Co-production leads to innovation in social care

By Kate Terroni, Director of Adult Social Care at Oxfordshire County Council

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

Co-production is all about the sharing of power. The belief that if you ask people what they want, you will get a constructive answer; that professionals are not the font of all knowledge and that innovation can sit with people who access services and their families. Ultimately, we want people who use services to challenge professionals and tell them what is most important to them when designing those services.


As part of our work on co-production we set up Oxfordshire’s Co-production Board, which the group has named ‘Team-Up’. We asked them to define their vision of co-production and they said:

Co-production means people are involved in designing, delivering, reviewing and choosing a service, when that service affects the community.

The reason co-production is important is because when people who use services, their families and carers are involved in designing services it makes the services much better for people and more sustainable.

I recognise that using co-production is difficult and presents a significant challenge to the way we work. From the council’s perspective it means we have to be willing to relinquish ‘control’; to be prepared for the process to take longer in order for people’s input to be meaningful and to have confidence that they can design services within budget.

Many people are used to managing a budget and understand the realities of having a finite amount of money. Being open and honest about the amount of money available also means that people understand the challenges the council faces in balancing its budget. 

We’ve received positive feedback from the people who’ve been involved in some of our initial co-production projects; with a good example being the work to redesign the way people transition from children’s to adult’s services.

Our overall experience has been that by involving people as partners in the design of services, they often think of solutions that we as professionals haven’t considered. Involving people in the design of services usually means that we’re likely to get it right first time.

Kate Tweets @kateterroni
Co-production in Oxfordshire on Twitter @oxoncopro

Overcoming the barriers to co-production

By Deborah Ivanova – Deputy Chief Inspector Adult Social Care (London and South) Care Quality Commission

At the Care Quality Commission I have the pleasure of taking part in our bimonthly adult social care co-production events which are invaluable both to the organisation and to me personally.  The success of co-production lies in the impact it makes: at CQC we do things differently as a direct result of our sessions, but it’s not always easy.  We work to overcome the barriers to co-production by creating accessible, interesting, well attended and useful events. 

Making co-production events worthwhile is all about including a wide variety of people, which we do by inviting a mix of providers, experts by experience, public representatives, voluntary groups and more. The diversity is part of what makes them so special and we are always inviting new faces to make sure we have a mix of people who have unique ideas and points of view. 

When we have the right people around the table it’s important to make sure the discussions are focused. We look at topics which people are really passionate about and we have facilitators to draw everyone together to make sure we have a focused discussion.  I often take on the role of facilitator, which can be challenging when not everyone has the same opinion! As each table discussion draws to a close we present the key points visually and verbally, making sure we have agreement on what is important to take forward.

Making co-production events accessible to everyone is important and we try to structure the day to make sure everyone can get involved. If anyone has special requirements, such as where they sit or needing information in different formats we make sure this happens. We want everyone to feel they can contribute their views and have open conversations.

To make co-production real we need to recognise what the barriers are and create events which people want to attend and where they are listened to. I look forward to discussing this more on the panel at the upcoming SCIE co-production festival, and hope to see you there.

Calling on evidence co-producers

By Pippa Coutts, Policy and development manager, Carnegie UK Trust

I am becoming a veteran of alliances, such as the Alliance for Action and the Alliance for Useful Evidence, as well as working in various third, statutory and academic collaborations. Not surprisingly, I believe in the value of working together to try to overcome complex problems: and perhaps co-production is the holy grail of collaborative activity, when power and roles are truly shared. However, preparing for a talk today on the co-production of evidence, I was struck again by the huge potential but degree of change that’s needed for co-production to happen.

An appetite for co-produced evidence

Carnegie UK Trust has a long standing interest in the use of evidence in the pursuit of improved societal wellbeing. It also believes that giving people more control enables wellbeing. These objectives have led us to think about the possibility of co-produced evidence. The appetite for this was demonstrated in a recent survey where over two thirds of respondents reported they participate in the co-production of evidence. This also hints at one of the issues that might be hindering co-production: lack of conceptual clarity. What do people mean when they say they participated in the co-production of evidence? If we were to measure that activity against the principles of co-production how far would it measure up?

