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

How to do co-production - Structure

Thinking about structure involves considering how an organisation or initiative is arranged. This includes looking at decision-making structures, leadership and the way the organisation plans and develops projects.

An evaluation of six peer support work pilot projects found that the development of peer support had been held back by the lack of infrastructure and clear role descriptions. Also, integrating peer support workers within existing teams was a challenge. [17*]

So it is very important to change the role, systems and structures of an organisation so that it can support co-production. [14] Examples of the types of structural changes that might be required are:

This may be particularly challenging for large organisations as co-production puts an emphasis on personal relationships. Organisations will need to move away from centralised and hierarchical structures so that they can support co-production. [14]

There is a need for more evidence about the structural changes that organisations need to make to achieve transformative co-production. [14]

Building on existing structures and resources

Developing a co-productive approach does not necessarily mean starting from scratch. There may be an opportunity to build on existing cultures, structures and practices. [17*]

The most successful co-production may come from building on the resources already in the community: ‘Clearly, the most effective and efficient forms of community co-production tap into existing social networks.’ Outreach work in the community is a way of identifying and building links with the community. [10]

Identifying and involving the right people from the start

It is important to identify all the people who need to be involved in any co-production project or initiative at the beginning of the process. [20]

Resources for co-production

The costs of doing co-production and getting people on board are an important issue to think about. As a new process, co-production is time-consuming and will need resources for building the project and for support. [12] If there is a reluctance to commit resources, this may affect how the project progresses and what it is able to achieve. [12, 56*]

In rural areas, the costs of co-production will be particularly high because people will be coming to the project from a wide geographical area and they may need to travel some distance. [23] It is recommended that people’s expenses – like train tickets and hotels – are paid where possible. [22]

Structures for valuing and rewarding people

The issue of paying people emerged as a key concern in the practice examples and in the discussions at the Project Advisory Group. Some of the practice examples saw this as one of the most difficult issues that they experienced in the co-production process.

It has been recognised for a long time that payments to people who use services and carers for taking part in activities such as co-production are a problematic matter. This is mainly because of the impact of rules and regulations around welfare benefits. [58] SCIE has produced a guide to the most recent changes to these rules. [59]

There are growing constraints on financial resources and some organisations may find it difficult to pay fees. They may only be able to use other ways of rewarding people.

Time banks are used more and more as a way of rewarding people who take part in co-production. The simple principle behind them is that one hour of everyone’s time should be valued in the same way. They are a way for people to exchange skills and services. They have been described as providing a way of valuing and measuring the work done by people and communities that is not paid. [25]

Time banks have been described as showing some of the core values of co-production. [59] They recognise people’s assets, support equality and they include reciprocity (where people get something back for having done something for others). The benefits of time banks are as follows:

There is a growing number of successful time banking schemes in the United Kingdom and abroad. Two examples of time banks are:

Timebanking UK has a practical online guide to setting up and being a member of a time bank.

Rewarding people for getting involved in co-production activities is clearly important. But there is also a need to recognise the other benefits that people who use services and carers can gain from the experience of co-production. This is an area where there is strong evidence. For example, being part of an organisation that is led by people who use services is a positive experience. It contributes to a sense of shared identity and purpose. And it also improves the outcomes of a project. [41*]

In the mental health field, peer support workers report benefits around the building of confidence and self-esteem. [61*] They also say that co-production has helped them in their personal recovery from mental health problems. [61*, 62*] And it can improve peer support workers’ chances of further employment too. After one peer support training programme, three-quarters of the people who attended went on to take part in or set up mutual support groups. [63*] ‘Gone from how we were unemployable because we’re mentally ill, to mentally ill, therefore, we’re employable.’ [62*]

People may get similar benefits from other co-production activities. If people who use services and carers understand the benefits of co-production this is likely to encourage them to take part. This maybe especially helpful in projects where it is not possible to offer direct financial rewards.

The Project Advisory Group noted that professionals also gain from the experience of being involved in co-production. Professionals often say that working in a co-productive way is more satisfying and rewarding.

Structures for communication

The Culture subsection noted how important it is to use language that is accessible and understandable for everyone involved.

Accessible communication needs to be supported by strategies that are flexible and use a range of different approaches to communication. This will ensure that people have as much opportunity to take part as possible. These approaches should include meetings, telephone conversations and online interaction. [64]

The main evidence about the importance of communication comes from the practice examples, detailed below. This is an area where more evidence is needed. The importance of relationships in co-production suggests that personal contacts and ‘word of mouth’ (people telling other people about something) may have a particularly important role in the co-production process.

Social media may have a lot of potential for supporting co-production. For example, it can help to overcome the barriers that people face in accessing information and services. It can also provide new ways of influencing public awareness and policy. [18] And Facebook has been used to start some community projects. [65] But there needs to be a focus on the media that most people are likely to use. While social media has become a popular way for councils to communicate with people, email and text messaging are better ways to reach many people. When organisations and projects think about how they are going to communicate with people, they need to make sure they take a balanced approach. [66]

Recommendations

  • Involve everyone who will be taking part in the co-production from the start.
  • Value and reward people who take part in the co-production process.
  • Ensure that there are resources to cover the cost of co-production activities.
  • Ensure that co-production is supported by a strategy that describes how things are going to be communicated.
  • Build on existing structures and resources.

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