Searching for the Aha! moment. Co-production in care

By Sophie Chester-Glyn, Managing Director, Manor Community

When I mention the phase ‘co-production in care’, I often get a confused look or blank stare back. It doesn’t quite roll off the tongue and takes some explaining before you get that ‘Aha!’ moment. Over the past two years we have strived to get that ‘Aha!’ moment throughout our organisation. Coming up to co-production week, we’ve reflected on how we’ve embedding it into our care.

Our journey started in early 2016 when I was asked by a manager what colour I wanted to have one of our care homes painted. My response was ‘I don’t know, I don’t live there’. Even though we knew about co-production we obviously weren’t yet living and breathing it. So, we began to change the culture of developing services from a bottom up rather than top down approach.

Using technology has been crucial. We collaborated with a software development company which helped us adapt an internet Cloud based product into an accessible staff and client intranet site. We are now integrating real-time feedback systems such as Survey Monkey into our intranet site. This enables clients to connect efficiently with senior management. They can now individually and quickly vote on everything from their care experience to activities, staff practice and service design. This also enables clients, families and staff to have a direct input into strategic decisions-making. Feedback on this new system has been fantastic. Both staff and clients enjoy using the system and it has proved to be a great way for co-production to be fun and interactive.

Getting feedback from people is crucial, but co-production is more than that. In fact, we have found some people misunderstanding co-production as simply engagement. Some local authorities might let people know about their plans after the decisions have been made or without providing accessible means whereby people can have an input. TLAPs ‘co-production’ ladder has been helpful in explaining the ‘co-designing’ aspect of co-production. Involving people in writing policies has helped us. 

We support people with mental health, learning disabilities and autism. Within this client group we have an enormous amount of talent. Over the past few weeks we have been hiring people who we support to help edit and design our operational policies, this has been especially exciting for those who have a particular skill in accuracy and attention to detail. We have also consulted with the people we support on our easier read documents on voting, staying safe in the heat and internet security.

When deciding how to implement our social values policy, one of the people we support found out about a local charity that helps feed the homeless. He expressed an interest in supporting the charity. Now one of our care homes and its residents help prepare and service meals to homeless people in Bristol. This gives everyone a feeling of achievement and self-worth and contributes to our community involvement.

Co-production has brought great benefits to our culture and quality of care. Events like Co-production week help to share good practice and spread the word. So hopefully more people can understand what co-production is, how to do it and to get that ‘Aha!’ moment.

Promoting co-production in the care sector

By Penny Holden, with Martin Symons, Members of the Making it Real Norfolk Board - and Mary Fisher (Making it Real Norfolk)

With special thanks to Christine Futter and Sarah Steele from Norfolk and Suffolk Care Support, for their contribution.

The recent CQC Report “Better Care in My Hands” found that people with long-term health and care needs are least likely to report feeling involved in their care and in making choices about their daily life. Making it Real Norfolk believes the best way to improve services is to ask the people who use those services what they need and how best to provide it. If co-production is taken seriously then, as Martin Symons says, “Co-production works for everyone, people feel they have choice and are in control ”.

Martin Symons and his Boma

We want to use our skills and lived experience to improve service user involvement and promote co-production in the adult care sector. We began this work at the Norfolk Care Conference in Nov 2017. Two of our members, Penny and Martin, developed an idea and have taken the lead role in promoting it. Penny says, “we are the people who currently use services, we are people who will using the services in the future and we are the people who will use services that are currently not available. We have lived experience of our own conditions, we are the experts who can help care providers to get it right. Co-production ticks all the boxes and it is the future.”

A bit about us – We are a group of people with lived experience of disability and unpaid carers. We have links to community groups, user led organisations and strategic partnerships. We work in partnership with Norfolk Adult Social Care and Norfolk County Martin Symons and his Boma Penny and Martin talking to care providers Making it Real Norfolk board meeting Council – councillors are also co-opted onto our board - so that service design reflects the voice of service users and carers.

