Change Model Stage 5: Making co-production central

How you make co-production central

For IMPACT, co-production means that people with lived experience have been co-leaders of the change throughout and that the following four principles are embedded – equality, diversity, accessibility and reciprocity. Below are some of the ways we have made this work:

  • Be honest about what level of engagement you are working at. True co-production is the goal, but if you are only able to ‘consult’ or ‘engage’, be transparent and don’t call it co-production.
  • Make an effort to connect with people from different backgrounds, cultures, and experiences – especially those who may have been excluded before.
  • Recognise that all types of involvement require time, planning and resources such as travel, digital access and carer support.
  • Being involved should not only help the process of change but also be beneficial for the person with lived experience through, for example, growing their networks and skills.
  • People’s expenses should be met and there should be financial recognition of their time.
  • Sometimes co-production is messy. People might disagree, trust might break down, or things may not work out as expected. Be open to learning, reflect together and be willing to make changes.
  • There are often unequal power imbalances in which people who receive support are expected to comply with what is asked. Co-production requires equal relationships with shared decision-making.
  • People who have previously participated in co-production can help to mentor and support those getting involved for the first time, which can help people to develop confidence and skills.
  • Co-production works best where there is a long-term collaboration as this enables people, practitioners and organisations to develop a more open, honest and trusting relationship. Building in time to get to know each other throughout the process enables relationship building.
  • Following a project, it is important to inform people with lived experience how their views influenced the change, what was not possible and the reasons for this.

Examples within IMPACT

Prior to the Neighbourhood Teams Demonstrator in Leeds, the city council had decided to pilot a new approach to homecare contracting in which a single organisation would be responsible for supporting people in a locality.

This was initially developed in discussion with a citizens’ panel of people who access home care support and family carers through the facilitation of Healthwatch. However, funding for their support had ended and due to the busyness of the project team, the co-production arrangements had stalled.

To maintain the voice and influence of people with lived experience in the next stage of the process, the citizens’ panel was reactivated.  This was reoriented to a service improvement way of approaching issues, to generate ideas and emphasise specific areas of practice that needed change. Citizen panel members said that they felt listened to and valued and had been collaborators in co-producing the practical changes within the delivery of the new home care approach.

The Positive Futures NI project is seeking to change practice from minimal involvement, towards planned, regular (monthly) co-produced/developed involvement in the monitoring of internal quality of support. To achieve this change, an expert by experience monitoring group, ‘The Incredibles’ (adults with learning disability), has been established to meet monthly during the lifespan of the project.

In addition, the IMPACT Facilitator has been working closely with the Positive Futures advisory board (a group of experts by experience with a lived experience of living with a disability to help inform and shape the project). Pre-testing of the experts by experience monitoring group has been undertaken at the beginning of the project and again at the end to identify understanding of monitoring and regulatory processes with this group. 

The peer-led approach to this project has developed a sense of ownership and connection for those involved.  They have been able to provide several ideas to help the outputs of this project (for example, recommending a video/animation/artwork to share their key messages). 

Given the diversity of the group, it has been important to use participative methods of engagement and to adapt to each member’s individual needs. To mitigate some of these challenges, we have been working on the strengths of the group and establishing a ‘contract’ from the outset to identify how we will work together. Using plain language and easy-read communication aids have been key. Further key learning has been the use of inclusive practices for people with learning disabilities who do not communicate verbally or unable to attend groups. 

Networks follow a collaborative process in which members help to shape the questions and content for discussion and provide insights from their own practice and lived experience. At the initial briefing meetings, an online post-it wall is used to ask co-ordinators to feed in suggestions of what the first evidence review-based discussion material should include. They are then invited to feed back on the first draft of its scope and content, and to share examples from practice or lived experience that the evidence review process hasn’t picked up.

For example, in the Remodelling the Front Door Network, members identified a gap in understanding about population needs and the importance of this in shaping approaches to managing the ‘front door’ when people first try to access social care support. In response, action plans were established to gather data to understand local population needs and strengthen involvement of lived experience evidence to understand if needs have been met.

IMPACT and The National House Project (NHP) have co-production at the core of their approach. Key co-production activities included:

  • Three co-production sessions
  • Six workshops in Coventry with the Local House Project (LHP) and partners
  • Two co-production sessions and asset mapping with Fife LHP
  • IMPACT coaches also spent time informally with young people at the LHP, using the base for meetings and planning sessions

NHP has a psychologically informed approach which draws on several theories to help build a safe and robust practice framework (ORCHIDS). Work with young people draws from the theories of attachment, trauma, adolescent development, resilience and self-determination.

As the co-production plan evolved, we became cognisant that we would be asking participants to share their experiences, including challenges as well as successes. Both IMPACT Coaches attended Trauma Informed Level 1 training and worked with LHPs to understand local trauma informed approaches and linked with NHP staff to seek specific advice about how to best support young people and adults through the process.

When looking for guidance to support our approach we were drawn to a Trauma Informed Checklist for Events, develop by the Mental Health Coordinating Council in New South Wales, Australia.