Experiences and understandings of co-production in adult social care: Findings from SCIE’s Co-production Survey 2023
Over the last few decades, the concept of ‘co-production’ has gained significant attention within the social care sector. As support for the approach grows, we are achieving a consensus within adult social care that it is right that those who use services should be involved in designing and developing them. The Care Act 2014 specifically includes the concept of co-production in its statutory guidance. The guidance defines co-production and suggests that it should be a key part of implementing the Care Act.
Through the use of an online survey, we captured insights and experiences across various roles and levels of responsibility, to uncover valuable knowledge about the realities of co-production in adult social care. This was done by investigating the understandings and experiences of co-production from both people who draw on care and support, and those who provide it, shedding light on the potential benefits, barriers, and opportunities.
The recommendations put forward throughout this report aim to bridge the gaps in understanding of what co-production entails, how it should be implemented, and why we need it. By embracing and implementing these recommendations, we can continue the journey towards achieving the best possible version of co-production, where principles are known, understood, and integrated throughout all areas of adult social care.
Overview of findings
This research unveiled compelling findings that shed light on experiences and understandings of co-production in adult social care, from the perspective of those who draw on care and support, and those working in the sector.
- 72% of staff working in adult social care reported previous familiarity with the term ‘co-production’, whilst this figure stood at 56% of individuals with lived experience.
- It was found that senior leaders with the least exposure to frontline working had a much better knowledge of co-production (95% familiarity) than those working in direct care delivery (41%).
- 59% of people with lived experience reported previous opportunities to be involved in co-producing their own care and support, whilst only 37% had been involved in co-producing services or policies.
- Familiarity with co-production was higher in the NHS (79% had heard of the term), Local Authorities (79%), and not-for-profit organisations (81%) than it was in for-profit organisations (56%) and those working for an agency (58%).
- Key barriers experienced by social care staff to implementing co-production were time (reported by 47%), organisational culture (31%), cost (26%) and communication (25%).
- We found instances of misinterpretation of what co-production is or involves, particularly from staff in direct care roles. Some considered co-production to be the same as person-centred care, interprofessional working, and integrated care.
- Respondents voiced issues regarding the inclusiveness and representativeness of co-production, describing instances where we are not reaching out to all, and extending participation beyond the 'familiar voices'.
- Many respondents spoke of a sense of distrust and disillusionment with co-production, and due to the incorrect use of the term it had become diluted and had lost meaning to some. Others voiced experiences of 'co-production for the sake of co-production', describing it as a box-ticking exercise or commenting on staff within social care only paying "lip service" to the approach.
Calls to action
Working in partnership with members of the National Co-production Advisory Group (NCAG) and SCIE’s Co-production Steering Group, we have outlined the following recommendations:
- It is crucial that sufficient resources are allocated towards co-production, ensuring staff have protected time to carry this out. Investment in such areas will equip staff working in adult social care with the necessary tools and resources to engage in co-production effectively and meaningfully, and ensure services are fit for purpose.
- There is a need to prioritise comprehensive training and education for every staff member working in adult social care, empowering them with the knowledge of co-production, what it is and how to apply it across diverse roles in the sector.
- Training and development should focus on new starters in the sector, but also be repeated to allow for best practice examples and learnings to be shared amongst all adult social care staff. This could be done through mentoring and partnering with people with lived experience.
- There should be investments in grassroot organisations who are already connected to people with lived experience and organisations who are doing co-production well.
- To avoid instances of misinterpretation and misunderstanding, a consistent definition of co-production needs to be shared widely, with practical examples that bring the skills, values, and behaviours of co-production to life.
- New context-specific co-production groups/panels should be established for each project, ensuring that they truly reflect the diverse population impacted by the service/product/policy under consideration.
- To foster greater inclusivity and representativeness in co-production, there needs to be a shift in the approach, from reactive to proactive. To ensure effective outcomes, more needs to be done to reach out to diverse communities so that people’s needs are met, and all voices are heard.
- Research that examines the experiences of co-production in adult social care from the perspective of staff and people with lived experience from marginalised communities should be prioritised.
- Raise awareness of how co-production can be implemented at different levels – for example, individual (personal support and care plans), operational (designing and reshaping services) and strategic (informing approaches).
Barriers to co-production: selected quotes
To better understand what could support co-production to happen more of the time, we asked participants to consider any potential barriers to workers successfully implementing co-production in their role. Below is a selection of quotes from survey respondents (see full report for more detail):
The time frame for co-production are not those of funders and strategic partners, and while they come to see the benefits, this time is not factored in.Staff (strategic leader) #224
Establishing rapport, building relationships takes time. This isn't valued by management who want to slot people into 30 min time slots for assessments/interventions. The ever-increasing workload and responding to urgent needs is turning us into a reactive, not a proactive person led service, it makes me sad.Staff (manager) #208
I think it requires a whole systems approach, there are fantastic pockets of co-production taking place but it should be properly resourced and meaningful. Changes are required throughout the organisation to create spaces for co-production to take place and empower individuals.Staff (social worker) #348
Staff are often moved to work at different services or due to high turnover different staff are coming and going due to this co-production is very difficult for lots of people I've supported over the years co-production comes after building up professional working relationships.Staff (support worker) #155
Reach - our co-production boards are not representative of race/ ethnic diversity in the community.Staff (carer) #433
We have found that there is a disconnect between different levels of the social care workforce surrounding what co-production is, and how it should be implemented.
Our calls to action, formed in partnership with those with direct experience of adult social care, and utilising the evidence gathered throughout this research, aim to address these discrepancies, align our collective efforts, and steer us forward towards achieving the best possible version of co-production.
In terms of future research, there are a number of possible next steps we can take towards reaching this, and the following should be explored:
- Understandings and experiences of co-production in marginalised communities. Findings from our research suggest that certain groups are being defined as "hard to reach" and are therefore not included in co-production initiatives. We therefore need to prioritise research in this area and examine experiences of co-production in adult social care from the perspective of staff and people with lived experience from marginalised communities.
- A theory of change framework for co-production and map resources to support individuals and organisations to measure outcomes and assess the impact of co-production. Whilst we heard from a range of perspectives on why co-production is important, research should also explore the questions "is co-production working in the intended way?" and "is it worthwhile?". By utilising resources and expertise to evaluate impact, individuals and organisations can demonstrate that investment in co-production is worthwhile.
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Department of Health, (2014) Care and support statutory guidance: Issued under the Care Act 2014 London: Department of Health
Social Care Institute for Excellence, (2022) Co-production: what it is and how to do it, SCIE
Think Local Act Personal, (2021) Ladder of co-production, TLAP