Co-production in social care: What it is and how to do it
What is co-production - Principles of co-production
Some commentators have suggested that it may be useful to approach co-production as a set of distinctive principles rather than trying to define it.  The following principles of equality, diversity, accessibility and reciprocity are critical values for putting co-production into action.
Equality – everyone has assets
Co-production starts from the idea that no one group or person is more important than any other group or person. So everyone is equal and everyone has assets to bring to the process. [14, 15, 16] Assets refer to skills, abilities, time and other qualities that people have. This is different from approaches that focus on people’s problems and what they cannot do.
Much of the writing on co-production focuses on the need to recognise the assets of people who use services and others in the community. However, the assets that workers, practitioners, managers and other professionals bring to the process also need to be recognised. [12, 13] Peer support workers have challenged a ‘them and us’ culture as not being compatible with a culture of co-production. [17*]
The Project Advisory Group that oversaw the development of this guide pointed out that equality can only be achieved with a shift in power towards people who use services and carers.
The Healthy Living Club
People who do and do not have dementia help to run this club. Everyone involved uses their assets to make a contribution to the club.
They have discovered that between them they have a range of talents and skills. These include, bid writing, book keeping, computer work, information technology skills and music making. All these skills are used to run the club and its activities. Everyone contributes to how it functions and the decisions that need to be made to the extent that they are able and willing to do so.
All Together Now
This initiative involved moving from a ‘deficit-based approach’, which emphasised what people with dementia could not do, to an asset-based approach. It used a model of shared living that built on the strengths and contributions of people living with dementia, their families and staff.
Achieving this required a different approach to the assessment of people living in the home. The new approach, called an exchange model, recognised that everyone is an expert and assessment involved negotiation between different people, including the person with dementia. This contrasts with the procedural model of assessment that focuses on professionals determining and asking the questions, often accompanied by lots of form-filling.
For a culture of equality to be fostered, everyone involved in co-production will need to get to know each other. There can be complexities around this issue because of the unequal power relationships between professionals and people who use services, and between people who use services themselves.
It can take time and considerable patience to address these issues. Training and support will be a key part of achieving this and ensuring that there is equality in the principles and practice of co-production. If people who use services are brought into the process without this, they will be at a disadvantage in their relationships with professionals.
Experienced and well-trained people who use services bring a lot of value to co-production, particularly in terms of more equal and potentially more challenging relationships with professionals. This can sometimes lead to them being dismissed as ‘the usual suspects’.  However, they do have the capacity to make a particular contribution to the leadership of co-production initiatives.
The Project Advisory Group also recognised that there is a danger that some people who use services can become too like professionals (which can be called professionalisation or isomorphism).
The principle of equality and recognising that everyone brings assets to co-production that should be used and valued, provides the basis for a balanced approach to this issue. If everyone is treated as equal in the process of co-production, greater experience or expertise should not mean greater power. So no one group (professionals, experienced or less experienced people who use services and carers) should have a greater role to play.
It follows from the previous principle that diversity and inclusion are important values in co-production. This can be challenging but it is important that co-production projects are pro-active about diversity.
It has been found in work on the involvement and participation of people who use services that some groups are under-represented or excluded from such work, and this is likely to apply equally to co-production.
People who use services can be excluded because of equalities issues or because of the nature of their impairment. The main groups likely to experience exclusion are:
- people from black and minority ethnic communities
- people from lesbian, gay, bisexual and transgendered communities
- people who communicate differently
- people with dementia
- older people who need a high level of support
- people who are not affiliated to any organised group or ‘community’. 
Where a person lives can also be a barrier to participation: people living in residential homes, homeless people, Gypsy and Traveller communities and people in prison experience exclusion on this basis. 
How to do co-production includes some practical advice for projects and initiatives to ensure that that activities are inclusive for all communities and groups. The practice examples demonstrate a range of approaches to achieving diversity.
The Healthy Living Club
This club has successfully involved people with dementia and people from a wide range of ethnic backgrounds, reflecting the diverse community where the club is based. It has achieved this by having one-to-one conversations with people as a means of building on what takes place during formal meetings.
This project carried out an equality impact assessment – that is, looking at the likely or actual effects of its policies on different groups of people – and this led to young disabled people in Gypsy and Traveller communities and young disabled care leavers becoming part of the project.
Birmingham City Council’s Adults and Communities Directorate
This directorate ensures that planning for co-production includes thinking about how to promote activities to the city’s diverse communities. In practice this has meant using networks in the community such as churches and schools.
Co-production is approached as an opportunity for people from different backgrounds, with different skills and experiences, to work together as equals. There are two quality boards led by people who use services and the terms of reference for the boards include a requirement to ensure that people who use services from black and minority ethnic communities are represented.
Access needs to be recognised as a fundamental principle of co-production as the process needs to be accessible if everyone is going to take part on an equal basis. [20, 21] Accessibility is about ensuring that everyone has the same opportunity to take part in an activity fully, in the way that suits them best. 
As well as physical access, making sure that information is accessible and that it is provided in appropriate formats is a key part of making sure that everyone can take part in co-production. This is important as co-production can bring together diverse groups of people, from managers and practitioners to people who use services, carers and families. It may also involve staff coming from different disciplines and backgrounds. Some of the language used can be problematic because it can involve jargon that is inaccessible.  And it is particularly important that all stakeholders understand the term co-production itself in the same way.  Getting the language right so that everyone understands each other is therefore essential.
There is also a broader issue about all information being available and shared. All parties need to have enough information to take part in co-production and decision making. There may be issues around confidentiality and information sharing, which will need to be resolved for co-production to be successful. For example, confidentiality is key in work shared between peer support workers and professionals. [17*]
Another important aspect of accessibility is time and timing, which can be overlooked. Several reports have referred to the impact of time on co-production and the need to allow time for co-production to develop. [12, 20, 24]
Redesigning Support for Care Leavers
This project encountered challenges around the language used in the work, including the use of the term ‘co-production’ itself. The designers who facilitated the project also brought their own language to the project associated with their design approach, such as ‘prototype’, and while this was discussed and explained in detail, some still found it difficult to follow.
This project recognised that for co-production to work it was important to have good communication and also to make sure that everything was accessible. It found that breaking everything down into clear actions was helpful.
‘Reciprocity’ is a key concept in co-production. It has been defined as ensuring that people receive something back for putting something in, and building on people’s desire to feel needed and valued.  The idea has been linked to ‘mutuality’ and all parties involved having responsibilities and expectations. 
Older people can feel supported by services that use reciprocity and mutuality in their approach. Methods can be formal – based on reward schemes such as time banks – or informal – being about developing positive relationships. Flexibility is important to the success of working in this way. Clear communication and raising people’s awareness are also important factors. 
The word ‘reciprocity’ may be considered as a piece of jargon when discussing co-production. It may not seem particularly accessible but there is not another word that fully captures what it means. Also, if used carefully, with a full explanation and discussion with everyone involved in the co-production process, the term can form a positive part of the process and help to highlight the sense that co-production is new and different from previous approaches.
This organisation’s approach is based on the idea that people like to help each other and it believes that this avoids the need for complex bureaucracies. It sees this approach as being different from models such as time banks because it is not about putting something in and getting something of equal value back.
The Healthy Living Club
This club grew from the closure of a day centre for people living with dementia due to budget cuts. Everyone involved thought that this was a great loss and they have shared their skills and experiences to build the new club, which they all benefit from.
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