Co-production in social care: What it is and how to do it

How to do co-production - Practice

Making co-production happen in practice is about all those who are involved in the process – who may have different perspectives – working together to achieve agreed aims. This means building relationships. In several of the practice examples this was described as developing the conversation.

But there can be difficulties in the relationships between the people who use services and professionals. For example, one study found that there were tensions in the relationships between volunteers and staff in a chronic disease self-management programme in Australia. Professionals felt that the volunteers were not contributing to the programme very much and saw them as a burden to their work. The volunteers found their relationships difficult because they were not given status or a strong voice in their role in the programme. [67*] In another study, on peer support workers, relationships between peer support workers and professionals got better over time. Group supervision sessions were used to talk about and address concerns. [62*]

It is important to make sure that people who use services attend all co-production meetings. This will help new working relationships to develop. It will also help with the shift in power that is involved in transformative co-production. [24] It will also be helpful if people who use services are given opportunities to meet on their own to talk about and agree their priorities.

The Project Advisory Group stressed that the relationships involved in co-production need to be based on trust and confidence. The group argued that the success of co-production is likely to be based on the people involved and their relationships. Success needs to be defined in terms of achieving the long-term goals of the co-production, with understanding that there may be some mistakes along the way.

This is reflected in the concept of the ‘relational state’. [68] Public services and governments need to be based on a relationship approach, with the devolution of power at all levels, so that people have power as well as responsibility. An important part of this concept is the idea that governments and service providers need to trust citizens and people who use services.

Access

Access is a fundamental issue in any type of work with people who use services and carers. It is a cornerstone of equality. Co-production cannot happen if processes and practices are not accessible.

It is important that information is accessible. [21] It is also important that meeting places are accessible. [20, 21] But this accessibility needs to flow through the whole process of the meeting. People need to be able to easily prepare for, get to and be heard at meetings and events. They then need to be able to follow progress through minutes and reports. [20]

SCIE has produced a thorough guide to holding accessible meetings and events. [22]

Independent support

Two of the practice examples found that using an independent facilitator was helpful to the process of co-production. The Project Advisory Group also saw the potential value of using independent support/facilitators to help with co-production. It also suggested that advocates could help to support people who use services to be part of co-production.

Care may need to be taken to make sure that the person chosen for this role is acceptable to everyone concerned.

Building community capacity

Taking action to develop or utilise the capacity of the constituent community, the people living in a particular area or the users/potential users of a specific service to take part in co-production is crucial to its success.

The need to build the capacity for co-production in wider communities was a particular concern of the Project Advisory Group. It links particularly to issues of funding and making sure that user and community organisations have enough resources to actively support co-production. The Project Advisory Group saw working with organisations run by people who use services as essential to co-production and the empowerment of people who use services.

It may be useful to map the assets and resources in a community rather than just looking at problems and needs. [15] Where a community does not have the capacity to develop co-production, it would be necessary to identify exactly what capacities are needed and how they can be developed. [23]

The Scottish Community Development Centre has produced a guide to developing community capacity for co-production. [69] This highlights:

Co-production and staff

Engaging with frontline staff and practitioners is an important part of the co-production process. Frontline staff are as essential to co-production as people who use services are, but this is often overlooked. [25] The change in the way organisations work with co-production needs to be accompanied by changes in the way staff and professionals work. This includes a change in focus from people’s problems to their abilities and assets. Also, frontline staff need more scope to make decisions. Management processes need to recognise and reward these changes.

Achieving this can involve reviewing staff roles and changing human resource policies. [15] For example, appraisal procedures can be developed to support new ways of working co-productively. Managers should explore ways in which people who use services can give feedback on the staff they work with and use this in supervision and appraisal. [70]

As an example, the London Borough of Lambeth has said that staff are an essential part of its approach to co-production. It called this ‘the co-operative council sharing power’. It noted that this meant that the council needed the right approaches to recruitment and training. It included an assessment of each staff member’s ‘co-operative’ approach in their appraisals. It also introduced recognition and reward schemes to give staff further incentives to support new ways of working. [13]

There are examples of co-production being used in relation to staff issues in residential homes. This includes involving residents in developing job specifications and staff training. During the recruitment process job candidates were assessed for their ability to relate to the people they would be working with. [71]

Training and support

There is a clear need for training and support for professionals and practitioners to help them to adopt a co-production approach. [21, 42] It is also important that to make sure that everyone else involved in co-production – including people who use services and carers – is given appropriate training and support.

In the mental health field, peer support workers have been found to benefit from initial training followed by ongoing support and supervision meetings every two weeks. [62*] It is important there are suitable line management and supervision systems for peer support workers. [17*]

Commissioning

Commissioning (the process of buying services from other organisations or people not directly employed by the commissioner) is recognised as a key part of the co-production approach. [15, 42]

For co-production to be successful, organisations need to change their systems for commissioning. This involves developing approaches that recognise the social, economic and environmental impact of commissions. [15] It also involves moving to commissioning based on outcomes rather than outputs (outcomes would describe the changes a service delivers to the lives of people, while outputs would just be the number of people helped). This can present problems for commissioners because outcomes can be difficult to measure. [41]

For commissioning to be co-productive and meet the challenges of reduced resources, it should have the following aims:

To achieve these aims, commissioners need to embrace the following complimentary approaches: including co-production in the commissioning process itself and including it in the services they actually commission. Co-producing the commissioning process means people who use services and wider communities being part of decision making. Commissioning co-productive services is achieved by awarding contracts for services to suppliers that use co-productive approaches. It is important to make clear to potential suppliers that co-production is a key quality criterion on which tenders will be assessed. The New Economics Foundation has produced several examples of documents to support co-production in commissioning.

Guidance has also been produced on how local authorities can develop stronger links with the communities they serve through strategic commissioning. This includes:

As noted above, organisations run by people who use services (often referred to as user-led organisations) and carers have a key role in co-production. SCIE has produced a comprehensive guide to how local authorities can support user-led organisations so that they are in a position to bid for and provide services in a way that supports co-production. [54]

There are three steps that can be used by local commissioners to support user-driven commissioning:

Recommendations

  • Ensure that everything in the co-production process is accessible to everyone taking part and nobody is excluded.
  • Ensure that everyone involved has enough information to take part in co-production and decision making.
  • Ensure that everyone involved is trained in the principles and philosophy of co-production and any skills they will need for the work they do.
  • Think about whether an independent facilitator would be useful to support the process of co-production.
  • Ensure that frontline staff are given the opportunity to work using co-production approaches, with time, resources and flexibility.
  • Provide any support that is necessary to make sure that the community involved has the capacity to be part of the co-production process.
  • Ensure that policies and procedures promote the commissioning of services that use co-production approaches.
  • Ensure that there are policies for co-production in the actual process of commissioning.

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