Breaking down the barriers to co-production

Co-production is about people who use services and carers working in equal partnership with professionals to design, deliver and evaluate services.

The theme of SCIE’s third annual Co-production Week in 2018 was Breaking down the barriers to co-production. Over 100 people took part in SCIE’s Co-production Festival with its six workshops and panel discussion, and 364 people logged on to two webinars.

This report draws together the learning from these events and discussions. It presents an outline of what is holding back co-production and identifies some possible solutions to break down these barriers and promote future progress.

Co-production isn’t always a ‘natural’ or easy way to work. We should see co-production as a long-term goal achieved by having a shared vision and strong leadership.

SCIE Co-production Festival attendee (2018)

How we carried out this work

At SCIE’s Co-production Festival in July 2018, 120 people were split into six workshops with 16–20 people in each. Each workshop was given the same task:

Identify as many barriers to co-production as you can. Think about solutions to each of these barriers.

Webinars

We ran two webinars during Co-production Week. In each we asked people survey questions or carried out ‘web polls’ about their experiences of co-production. We show people’s answers and thoughts in Barriers and solutions in numbers.

Key activities and points of the day

A graphic artist captured key activities and points of the day. Snapshots from her illustration are below. (Click the images to view)

Key messages

  • Lack of clear policies and legislation on co-production
    There should be a legal requirement for co-production and stronger policy drivers that create a push for co-production to happen.
  • A lack of knowledge and understanding about what co-production means More training and accessible resources (case studies, templates and practical guidelines) are needed so people can better understand what co-production is and to show them how to do it well. These should be co-produced with people who use services and carers. These resources will also help avoid confusing co-production with consultation or partnership working.
  • Attitudes, power sharing and fear of the unknown
    Change should be driven equally by professionals and people who use services. Developing values or a charter that everyone signs up to at the start of co-production work can overcome this.
  • Organisational culture
    There should be senior leadership buy-in and a strong vision for co-production to change the culture within an organisation and make co-production happen across all levels of work.
  • Money and resources
    When budgets are tight, organisations are less likely to invest in new approaches such as co-production. Innovation is the solution to this and being willing to try new approaches to working with people who use services and carers. Co-production needs to be properly resourced and projects need to be well planned to provide time for co-production.
  • Accessibility
    Co-production isn’t always accessible to everyone with different support needs, e.g. mental health needs or learning difficulties. Meetings and activities should be accessible so diverse groups of people can take part and get their voices heard regardless of disability.

Key findings from our web polls

  • 21 per cent of people thought there was a good understanding of co-production in their organisation or area.
  • 32 per cent of people thought senior leaders lead co-production by setting a good example in their organisation or area.
  • 36 per cent of people thought professional attitudes are a major barrier to co-production.
  • 40 per cent of people thought people in their organisation or area have the skills and knowledge to support co-production.
  • 75 per cent of people thought a legal duty would strengthen co-production.
  • People said the two things that would strengthen co-production the most are bringing together evidence of what works in co-production and more leadership from senior managers.
  • The most important thing that SCIE could do to strengthen co-production was to develop practical guides to support people to do co-production.

Barriers to co-production and their solutions

Listed below are eight barriers identified by participants. They shared ideas about how to overcome each one.

Many of these barriers are linked, so action will need to consider and address a range of the barriers to successfully develop and improve co-production.

  • Lack of clear policies and legislation on co-production Open

    Most new health and social care legislation and policy makes reference to the need to involve people who use services and carers. But there is no legal requirement for organisations to co-produce.

    Solutions

    • There could be a legal requirement for co-production or stronger drivers that create a push for it to happen.
    • Develop (co-produced) standards for co-production with guidelines and templates.
    • A national lead person for co-production.

    There should be a legal requirement to co-produce.

  • Lack of knowledge and understanding Open

    A lack of knowledge and understanding of co-production is a major barrier. This means that many organisations and professionals think it is too difficult to co-produce their work. They often believe co-production to be expensive and/or having no clear benefit.

