Co-production in health and social care – why it is important

At The Access Group we are aware that with any new approach in healthcare or social care the most important thing to do is ensure everybody knows and understands what the approach is. Without a common understanding and shared goals of the approach it will be counter-productive.  

We want to make sure all parties know and understand what co-production means, why is it important and how its framework can be implemented across healthcare, social care as well as how it can be used to improve mental health and wellbeing.  

This article will review everything there is to know about co-production in healthcare and social care, as well as what are the challenges when implementing the approach successfully and how technology can help encourage more collaborative working  across a variety of parties to help achieve the best outcomes for your local community. 

What is co-production? 

There are many different definitions of co-production. It can be used in a variety of ways across numerous  different sectors. Each sector may use or adapt definitions to best suit the sectors needs.  

In general, co-production is an approach to describe working in partnership with other organisations to make important contributions to improve the delivery of a service further.  

The National Co-Production Advisory Group define co-production as: 

“A way of working where everybody works together on an equal basis to create a service or come to a decision which works for everybody.” 

Co-production in health and social care however, is used to describe partnership working between people who draw on care and support, carers, and citizens to improve its services.  

What makes co-production different to other approaches in health and social care is that it encourages involvement from people who use the services to ensure there is equal participation from everybody involved at the very start. This allows local authorities therefore to work in collaboration with citizens and other organsiations to commission the care that matters to the individual.  

Co-production also enables organisations that provide care and support to empower people who use their services to shape, design and develop those services.  

Why is co-production important? 

 

Co-production in health and social care is important for many different reasons. Ultimately through sharing knowledge, experience, and expertise more person-centred care and better quality care can be delivered to individuals to ensure all local authorities are delivering their duties and responsibilities under the Care Act.  

Through this local authorities can be better prepared for the upcoming demand in health and social care to ensure the correct number of resources are readily available and that the services that are available best meet the needs of the individual.  

One of the other major benefits from co-production is the opportunity for service quality to improve. This is because the approach allows different organisations to work together and work to their strengths to ensure services are better aligned with the needs of the community. Through actively involving end-users themselves both the quality relevance and effectiveness can be improved from the feedback the end-users provide.  

Through service users being involved in designing their services, the co-production approach in health and social care also enable individuals to say and share the concerns that most affect their lives. This involvement promotes a sense of ownership and responsibility to help encourage further involvement, engagement and satisfaction from end-users with the services they receive.  

Another reason why co-production is important in health and social care is that through encouraging the sharing of diverse perspectives, knowledge, and experiences, service users, carers and care or support workers alike can offer great insight to help establish and contribute to more innovative and creative solutions. These new innovative ideas can then be led by the specific experts to improve outcomes further.  

A final benefit of using a co-production approach in health and social care is that it improves transparency across both the health and social care markets. This is because co-production offers shared decision-making with stakeholders and end-users to develop collaborative governance where resources can easily be shared to improve patient outcomes every time. 

Using a co-production approach in health and social care also helps to address both social inequalities and more non-clinical issues that individuals could be suffering with in the community. This helps to develop a more population health management approach to ensure all care needs and non-clinical needs are catered for to promote equal access to care.  

Co-production in health and social care is crucial therefore as not only can it help ensure all responsibilities of the Care Act are followed, it helps councils prepare for the upcoming CQC inspections of local authorities, and most importantly it concentrates on the impact services can and will have on an individual at every step of the process. This helps individuals have better access to the care and support services they need, it improves outcomes, reduces pressure on the NHS, and also it improves the health and wellbeing of a community as a whole.  

This collaborative approach with a variety of stakeholders, end-users, and carers therefore allows knowledge to be shared for services to be adapted as needs change, so all individuals have access to the care and support they need when they need it.  

Co-production framework – How does it work? 

As already discussed co-production can be defined in many different ways. Because of this it can also work in different ways too depending on what the overarching aims and objectives are for an organisation or groups of organisations using the approach.  

What is crucial is that all parties and organsiations involved are on the same terms and share the same goals.  

