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

Practice example: All Together Now project

About the project

The project began in 2009, working with people with dementia living in residential care, their families and the staff working with them.

The project (which formed part of the Corporate Outcomes Agreement (2010-2013) of the City and County of Swansea) has challenged the traditional impersonal, deficit and task-based 'hotel model' of service in dementia care homes. It has developed an interdependent and reciprocal model of shared living that builds on the strengths and contributions of people living with dementia, their families and staff. And it uses the values and practices of co-production.

This has also involved challenging the language of dementia, which is often based on deficit and loss. They have moved away from terms like 'elderly mentally infirm' and so-called 'challenging behaviour' and recognised that 'suffering' for people with dementia is more often caused by barriers due the environment around them and other people's attitudes rather than the condition itself.

What has co-production meant to the project?

Co-production is based on a values approach that is about building relationships, is a force for good, and can be used in a variety of settings. The project has shown that it can be used in the development of social work and social care services. It has promoted not only the wellbeing of people living with dementia but also the wellbeing of carers and staff.

What has helped in implementing a co-production approach?

An approach has been developed that allows staff and people with dementia to develop relationships that are based on recognising each other's expertise and mutuality (people working together to achieve their shared interests). This has included an 'exchange' model of assessment that recognises that everyone is an expert and that the assessment is a negotiation between those involved. This is different from models of assessment that follow procedures and focus on filling in the form of the assessing agency, and from the questioning model where the professional dominates the process. [77]

Care homes have traditionally been about a linear transaction - staff delivering a service to be received by the people who live in the home. Co-production has resulted in a different approach being taken. This is based on a model known as the 'senses framework', with people who use the service, carers and staff achieving a sense of security, continuity, belonging, purpose, achievement and significance. [78] This involves a move away from the setting of tasks to a focus on feelings, emotions, relationships and interdependent wellbeing.

What difficulties were there in implementing co-production?

Risk aversion has been a significant problem in many care homes across the region, where more strengths-based approaches have been developed. This includes risk aversion related to health and safety. In effect, this says 'you must sit in your chair because if you move around the home and be part of running it you might fall or put someone else in danger'. There has also been experience of emotional risk aversion, which encourages staff not to show feelings or emotion because of potential safeguarding issues. All of this has had to be overcome so that staff can use touch to support someone in the right way. Within the City and County of Swansea, this has resulted in the development of a 'choice and risk benefit' framework. This sets out a system for identifying, assessing and managing risks. It also sets out a system for balancing potential benefits of taking a risk against the possible problems it could lead to. It also includes a section on the importance of 'Cwtch', a Welsh word meaning 'a bit of a hug'/creating a safe place.

What are the main strengths in the approach that has been taken?

The main strength of the project is that it has brought together everyone taking part, including older people, family carers, practitioners, and providers from across the statutory and voluntary sectors. The initial project development was based on a community development approach known as LEAP (learning, evaluation and planning). This was used because of its outcomes-based approach to planning and evaluation and its focus on learning collaboratively.

What have been the main outcomes of the project?

The outcomes have been around people with dementia achieving what they want in their lives and improving their quality of life. This has been done by maintaining personal identity and focusing on meaning and purpose, not care that is based on tasks. For example, a man who had become known for having so-called 'challenging behaviour' soon settled in one particular care home and joined staff on shopping trips. He no longer needed specialist nursing care because he was being listened to and had the opportunity to form relationships with staff and people in the community.

How has the project worked to engage all sections of the community?

It has been crucial to map out the parameters of the care home community, identifying stakeholders and using the knowledge of social work, occupational therapy and social care staff to make sure that everyone is included. The project has challenged the idea that only activity coordinators can work with people living with dementia to help them get involved in meaningful activities. Activities are everyone's business within a co-productive care environment. Someone who works in the kitchen is valued not only for the food they cook, but also for involving residents who are living with dementia in preparing food.

What advice would the project give to others?

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