Co-production in social care: what it is and how to do it – At a glance

SCIE At a glance 64
Published: October 2015

Key messages

Co-production is about developing more equal partnerships between people who use services, carers and professionals.
It is important to have an agreed definition between everyone taking part in any co-production activity.
There are key principles for co-production around equality, diversity, access and reciprocity.
Co-production can help make the best use of resources, deliver better outcomes for people who use services and carers, build stronger communities and develop citizenship.
To do co-production, organisations need to make changes to their culture, structure and practice and to regularly review progress.

Introduction

This At a glance briefing summarises SCIE's guide ‘Co-production in social care’ and has been developed in partnership with Think Local Act Personal (TLAP). Co-production is a key concept in the development of public services. It has the potential to make an important contribution to all of the big challenges that face social care services. Co-production can support:

implementation of the Care Act 2014
cost-effective services
improved user and carer experience of services
increased community capacity
outcome-focused and preventative services
integration.

A key lesson of the Francis, and the Winterbourne View Inquiries is that service providers need to develop more equal partnerships with people who use services and carers.

The Care Act 2014 is one of the first pieces of legislation to specifically include the concept of co-production in it’s statutory guidance. The guidance defines co-production and suggests that it should be a key part of implementing the Care Act.

What is co-production?

In its simplest essence, to co-produce is to make something together. Co-production is not just a word, it's not just a concept, it is a meeting of minds coming together to find shared solutions.

People are equal partners and able to share power.
Member of TLAP's National Co-production Advisory Group

Co-production is about developing more equal partnerships between people who use services, carers and professionals.

Co-production can be a slippery concept and if it is not clearly defined there is a danger that its meaning is diluted and its potential to transform services is reduced. At the same time, a definition that is too narrow can stifle creativity and decrease innovation. Definitions and language are important but the move toward co-production needs to be more than just a change in words. There is a danger of wrongly assuming that the right words will be followed by the right actions.

The National Co-production Critical Friends Group, a very diverse cross-sector network, agreed this definition:

'Co-production is a relationship where professionals and citizens share power to plan and deliver support together, recognising that both have vital contributions to make in order to improve quality of life for people and communities.'

The Care Act 2014 statutory guidance offers the following definition:

‘"Co-production" is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered.'

SCIE defines co-production as 'people who use services and carers working with professionals in equal partnerships towards shared goals'.

The range of definitions and the use of terms such as ‘co-creation' and ‘co-design' can be bewildering. However, there are a few things we can say with some certainty about what transformative co-production is about:

There is movement on from involvement and participation towards people who use services and carers having an equal, more meaningful and powerful role in services.
People who use services and carers are involved in all aspects of a service – the planning, development and actual delivery of the service.
Power and resources are transferred from managers to people who use services and carers.
People who use services, carers and staff are assets and are valued.
It is recognised that if someone makes a contribution they should get something back in exchange.
Frontline staff are seen as a group that needs to have more independence and a greater role in planning services.

Principles of co-production

It may be useful to approach co-production as a set of values. The following principles of equality, diversity, accessibility and reciprocity are critical values for putting co-production into action.

Equality – everyone has assets

Co-production starts from the idea that no one group or person is more important than anyone else and everyone has skills, abilities and time to contribute.

Diversity

Co-production should be as inclusive and diverse as possible. Particular efforts may be needed to ensure that seldom heard groups are included.

Accessibility

Making everything accessible is the way to ensure that everyone has an equal opportunity to participate fully in an activity in the way that suits them best.

Reciprocity

Reciprocity means people get something back for putting something in.

There are formal ways of doing this, like using time banks as a way of rewarding people, but sometimes the reciprocity comes from the more equal relationships that develop between people and organisations.

Costs and benefits of co-production

Co-production can help ensure that resources are used to develop the services that people really want. Co-production is linked with better outcomes for people who use services and carers. Co-production can help build stronger communities and develops citizenship. There are up-front costs when organisations start co-production as money may be needed for training, access requirements and other expenses. However, it may lead to savings in the longer-term because it can help to ensure that people get services that they really need.

How to do co-production

When looking at how to do co-production, it is helpful to think about organisations being like a jigsaw with four pieces.

For co-production to work effectively, change will need to happen in each piece of the jigsaw.

Jigsaw image showing Culture, Structure, Practice, and Review

Practice example

Islington Council has developed a Framework for Involvement in Adult Social Care to provide a solid base for co-production that is accessible, inclusive and impactful.

This includes a reward and recognition policy that covers payment at London Living Wage, a flexible approach to access expenses, individual support with benefits issues, and optional donations to service user and carer groups. Co-producing the policy has made it possible to find solutions to the challenges involved in rewarding service users and carers who work with the council.

Culture

Organisations' cultures are the beliefs and values that shape them and the way they work.

To co-produce, organisations need to:

develop their culture so that co-production runs through the whole organisation and everything it does
build their culture on a shared understanding of what co-production means, how it is done and will be achieved
make their culture risk-aware rather than risk-averse.

Structure

I want to be fully involved as soon as the idea blossoms. Asking me for my opinion once the idea is set means that I can't influence the agenda.
Member of TLAP's National Co-production Advisory Group

I need the right support so that I can be fully involved and included. I want to be asked for my views even if it takes more time to involve me.
Member of TLAP's National Co-production Advisory Group

To achieve co-production, the organisation structure and systems need to:

involve people who use services and carers from the start
value and reward everyone who takes part in the co-production
ensure there are resources to cover the cost of co-production
have a plan to make sure that everyone is able to communicate with each other
build on existing structures and resources.

Practice example

Birmingham City Council’s People Directorate (Adult services) is one of TLAP’s Making it Real* sites. It has developed a range of structures to support co-production work with citizens.

These include:

two citizen-led quality boards that co-produce minimum standards for services
ensuring that people who use services are involved as early as possible in specific projects and at all stages of service development
allocating resources and staff time to supporting co-production.

* Organisations who are willing to co-produce three priorities with people who use services and carers can access further information through TLAP's Making it Real website.

Practice

Organisations and their staff support co-production by:

making sure that everything in the co-production process is accessible to everyone taking part
ensuring everyone has the information they need to be part of co-production and decision-making
providing training for everyone in co-production and any other skills they will need
having a plan to make sure that everyone is able to communicate with each other
thinking about whether an independent person or organisation could help make co-production happen
making sure that frontline staff have everything they need to work using co-production approaches including time, resources and flexibility
providing any support needed to ensure the community involved has the capacity to be part of the co-production process
using co-production in the commissioning of services.

Practice example

All Together Now is a project working with people with dementia living in residential homes in Swansea. Using co-productive approaches has meant that staff roles sometimes changed, for example, kitchen staff began to cook with people rather than cooking for them.

Review

Organisations need to monitor their processes and outcomes by:

regularly reviewing to ensure that co-production is making a real difference and that the process is following the agreed principles
co-producing these reviews and evaluations
using the findings from review processes to refresh co-production and support continuous learning.

Practice example

New Belongings is a national co-produced programme which works with local authorities to improve support for care leavers. Its work in Cheshire highlights the importance of approaching co-production as an evolving process with people who use services involved in all aspects including monitoring. A key lesson is that everyone needs to be willing to learn and not everything will work the first time.