Co-production in social care: What it is and how to do it

Practice example: Birmingham City Council's Adults and Communities Directorate

About the organisation

The Adults and Communities Directorate at Birmingham City Council has made a commitment to working with people who use services, carers and citizens through co-production. It sees this as a way of working in partnership to understand and agree the things that need to improve and work together to change things for the better.

The council recognises that many people, communities and organisations have valuable skills, knowledge and views that they can contribute. It is committed to working with the public to help make sure that it makes the best use of its resources for those most in need.

Citizen-led quality boards and Making it Real

The directorate has set up two citizen-led quality boards - one covering the work of assessment and support planning services and one for commissioning.

People who use services and carers on these boards work with staff to provide quality assurance based on their experiences and views. They:

• say where they have areas of concern
• make recommendations for how things could be improved
• co-produce new minimum service standards
• highlight areas of good practice.

This is usually through task and finish groups with wider representation from other people who use services and organisations.

Much of the boards' work is linked to the national Think Local Act Personal 'Making it Real' framework. This sets out what people who use services and carers expect to see and experience if support services are truly personalised. It is helping to check and improve the directorate's progress towards transforming adult social care from the perspective of people who use services and carers.

Co-production in practice

Examples of some of Birmingham's co-produced work include the following:

• developing new minimum standards for its access service and the way social care workers carry out social care assessments and reviews
• introducing a new customer satisfaction questionnaire so that it gets direct feedback from people who use services and carers
• creating a 'good practice award' for residential care providers delivering personalised services - shortlisted by council staff with a final decision by the citizen-led quality board members
• citizen-led quality board members in the development of a care home quality rating system - this will help the citizens and the council choose the best care
• identifying three priority areas of work and a resulting action plan
• working with those people who use services who get direct payments so that support can be improved
• organising an opportunities fair for the citizens of Birmingham who have learning disabilities, physical disabilities, mental health issues, sensory impairments or are older adults.

What do the people involved in the project think about their experience of co-production?

Volunteers who worked on the first opportunities fair said that they wanted things to be done differently the second time it was run. They wanted to be more involved all the way through the planning process for the opportunities fair, not just at the event. They felt ready to be part of lots more decision making and took an active role in deciding the venue, the structure of the day, marketing and defining the role and responsibilities of the volunteers.

Service-user volunteers 'buddied-up' with volunteers from the Department for Work and Pensions (DWP) to make sure that they had as much support as they wanted to do their work. Feedback from all the volunteers was extremely positive. For example, DWP volunteers felt that they had grown in confidence working alongside volunteers with learning disabilities, in some cases for the first time.

Staff have reported a real sense of commitment to working together and have found co-production very energising. Working alongside new people from different backgrounds and organisations who are passionate about co-production has been refreshing. It has given them the opportunity to look at situations from different perspectives, and work to a shared goal with everybody committed to working on the same task to achieve a positive outcome. This has been welcomed, particularly in the current climate of severe cutbacks in funding, which can sap people's morale and energy.

What has helped in implementing co-production?

• having a team of people who really believe in the whole ethos of working with people as equals - co-production can't be seen as an add-on; it has to include everyone from the start to the end of the project
• agreeing the 'vision' - identifying the shared goal and what it will look like
• acknowledging people's qualities and matching tasks and roles to people's skills and preferences
• giving people time to be really involved - breaking things down into manageable and measurable chunks
• evaluating past co-produced projects and carrying learning forward to improve the next one
• using person-centred approaches - recognising that everyone has a right to equality, to be included in society and to have as much choice and control as possible in their life
• having inclusive and interactive meetings - making sure that everyone is involved in every meeting and that their voice is heard - having accessible venues and times and using ground rules for meetings are important for this
• having good clear communication - finding out what a person's preferred way of communicating is, for example easy read print, large print or email
• being creative and ambitious but realistic about what is possible
• being honest and acknowledging that there will always be some constraints, for example finite budgets, confidentiality and time.

What challenges have there been in implementing co-production?

• So many people wanted to be involved in organising the opportunities fair that the planning group became very big and there was a danger of losing the focus of the project.
• Lack of awareness about co-production - if co-production is to work across the organisation, it has to persuade and educate others about what it means.
• The organisation needs to actively participate and work together to change the culture of the organisation to one of co-production.

What are the main strengths of co-production?

• It provides opportunities for people from different backgrounds, with different skills and experiences to work together as equals to make a positive difference.
• It helps people to see the same issue from a different perspective.
• It encourages people to take joint responsibility for solving problems and making improvements.
• People who have been involved in the project have grown in confidence and self-esteem and say that they are now ready to take on new challenges.
• People are sharing their social networks so that the number of people and groups that the project can reach is increasing.
• There are shared rewards of a job well done.

How has the project worked to engage all sections of the community?

The opportunities fair project reached different sections of the community by:

• offering opportunities to get involved to people who use services, carers and established groups of people who use services
• involving members of adults and communities citizen-led quality boards, with the terms of reference for both boards including a requirement to make sure that they have representation from people who use services who are from black and minority ethnic communities
• organising over 90 internal, external and third sector organisations - such as the education service, the DWP and Autism West Midlands - to take part in the event
• making sure that the vision and planning of the event considered promoting opportunities that reflected the diversity of the citizens of Birmingham, for example age, gender, disability and sexuality
• using community networks, for example churches
• researching what organisations and groups exist in Birmingham so that as many different groups of people and individuals as possible are reached for this project and in the future
• advertising the event via a mail-out to all carers and Birmingham schools to target young carers and young people who will soon be leaving school and may need adult social care services
• using a range of media to advertise the event - 'word of mouth', radio, the council's website, posters, flyers and the local newspaper
• social media - Twitter.

What advice would the project give to others considering using co-production?

• Do it - it'll make you feel good!
• Team work is essential.
• Involving people with skills and expertise in engaging with citizens, people who use services and carers is key.
• It is essential to have support for co-production from senior managers.
• Make sure that you have resources to support the project, for example, dedicated time and a budget.
• Spend time planning and identifying what you want to achieve - break it down.
• Have a vision but be flexible.
• Keep focused on the project - acknowledge any individual difficulties, but deal with these outside the main work.
• Have a core group of experienced facilitators.
• Harness people's enthusiasm - then the passion will snowball.
• Have fun and celebrate your successes!