Co-production

The Community Involvement Group is a workstream group of County Durham Together, involving representatives from Durham County Council, Health and Care Services and Voluntary and Community sector organisations who are responsible for activities that aim to involve residents in the decisions that affect their lives. The group meets monthly to identify opportunities to join up work, reduce duplication, share good practice and develop resources that will help others to carry out high quality involvement activities.

What is co-production?

“Co-production is about developing more equal partnerships between people who use services, carers and professionals…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.” (Social Care Institute for Excellence)

The key principles of co-production are:

• Equality – no one group or person is more important and everyone has the skills, abilities and time to contribute.
• Diversity – making the necessary effort to be inclusive and diverse.
• Accessibility – everyone should have the opportunity to take part in a way that suits them best.
• Reciprocity – people get something back for putting something in.

Why is co-production important?

Involving and empowering local communities, particularly disadvantaged groups, promotes health and wellbeing and reduces health inequalities. This is recognised in local and national strategies.

“Participatory approaches directly address the marginalisation and powerlessness caused by entrenched health inequalities” (PHE A guide to community-centred approaches for health and wellbeing 2015).

Co-production is written into the Care Act which is a framework of legal obligations for local authorities.

"In developing and delivering preventative approaches to care and support, local authorities should ensure that individuals are not seen as passive recipients of support services but are able to design care and support, based around achievement of their goals. Local authorities should actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community.” (Care Act, 2014)

There is strong evidence to suggest that when people are involved in the decisions that affect their lives, they are likely to have better health outcomes.

Co-production can help us work better by:

• Building and maintaining positive working relationships.
• Making the most of existing assets e.g. people, structures and resources.
• Increasing self-worth and confidence of those taking part
• Increasing skills and experience of those taking part
• Improving peer networks and support and gaining a new sense of purpose.
• Making services a better fit for the people that use them, and more accessible.

The language and terminology we use can be different across settings and sectors. The CDT Community Involvement Group has outlined its collective understanding of the different kinds of involvement:

Inform

Providing accessible information about a topic.  This might include plans or proposals to change a service as part of a wider involvement plan or could be a post on a website to leaflets and booklets.

Educate

A learning opportunity where people are helped to understand a topic, and there is a feedback loop which indicates this has been effective.  This might include how plans or proposals to change a service may affect them. This can be a long-term project or a phase within a wider involvement plan.

Consult

A more formal process where people have the opportunity to express their views and influence plans or proposals, often via a survey or focus group.  Most consultations have a fixed window for people to respond, which will be a minimum of 4 weeks, but can be part of a wider involvement plan timescale.

Engage

A relationship where people are supported and encouraged to express their views and ideas to influence plans or proposals. This is usually achieved by people, responsible for services, building a working relationship with targeted groups or individuals.  Engagement activities could be over a few weeks or a one-off workshop.

Co-design

An equal relationship where people (who design, deliver or use services) work together to design services or projects.  The co-design project is complete when plans are agreed and there is no further involvement (e.g. in monitoring or evaluation).  The timescale will depend on how complex the project is.

Co-produce

An equal relationship, where people (who design, deliver or use services) share strategic decision-making and work together to design, deliver, evaluate and monitor the quality of services or projects. Co-production projects can require significant time and resource.

As illustrated in the Spectrum of Involvement diagram above, the boundaries between different kinds of involvement can be blurred.

Co-production is not always a quick and easy process. Some of the challenges include:

• Resources – is there enough officer time, budget and timescale to facilitate co-production?
• Clear boundaries – do we know all the parameters of the project at the outset?
• Facilitation skills – is the person developing the project trained or best placed to facilitate?
• Organisation culture – can the risks of shared decision-making be managed?

Remember in our activities:

• Being reflective and self-aware takes skill and practice and might not come easily without training or a supportive culture.
• Resisting the urge to justify or defend the way things are, and looking at what else might be possible can be difficult when we are under pressure.
• Being aware of unconscious bias is something we need to check continually because our values and beliefs are formed early and can affect the way we respond to others.
• Emotional intelligence is a key skill for good facilitation of co-production.