Co-production only works and can be successful in health and social care when everyone understands the difference between co-production and involvement. For example, involvement means being consulted and asked for opinions being unaware if that feedback will be taken onboard. Whereas co-production promotes equal partners and co-creators regardless of your background, so each individual will participate and create at the same level.  

In many cases in health and social care co-production can be broken down into four stages: 

1. Co-design  

This is where everyone involved plans the services required in a specific area or local authority.  

2. Co-decision making  

Here everyone discusses the allocation of the resources needed to ensure even more deprived areas have access to the care and support they may need.  

3. Co-delivery of services  

The third stage of co-production is then delivering the services decided. This also includes voluntary workers helping to deliver the services needed too.  

4. Co-evaluation of the service  

The final stage is where every party and organisation contributing to the approach shares their experiences and thoughts to analyse how a service has been delivered, what could improve it, and whether a service may need to change due to care needs changing.  

This then also helps to acknowledge whether particular services are still needed, needed more or needed less, and if needed less what else could be needed instead.  

Another way co-production can be referred to when explaining how it works is the through the ladder of co-production. Like discussed above, co-production can operate at many different levels including strategic, service design, development, and the individual themselves.  The ladder of co-production therefore describes the series of steps that are needed towards full co-production in health and social care.  

What are the principles of co-production? 

In order for co-production to be successful it is critical that the 6 key principles of co-production are put into practice. 

1. Recognizing people as assets  
2. Building on people’s capabilities  
3. Developing two-way, reciprocal relationships  
4. Encouraging peer support  
5. Blurring boundaries between delivering and receiving services  
6. Facilitating rather than delivering  

One of the main things to remember is that co-production is more than just talking about things together it is about doing things together to achieve better outcomes.  

It is also argued that there are 4 additional values that are critical in putting co-production into practice and that by including these values co-production can be as inclusive as possible. These values are: 

1. Equality  

A lot of the writing on co-production concentrates of recognizing people as assets by referring to skills, abilities, time, and any other potential qualities individuals may have. This ensures that right from the start no one or group is more important than anyone else.  

It can take time for everyone to understand the value of equality in co-production which is why training and support throughout the process is crucial to provide a balanced approach.  

2. Diversity  

Similar to equality, successful co-production should be as inclusive as possible. It is crucial therefore that co-production projects are pro-active about diversity so no groups are under-represented.  

3. Accessibility  

In order for co-production projects to involve everyone they need to be accessible for everyone to take part on an equal basis. It is essential therefore that everyone has the same opportunity to take part in an activity completely in a way that best suits them.  

Local authorities therefore, should, where possible, promote participation in providing co-produced interventions with individuals, families, friends, carers and the community.  

4. Reciprocity  

Here reciprocity ensures that people receive something back for putting something in. This is considered highly important in co-production as it can take time and sometimes can be demotivating.  

Through ensuring reciprocity, individuals that feel demotivated or unenthusiastic to run through the process again is reduced and instead it builds on people’s desire to feel needed, valued, and that their contributions have had a positive impact on their community.  

Co-production examples 

Co-production can be very diverse when it is operated correctly. Across the health and social care market it can be used differently to help individuals and particular groups, including more vulnerable ones.  

Co-production in mental health 

 

Co-production in mental health tends to follow 3 main objectives: 

• Re-connecting individuals with family, friends, neighbours, and the community  
• Signpost individuals to community activities, volunteering or peer support to help reduce loneliness and social isolation  
• Help individuals be included in society with reduced stigma and discrimination to mainstream services such as education, employment, and housing 

An example of co-production in mental health is social prescribing. Social prescribing is an approach which encourages co-production as individuals are referred to Social Prescribing Link Workers where they co-produce their social prescribing journey together to best suit their needs. 

This helps individuals to establish their own goals and make better use of the services and resources that are available around them improve their mental health and wellbeing as well as any other wider social determinants of health they may be suffering with.  

Action Together for example, one of our customers at Access Elemental Social Prescribing, found that by using our social prescribing software they were able to record the benefits of co-production in mental health better.  

For example, they were able to record that 94% of individuals noticed an improvement in their health and wellbeing since engaging with social prescribing and that 66% of clients felt more satisfied with life.  

