We have recently supported a number of related projects. During our work, we pulled together research to present to strategic leads and commissioners about inequalities in mental health support, this includes:

1. As of June 2023, 143,119 people were waiting for an autism assessment in England, new NHS data has revealed. This is a 47% increase in the number of people waiting in just one year.
2. 79% of autistic adults will experience poor mental health with 50% of autistic adults experiencing depression.
3. In total 2,035 autistic people and people with learning disabilities are in inpatient mental health hospitals in England.
4. 1,310 (64%) of these people are autistic.
5. There are 215 under 18s in inpatient units that are autistic or have a learning disability. Of these, 93% are autistic.

There has long been a call for change, including discussion of Mental Health Act Reform, but without a shift in the way we currently approach mental health support, for autistic people and people with learning disabilities, that it is unlikely to achieve the changes that campaigners, organisations and individuals are asking for.

A movement in mental health approaches: Intersectionality

With evidence also of racial and ethnic inequalities in mental health and some discussion on late diagnosis, and mis-diagnosis before diagnosing autism in women and girls, I have considered the need to look at mental health, autism and learning disabilities through the lens of intersectionality, looking at the experience of autistic people and people with learning disabilities, in recognition of the potential multitude of additional inequalities faced by this group.

Research in Practice describes intersectionality as a framework for examining, deconstructing and challenging the idea that parts of a person’s identity are experienced as discrete categories.

Through this lens, I have considered the need to look at identity, how and when people seek autism diagnosis, and how health and social care support can work together, to support individuals who are asking for ‘mental health support’. With complex legal frameworks at play, including the Mental Health Act, Mental Capacity Act, Care Act, The National Health Service Act, Human Rights Act and many others, I am currently working on supporting organisations to understand how a person may present as needing support from the mental health system, how this translates into commissioning needs, now and for the future, and how the current system can align to offer support within current approaches, while we await the wider reform that is in discussion.

I have plenty more to learn, more evidence to gather and more importantly, more people to work with, who are directly impacted by the current mental health, health and social care, system.

With many organisations sharing research and guidance on good practice, I hope to continue to support organisations to embed these, with additional demographic and intersectional considerations each area will undoubtedly require.

If you would like to get in contact to discuss how we can support your organisation please email us: info@scie.org.uk

Despite the Care Act’s impact, there’s a palpable sense that the transformation of services is still ongoing. Implementation of its provisions has been challenging and incomplete, leaving many ambitions unrealised. Today, the reality for many seeking to access social care services is one of frustration and inequality.

A major challenge has been funding, which has not kept up with demand for social care. Over the years, local authorities’ budgets have been squeezed, piling pressure on an overstretched social care system. With rising costs of care, fewer people now receive state funded support for their care needs.

The workforce remains unstable, with higher turnover than other industries. Morale among social care professionals has fallen as they find themselves with more work to do, but with less time and resources. In some cases, tasks like providing accessible information and carrying out care assessments have been reduced to mere signposting.

Despite these challenges and ongoing pressures, there has been a longstanding lack of appetite by the main political parties to address the root causes, particularly how care is funded. For people to experience the quality of what they need and deserve, we must also change the way social care is organised, including exploring the potential for new service models and the role of innovation.

Recent calls for revisiting the balance of responsibilities between individuals and the state open the door to reshaping the narrative about care work to reflect its skilled nature and its value to society.

With emerging policies, innovations, and campaigns, there’s hope for a fairer and more equitable social care system. As we look ahead, the Act’s core principles remain our guiding star at SCIE, driving our commitment to improving social care for all.

Resources

What good looks like (local.gov.uk)

NHS England » Brick by brick

NHS England » Joint guiding principles for integrated care systems – learning disability and autism

National strategy for autistic children, young people and adults: 2021 to 2026 – GOV.UK (www.gov.uk)

Building the right support for people with a learning disability and autistic people – GOV.UK (www.gov.uk)

NHS England » Meeting the needs of autistic adults in mental health services

Learning from Lives and Deaths – people with a learning disability and autistic people (LeDeR) – King’s College London (kcl.ac.uk)

NHS England » Culture of care standards for mental health inpatient services

The transformation of social care

Looking back, there is no doubt that the Care Act 2014 has been transformational. For the first time, there was an improved focus on people’s wellbeing and independence. This meant shifting from a service-led system to enabling individuals to have choice and control over the care and support they needed. The role of unpaid carers was also acknowledged by the Care Act with a new statutory requirement for local authorities to assess and meet their wellbeing needs, too.