Working through the following steps can help you get the most out of your project or initiative. There is some overlap between the different sections.

Identify a suitable project and develop an outline

• What do you want to achieve?
• What are the timescales? (These can vary but it is unlikely you can deliver a co-production project well in less than 6 months).
• Do you have management support for the project?
• Can all aspects of the project be co-produced or just some?
• Can you identify any initial barriers or challenges?
• What experience do you have of co-production? Do you need any training or help?

Resources, legal factors and policies: making sure you are compliant

• Is there a budget to cover things like refreshments, expenses or fees? Who is responsible for it?
• What other resources are needed? e.g. staff time or IT support
• Are you aware of policies and procedures in your organisation that may relate to this project? For example data management, equality and diversity, remuneration (paying and reimbursing people); accessibility; consultation protocol.

Recruiting a co-production group: getting the right people along

• Who does the project affect? Who do you need to involve?
• Have you completed a partner mapping activity? Can anyone help you with this?
• How will you communicate effectively with the people you want to involve?
• How will you make your information or events more accessible? Have you considered literacy and digital inclusion?
• Will participants need additional support or training beyond induction? e.g. pre and post-meeting briefings, peer support etc.
• Are you offering remuneration?

Co-designing: working together to plan specific involvement activities

• Who needs to know what and when?
• How will you exchange information with people? (you might use more than one method – think about as many scenarios as possible)
• What are the key messages that you want to share with people?
• How can you promote your co-production work to a wider audience?

Co- delivery: working together to deliver the project

• How will you communicate with each other and make sure tasks are completed?
• How will you make sure that everyone’s views are valued equally?
• Do you need any support, for example around facilitation?

Co-evaluation: reviewing and learning from what you've done

• Have you agreed from the start how you will measure the impact of what you do?
• How will you know what difference using co-production has made? Consider the impact on service users and the co-production participants.
• How will you review the success of your project whilst you are doing it?
• How will you share information with others?

To complement your overarching project delivery plans (including DCC Consultation and Engagement Plan where appropriate), we have included the following co-production resources:

• CoProduction Toolkit Appendix 1 Planning Guide
• CoProduction Toolkit Appendix 2 Recruitment and Partner Mapping Guide
• CoProduction Toolkit Appendix 3 Project Terms of Reference (Word)
• CoProduction Toolkit Appendix 4 Reviewing Involvement Activities (Word)

You will also find other resources further down the page including:

• Links to external resources
• Case studies

We can also support with an Introduction to co-production presentation and e-learning course.  Please email us at publichealth@durham.gov.uk using the CDT Community Involvement Group as your subject line.

Co-production in health and social care

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

NHS England: How co-production is used to improve the quality of services and people’s experience of care: A literature review

Think Local Act Personal: What is coproduction?

Durham University: Moving Social Work - new co-production animation

Co-production in the wider system

LGiU: Co-production - developing an equal partnership

Mind: Co-production Influence and Participation Toolkit

The University of Sheffield: Doing co-production

Co-Production Collective: Our Approach

The National Lottery Community Fund: Co-production - The benefits for people and organisations

Local Government Association: Co-production

Involvement

Involve: Publications

Durham University Centre for Social Justice and Community Action - Participatory Action Research Toolkit

Co-Production Collective - welcome

NHS Digital Service Manual: Design principles

SCIE: Holding accessible and inclusive meetings (Webinar recording)

Health Literacy

The First Word

Hemingway Editor

NHS Digital Service Manual: Health literacy

We would like to gather case studies to develop our shared understanding of what works and things we learn along the way. If you have been involved in a co-production project, or if you are thinking about developing one, we would love to hear from you. Please email us at publichealth@durham.gov.uk using the County Durham Together Community Involvement Group as your subject line.