Social prescribing can help improve mental health in many ways therefore, as it can help people access non clinical services as a part of a package of care to reduce pressure on the NHS, as well as offer services to more vulnerable individuals or at-risk groups to encourage them to take part in community-based activities where previously they might not have had that opportunity to.  

Co-production in healthcare  

 

Co-production in healthcare again can be used in different ways depending on the group or the individual which care and support is being structured for.  

There are a variety of great examples of how co-production has helped to make further improvements in healthcare to ensure all care is person-centred and puts the patients first.  

NHS North Cumbria for example demonstrates how they have adapted the co-production process in a variety of ways to help improve health outcomes for a variety of groups including young children, more vulnerable adults, children with autism, health apps, and rapid process improvement workshops.  

For example, NHS North Cumbria CCG and Cumbria County Council collaborated to jointly co-produce an open space event at Brathay Trust. The event was to be held for ‘looked after’ children under the age of 12 and those between 12 and 18. The events were designed to give children and young people the opportunity to discuss issues about their health and care openly to be more included in their future care plans.  

West Yorkshire Integrated Care Board (ICB), a customer of our Commissioning Software is another example of how co-production can work successfully in healthcare. Through West Yorkshire ICB using our Access Adam system the whole process of onboarding providers and organising appropriate care packages for individuals were digitsied to make it easier for all parties to access the information required to make the process quicker and safer.  

Any missing information could easily be requested through the system which then fed through to the centralised patient records to ensure every clinician and provider had the most up-to-date information and avoid having vital intel missing about an individual’s needs.  

The system allowed all clinicians and providers to work together to organise better quality care packages by being able to update their information when they needed to so every individual could be placed into care placements that are 100% safe and complaint as well as adaptable to care needs changing. 

Co-production in social care 

 

Co-production in social care is also important to ensure that all adults receive the best quality of care regardless of where it is delivered. Whether it is within their own home, in the hospital, or in a residential home.  

The Social Care Institute for Excellence (SCIE) have a variety of excellent examples of how co-production can be used in adult social care.  

One example is where the mental health charity Mind started working with a number of different adult social care services, workers, end-users as well as additional services to provide better strategy development when  looking at how to diversify who Mind worked with so every individual could be represented.  

At every stage individuals from a variety of ethnic communities were brought into the project to lead and provide insight in how to overcome barriers and develop connections so all ethnic groups have the same accessibility to adult social care services.  

The example also demonstrates the benefits of applying a continual learning process rather than an end point as this allowed Mind to easily adapt as needs changed so no individual would be left without.  

What are the challenges in implementing co-production in health and social care? 

One of the biggest challenges in general is making sure everyone contributing to co-production projects knows and understands what it means and what their shared goals are; co-production in health and social care is no different.  

Without shared understanding it makes it very difficult for all parties and organsiations contributing to the project to go in with a blank agenda and ensure everyone has an equal voice.  

One of the biggest reasons for failure is because there are often power imbalances within a project. It is crucial that when a co-production project takes place all local authorities start small and then you gain more experience the bigger future co-production projects can get. This is because educating new parties on what co-production is will get easier the more hands-on experience you will get.  

Another challenge that some parties, organsaitons, carers, and end-users may have is that they do not realise that their treatment or the service they deliver is an example of co-production due to not understanding the jargon itself. In order to ensure everyone fully understands what it is and the impact it can have it is best to use more neutral language such as non-clinical support and re-connecting the community. That way when educating others you can make it clear that the projects work around what is important to the individual.  

Another challenge that has made co-production difficult in recent years is the lack of clear policies and legislation in co-production. Despite co-production being recommended as a good way of working in the Care Act 2014, the uptake in NHS Trusts and local authorities in recent years has been limited. In fact in 2018 a survey conducted by SCIE found that only 21% felt there was a good understanding of what co-production meant and 75% of people thought with more legislation around co-production would strengthen massively.  

A final barrier that can make successful co-production difficult is the cost of running these projects. As we are all aware health and social care budgets are getting more and more stretched each year making it crucial to spend the budget wisely.  