    Professionals should understand that co-production is a different way of working with people who use services and carers. It is not the same as approaches such as consultation and involvement, where often key decisions have already been made before involving people who use services. Work is sometimes taking place with people who use services and carers which is called co-production but it is not being done in a meaningful way. It can result in co-production being viewed as a token gesture or a tick-box exercise rather than having an actual impact.

    Another way that co-production isn’t done in the most meaningful way is when change is being driven by managers and professionals.

    Solutions

    • Clearly define what co-production means with information on the principles or values that guide how to do it. These could be developed by national organisations or a network of people who use services and carers.
    • Have more training and support for all staff, beginning with the induction process and then on an ongoing basis as part of their continuing practice and development.
    • This training and support must be co-produced with people who use services and carers and their organisations. This means training that is designed, delivered and evaluated by them.
    • Develop networking and contact between professionals working on co-production.
    • Start pilot co-production projects and spread the practice from there.
    • Have co-production champions or local ambassadors with local expertise who can demonstrate how to do it meaningfully.
    • Produce evidence to show the benefits of co-production.
    • Create systems to monitor co-production.
    • Recognise the importance of developing relationships between everyone involved including councillors, senior managers, people who use services and carers.
    • Involve disabled people and people who use services in all parts of co-production right from the beginning of the work through to the end.

    Clair Tesla – SCIE Co-production Network

    How do we ensure local authorities understand the value of co-production? They still don't get it.

    Provide positive examples. Have co-production champions.

  • Attitudes and power-sharing Open

    Some participants felt that both professional’s and service users’ and carers’ attitudes towards co-production needed to change.
    There was some concern about professional attitudes including:

    • Thinking things have to be done in the way they have always been done
    • A culture of ‘gatekeepers’ – staff having too much in control, particularly in places like residential homes
    • Being risk averse
    • Believing people who use services and carers are not able to take part in co-production because of factors like age or disability

    These have a big impact on organisations and professionals' ability to share power with people who use services and carers, which is essential to true co-production. People who use services and carers can sometimes have views and experiences that make it difficult for them to be part of co-production. These include:

    • They might think it is too difficult
    • Previous negative experience with social or health services can mean they find it difficult to trust professionals
    • They are sometimes frightened of getting involved as they believe they will get into trouble for saying what they think

    Solutions

    • Set up peer groups so that people can support each other.
    • Try to keep going with it even if it is difficult.
    • Provide training on speaking out.
    • Develop a co-production charter or a set of values that guide co-production that everyone signs up to.
    • Champion a human rights approach.
    • Set up a 'mechanism for change' - for example, the London Borough of Hammersmith and Fulham set up a disabled people's commission to advise on what was important to disabled people which has helped develop co-production in the council. The London Borough of Newham has co-production forums for its adults' and children's services.
    • Give staff permission to take time and build relationships.
    • Give people who use services and carers leadership roles in co-production, with appropriate support and training.

    Sharing power means each professional should partner with us.

    I am not a client or a user – I am a citizen and fully human.

    Kevin Caulfield – Hammersmith and Fulham Disabled People’s Commission

    Dr Remi Oslinsanya – Carers Co-production in Newham

    Lost Voice Guy

  • Organisational culture and staff Open

    Organisations that are trying to work using co-production do not always succeed in making it a basic part of their culture. Making co-production run through everything an organisation does is often referred to as embedding co-production. Doing this ensures that it takes place across all levels of an organisations’ work and becomes ‘everyone’s business’.

    In these organisations there is often positive work on co-production but this is lost when the staff involved leave the organisation. Sometimes co-production work takes place in isolation and there isn’t a clear plan to embed and make it happen across an organisation.

    Solutions

    • Ensure senior leadership buy-in to make co-production fundamental to everything an organisation does and all staff are signed up to it.
    • Involve people who use services and carers in leadership.
    • Provide co-production training for all staff.
    • Have a co-production team.
    • Make co-production ‘the way we do things’ – include it in all policies and job descriptions.

    See co-production as a long-term goal. Have a shared vision and strong leadership.

    Across an organisation, see co-production as cultural change.

  • Fear of change and the unknown Open

    Some organisations and individuals fear co-production as something unknown and potentially risky. Co-production is not a ‘natural’ or easy way to work for some people and means they need to make big changes to the way they work, leading to a reluctance to share power.