We have teamed up with Norfolk and Suffolk Care Support (N&SCS). N&SCS support the health and social care market to deliver health and social care excellence; they do this by supporting the care market to develop skills, knowledge and values of the paid and unpaid workforce. We have worked with Norfolk & Suffolk Care Support in the past and they have a proven track record in their commitment to seeing co-production in practice. We will soon be starting work with N&SCS to coproduce a set of resources for care providers to use. The resources will highlight good practice and provide a guide to improving service user involvement for those groups identified in the CQC report who report feeling less involved in their care than other groups. 

The project also includes an event to showcase the resources to care providers. We will co-host the event with N&SCS. This will give us a chance to network with care providers and talk about ongoing involvement. Mary says, “When people are involved in shaping their care, people feel that they are part of the solution and not the problem”. Work begins on our project with care providers on 11 July 2018 and we are really excited. Wish us luck! 

Christine 

Mary 

Penny

Sarah 

On the board in Oxfordshire

By Ben McCay,  Team-Up Board member and member of My Life My Choice, Oxfordshire

My Life My Choice asked me if I wanted to visit a co-production board meeting in Oxfordshire, which was on the 3rd April 2018 and I said I would like to attend.

At the meeting it was explained to me by the board members that they wanted people with experience of using services within Oxfordshire to come and visit to see if they would like to become a permanent member of the co-production board.  Danie who is the co-production lead at Oxfordshire County Council explained to me and the other people visiting about the co-production aims and plans. I was thanked for visiting.

My Life My Choice asked me if I would like to become a permanent member of the co-production board and explained if I did Danie and some of the other board members would interview me about why I wanted to become a board member and what my motivation for joining was and what did I think I could contribute to the table. 

I thought I could use my experiences of using services to help lead the way in designing good quality co-produced services. I had an interview.

I then attended my second meeting as a full board member. At the meeting we had to review the Oxfordshire co-production champions training. The board did one day of the training and were asked to give our feedback.

I gave positive and constructive criticism to help shape the training for the champions. I really enjoyed working in small groups at the training discussing how to put literature into plain English. We then wrote down our plain English and fed back to the other groups.

After the training I felt I had a better understanding of what co-production is.

I attended the co-production festival in Camden which is part of co-production week and enjoyed being part of group discussions and feeding my ideas back to the other people. I learnt more about SCIE and enjoyed the music and seeing The Lost Voice Guy perform.

I am looking forward to being on the co-production interview panel to help employ a new member of the co-production team. 

I am very pleased to be part of the work the co-production board are doing in working towards promoting co-production and shaping services to improve them in the future.

Co-production and the NHS

Kath Sutherland, FRSA – Founder of START Ability Services and SCIE Co-production Steering Group member

The NHS is 70 and there is no doubt that we have made some phenomenal achievements in that time, not least in the discovery of DNA!  However, with much focus on medical advancements, few have mentioned the importance that co-production plays in supporting an individual’s physical and emotional wellbeing, as well as in reducing the ever-increasing costs facing the NHS.   

The contribution of lived experience 

Individuals, their families and day-to-day supporters have valuable knowledge to share with health and social care staff that can meaningfully impact upon their recovery and their successful and timely discharge from hospital.  And yet, this expertise is often ignored, even though access to information and full participation in all aspects of decision making is essential to ensure the emotional and physical wellbeing of our population.  

As a result, many people with impairments have very negative experiences when using health and social care services.  Our support is then requested as people are trapped in hospital unable to return home, as they cannot secure appropriate community support.   

Too many people face unnecessary barriers

One such person was Elizabeth, who after fracturing her hip, faced a catalogue of errors and omissions with medicine management, physiotherapy and rehabilitation services.  Her pre-existing impairments and mobility difficulties were ignored, and she encountered significant isolation from her family and friends causing barriers to her discharge, due to a lack of consideration for her speech impairment and hearing loss.  This situation was intolerable and entirely inappropriate.  

