Co-production in social care: What it is and how to do it
Practice example: Oxfordshire County Council’s Co-production Programme
About this project
In this instance, we are talking about a programme, not a project. The Co-production Programme is about embedding co-production in Oxfordshire County Council (OCC) so it becomes the way the Council works.
In 2016, OCC decided it wanted to embed co-production into its processes and practice, so asked SCIE for support with how to do this. SCIE ran four workshops –initially with people working at OCC, and people who use services. In the last workshop, the group agreed on seven main shifts that OCC would need to implement to make it a more co-productive place to work.
These shifts were:
- senior level commitment to co-production
- a co-produced training programme
- establishing a co-production board
- resourcing (putting some money into the programme, e.g. by establishing a co-production team)
- having a written agreement (or concordat) e.g. setting out terms of reference and how things would work
- evaluation of the whole programme.
In September 2017, OCC started a co-production team and the programme has been running ever since. Oxfordshire has a history of co-production, and in some parts of the Council too. But this was the first time senior leadership within the Council had made such a big commitment to it, and invested in it becoming embedded as a way of working.
What has helped in implementing a co-production approach?
In addition to the seven shifts outlined above (see ‘About the project’), all of which were adopted, the following have been crucial to the implementation and spreading of co-production within the Council:
- Growing a local network - establishing the Oxon champions network
- An organic approach - starting the journey with those who are willing, and gradually bringing in others along the way
- Visible organisation-wide commitment - co-production is written into the corporate plan
- A shift in national guidance and expectation - requirement from CQC to be doing (more) co-production
- Sharing the message externally - going out to people, visiting local groups to talk about its work and encourage people to get involved
- Events and marketing - raising the national profile of co-production. Holding Oxfordshire’s first ever co-production festival
- Supporting staff knowledge and confidence – for example, commissioners and project leads to understand co-production and how to do it. This has been essential, and done through a range of things e.g. providing guidance and advice, upskilling staff, helping to facilitate co-production events, modelling best practice, supporting staff to be able to push back as and when necessary in order to do be able to co-production, supporting people to have the confidence to try
- Sharing the message internally - attending team meetings across the Council to talk about its work and encourage people to get involved
- Developing training and resources – for example, face-to-face training and Oxfordshire’s Co-production Handbook
- Developing the right mindset – being patient, and having faith in the process; repeating messages as often as necessary; staying positive
What difficulties have there been in implementing co-production?
Some of the barriers to co-production that have been faced:
- Training – lack of understanding about the benefits and need for co-production
- Complexity issues – around the scale, scope and framing of the problem, and how to apply culture change in a vast complex system
- Lack of buy-in, or at times the necessary support required
- Change fatigue or resistance to change - working in culture where things change quickly and often
- Priorities – co-production is not given priority and is seen as an additional developmental piece which comes second to existing strategic priorities
- Time and resources – not giving enough time or resources to the process
- Political constraints/ legal implications – challenges around application of a very different way of working that is not always easily aligned to the existing system or approach
- Involving more/relevant people - lack of varied representation; relying on the same people
- Motivation issues - people not feeling valued; loss of trust; loss of participation as result; people’s contributions not being respected/ listened to; history (e.g. negative previous experiences put people off)
- Communications – failure to manage expectations and relationships through clear consistent comms
- Creativity – not having time or experience to think more creatively about how to facilitate co-production
What have been the main outcomes of the project?
The programme is ongoing, but work done so far has been evaluated by SCIE. Highlights from the report and from information gathered by the co-production team include:
- The number of people involved in co-production in Oxfordshire is over 30 times what it was at the start of the programme
- Number of co-produced projects in adult social care increased from a target of five to seven per year to over 20, and growing
- Co-production has spread throughout the Council, with projects happening in many other areas, and given senior level support
- Perception of OCC by members of the public has vastly improved
- Understanding of co-production by adult social care staff, and their confidence in using it, has grown as a result of the programme
- 85–89 per cent of staff members in adult social care believe that co-production has improved relationships between people using services and OCC
- The Board has grown in confidence, authority and influence; increase in membership
- Champions have taken ownership of their role, and facilitated and supported co-production in their respective areas
- Evidence of cultural and systemic change within the Council and the health and social care system
- Assessment of providers’ co-production approach included in some tenders and contracts
- People with lived experience were involved in evaluating tenders
- More people who uses services and carers were involved in recruitment including of the new Director of Adult Services
- Profile of Co-production Oxfordshire raised locally and nationally, through conferences, seminars, workshops, visits from/to other councils and social media
- Recognition from external independent bodies including SCIE, the Care Quality Commission and the Local Government Association Peer Challenge
- First ever Oxfordshire Co-production Festival attended by over 160 people
How has the project worked to engage all sections of the community?
We do this in a number of ways, for example:
- Advertising publicly for involvement in our work (e.g. website, flyers, newsletters)
- Using existing community contacts (for their involvement and to tap into their networks)
- Going to where people are…community groups, support groups, providers, organisations, events, public meetings, etc to talk about what we’re doing and try to encourage people to get involved
- Using colleagues’ networks and contacts
- Always keeping an eye and ear out for people who may wish to get involved e.g. people who speak at events or public meetings, people who appear in relevant news stories, etc
- Attending or running events
What advice would you give to others?
In addition to the points above, OCC’s Co-production Handbook pools all experience and learning to date.
SCIE’s recommendations in its evaluation report for what should happen next are also useful for anyone trying to implement this kind of programme:
- Recognise that culture shift takes time and needs to happen at all levels
- Acknowledge a tension between the Council’s legal responsibilities and public accountability, and the co-production ethos of sharing power and equality. Use co-production to collectively manage this tension.
- Reassure staff that they will be given time to do co-production
- Continue to provide administration and facilitation support for the Board and champions
- Ensure that the role of champions is clear and complements the Board
- Increase diversity within the Board and champions
- Support and facilitate the growth of local user-led organisations
- Invest time and resources in going out to engage with people (commissioners and project leads)
- Induct new Board members and champions to give them experience of the Council
- Continue to monitor progress and evaluate the programme
View more: Co-production practice examples
All SCIE resources are free to download, however to access some of the following downloads you will need a free MySCIE account:
- Webinar slides: Lessons from Oxfordshire 5 Feb 2020
- Co-production in social care: What it is and how to do it (Guide)
- Co-production in social care: What it is and how to do it (Easy read)