Financial difficulties mean that councils often have to pritotise other things and this  can reduce their engagement with co-production. Due to co-production also not being a quick fix and a longer process than most, some organisations will be reluctant to try new approaches and instead stick with what they know so they don’t risk ‘wasting’ their budget. Some funding also doesn’t always allow for co-production either extending these financial difficulties even further.  

One way to ensure that financial difficulties and a lack of funding doesn’t limit your co-production project is to make better and smarter usage of the resources you have. Remember every person contributing is an asset and using their experience and their resources collectively can help better use of them to make better use of restricted budgets. Through sharing resources you prevent local authorities doubling up on the same resources when it may not always be necessary. This can also demonstrate that co-production doesn’t have to be expensive when it is done properly.  

How can technology help ensure co-production in health and social care? 

 

There are many ways technology and digital solutions can be used to help make implementing co-production in health and social care more effective.  

One of the key steps that will help any health, social care, or mental health organisations is to digitse their processes and data and information handling. It is the first and arguably most crucial step to digitally transform a service in health and social care as it makes both documenting and managing activity more efficient and saves your local authority significant amounts of time, so more time can be spent on more innovative approaches such as co-production.  

New Directions Flexible Social Care Services found that moving to electronic documentation allows them to be as co-produced as possible across their variety of services including supported living, young adults with learning difficulties or autism, and mental health needs.  

New Directions’ move to electronic care planning improved engagement in organsiaing and scheduling care as well as helping them receive an outstanding CQC rating for they way they organise and deliver their care. They also found through using Access Care Compliance their auditing processes could be richer in information, less admin intensive, more actionable and trackable, and most importantly it saved time admin which could then be spent on improving their co-production approach further.  

 

At The Access Group we understand the importance of commissioning and delivering person-centred care that matters to each and every individual. We provide a suite of solutions that help make that process better across the care continuum and allow more time to be spent co-producing services.  

Our Access PAMMS suite offers a variety of modules that can support your collaborative working with providers to increase quality, as well as help you be more creative with your resources to better manage future demand with our demand modelling and quality assurance technology.  

 

To find out more on how technology can help local authorities  work with other organsiations to deliver better co-production projects discover our local government software today.  

Find out how our digital solutions can help all co-production projects in health and social care be successful regardless of the project, from helping create better co-produced social prescribing journeys with Link Workers and end-users, to joining up care and resources across primary and secondary healthcare, social care, and the care sector in virtual wards so all clinicians consistently have the information needed to deliver the best quality care.  

Summarising co-production in health and social care 

In this article we have defined what co-production is in health and social care and why is it important in enabling more better person-centred care across the whole of healthcare, social care and related services.  

The article highlighted the importance of working collaboratively as well as the other benefits co-production in health and social care can deliver including: 

• Improving people’s motivation to work towards their own outcomes-based goals  
• Giving the opportunity for people to share concerns people may be uncomfortable with 
• Empower everyone participating in the process  
• Improving people’s confidence  
• Being more able to identify common issues with services and identify gaps and issues with individuals’ support  
• Deliver safer and better quality person-centred care 

We have also highlighted different examples of how co-production can be used in practice across health and social care explaining how co-production cannot just help in clinical settings but in non – clinical settings too, to help improve the health and wellbeing of a community and help overcome the wider social determinants of health an individual may be suffering with.  

We reviewed how at The Access Group we have a variety of digital solutions that can be applied to help all co-production projects regardless of the aims of the project or the health and social care sector it is being applied to. Whether its to make more effective care plans, make the transition of continuing healthcare from primary to secondary to domiciliary care more seamless, or improve mental health with offering social prescribing services, we have a suite of digital solutions that can help your local authority across the care continuum.  

Discover more about how our local government software, our care planning and care compliance software can help make co-production simpler and more effective today to achieve better outcomes and more person-centred care that matters to the individual every time.  

Contact us today and let’s get the ball rolling in deciding what your local community wants to improve on and discuss how you can work with other stakeholders to see how your resources can be used innovatively to achieve that goal.