The adoption of co-production principles and practices in social care is another of the key changes we have seen. The Care Act 2014 was the first piece of legislation to include the concept of co-production, emphasising the importance of placing people at the heart of their care and involving them in the design and delivery of services.

Over the years, we have seen the value of co-production increasingly recognised and good practice adopted, most recently in the Government’s 2021 Adult Social Reform White Paper. The regulation of social care has evolved to include people’s experiences, in the form of “I” and “We” statements, in the evaluation of care quality and safety. Co-production also underpins and informs all our work at SCIE, enabling us to spread best practices across the sector.

The challenges ahead

Despite the Care Act’s impact, there’s a palpable sense that the transformation of services is still ongoing. Implementation of its provisions has been challenging and incomplete, leaving many ambitions unrealised. Today, the reality for many seeking to access social care services is one of frustration and inequality.

A major challenge has been funding, which has not kept up with demand for social care. Over the years, local authorities’ budgets have been squeezed, piling pressure on an overstretched social care system. With rising costs of care, fewer people now receive state funded support for their care needs.

The workforce remains unstable, with higher turnover than other industries. Morale among social care professionals has fallen as they find themselves with more work to do, but with less time and resources. In some cases, tasks like providing accessible information and carrying out care assessments have been reduced to mere signposting.

Despite these challenges and ongoing pressures, there has been a longstanding lack of appetite by the main political parties to address the root causes, particularly how care is funded. For people to experience the quality of what they need and deserve, we must also change the way social care is organised, including exploring the potential for new service models and the role of innovation.

Recent calls for revisiting the balance of responsibilities between individuals and the state open the door to reshaping the narrative about care work to reflect its skilled nature and its value to society.

With emerging policies, innovations, and campaigns, there’s hope for a fairer and more equitable social care system. As we look ahead, the Act’s core principles remain our guiding star at SCIE, driving our commitment to improving social care for all.

I was interviewed by Kate during the process of making her documentaries and she told me that the cost of her late husband’s basic care needs was nearly £4,000 per week. Kate earns a good salary, yet how can she, let alone anyone else, afford that week in, week out for who knows how many months or years?

The social care sector needs a shake-up. We have an amazing workforce, but they are underpaid and overstretched. We rely heavily on unpaid carers, but sadly, they often do not get the recognition or support they deserve. It’s easy to forget that many will also be working full- or part-time to earn the money needed for some form of professional care for their loved one. They may also, like Kate, be raising children. It’s an exhausting and impossible task.

I am thankful, at least, that the Government’s Accelerating Reform Fund (ARF) – an initiative to encourage and grow innovation within the social care sector, for which SCIE is providing hands-on support – is recognising the crucial need to transform adult social care and provide much-needed support to unpaid carers.

Of the 122 projects registered across all 42 integrated care systems (ICS) for ARF support, about 7 in 10 have an element focusing on unpaid carers. This is at least one project within each of the 149 local authorities in England that has received funding. These include:

• A project in Coventry and Warwickshire to expand a digital self-help tool that will enable carers to identify local support and access bespoke information to support their own wellbeing
• Connecting hospitality, tourism and leisure businesses with unpaid carers in West Yorkshire so they can donate holidays and experiences to carers as a way to recognise their invaluable contribution to society
• Scaling up approaches for identifying unpaid carers in south-west London, such as through hospital discharge programmes, and referring them to carers networks

I am excited by the scope and potential promise of each project funded by the ARF so far. At SCIE, we are working alongside all local authorities involved to share knowledge, insights and best practice so that we develop these projects and learn how to successfully to scale them up to a national level.

Collaboration and innovation are key to changing the future of social care, and I hope that this is a first step to easing the financial, physical and emotional burden that so many unpaid carers experience as they do their best to care for the people they love.