    Solutions

    • More knowledge and understanding of co-production, as detailed above.
    • Support and encouragement from colleagues.
    • Encouragement to take the first steps and think about taking risks to work in a different way.

    Fear of the unknown stops professionals from listening.

    Recognise that people who use services are a huge, free resource.

  • Money and resources Open

    As with most areas of social care and all public services, there is concern that there is not enough funding to support co-production. Financial difficulties mean that councils have to prioritise their work and this reduces their capacity to engage in co-production. It also leads to greater time pressures with decisions needing to be taken quickly and time is not allowed for co-production.

    Often in difficult times organisations aren’t willing to try new approaches and instead stick to what they know.

    In addition to these issues, the way funding processes are set up do not always allow for co-production.

    Solutions

    • Better, smarter and creative use of resources.
    • Make sure there is dedicated time for co-production.
    • Provide specific funding for co-production.
    • Share resources between organisations.
    • Demonstrate how co-production results in better services with lower costs when it is done properly.

    Training and positive examples informing people of the outcomes [including] saving money.

    Innovation is the solution.

    Local authorities do grasp the importance but all are struggling with the savings imposed by central government.

  • Access Open

    Making co-production as accessible as possible is a key principle for co-production but many people continue to experience barriers to participation. Failing to make something accessible means that some people will be excluded.

    The key barriers identified were:

    • difficulties getting to meetings and events
    • timing of meetings and events
    • expenses not being covered or paid quickly enough
    • lack of access to information
    • lack of information in accessible formats.
    • use of inaccessible language and jargon.

    People with learning difficulties specifically highlighted problems around inaccessible information. They also highlighted the speed at which many co-production activities take place and said this makes it difficult to understand things and get involved.

    Language and the ways organisations communicate can be major barriers to people taking part in co-production. The word co-production itself is seen by many to be a jargon word that creates a barrier to co-production, along with other jargon and technical words.

    People can be involved with services at many times in their lives including difficult points, such as when they are ill or when they are having a crisis. People in these situations may need particular support to be involved in co-production.

    Solutions

    • Co-produce the format of the meetings and activities so they are accessible.
    • Develop everyone’s understanding of different groups of people who use services, and carers who have different disabilities or long-term health conditions.
    • Organise transport.
    • Make expenses available on the day of an event/meeting and in cash if possible.
    • Ask everyone about their access needs
    • Train staff to write Easy Read documents.
    • Slow down – allow more time for meetings so that they are not rushed and there is plenty of time to talk about things. Make sure everyone understands everything and take breaks when people need them.
    • Be creative.
    • Work on digital approaches to co-production using things like video conferencing/Skype – but remember this is not accessible for everyone.
    • Always make time for the 'quiet voices' and support them to be heard.

    People need to understand it’s ok to slow things down

    Work differently. Not everything needs ‘meetings’

    Jessica Thomas – The Advocacy Project

  • Valuing people Open

    People who use services and carers need to feel that the contribution they make through co-production is valued. People often feel this is not the case and being asked to do co-production without being paid can be part of this.

    Solutions

    • Make sure that co-production is a positive experience.
    • Pay people wherever possible and where people want this.

    Summary film of the day

Barriers and solutions in numbers

We ran two webinars on breaking down the barriers to co-production – 364 people took part. View a recording of the webinar.

During the webinars we asked eight questions about attitudes to co-production, what the main barriers to co-production were and what it looks like for people in their local areas.

What we learned from the webinar poll

There is a generally shared definition of co-production in my organisation or area
In my area or organisation professional attitudes are a major barrier to co-production
There is a good understanding of good practice in co-production in my organisation or area
If there was a legal duty to co-produce it would strengthen co-production in my area or organisation
In my area or organisation senior leaders lead co-production by setting an example
In my area or organisation people have the skills and knowledge to support co-production
What do you think would strengthen co-production the most?
What is the most important thing SCIE can do to strengthen co-production?

Keep up to date

Improve participation and co-production with people who use services and carers to develop and deliver better social care and health provision. Find out more about SCIE’s co-production work and our consultancy and improvement support service. If you would like to talk to our team about how we can help, please complete our enquiry form.