Co-production: what it is and how to do it

The term ‘co-production’ describes working in partnership by sharing power between people who draw on care and support, carers, families and citizens.

This guide is about how to do co-production. It was co-produced with people who draw on care and support, carers, support providers and staff from the Social Care Institute for Excellence (SCIE).

Introduction

Co-production is a key concept in the development of public services and it has the potential to make an important contribution to all the big challenges that face social care provision.

This is a guide to what co-production is and how to develop co-productive approaches to working with people who draw on care and support and carers. It is aimed at managers and commissioners, frontline practitioners, and people who draw on care and support and carers.

The Care Act 2014 specifically includes the concept of co-production in its statutory guidance. The guidance defines co-production and suggests that it should be a key part of implementing the Care Act. In particular, co-production should be used to develop preventative, strength-based services, support assessment, shape the local care market, and plan information and advice services.

Definitions of exactly what co-production means vary, but the term is used to describe partnership working between people who draw on care and support, carers and citizens to improve public services.

There is an interest in co-production across the full range of public services, not just social care and health. Public, voluntary and private sector organisations and politicians have shown an interest in co-production. This interest reflects the widespread acknowledgement that the citizen has a vital role in achieving positive outcomes from public services.

Implementing co-production can be challenging and complex. It involves looking at every aspect of how an organisation works. This resource draws on the learning from a wide range of sources to help managers, practitioners, people who draw on care and support and carers to both understand and implement co-production in social care and beyond.

What is co-production?

If co-production is not clearly defined, there is a danger that its meaning will be diluted and its potential to transform services will be reduced. At the same time, a definition that is too narrow can stifle creativity and innovation. An important part of the process of co-production is for organisations and projects to come to an agreement on what they understand co-production to be and the principles that will guide its implementation.

This section of the guide looks at how co-production can be defined and then outlines a set of co-production principles that can help to give direction to co-production projects.

Defining co-production

There is no single formula for co-production, but there are some key features that are present in successful co-production initiatives. They:

• define those who access care and support as people with skills
• break down the barriers between people who draw on care and support and professionals
• build on people’s existing capabilities
• include reciprocity (where people get something back for putting something in) and mutuality (people working together to achieve shared objectives)
• work with peer and personal support networks alongside professional networks
• facilitate services by helping organisations to become agents for change rather than just being service providers.

Definitions of co-production include:

Principles of co-production

The principles of equality, diversity, accessibility and reciprocity (or getting something back for putting something in) are critical values for putting co-production into practice. Acting in accordance with these principles helps to make co-production as inclusive as possible, and demonstrating a commitment to inclusivity shows that co-production is genuine, or authentic.

Equality – everyone has assets

Co-production starts from the idea that no one group or person is more important than any other group or person. So, everyone is equal and everyone has assets to bring to the process. Assets refer to skills, abilities, time and other qualities that people have. This is different from approaches that focus on people’s difficulties and what they cannot do.

Much of the writing on co-production focuses on the need to recognise the assets of people who draw on care and support and others in the community. However, the assets that workers, practitioners, managers and other professionals bring to the process also need to be recognised.

Equality can only be achieved with a shift in power towards people who draw on care and support and carers.

For a culture of equality to be fostered, everyone involved in co-production will need to get to know each other. Sometimes, a commitment to equality can be put to one side because of the urgency to get things done. This danger can be guarded against by good planning.

There can also be complexities around this issue because of the unequal power relationships between professionals and people who draw on care and support, and between people who draw on care and support themselves.

It can take time and patience to address these issues. Training and support will be a key part of achieving this. If people who draw on care and support are brought into the process without this support, they will be at a disadvantage in their relationships with professionals.

Experienced and well-trained people who draw on care and support bring a lot of value to co-production, particularly in terms of more equal and potentially more challenging relationships with professionals. This can sometimes lead to them being dismissed as ‘the usual suspects.’ However, they do have the capacity to make a particular contribution to the leadership of co-production initiatives.

The principle of equality and recognising that everyone brings assets to co-production that should be used and valued, provides the basis for a balanced approach to this issue. If everyone is treated as equal in the process of co-production, greater experience or expertise should not mean greater power. So, no one group (professionals, experienced or less experienced people who draw on care and support and carers) should have a greater role to play.

Diversity

It follows from the principle of equality that diversity and inclusion are important values in co-production. Co-production should be as inclusive as possible. This can be challenging but it is important that co-production projects are pro-active about diversity.

It has been found in work on the involvement and participation of people who draw on care and support that some groups are under-represented or excluded from such work, and this is likely to apply equally to co-production.

People who draw on care and support can be excluded because of equalities issues or because of the nature of their difficulties. The main groups likely to experience exclusion are:

Where a person lives can also be a barrier to participation: people living in residential homes, homeless people, Gypsy and Traveller communities and people in prison experience exclusion on this basis.