• Kate Garraway documentary highlights urgent need for social care improvements, says SCIE
• £20 million boost for adult social care innovation announced

Colleagues from Luton’s safeguarding teams helped us work through the legal and practical issues that could impact decisions on the frontline on how to respond to a potential safeguarding case, and we role-played being a member of the multidisciplinary adult safeguarding hub (e.g. the police, community nurse, family member, etc.), as part of our safeguarding training.

This case study work shone a light on the complexities of safeguarding on the frontline in a local authority, and how the response to each case must be very nuanced, ensuring personal wishes are respected. Decisions are rarely being black or white, yet they have a direct impact on individuals who may often require a range of help. Practitioners also stressed that trust and support from their local leadership is essential to their everyday work so they can be confident in their sensible judgment and collaborative decisions.

What struck me was not only our local authority colleagues’ expertise and dedication, but also their willingness to openly share their experiences and engage with us about their concerns, the intricacies of their jobs, and what elements they would like to change if possible.

From our point of view, discussing matters with local experts, also helped us to understand how important it is that national safeguarding legislation and guidance can be translated locally and the importance that what we do, enables local experts to provide the best possible support to people who are vulnerable.

My colleagues and I wish to thank SCIE and Luton Borough Council for making this event such an informative and engaging day, whilst also challenging us on how the department can help to further improve safeguarding both nationally and locally.

• SCIE safeguarding resources and support

The programme set out the impact that a care home owner seemingly focused on profit margins, has on the staff he employs and the residents. Through restrictive contracts, the apparent ignoring of understaffing concerns, and a closed culture, we see how residents are harmed through neglect (multiple safeguarding alerts, missed medication, poor manual handling practice etc). The closed culture developed by the owner made it that much harder for management and staff to whistleblow.

There is sadly a continuity in the themes and messages drawn from other investigations into residential settings including Whorlton Hall (an independent registered hospital supporting autistic people or people with a learning disability), This was also subject to a BBC Panorama undercover investigation which exposed abuse and poor care. Our safeguarding adult review, commissioned by Durham Safeguarding Adults Partnership, detailed a number of findings which were discussed by the Coalition for Change including:

• failing to listen to and act on concerns raised by individuals and families;
• regulation and commissioning failing to recognise or respond effectively to the warning signs of abusive cultures becoming established;
• weaknesses in short-term commissioning with no effective means of assessing the quality of care or outcomes being delivered at many high cost placements
• challenges in the system’s ability to hold the directors and shareholders of care organisations to account.

At Addison Court, we saw how overseas staff were taken advantage of therefore becoming part of the closed culture, we know open cultures are ones where organisations involve and listen to, residents and relatives. They are transparent in their practice and raise concerns with the commissioners and relevant health organisation. They invest in, and ensure staff are trained and supported to provide good care in line with what is expected, and staff are given information about external support agencies to contact for advice and guidance. In such settings residents and staff thrive.

At a time when a number of care providers are relying on overseas staff, it is vital that there is clear guidance on how such staff are recruited. Allied to that it is important that consideration is given not just to the standard induction training and support that would be provided to local staff, but also what is needed in terms of supporting staff to understand expectations, the different statutory and regulatory frameworks and the code of conduct under the respective professional body.

We know there are a number of care providers who focus on providing good person-centred care. They will own up to mistakes and learn from them. Evidence, including from the Care Quality Commission, shows that good leadership and a strong culture that values and listens to staff, and gives them time to listen to and work with residents, are essential to deliver better and safer care. Every care home needs to review their safeguarding practice on a regular basis, and we urge them to seek help when they need.

We at the Social Care Institute for Excellence are here to help any care home or provider requiring support to improve in this area, and we urge all support organisations to help shine a light on the need for open, not closed, cultures..

• SCIE safeguarding resources and support

When I met with the YOURmeds user, she shared that the device greatly improved her quality of life. It helped her manage her medication and prevent unnecessary visits from care workers disrupting her daily routine. It had also reduced her medication, as regular medication had got some aspects of her condition under control. She would encourage others to use this device.

