Co-producing quality improvements in health and social care

Co-production refers to a way of working where people who use health and care services work in equal partnership with health and care staff in designing and delivering activities, projects, or services. The approach builds on the recognition that people with lived experience are often best placed to advise on what support and services will make a difference to their lives. There are many different definitions of co-production and approaches on how it should be achieved. The Coalition for Personalised Care and its partners developed a model for co-production which sets out five values and seven steps to create a culture of co-production.

Co-production in practice

NHS England are leading work to ensure co-production is embedded across the NHS and becomes the default position for improving care. In October 2021, they funded 10 system-wide organisations to use a co-production approach to improve services. These covered a mix of systems including Cancer Alliances, Integrated Care Systems, and Health and Social Care Partnerships. NHS England commissioned Picker to evaluate the co-produced improvement projects to identify learning and inform improvements.

At the time of the evaluation, there was variation across the ten systems on the progress made and the extent to which projects were being fully co-produced. But there was good evidence about the factors that supported effective co-production, and about the perceived value of the approach.

What helped to facilitate co-production

• Working with third sector organisations to help recruit people with lived experience for project steering groups and/or for wider engagement work with local communities. 
• Educating and training people on a co-production approach to quality improvement, including highlighting its value and how it differs to other approaches.
• Engagement and relationship building with people with lived experience prior to co-producing improvements.
• Planning and putting processes in place to support co-production, such as providing support for people with lived experiences, scoping who needs to be involved, and developing a code of conduct for meetings.
• Funding for recruitment, expert involvement, facilitators, translators, and payment to recognise the time and effort that people put into co-production.

The value of co-production

Most systems were yet to complete their projects, but the values of co-production were recognised as:

• Addressing the right area for improvement.
• Improving project implementation.
• Bringing services together.
• Providing insight for other work.
• Giving more consideration to inclusion.
• Responsibility to action findings.

People with lived experience largely shared positive views of co-production, including being equal partners with health and care staff, having their views listened to, building their confidence, and enjoying working with others to improve care

I definitely feel equal. I could say something that [a staff member] probably isn’t sure of … and I could explain it because I know it. That’s not being big-headed about it, I’ve lived for nearly 50 years with [condition] so I want to believe that I know what I’m speaking about.”

Person with lived experience, Interview

The challenge of co-production

Key challenges faced by systems included resource and time constraints, recruitment of a diverse group of people with lived experience, managing expectations, a lack of understanding of co-production by some staff, and learning how to share control and to work in a different way. Some of these challenges to co-production, such as the time commitment required by professionals and people with lived experience, have previously been recognised.

Case studies

We worked in partnership with the systems to produce case studies that summarise their co-produced projects. These are a useful resource for those wishing to learn more about co-production as they highlight key learnings. Follow the links below:

• Cambridgeshire and Peterborough Integrated Care System: Co-producing service improvements for children and young people with complex needs
• Central London Community Healthcare: Engaging with under-represented populations with diabetes
• East of England Cancer Alliances: Improving access to cancer services for Eastern and Central European communities
• Hampshire & Isle of Wight ICS and Dorset ICS / Wessex Cancer Alliance: Our Cancer, Our Way-Always!
• Lincolnshire Clinical Commissioning Group: Co-producing a factsheet to support people living with cancer
• Nottingham and Nottinghamshire Integrated Care System: Co-production as the default approach across a system
• Sussex Health & Care Partnership: Working with children and young people to improve support for those with eating difficulties
• Wirral Clinical Commissioning Group (Living with and beyond cancer): Living with and beyond cancer: co-producing a roadmap