Elizabeth’s story in her own words

 “My experience as an inpatient was one of isolation, lack of control and subsequent depression.  However, this was not as a result of the fracture I sustained, or indeed the attitude of staff towards my impairment.  It was purely as a result of a lack of consideration of my needs and a significant lack of planning and co-ordination of my discharge.  This resulted in an unnecessarily lengthy hospital stay, where I was significantly isolated from all of my family and friends.

Upon receiving my complaint, I was contacted and asked if I could meet with senior managers to look at the issues I had raised.  This was very positive as I then worked with the managers to ensure that staff were reminded of policies and practices, in relation to the issues I had raised, but with a particular focus on the implementation of person-centred support that meets accessibility requirements.   This has resulted in a significant benefit for the community as a whole, as the hospital now have a 99% satisfaction score from patients and family, whereas this was previously registering in the region of 60%.”

Co-production is the way forward! 

The striking thing is that, as the principles and practices of co-production are spreading, the responses people receive to complaints are becoming more appropriate and effective.   Indeed, the actions taken since Elizabeth’s complaint (and since complaints from many others) have enabled Board members, staff, patients, carers and visitors alike to significantly benefit from the more accessible, person centred environments that have now been created.  Perhaps it is time that we all realised the amount of money and distress that could be saved if co-production was applied to all areas of health and social care? 

Why the England penalties were all about co-production

By Steve Palmer, SCIE communications manager 

I’m not sure if Gareth Southgate’s ever heard of co-production but I’d like to suggest that what he did last night was immersed in co-production. In 1996 Southgate missed a penalty in the semi-final of the Euros and we went out against Germany. This man has lived experience. When he became England manager, one of the things he did was to start talking about penalties and what happens when we take them. And he got the team to practice penalties at the end of training, when they were tired. In other words, he replicated some of the conditions that exist when you’ve played 120 minutes of football and as the nation holds its breath. Last night wasn’t a fluke. It was the result of a strategy. But, essentially, Gareth worked with his players so that they took control. He led them but they were centrally involved in the design of the strategy, drawn from Gareth’s lived experience. 

That sounds like co-production to me. And no doubt there was some luck and we might lose the next shoot-out, despite that strategy. But the point is that Gareth Southgate has drawn on lived experience and co-produced a stunning England victory. Something that no ‘traditional’ England manager has done. Every day in every way, people who have care and support needs are available to shape services so that everyone is in a better position: the people themselves and their carers, but also commissioners and service providers. People with lived experience have stood on the penalty spot and missed but they’ve learnt from it and they’re helping the shape the way that care and support is designed. Perhaps we should tell Gareth Southgate about co-production. I think he’d like it.

Fulfilling Lives Programme: Co-production every time

By Stacey Murton, Opportunity Nottingham 

Expert Citizens and Beneficiary Ambassadors

Across the country, 12 Big Lottery-funded Fulfilling Lives Programmes are working to create system change and improve services for people with multiple needs. And co-production is playing a key role.  

“Co-production is about working together, taking risks together, being responsible together, and solving problems together” – this quote is taken directly from three co-production workers at the Fulfilling Lives WY-FI project, which has its own network dedicated to co-produced work.

The FulfillingLives South East Project has a team of peer researchers (volunteers and paid staff with lived experience), who interview clients once a year, to gather feedback about the project. The peer researchers advised that questions weren’t clear, and the quality of feedback was variable. Therefore, the project decided to co-produce a new version of the survey, with everyone’s input. A new set of questions were drafted, reflecting everyone’s views, and covering a range of issues. The peer researchers were then asked about how to word the questions in a way that was clear, approachable and non-stigmatising.

The feedback from clients, interviewers and staff was very positive. The interviewers feel more confident conducting a survey they helped to create. From a research perspective, the depth and quality of information is much improved, and more useful to a wider range of people within the organisation.