I also met with both health and social care teams from Manchester and Stoke-on-Trent who use YOURmeds. They felt that the use of YOURmeds greatly helped both their constituency and their bottom line as they now did not need to send as many care workers to people’s homes to ensure that medication was being taken. However, despite being used in a city as large as Greater Manchester it is currently only reaching between 30 – 40 people. When we asked why the device is not being used more widely given its success, it was reported that funding for medication management falls into a grey area. Medication is normally funded by the NHS. However, ensuring people take their medication falls to social care workers. This system is an example of the importance of further joining up NHS and social care programming as both are needed to help people live fulfilled and independent lives.

YOURmeds is simple in its innovation which is part of its appeal. Not every innovation needs to have a ‘wow’ factor, sometimes it’s the smaller actions that can make the greatest change in someone’s lived experience. This is a simple but effective solution to medication management. It would be worth further investigation of the barriers as to why this has not been taken up more widely. There is some concern by users that they will lose personal contact if they do not have a care worker checking in on their medication. I believe this should be looked into further as that personal connection is important. However, I wonder if reducing the number of short personal contacts could lead the way to more meaningful interactions in the long-term since care workers might not be as thinly stretched to address medication uptake as well as all other responsibilities.

I greatly enjoyed my time in Manchester speaking with people with lived experience with the YOURmeds device and local authorities’ experiences in supplying them. I look forward to going on more site visits in the future to learn more about innovative products and programmes across the UK.

• Kathryn tweets @kathryn1smith

1. Risk assessment and information sharing

Risk factors for sexual abuse within the older population include being a woman, increasing age and having limited mental capacity. For people with learning disabilities women are again at higher risk, as are those with a more severe cognitive impairment and those living in services as opposed to living with a family. Across both groups perpetrators of sexual incidents are considerably more likely to be men, and more likely to be another person receiving a service.

The reviews found gaps in the initial assessment at the point of admission to a care home. Initial assessments frequently focused only on needs and not risks, which meant that staff had limited knowledge of the risks someone might pose to others.

This was especially true when the new resident was self-funding their placement with no input from social services. Social workers tend to carry out more robust assessments and often have more detailed history surrounding the person.

Even when social services were involved and risks were known, if the person was moving from one local authority area to another there was often no system for passing on crucial information.

Key information held by families as well as statutory agencies and outgoing care providers wasn’t shared in many of the cases looked at, making it difficult for new providers to make informed decisions about the level of risk and how to manage it. Instead various agencies and individuals had pieces of information that if brought together might have highlighted patterns of escalating behaviour that needed to be addressed urgently.

Even when risk was identified SARs found there was often no local multi-agency forum to consider those risks, and what action could be taken to reduce them.

When an incident had occurred, local authority safeguarding teams usually relied exclusively on the care provider to take full responsibility and come up with the answers. Not all care providers are equipped to do this in high-risk situations, and most will need help from specialist health services to provide wrap-around support and robust risk management strategies.

Safeguarding teams also tended to focus largely on the victim when making enquiries not the perpetrator, possibly leading to an incomplete picture and an unbalanced response to risk management.

Failing to share information, to collaborate with other providers and to properly assess makes it difficult to manage risk across a whole care setting population.

The Care Quality Commission (CQC, 2020) identified the need for risk assessment that takes account of the needs of those already living in a residential setting when considering new residents.

2. Language and misconceptions

An overwhelming finding was the use of inappropriate language to describe sexual assaults, particularly in relation to older people. It was common for assaults to be described as ‘disinhibited behaviour’ or ‘sexually inappropriate’, often attributed to dementia. Researchers found staff often had difficulty accepting that sexual assaults could happen at all, believing incidents must be rare, and often disbelieving victims when it did arise, particularly those with a diagnosis of dementia. Some researchers found that the emotional responses of victims following an assault could in fact mirror symptoms of cognitive impairment.

Misconceptions and the use of inappropriate language minimises the seriousness of the assault and often leads to inadequate responses that leave harmful behaviour unchecked. Non-consensual sexual activity is a serious sexual assault, it is a crime, and it should be recorded and responded to as such by all providers and agencies.

SCIE’s engagement with safeguarding adults boards (SABs) and police forces has also identified two wider points about the involvement of the police. The first is a general reluctance to involve the police. The second, a reluctance to pursue a prosecution because of challenges around gaining evidence, or the vulnerability of the perpetrator (as was the case in some of the SARs we looked at).

