Wicked issues – complex problems that cannot be solved in a traditional fashion – are endemic in the NHS. They are nothing new. But the current challenges facing the NHS, social care and others are arguably the most ‘wicked’ yet. There is a danger that the new models of care discussed in the Five Year Forward View will be implemented in ways which fail to recognise their inherent complexity. This is because the issues surrounding integration involve a number of different organisations and people with competing interests, who disagree about what exactly needs to change, and how.

Developing new plans can be tough, partly because of how difficult it can be to win the backing of local citizens for radical change. What happens to a vision that isn't followed by a widely owned and agreed plan? In these instances, it very often gets stuck, opposed by the very people who are most expected to benefit from it: patients, people who use services and the wider public. In order to build visions and plans that are more likely to be sustained, it is critical to have service user, patient and carer involvement in service design, commissioning, and delivery. That’s co-production.

This report summarises the findings from a research study which sought to explore how we can better broker constructive conversations with citizens to tackle wicked issues when implementing new models of care. The research was undertaken by the Social Care Institute for Excellence, working in partnership with PPL and the Institute for Government and funded by the Health Foundation’s Policy Challenge Fund.