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. [10] 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.

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’. [18] 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.

Diversity

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:

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. [18]

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.

Accessibility

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. [22]

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. [21] And it is particularly important that all stakeholders understand the term co-production itself in the same way. [23] 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*]

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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]

Reciprocity

‘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. [25] The idea has been linked to ‘mutuality’ and all parties involved having responsibilities and expectations. [3]

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. [26]

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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.

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