3. Policies, guidance, and staff training

Another common theme was the lack of sexual safety policies, processes, and guidance for staff, not only to help them recognise serious sexual assault but to prevent it. In the cases reviewed there were often predictors of dangerous behaviour that if know about or responded to earlier might have prevented subsequent harm. In one case sexual assaults perpetrated against care staff were dismissed when they should have been seen as significant, and a possible precursor for assaults against victims unable to protect themselves. In another, clearly delusional beliefs and fixations displayed by the perpetrator toward the victim were not taken seriously. In a third case the absence of a shared understanding of the significance of historical sexual incidents and a proper process for careful handover at the point of transition, left young people at risk.

Most commentators concluded there would be benefit in the introduction of suitable sexual safety policies, guidance, and quality standards to promote best practice, instil confidence in staff, and provide a framework for staff training.

Any guidance should be linked to the Mental Capacity Act 2005 to help staff understand:

• That in the absence of capacity to decide about taking part in sexual activity, the activity is non-consensual and is an assault
• Even when a person is believed to have capacity providers and agencies cannot rely solely on the person themselves to manage their own potentially harmful behaviour.

Training for staff not only needs to equip them to recognise sexual abuse but also to see sexual safety in its broadest sense, including environmental/cultural sources of vulnerability (e.g. the impact of having a care population with a wide range of needs, the layout of a building and staffs views on relationships), as well as issues such as self-empowerment. Training needs to be supported by the provision of appropriate assessment and risk assessment tools alongside detailed guidance.

This might be an area for local SABs and/or commissioning teams to get involved with, as having a shared and consistent local approach will help to avoid some of the challenges around information sharing, multi-agency responses, and different interpretations of risk.

4. Staffing

The final key theme to emerge was the significance of low staffing levels and high staff turnover. Good risk assessment and risk management requires close observation and consistent practice if sexual abuse is to be prevented. Staff require training, guidance and time and space to practice and reflect. Staff shortages leave gaps and high staff turnover dilutes skills and knowledge. Even in the statutory

sector reviewers found that pressures of work fostered a culture of ‘assess and forget’ rather than ongoing enquiry when risks were known.

Although perpetrators are much more likely to be other users of services some abusers are paid employees or visiting workers, and the review highlighted the risks associated with the loss of legacy data concerning previous allegations against members of staff due to systems changes. It also identified significant risks linked to the employment of family members working together in the same service, creating the potential for collusion with abusers and the dismissal of allegations.

Finally, the findings questioned the effectiveness of the processes followed by providers and safeguarding teams when the Crown Prosecution Service (CPS) decides not to charge a person (be it a member of staff or another user of the service), when they believe there is insufficient evidence to convict. One SAR reviewed involved a care assistant ultimately convicted of sexually assaulting 3 women with learning disabilities, who had been the subject of similar allegations twice before but reinstated following the CPS decision with no apparent follow-up safeguarding action.

Employers and safeguarding teams work to a different threshold than the police when an allegation is made, one where the likelihood of an incident having occurred is assessed ‘on the balance of probability’. In the absence of a multi-agency assessment of this probability the right actions may not be taken, and the risk of harm will remain.

Conclusion

Although we will never be able to eliminate the risk of sexual abuse entirely, SCIE’s research and review of a small sample of relevant SARs showed numerous missed opportunities to minimise it. It also showed common systems failures that leave people with care and support needs and staff unsupported and exposed.

The themes identified resonate with broader issues around effective safeguarding practice beyond sexual abuse. By ensuring staff are supported through up-to-date training, and policies and guidance that are regularly reviewed, care providers can improve the quality of care that residents receive and help to reduce the risk residents face from sexual or other forms of harm within a care setting.

Podcast: Sexual assaults in care homes

SCIE safeguarding resources and support

Getting the right people in the room

The project is funded by the Dunhill Medical Trust, managed and evaluated by SCIE, with project partners Socialudo and Housing LIN. United St Saviour’s Charity, based in Southwark have been a key local partner, helping us link to different organisations on the ground. We had a fantastic turn out with a number of teams at Southwark Council represented, local providers, developers, charities, NHS, the local care partnership, occupational therapists and community groups.

