Local people: the real experts by experience for better joined-up care

At least five million adults use a combination of health and care services, and 6.5 million people provide unpaid care to relatives and friends, amounting to an estimated £132 billion a year worth of support. Around three million people undertake voluntary work within health and social care.

These are the real experts on how health and care systems do – or do not – work together to meet people’s needs. They provide the critical and unique perspective required to reshape the system, and they bring strengths and networks to support improvement. Yet their contribution is too often overlooked or undervalued.

As noted in the NHS Five Year Forward View, ‘patients, their families and carers are often “experts by experience” and their voice is crucial to service and system redesign’.

Furthermore, there is evidence, as shown in The King’s Fund report, Volunteering in health and care, suggesting that volunteering is not only beneficial for the people who receive help, but also for the volunteers themselves, in terms of improved self-esteem, wellbeing and social engagement.

Higher levels of social integration and lower levels of loneliness increase people’s health and happiness and have far-reaching consequences for educational attainment and the reduction of crime.

This section outlines approaches to supporting joined-up working through co-production, asset-based places, engagement and self-care.

new models [of care should] also draw on the “renewable energy” of carers, volunteers and patients themselves, accessing hard-to-reach groups and taking new approaches to changing health behaviours.
Simon Stevens, Chief Executive, NHS England

Co-producing change with people and communities

To make change effective, it should be coproduced with local people and communities. This means local leaders sharing power and responsibility with local people to design services and working arrangements that reflect their experience, needs and preferences.

To engage effectively with people and communities, providers will need:

time, resources and skilled staff
authentic relationships with shared purpose, responsibility and trust
genuine leadership commitment to active listening and willingness to take action for change together.

SCIE’s co-production resource explains how to put co-production approaches into practice in organisations and projects. It uses a whole-system approach and a ‘jigsaw model’ for the management of change.

The four pieces of the jigsaw are:

culture – the beliefs and values that define organisations and the way they work
structure – the way organisations are arranged and the systems set up to carry out their work
practice – how organisations and the people who work for them carry out their work
review – monitoring how the work is carried out and the outcomes or impacts that result from the work.

Checklist

Issues to consider include:

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Get real commitment to sharing power between professionals and the public, for example, through co-chairing meetings.

Make co-design/co-delivery sessions accessible and inclusive for people with a range of different needs.

Manage any conflicts that may potentially arise and equally share responsibility for resolving these.

Balance the time required to properly engage with the public at a pace which works for them, with programme delivery needs and deadlines.

Reimburse people appropriately for their time and expenses, so that they feel valued and can afford to take part in a way that is sustainable and does not undermine other voluntary activity.

Engage with a range of people who reflect the diversity of local communities and are relevant to the particular services in question.

Train both professionals and public and community representatives in working together in a new way.

Keep people up to speed on the health and care system in a way that allows them to contribute freely and with knowledge.

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Case studies

Working Together for Change Open
Working Together for Change (WTfC) is a best practice approach to co-producing change with people and families. Its simple six-stage process is designed to be low cost and low tech, and can help commissioners and providers make better use of scarce resources and improve productivity, leading to better outcomes for people by ensuring services provide the things they want and need in a way that makes the most sense to them.

Working Together for Change has been used to great effect by providers and commissioners to review how well services match the priorities of local populations. Some examples include the following:
- MacIntyre, an award winning national provider, has recently adopted Working Together for Change as a means to embed co-production across its services.
- In Lancashire, the process has become a core part of the commissioning cycle and is run regularly to ensure commissioning priorities reflect what people most want and value from services. Most recently, commissioners used the process to help review how well direct payments (DPs) were working for people and what the future shape of direct payment support services should look like. See TLAP: Direct payments used to purchase personal assistants – Lancashire County Council.
- The process has also been used at a sub-regional level in the Manchester region to inform the first ever subregional market position statements (MPSs). Trafford, Manchester and Stockport councils have used the Working Together for Change process to ensure that the market position statements give the right messages about what services should be provided in the future.
There are also examples of co-production in the SCIE Co-production guide, including how local authorities, care, health and housing providers have taken a coproductive approach to developing and delivering services.

Tools and resources

The challenge of co-production – Nesta and New Economics FoundationOpen

This is a discussion paper on how equal partnerships between professionals and the public are crucial to improving public services.

Visit: The challenge of co-production – Nesta and New Economics Foundation.
Co-production in social care – what it is and how to do it – SCIE guide Open

This is a guide to what co-production is and how to develop co-productive approaches to working with people who use services, and carers. It is aimed at managers and commissioners, frontline practitioners, people who use services and carers. It includes practice examples and short videos.

Visit: Co-production in social care – what it is and how to do it – SCIE guide.