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

What is co-production - The policy and legal context

The role of co-production in the health and social care field has been recognised more and more in recent years, both nationally and internationally.

The ideas and values of co-production have been included in a growing number of policies and laws in England and Wales.

Co-production and the Care Act 2014

The Care Act 2014 is a very important piece of legislation for social care. See SCIE’s Care Act pages.

It is one of the first pieces of UK legislation to include the concept of co-production in its statutory guidance.

The Care Act's statutory guidance (opens new window) provides a definition of co-production as:

Local authorities should, where possible, actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ”Co-production” is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered.

This definition is not as helpful as other definitions as it only talks about people who use services influencing rather than working with professionals in equal partnerships. However, it is positive that it emphasizes the range of activities that can include co-production. It makes clear that it is primarily people who use services, carers and the community that should be involved in co-production.

Co-production is also referred to at a number of points in the statutory guidance:

Information and advice

Adopting a “co-production” approach to their plan [for information and advice], involving user groups and people themselves, other appropriate statutory, commercial and voluntary sector service providers, and make public the plan once finalised.

Prevention

In developing and delivering preventative approaches to care and support, local authorities should ensure that individuals are not seen as passive recipients of support services, but are able to design care and support based around achievement of their goals. Local authorities should actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community.

Assessment

To support co-production, the local authority should establish the individual’s communication needs and seek to adapt the assessment process accordingly. In doing so local authorities must provide information about the assessment process in an accessible format.

Market shaping

Local authorities should pursue the principle that market shaping and commissioning should be shared endeavours, with commissioners working alongside people with care and support needs, carers, family members, care providers, representatives of care workers, relevant voluntary, user and other support organisations and the public to find shared and agreed solutions.

Strengths-based approaches

Strengths-based approaches might include co-production of services with people who are receiving care and support to foster mutual support networks. Encouraging people to use their gifts and strengths in a community setting could involve developing residents' groups and appropriate training to support people in developing their skills.

Developing local strategies and plans

A fully co-produced approach (to developing a local implementation plan) will stress the value of meaningful engagement with people at all stages, through design, delivery and evaluation, rather than simply as “feedback”.

Co-production is an important way of achieving the overarching aims of the Care Act including prevention, wellbeing and the focus on outcomes. It should be a consideration in all aspects of the implementing the Act. For example, co-production can help to ensure that advocacy services meet the requirements of the Act. See SCIE guide Commissioning independent advocacy

The NHS five year forward view

The NHS five year forward view  is a very important policy document that sets out a vision for the NHS over the next five years. Whilst it does not mention co-production, it does echo many of the values and aspirations of co-production.

One of the great strengths of this country is that we have an NHS that – at its best – is “of the people, by the people and for the people”.

The 2010 NHS White Paper, Equality and excellence: Liberating the NHS

The 2010 NHS White Paper, Equality and excellence: Liberating the NHS, [27] included the aim of giving people who use services a stronger say, with more ‘clout and choice in the system’ (p 16). The term co-production is not used but the goal of services making decisions in partnership with people who use services and giving people full information to support their decision making clearly reflects co-productive approaches. The Secretary of State for Health at that time used the phrase ‘no decision about me without me’ to sum up his ambition for the way that the NHS should work. [28] This was adapted from one of the key mantras of the disabled people’s movement – ‘nothing about us without us’. Both are good ways of thinking about co-production.

A vision for adult social care

The 2010 report A vision for adult social care: Capable communities and active citizens [29] refers more explicitly to co-production. It sets out an approach to social care designed to use the potential of local support networks and build upon the capacity of communities. It refers to several examples of initiatives that call themselves co-production, and refers more broadly to co-productive principles such as reciprocity and innovations such as time banks.

Caring for our future

The 2010 social care White Paper, Caring for our future, [30] outlines several key areas in which user-led organisations can play an important part in social care. These organisations can give people who use services a voice and also provide some support services directly, particularly around advocacy, peer support and joint purchasing by people with personal budgets.

The Health and Social Care Act

The Health and Social Care Act 2012 includes a number of requirements that relate to co-production and broader ideas around participation/involvement. It sets out requirements for engagement:

Think Local Act Personal partnership

Co-production in the form of new, collaborative ways of working and new partnerships is a key aspect of personalisation. [2] To help organisations to develop personalised services, the Think Local, Act Personal partnership’s Making it Real programme has set out a framework for action. It stresses the importance of co-production with people who use services and other citizens. [5]

Policy and legislation in Northern Ireland

Policy development in Northern Ireland has yet to embrace the language of co-production although it is beginning to take on some of the principles and features of co-production. Social care guidance from the Department of Health, Social Services and Public Safety [31] and Social Care Guidance and then the Health and Social Services (Reform) Northern Ireland Act 2009 have established requirements for personal and public involvement (PPI).

The Public Health Agency says that PPI should:

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