Game play

The players were in four teams: policy makers, developers, service providers and the community group. The teams had to communicate, negotiate and compromise to improve the wellbeing of residents in the fictional place of ‘Hopetown’. As part of the evaluation, I was the note-taker for the developers. They were tasked with making a profit and formed an early strategy of finding out what the other teams wanted and what the policy makers would approve. I observed that the developer’s job was much easier when the community and policy makers were in alignment. As in real life, time moved on in the game, budgets were reduced and the number of people in unsuitable housing increased. Difficult decisions had to be made, highlighting the challenge of both reacting to immediate needs while planning longer term.

Participant:

For me, the energy and ideas in the room and the personal links being made across a range of teams and organisations in Southwark during the day was a highlight.

Next steps

Initial feedback from players was around the importance of partnership working and inclusion and the opportunity to work with key stakeholders from across Southwark going forward. The Game was followed two days late by a workshop to focus on next steps and priorities which we will feedback to the participants. SCIE will be overseeing a follow-up evaluation in January to see what has happened in Southwark since the Game, and the project will be reporting in March.

• Socialudo

The Reconnect Communities, modelled on care usually provided for people with autism, have a significantly higher staff ratio and a higher standard of training than a traditional dementia care home. The effects of their whole approach are immediately evident, every single person was meaningfully occupied, either with social activities or a ‘job’ that they had selected for themselves. For example, the laundry is not a locked room, residents are welcome to come in and put their washing in, hang the washing out or fold some laundry. There’s a workshop, unlocked, where residents can go in and do some painting, woodwork or something else that interests them. The garden is open for gardening, growing fruit and veg when the weather allows. All these activities safe in the knowledge that there are always staff around with time to support.

Paisley Lodge has an upstairs care home run on the traditional model of care with a separate pricing and referral process (albeit still using Paincheck). I asked one of the staff what the differences were from her perspective. She was very animated in the difference telling me she didn’t like working upstairs, she gave me an example of a lady who was prone to wandering and could be aggressive, upstairs she had to be ‘managed’, sat back down or maybe even ignored if staff were busy; downstairs a lady with similar needs was observed quietly and different staff would intervene to distract, look out for any problems, help the person to communicate their needs and become occupied more usefully – meaning this kind of behaviour was rarely a problem.

I felt quite uncomfortable at this ‘upstairs/ downstairs’ model and feel that to juxtapose the two care options within one building is especially unfair as many residents ‘upstairs’ would benefit from a Reconnect model but might not have been adequately referred or are unable to afford the fees. It is worth noting, though, that the ‘upstairs’ traditional dementia care model is providing a high standard version of the regular dementia care home model. Orchard Care homes have persuaded commissioners across the country to pay double the usual care home fee to place people in the reconnect communities, providing evidence and statistics to show the savings achieved reducing costs across the system in places such as frequent hospital visits, placement breakdown and medication. Not to mention the impact on the persons wellbeing and happiness which was the crucial takeaway for me.

I have long felt that we have age discrimination built into our care and commissioning model with younger people receiving exponentially larger care packages than older people. In my view, this is because we don’t value the emotional and social wellbeing of older people, the need for them to be meaningfully occupied in just the same way as younger adults. If the Orchard Care Home model was rolled out across all older people requiring care and support, it would come at a cost, but what might the savings be to other parts of the system, and isn’t this the kind of care we would all want for ourselves and our loved ones in older age? Taking a people-first approach to care homes and prioritising an experience for older people with dignity and respect is the standard social care should uphold.

• Kathryn tweets @kathryn1smith

When I visit my family in New Zealand, I have to re-train myself. It seems to me that in New Zealand there often seems to me a real interest in ‘how you are’ and ‘what you are doing’. So, I come prepared to both ask and answer in a genuine way. It is not unknown for simple transaction in a shop with a stranger to take 10 minutes!

• Co-production Week 2023
• Camphill Village Trust

When you give or receive an answer that offers more than the obligatory ‘I am good thanks but what about this weather’ it may take us out of our comfort zone, and we can be challenged by this but on other occasions we may find ourselves walking through a door of opportunity that opens an infinite range of possible directions and collaborations.

This to me is the beginning of co-production. It’s the awareness to ask the questions and being open to creating an environment where we encourage people to be confident, comfortable, and brave enough to tell their stories, share their ideas and most importantly how they plan to achieve them.