At Opportunity Nottingham, a key piece of fully co-produced work is The Pledge. It focuses on the improvement of beneficiary and staff experiences across all services. A number of workshops and meetings with Expert Citizens and service staff took place in order to create The Pledge. It considers what Beneficiaries would like from a service, how they would like to be treated, and they will engage with services and treat service staff. At its core are honesty, understanding and belief. The aim is that The Pledge will be adopted by other services in Nottingham, and set a level of service delivery and interaction that everyone can work towards.

For the Fulfilling Lives Programme, co-production isn’t just a buzzword to throw into articles and tenders. Co-production means real change.

It means listening to all voices around the table.

It means valuing lived experience and being respectful of different perspectives.

It means co-creating something and educating each other.

It means rebalancing the power structure; enabling people who have ‘walked the walk’ to do some talking. 

Co-Production, representation and different perspectives

By Kevin Minier, carer and Co-production Network member

Kevin (left) at the Co-production Week webinar, July 2018

Why do we acknowledge that a Co-Production Team must be representative?  Include the views of ALL stakeholders?  That everyone’s voice is important?  It is because nobody can truly stand in somebody else’s shoes, walk somebody else’s walk, live somebody else’s life.  We all have different experiences and different aspirations.

Co-Production must embrace everyone’s different perspectives and differences – it is who we are. As a Carer my primary focus is getting good support for myself and excellent support for the person(s) I care for.  Yes, I am considerate about the needs of other stakeholders including: people who use services, clinicians, care workers, support staff, managers, business owners, taxpayers, health authorities and local authorities. And it is commendable to put the needs of others before my own.  But, as a Co-Production Team Member it is my duty to clearly express the needs and concerns of the stakeholders I am there to represent.

This is a good thing and PART of being an effective Co-Production Team Member.  It would be wrong to prevent a stakeholder from expressing their particular perspective and experience. Of course this should be done in a constructive and respectful manner.  A problem shared is the only chance of resolving the problem. This requires trained Co-Production Facilitators to allow stakeholders to express themselves freely and to not allow unacceptable judgements or statements go unchallenged.

This is how we ALL grow.

One of the many benefits of being a Co-Production Team Member.

Which rung on the ladder of co-production are you on?

By Kate Sibthorp, member of the National Co-production Advisory Group

Those of us who bang the co-production drum do so because we want to make a real difference in the lives of people who access services and believe that co-production is the best way to figure out how our health and care services can be as effective as possible.

The top step of the ladder of co-production describes co-production as an equal working relationship between people who access services and people who work in services, from service design to delivery, sharing decision-making from strategy to delivery.

However, some decisions have to be made which can’t be shared with people who access services, and many services can’t realistically involve people in their delivery. Many organisations have statutory or political obligations that genuinely aren’t appropriate for full co-production.

For example, the Care Quality Commission (CQC), which is in my experience an organisation that is very good at co-production, employs people who access services as members of inspection teams. Those people can’t take the final decision about the rating of a particular service because that’s a legal, regulatory decision; however, they can and do influence it. Also, strategically, the CQC held many engagement events with people who access services to get their views and advice on the rating levels. I believe people genuinely influenced the difference between ‘good’ and ‘outstanding’, as they said that some of the things that the CQC originally considered to be outstanding should be the norm if a service was good, and the ratings were adjusted.

There are also many areas of work that cry out for co-production. For example, can a local authority write a strategy on services for people with learning disabilities, or can a clinical commissioning group commission support for people who access mental health services without co-production? Personally, I don’t think so; the risk of getting it wrong, or missing something important is too great.

We tend to think of ladders as something to climb, but perhaps organisations should start at the top of the ladder of co-production and talk to people to work out how much a service or a piece of work can be co-produced. If there are genuine reasons for people not being equal partners in a particular aspect of the work, then move down the ladder for that aspect by all means, but be up front about it.