When thinking about diversity, it is important to remember that people are not ‘just one thing’.

Accessibility

Access needs to be recognised as a fundamental principle of co-production as the process needs to be accessible if everyone is going to take part on an equal basis. Accessibility is about ensuring that everyone has the same opportunity to take part in an activity fully, in the way that suits them best.

As well as physical access, making sure that information is accessible and that it is provided in appropriate formats is a key part of making sure that everyone can take part in co-production.

Some language can be problematic because it involves jargon that is inaccessible. And it is particularly important that everyone involved understands the term co-production itself in the same way. Getting the language right so that everyone understands each other is essential.

There is also a broader issue about all information being available and shared. All parties need to have enough information to take part in co-production and decision making. There may be issues around confidentiality and information sharing, which will need to be resolved for co-production to be successful.

Another important aspect of accessibility is time and timing, which can be overlooked. The impact of time on co-production and the need to allow time for co-production to develop are important issues.

Reciprocity – getting something back for putting something in

‘Reciprocity’ is a key concept in co-production. It has been defined as ensuring that people receive something back for putting something in, and builds on people’s desire to feel needed and valued. The idea has been linked to ‘mutuality’ and all parties involved having responsibilities and expectations. Putting reciprocity into practice can help to create a sense of togetherness.

The word ‘reciprocity’ may be considered as jargon when discussing co-production. It may not seem particularly accessible, but there is not another word that fully captures what it means.

Co-production and the Care Act 2014

The Care Act 2014 is one of the first pieces of UK legislation to include the concept of co-production in its statutory guidance.

The Care Act’s statutory guidance says:

This definition is not as helpful as other definitions, as it only talks about people who draw on care and support influencing – rather than collaborating with – professionals in equal partnerships.

However, it is positive that it emphasises the range of activities that can include co-production. It makes clear that it is primarily people who draw on care and support, carers and the community that should be involved in co-production.

Co-production is also referred to at a number of points in the statutory guidance, in relation to information and advice; prevention; assessment; market shaping; strengths-based approaches; and developing local strategies and plans.

Co-production is an important way of achieving the overarching aims of the Care Act including prevention, wellbeing and the focus on outcomes. It should be a consideration in all aspects of implementing the Act. For example, co-production can help to ensure that advocacy services meet the requirements of the Act.

The link with personalisation

Co-production has developed over a similar time period as ideas around services that are person-centred or tailored to the needs of the individual. And some have said that co-production is essential to making services more personalised.

Approaches developed by disabled people and the independent living movement have become central to social care services, with person-centred planning developing into personalisation. The development of personalised services has seen governments commit themselves to involving people more directly in service provision as well as taking responsibility for costs and risks. Various initiatives in England and Wales have emphasised the need for people to be able to choose and manage how their needs for support are met.

People who draw on care and support and carers being part of the co-production of the service they receive on an individual basis is a prominent feature of personalisation. Examples of this include direct payments and individual budgets. They draw a distinction between individual co-production and collective co-production where people work together on community issues.

Economics of co-production

Organisations, programmes and projects that use co-production have a complex and dynamic nature, which makes it difficult to assess their costs and benefits.

Evaluations of co-production tend to focus on how people have participated, and on their experiences, rather than on economic costs and benefits.

The costs of co-production

Issues around the costs of co-production can be complicated. While there is some evidence that it can reduce costs, the available evidence is inconclusive. This may be something that varies between different organisations and different projects.

Co-production may lead to short-term increases in the use of services and other costs as it increases people’s knowledge of and access to services.

Potential savings

One of the key arguments about the economic benefits of co-production is the potential returns from a perspective that focuses on prevention, and on early intervention when people’s needs arise rather than letting them get worse. So, if there is investment in community services, this means that people are less likely to need more expensive services (such as crisis and emergency services) later on. This will reduce the cost of acute services.

Other points to note about co-production and costs are:

• Co-production may lead to some costs being reduced and others increased.
• It may only be possible to know whether co-production is cost-effective by looking at things over a period of time. If it is cost-effective, it will have reduced the number of inefficient, ineffective and unwanted services.
• There will be costs associated with engaging with services and projects.
• It might be found during the co-production process that more spending is needed in some areas.

Economic evaluations of direct payments, individual budgets and personal health budgets have shown that they are cost-effective. Giving people who draw on care and support and carers more control over those services can improve their health and wellbeing. But it is important to provide more support in the form of information, advice and advocacy.

The benefits of co-production

Co-production approaches can bring a range of benefits and improvements for all concerned. Ensuring that everyone involved has a shared understanding of what benefits are expected from co-production is important to the success of the initiative.

Potential benefits from co-production can be divided into two types – instrumental and intrinsic benefits:

Professionals collaborating with communities and people who draw on care and support are likely to have a stronger focus on the outcomes of the support provided when they are co-producing, and potentially a greater focus on prevention. So, there are improved outcomes for people who draw on care and support as a result.

