Co-production in social care: What it is and how to do it
Practice example: Wellbeing Our Way
About the project
National Voices' Wellbeing Our Way programme aims to develop the ways in which charities and community organisations enable people to manage their health in ways which matter to them. In particular, Wellbeing Our Way aims to enable people to be active in:
- managing their health and working towards their personal goals
- making decisions about the care, support and treatment they receive, in relation to what’s important for their lives
- engaging with and shaping health and care support.
Wellbeing Our Way is supported by The Health Foundation, an independent charity working to improve the quality of healthcare in the UK. The programme started in June 2014 and is funded for three years.
What has co-production meant to the project
Co-production has been central to the development of Wellbeing Our Way: creating shared priorities, language and approaches among all those involved.
People with lived experience work alongside those working within charities to shape every aspect of the programme: bringing a wealth and diversity of experience to our strategic planning, practical development and external communications.
Examples of this co-production in practice include:
- Wellbeing Our Way’s co-produced model of impact, which contributes to the programme’s theory of change
- people who use services co-facilitating the programme’s series of POW WOWs (shared learning workshops)
- writing blogs, case studies and profiles for WOW Now (the programme’s e-newsletter)
- creating change through communities of practice, which bring together small, diverse groups of voluntary and community organisations to make real headway in developing some of the ‘more than medicine’ approaches we know can enable people to manage their health needs and live well
- contributing to Wellbeing Our Way’s strategic development through its steering group.
What has helped in implementing a co-production approach?
Wellbeing Our Way’s ‘curry and co-production’ day brought together around 20 people with lived experience and people from health and care charities. This day was held at the beginning of the programme and was invaluable in developing the programme’s vision and aims (which became its model of impact) and also for agreeing the programme’s language. For example, it was agreed to use the term ‘people with lived experience’ rather than ‘service users’ and to be explicit in communications that the programme is about both mental and physical health. These are subtle but important aspects that have helped to develop Wellbeing Our Way into an inclusive programme.
Offering payment for people's time, as well as reimbursing travel expenses and other expenses where appropriate, is an important aspect of enabling people to contribute to the programme. This demonstrates the significance the programme places on the time and expertise that people with lived experience give to the programme, and ensures that everyone involved receives recognition for the role they play. The reward and recognition policy has full details of how this is done.
National Survivor User Network's (NSUN) 4PI involvement standards have been a useful framework for considering how we develop our co-production approach. The standards recognise that genuine co-production entails a culture shift in services and organisations and aims to ‘hard wire’ the voice and experience of people who use services into the planning, delivery and evaluation of health and social care services (NSUN: Involvement for Influence).
What difficulties were there in implementing co-production?
Co-production brings together people with diverse backgrounds, skills, aspirations and communication preferences. This represents one of the main strengths of this approach, but it can also create situations in which strong and sometimes opposing views are held. This requires skilful negotiation to move beyond a ‘win-lose’ approach in which any compromise or proposed solution is perceived as one interest ‘winning’ at the expense of the other, towards a more inclusive approach.
It can be challenging to move beyond individual concerns towards exploring shared experiences. We have found that using a variety of facilitation techniques – such as world café and action learning, whole and small group discussion, and a range of facilitators – helps to ensure that everyone has an opportunity to speak and be heard. This creates a strong foundation for constructive debate which can lead to genuine change.
What are the main strengths in the approach that has been taken?
Wellbeing Our Way is a more creative and inclusive programme because of co-production. People with lived experience have brought a wealth of ideas and personal expertise – for instance by co-facilitating workshops and contributing to the programme’s communities of practice and external communications.
At a more strategic level, everyone involved in the programme is working to ensure that it is rooted in the aspirations of people living with ongoing health needs. At the same time, there is recognition of challenges faced by individuals in managing their health and wellbeing, and by organisations developing approaches to support people to have choice and control over their lives.
The programme has found that co-production is successful when it acknowledges the things that can be difficult and seeks to develop new, more effective approaches to overcome these challenges.
What have been the main outcomes of the project?
At this stage of the programme it is too early to point to clear outcomes that have resulted from co-production.
However, there is some anecdotal evidence to show that it is starting to have an impact:
- In this ‘Influencing Change’ case study, a Wellbeing Our Way participant reflects on how hearing directly from CHIVA’s young peer supporters enabled him to influence the development of a young people’s camp within his own organisation
- Another case study reflects how new opportunities for partnership working are supporting the development of James Whale Fund for Kidney Cancer's approaches to working with people with long-term health needs.
How has the project worked to engage all sections of the community?
The programme works to engage people with a wide range of experiences and health conditions.
Specific steps have included:
- Diversity monitoring helps ensure that people with a range of experience and backgrounds are involved in the programme. Health conditions and caring responsibilities are included alongside protected characteristics in our diversity monitoring.
- Work to involve ‘less heard’ groups through National Voices members who often work with diverse communities, and by inviting people with a range of backgrounds, identities and experiences to contribute to the programme.
- Careful consideration of the process of involving people – for instance, by using a range of facilitation techniques which offer different opportunities to contribute. For example, people value time to get to know others in the room so there is always time for people to share aspects of their work, aspirations and challenges.
- Wellbeing Our Way’s events are designed to appeal to small, user-led community organisations alongside very large charities, in order to facilitate valuable shared learning.
What advice would you give to others?
- Co-produce your vision and goals to ensure that they represent the aspirations of your stakeholders.
- Once your goals are established, work towards them determinedly, but be flexible about the methods – co-production throws up more creative and inclusive solutions than can be predicted at the outset.
- Co-production is about creating new, more resourceful solutions, not just finding the middle ground.
- Ensure that you have the right people involved. If specific skills, experience or characteristics are needed, be transparent about this.
- None of us will ever achieve perfect co-production! Stay open to challenge and be ambitious about better ways to work together.
Written by Natalie Koussa (programme lead – Wellbeing Our Way) and Patrick Wood (person with lived experience and member of Wellbeing Our Way’s steering group).
For more information, please visit Wellbeing Our Way.