It’s not uncommon for organisations to be engaging and consulting and thinking they’re actually co-producing. The ladder of co-production and many other excellent co-production resources on the TLAP website are there to help us all get better at co-production. Each co-production situation is unique. The people involved will have to decide their own definition, and think about how they’re going to work together, which decisions and resources can be shared, what they want to achieve, who is going to do what, and how this can all be supported

Whatever rung of the ladder you are working on (though hopefully not the bottom one!), keep thinking about how you can keep moving up and getting better at co-production, there are some key values that will help:

·       Everyone is equal and everyone brings knowledge, skills and abilities – value people for their contribution

·       Diversity is a real asset – a range of people from different backgrounds and experience will help you to get better information, ideas and make more rounded decisions

·       Knowledge, power and decision-making are shared in a culture of openness

And last but definitely not least, it’s not only about working with people who access services. Consider how you can include people who work face-to-face with people who access services and people from the back office functions – accountants could be good people to include!

Good luck!

A commissioner’s view

By Ann Nursey, Transitions Change Manager, Oxfordshire County Council 

SCIE has been working with Oxfordshire County Council (OCC) to support them to understand and develop co-production.

Ann Nursey (centre)

Recently, some members of our Moving into Adulthood – Working Together group met with the Directors of Children’s and Adult Services at Oxfordshire County Council. The Council had asked us to help them improve support for young people with disabilities moving into adulthood. Our Working Together group of parents, young people and front line staff met 8 times in the last year, and we also talked with other people who couldn’t come to the group. We put together a presentation about what we think needs to change. 

We are recommending that the Council develops an all age pathway for people with disabilities in Oxfordshire, which focuses on developing independence and self-esteem across a lifetime. There should be a children’s disability team, a young adults team and an adult disability team. There should be information officers in the young adults team who link with schools and colleges. We would like there to be a team of staff who work short-term with people to help them become more independent in specific areas of their lives. We think health, education and social care should work more closely together, and move towards integrated health and social care services. 

Our ideas came from young people, family members, and staff who got to know each other in the group and talked openly about their different experiences. We all wanted to make services for young people better, so there was a strong sense of shared motivation, and learning from each other.

The Directors said they liked what we were recommending and they are now looking at further details, like what changes would need to happen and what it would cost. They will tell the Working Together group what they decide, and how the group can stay in touch with the future work.

A carer’s view. Co-production in action in Oxfordshire County Council

By Kathy Liddell. Family Carer to a 21 year old daughter with a Learning Disability and Autism

SCIE has been working with Oxfordshire County Council (OCC) to support them to understand and develop co-production.

As a family carer of a daughter with a learning disability and autism, I found moving into adult social care from children’s services a daunting and worrying time.  It is a complex system with so many changes and without the right support and information as a family carer you can be left feeling confused and unsupported not knowing where or who to turn to or what to do next. 

When the opportunity to be part of the Moving Into Adulthood Service came up I was keen to be involved.  By using my own experience and that of other families I know,  I hope to help change the way things are done in the future; to make it easier for families to know what moving in to adult hood actually means for their family member; who they can turn to  for the right help and support; where to get the right information and to ensure that family carers are involved every step of the way – all whilst ensuring that the person using the service is at the centre of any decision. 

The opportunity to sit round the table with the people who organise, deliver and use the services, means that family carers like myself and the people we care for have a real say in the way that services are shaped and delivered. We are able to share our own personal experiences of what does and does not work. 

What has been clear is that everyone sitting round the table wants to see a change for the better. I think working together at this level has provided a unique opportunity to make a real difference to everyone involved. 

The fact that the lead for working together is coming from the Head of Adult Social Care means that the need for change is been taken seriously. As a result I hope that those families who will soon be embarking on the Moving into Adulthood Journey will, as a result of this change in approach, have a smooth and positive experience.