1. CORE 3: Unit 3 - Part D
Change depends on…
Being able to notice differences between how things are now, and how they could or should be
A strong desire for a different and better situation
A belief that things could change and improve
Supportive ways in which the change can happen – this includes:
deciding on the change needed
planning the change
trying it out
seeing how it works
Trainer Notes
PRESENTATION:
User involvement happens because people want things to change for the better - especially for users, carers and the public, but also for health and social services. For user involvement to be ‘real’ people need to believe change is possible and be open to change. They need to listen to user perspective about this change. Health and social service staff must want change even if it may question some things they were not expecting. Change depends on these things:
Present above points. 1A

2. Influence & decision-making
CORE 3: Unit 3 - Part D
Influence & decision-making
How much change you achieve depends on how much input you get as a user consultant.
You have to ask:
How far do user consultants get ‘inside’ an organisation and its decision-making process?
Trainer Notes
PRESENTATION:
Present above points. 1B

3. Influence & decision-making
CORE 3: Unit 3 - Part D
Influence & decision-making
If you use the idea of a tree, you can ask:
Do you only get to play with the leaves?
Do you get to sit on the branches?
Do you get down into the roots where everything is set?
Trainer Notes
PRESENTATION:
Present above points, then say: One user group used the idea of a lemon tree to help them work at user involvement and change in mental health services. The project was called the Lemon Tree Learning Project.
They developed training sessions to help services understand, establish and support more and stronger user involvement. Some services wanted to use everything the user group could offer them. Other services just wanted small pieces of it. The idea of the tree was useful in looking at how much input and influence they got as a user group. This indicated how much influence and decision-making users and carers were going to have in the organisation. Let’s talk about the three levels they used.
Note to Trainer: The Lemon Tree Learning project has different levels of user involvement – root, branch and leaves work. During this presentation, link these levels to the examples given by guest speakers in previous sections of the training. What level of user involvement was happening in their examples? 1C

4. Working at the roots Root work:
CORE 3: Unit 3 - Part D
Working at the roots
Root work:
allows the most influence and decision making for users, carers and the public
allows user consultants to get to the centre of the service and build strong support for user involvement from the top down.
sets a foundation for all future user involvement work in the service
The strength of this foundation will determine how effective user involvement will be at all the other levels
Trainer Notes
PRESENTATION:
Present above points. 1D

5. CORE 3: Unit 3 - Part D
Working at the roots
Root work involves slow relationship building work in order to create trust between staff and user consultants
It requires respect and patience
User perspective is seen as very important in root work
Services commit ongoing resources, time and energy to user involvement
Learning takes place over time – it is not a quick fix
Real effort is needed to create change, which can be hard for staff - they also need support during this work
Trainer Notes
PRESENTATION:
Present above points. 1E

6. Working at the roots: examples
CORE 3: Unit 3 - Part D
Working at the roots: examples
Meeting with a small group of health and social service staff, including someone in a key management position, and users and carers who use the service
Holding these meeting regularly over several months to listen to each other, develop ideas and make decisions - the meetings might cover:
what the concerns are from a user perspective
what the service has or has not done with these concerns
how they could work together
what policies they need – then creating these
Trainer Notes
PRESENTATION:
In the Lemon Tree Learning Project, the user group did root work when services had an interest in user involvement and wanted to work over a longer period of time to improve their ability to do user involvement. For example, this may involve:
Present above points. 1F

7. Working at the roots: examples
CORE 3: Unit 3 - Part D
Working at the roots: examples
what resources they need to support user involvement – then obtaining them
how they would invite all the staff to become involved
how they would invite more users and carers to be involved
holding service-wide events for staff, users and carers to attend
offering training to the staff
identifying user involvement structures and projects that staff are willing to do to improve services
monitoring the process and keeping the conversations going
Trainer Notes
PRESENTATION:
Present above points, then say: We have spent more time on the roots work, as it is the most important work and usually has the best outcomes. 1G

8. Working with the branches
CORE 3: Unit 3 - Part D
Working with the branches
Branch work:
usually works best when an organisation has already made a commitment and set up good support for user involvement
it extends what already exists
means developing people’s current skills, knowledge and attitudes about user involvement so that user involvement work becomes stronger and more successful for everyone
Trainer Notes
PRESENTATION:
Present above points. 1G

9. Working with the branches: examples
CORE 3: Unit 3 - Part D
Working with the branches: examples
When the Lemon Tree Learning project did branch work they gave training or advice to: 
user and carer only groups
staff only groups
mixed groups of user consultants and staff who were collaborating on a user involvement activity
The project staff worked as user consultants in doing training, facilitating or planning work with these groups
Trainer Notes
PRESENTATION:
Present above points, then say: There is already strong support for user involvement in the NHS – you learnt about this in Core 1. This training and facilitation resource is like branch work, as it helps make it really happen. However, not all services are well prepared for user involvement, so you will still be involved in doing lots of roots work. 1H

10. Playing with the leaves
CORE 3: Unit 3 - Part D
Playing with the leaves
Leaf work is very different. Leaf work is:
not tied into a strong commitment for real and ongoing user involvement within services
it is an easy or quick fix option for services - it looks like they are doing something, but if you ask the users and carers from the service, they will tell you that it feels token and weak
often one-off, ungrounded, independent events - they do very little to effect service change
Trainer Notes
PRESENTATION:
Present above notes 1I

11. Playing with the leaves: examples
CORE 3: Unit 3 - Part D
Playing with the leaves: examples
Leaf work has the same quality as leaves - they can be picked off the tree, wave around or float. They usually fall to the ground with very little impact – examples are:
give a one-hour talk on user perspective
talk about the project at a staff meeting
meet with senior staff to develop their user involvement policy but with no local user representatives involved
Trainer Notes
PRESENTATION:
Present above points, then say: The Lemon Tree Learning project was often asked to do leaf work. Although the most requested learning situation it was the least effective. 1J

12. CORE 3: Unit 3 - Part D
Summary
Root work is the most important work if user involvement is to become a reality
If user consultants are invited to do leaf work it is unlikely that they will achieve the amount of change they believe is needed
The Department of Health has created a document to help health and social services think carefully about the level of input they seek from users, carers and the public, and how to make this positive and real in their organisations
Trainer Notes
PRESENTATION:
Present above points, then say: The document is listed in your useful information section.
Note to Trainer: This document is: Department of Health (2003). Strengthening accountability: Involving patients and the public. Practice guidance - Section 11 of the Health and Social Care Act London: Department of Health. 1K