The contribution that co-production makes to developing social networks and communities is another benefit. It has been argued that this only happens where there is collective co-production with groups and communities and not where co-production is confined to individuals being involved in the services they receive.

Why does co-production lead to improved outcomes?

Evidence shows that incorporating co-production principles into programmes for people with long-term conditions can help them to gain knowledge, learn skills and adopt behaviours that are thought to be important in achieving better health and wellbeing.

How to do co-production

This section does not offer a step-by-step guide to doing co-production, as effective approaches will vary according to circumstances, but it gives guidance on key issues that need to be addressed to put co-production in organisations and projects into action. It uses a jigsaw model for the management of change.

The four pieces of the jigsaw are:

1. Culture – the beliefs and values that define an organisation and the way that it works
2. Structure – the way the organisation is arranged and the systems it has set up to conduct its work
3. Practice – how the organisation and the people who work for it conduct their work
4. Review – monitoring how the work is conducted and the outcomes or impacts that result from the work.

This is a ‘whole systems approach’ that SCIE originally adopted for participation because:

• organisations must change at every level – from senior management to frontline staff – if they want to achieve meaningful participation
• participation should become part of daily practice – and not be a one-off activity
• participation operates at different levels as there are many ways to involve people who draw on care and support in different types of decisions.

SCIE sees the jigsaw model as a useful way to approach co-production and has used it for its own co-production strategy.

Organisational culture is the collection of values, expectations, and practices that guide and inform the actions of everyone involved in an organisation, and it is key to determining whether co-production can take root. Co-production thrives in a culture that is transparent, open to change and comfortable with well-managed risk.

A change in culture may be necessary if there is to be progress with co-production. There needs to be a move from delivering services to facilitating services and from facilitating to enabling, rather than a one-way process of providing care.

A range of cultural issues need to be thought about so that professionals can successfully co-produce both with people who draw on care and support and carers. The issues range from ownership of the project throughout the whole organisation to valuing the skills and assets of everyone involved. The culture of the organisation also needs to embrace the key principles of co-production.

Thinking about structure involves considering how an organisation or initiative is arranged. This includes looking at:

• decision-making structures
• leadership
• the way the organisation plans and develops projects
• resources.

It is particularly important to change the systems and structures of an organisation so that it can support co-production. Examples of the types of structural changes that might be required are:

• new goals
• revisions to staff roles
• developing support networks
• new management structures
• revised procedures for commissioning.

This may be particularly challenging for large organisations as co-production puts an emphasis on personal relationships. Organisations will need to move away from centralised and hierarchical structures (where power remains in the hands of very few people) so that they can support co-production.

Making co-production happen in practice is about all those who participate in the process – who may have different points of view – working together to achieve agreed aims. This means building relationships.

But there can be difficulties in the relationships between the people who draw on care and support and professionals working in services.

It is important to make sure that people who draw on care and support attend all co-production meetings. This will help new working relationships to develop. It will also help with the shift in power that is involved in co-production. It is also helpful if people who draw on care and support are given opportunities to meet on their own to talk about and agree their priorities.

The relationships involved in co-production need to be based on trust and confidence. The success of co-production is likely to be based on the people involved and their relationships. Success needs to be defined in terms of achieving the long-term goals of co-production as a means of creating better services, which are more responsive to the needs of people who draw on care and support, with understanding that there may be some mistakes along the way.

Co-production should not be seen as a one-off activity. Successful co-production will introduce changes to systems that will lead to the ongoing review, development and delivery of new forms of support. Co-production therefore benefits from a culture of continuous learning about what has worked and what has not worked.

Review is a key part of the management of any organisational change. It is important for:

• monitoring progress
• marking the achievements and/or milestones that have been reached
• identifying areas where improvements can be made to the process or outcomes enhanced.

Review and evaluation are an essential part of any co-production initiative and should be conducted with people who draw on care and support. Review and evaluation may focus, for example, on a particular service or project, on a developing programme of co-production, or on annual performance of an organisation in relation to its ongoing commitment to co-production.

It is important to ‘measure what matters.’ Better outcomes for people who draw on care and support, and carers, are a key aim of co-productive approaches, so these should be evaluated. The contribution a project or initiative makes to developing innovative approaches should also be considered.

Evaluation should also focus on the actual difference that co-production makes to people’s lives.

Practice examples

View practice examples from a range of organisations and projects working with different people in different contexts, including organisations that provide social care and support, and organisations and projects that have taken co-productive approaches to benefitting citizens in other areas.

View: Co-production practice examples

Support from SCIE

Improve co-production with people who use services and carers to develop and deliver better social care and health provision. Find out more about SCIE’s co-production work and our consultancy and improvement support service. If you would like to talk to our team about how we can help, please complete our enquiry form.