
Beresford, P. (2001b) ‘Social work and social care: the struggle for knowledge’, Educational
Action Research, Vol. 9, No. 3
Beresford, P. Boxall, K., (2012) 'Social Work Education and Knowledge for Social Work
Practice', Social Work Education: The International Journal, Vol. 31, No 2,
Beresford, P. Branfield, F., Taylor, J. Brennan, M., Soutori, A., Lahani, M., Wise, G. (2006)
‘Working Together for better social work education’ Social Work Education: The International
Journal Vol. 25, No. 4
Beresford, P. with Page, L. and Stevens, A. (1994) Changing the Culture: Involving service
users in social work education CCETSW Paper 32.2, London: CCETSW
Beresford, P., Croft, S., Adshead, L. (2008) ‘We Don’t See Her as a Social Worker’: A
Service User Case Study of the Importance of the Social Worker’s Relationship and
Humanity, British Journal of Social Work, Vol. 38, No. 7
Branfield, F. (2009), SCIE Report 29: Developing user involvement in social work education,
www.scie.org.uk/publications/reports/report29.pdf [Accessed 26/4/2013]
COSLA, QAA for Higher Education, Scottish Social Services Council and Scottish Executive
(2003) The Framework for Social Work Education in Scotland [online]
www.scotland.gov.uk/Resource/Doc/47021/0025613.pdf [accessed 23 April 2013].
7
Dewey, J. (1997) Experience and education. New York: MacMillan
Fox, J. ( 2011) Modelling Best practice in service user and carer involvement in the Faculty
of Health and Social Care at Anglia Ruskin University: The development of e-learning
technology
www.inspire.anglia.ac.uk/assets/uploads/networks/issue14/networks_service_user_carer_in
volvement.pdf [Accessed 23/4/2013]
Glasby, J. & Beresford, P. (2006). 'Who knows best? Evidence-based practice and the
service user contribution'. Critical Social Policy, Vol. 1 No. 26
Harris, J. (2003) The Social Work Business, Oxon: Routledge
Lee, M.J., McLoughlin, C. Tynan B. (2007) 'Describing ICT- based learning designs that
promote quality learning outcomes' In: Beetham, B. and Sharpe, R. eds. (2007) Rethinking
pedagogy for a digital age; designing and delivering e-learning. Abingdon and New York:
Routledge.
Levin, E. (2004) Involving Service users in Social Work Education, London: SCIE
McPhail, M. (ed.) (2008) Service user and carer involvement: Beyond Good Intentions,
Edinburgh: Dunedin Academic Press
Molyneux, J., & Irvine, J. (2004) ‘Service user and carer involvement in social work training:
a long and winding road?’ Social Work Education: The International Journal, Vol. 23, No. 3
Sadd, J. (2011) 'We are more than our story: service user and carer participation in
social work education’, London: SCIE.
Scottish Community Development Centre (2011), Community Resilience and Co-production,
www.scdc.org.uk/media/resources/assetsalliance/Community%20Resilience%20and%20Coproduction%20SCDC%20briefing%20pap
er.pdf [Accessed 3/5/2013]
Smith, M. Gallagher, M., Wosu, L., Stewart, J., Cree, V.E., Hunter, Evans, S., Montgomery,
C. Holiday, S. and Wilkinson, H. (2011) 'Engaging with Involuntary Service Users in Social
Work: Findings from a Knowledge Exchange Project', British Journal of Social Work Vol. 42,
No 8
Taylor, I., Sharland, E., Sebba, J. and Leriche, P. with Keep, E. and Orr, D. (2006), The
learning, teaching and assessment of partnership work in social work education,
www.scie.org.uk/publications/knowledgereviews/kr10.pdf [Accessed 26/4/2013]
Wallcraft, J., Fleischmann, P. and Schofield, P. (2012), The involvement of users and carers
in social work education: a practice benchmarking study, London: SCIE
Warren, J., 2007. Service user and carer participation in social work. Exeter: Learning
Matters.
8