I work for Camphill Village Trust, a charity committed to the culture of co-production; underpinned by a belief That everyone should have a life full of opportunities and that every person should be fully involved in co-creating what this means for them.

This must start with asking the right questions, listening to the responses and harnessing everyone’s collective skills and talents and being brave as we go forward together.

Feeling valued

Recently I had the honour of co-delivering an embedding co-production workshop with Owen. Owen decided that the best way to tell his story was to read us his self-penned poem ‘I am as good as’. It was a powerful way to remind all present that there are times when we do not feel valued for the many skills and talents each of us has. Yet whilst we are all unique, we are all as good as each other.

I left that workshop making a pledge to always take the time to ask the right questions and then really take an interest in the powerful stories people share.

I think that this is a pretty good starting place to be part of co-producing lives full of opportunity for us all.

Challenge

Both organisations faced a potential barrier to full Co-Production due to a fixed timescale outside their control.

Key to successful co-production

Both concluded that the most important element of successful Co-Production was clear communication, both with internal staff involved and with people who would use the service externally.

Worcestershire Adult Social Care has recently launched a Co-Production forum called Building Together. The forum will include a paid Board of 10 people with lived experience and carers, as well as a peer network.

• Co-production Week 2023
• Worcestershire: Building Together through co-production

At the recent Building Together launch event there was emotion and applause in the room when the Director of Adult Social Care, Mark Fitton, signed a pledge to Co-Production on behalf of the council. The trauma informed pledge was created by the People with Lived Experience Advisory Group of the West Midlands Social Work Teaching Partnership. Worcestershire Adult Social Care is the first local authority to commit to the pledge and it is already changing practice.

Carrie Lewis, New Possibilities visual practitioner, captured the voices of people who shared their experiences at the launch event. We are using the visual tool to focus on what people told us Co-Production means to them and how we can work in a true partnership approach. The focus on clear language which people understand is already changing what language we use as an organisation.

• Co-production Week 2023
• Race Equality Foundation

When it comes to health and social care, Black, Asian and minority ethnic communities often face unique challenges and experiences that may not be adequately addressed through a one-size-fits-all approach. Coproduction ensures that their perspectives and experiences are taken into account, allowing for more tailored and effective support.

Involving Black, Asian and minority ethnic individuals in decision-making processes acknowledges that they are the experts in their own lives and can contribute valuable insights that professionals may not possess. This collaborative approach helps to bridge the gap between service providers and the communities they serve, fostering trust, mutual respect, and cultural competence.

We value coproduction because it:

• recognises that individuals should be active participants in the design and delivery of services
• promotes a sense of ownership and empowerment
• leads to more culturally sensitive and inclusive services
• can identify systemic issues and disparities within health and social care systems
• fosters a sense of social justice and equity.

Black, Asian and minority ethnic communities often have unique cultural, religious, and linguistic needs that can significantly impact their health and well-being. By involving people from these backgrounds in service planning, providers can gain a deeper understanding of these needs and design interventions that are respectful, accessible, and culturally appropriate.

A key part of our work is identifying and highlighting that Black, Asian and minority ethnic communities frequently face inequalities in access, quality, and outcomes of care. By actively involving individuals, coproduction enables a critical examination of these disparities and the implementation of targeted strategies to address issues. This can help reduce inequalities and promote better outcomes for Black, Asian and minority ethnic people.

Responsive, inclusive and effective services

Ultimately, co-production acknowledges that every individual, regardless of their background, deserves to be treated with dignity, respect, and fairness. By ensuring that Black, Asian and minority ethnic voices are at the centre of decision-making processes co-production can lead to transformative change in health and social care, making services more responsive, inclusive, and effective for all.

This Co-production Week, let us acknowledge and celebrate working together for positive change and inclusion. The more coproduction there is, the better our health and social care system will be, as it will reflect and meet the needs of everyone, regardless of their ethnicity or background. This is good for both service providers and Black, Asian and minority ethnic communities, paving the way for a more equitable and person-centred approach to health and social care.

Examples of Race Equality Foundation co-production

• Physical health checks for people with severe mental illness from African and Caribbean communities
• Improving the recording of ethnicity in health datasets