We want to hear your ideas

One of the reasons that I ask this is because, looking around it is difficult to find many instances of co-produced evidence. In the discussion paper, the Scottish Approach to Evidence, we concluded that the Scottish policy context with a focus on partnership and people is ripe for the co-production of evidence, but the evidence base lags behind. This includes both examples of co-produced evidence and evidence for the impact of co-production on outcomes. Two different concepts, but ones that have sometimes been conflated, to the possible detriment of co-produced research. Last year, to encourage more co-produced evidence, at a Roundtable with Newcastle University’s Institute for Social Renewal, we called for more clarity on what is good quality co-produced evidence. Following this, The Trust is continuing to explore how to assess the rigor and value of co-produced evidence, and I’d be delighted to hear your ideas.

Co-producing the development of Later Life Groups in prison

Contributors: 

Ahmed, prisoner 

Jolie Goodman, Programmes Manager for Empowerment & Later Life, Mental Health Foundation.

Jamie Bennet Governor HMP Grendon and Spring Hill

Jolie: The Mental Health Foundation has a decade of expertise in peer support and self-management initiatives, including running self-management groups at Parc Prison Wales.  I have managed the Standing Together project, facilitating peer groups in the later life housing sector. 

I’m co-producing the development of later life groups with staff and prisoners at Grendon and Spring Hill Prisons. I want to use the blog to reflect on the process and through conversations with a prisoner, Ahmed and Jamie Bennett the Governor of both prisons. Grendon is a closed therapeutic prison and Spring Hill, is an open prison. 

Prisons are major providers of social care for men in the country. The later life groups will be a combination of self-management and peer approaches., using the expertise of prison staff and prisoners to co-produce this work, through meetings, focus groups and a loneliness survey. 

Ahmed: During my experience in my role as Diversity and Equalities orderly I have spoken to many prisoners over the age of 50 about the stresses of being in prison and the impact this would have later in their life when they are released back into the community.

Bringing people together and enabling them to know that they are not alone is a form of empowerment and connection that I have experienced through group-work in prison. The recent focus group that took place in HMP Springhill showed the need of such an initiative. Residents are eager to be involved and are looking forward to the next step in the introduction of the loneliness survey.

Jamie: Prisons are having to respond to the needs of a changing population, including the rapid growth in the number of older prisoners. As a result, prisons are considering how they adapt. For example, how does the physical environment have to alter? What activities should be provided? What help do people need for life after prison? Which organisations does the prison need to connect with?

Although working with professional experts is part of the answer to these questions, much of this can come from the men themselves. They have hopes and aspirations for the future. They have time and energy to invest. They have skills and talents to contribute. 

Developing the capacity for self-help and empowerment is a way of improving the quality of service we provide and enabling the men to use their individual and collective abilities to support each other. 

Jolie: The findings  of the co-produced loneliness surveys will support and shape the funding bids for the later life groups.

This is what co-production looks like

By Sharon Allen, Chief Executive, Skills for Care

As I was sitting at our national conference earlier this year, listening to Disability Rights UK Ambassador Sir Bert Massie, Tina Coldham, Chair of SCIE Co-production Committee and TLAP chair Clenton Farquharson, being very clear about what people who need care and support need to think about when recruiting staff, I thought; "this is what co-production looks like".

Their lively and utterly frank discussion was one of the highlights of our conference and in this Co-production Week, a reminder of why we must include the lived experiences of fellow citizens in everything we do.

It’s something I’ve been committed to throughout my career because it is obvious to me that if we don’t include the voices and experiences of people who actually use care and support services, we end up doing things that neither work nor are person centred.

One the key drivers in our sector is leadership and leaders like me have to model in our organisations, that co-production is not an optional extra.  I'm fortunate that colleagues in Skills for Care get this and we work together to make it happen.

A great example of co-production is our information hub for individual employers which came out of a sector roundtable event. A smart idea, driven from day one by individual employers who provided invaluable insight and experience when the specification for this hub was being developed. They continued to guide and advise the project all the way through and in 2016/17 there were more than 40,000 page views on the hub.

Our Employing Personal Assistants toolkit was another project co-produced with employers. We worked with members of People Hub (the Personal Health Budgets Network) to ensure this resource was equally relevant to holders of Personal Health Budgets. The toolkit has proved popular because it is fit for purpose with 6066 people accessing the toolkit and 16000 page views.

Underpinning this was the creation and implementation of a participation policy so people offering their expertise are appropriately supported and reimbursed as no one should be out of pocket when they support co-production.

Our recently published autism guides were co-produced with people with lived experience so they were able to shape guides that could actually have an impact. Some of that co-production group also made videos to increase the awareness and understanding of autism which can be viewed here.

More recently we had a representative from West of England Centre for Inclusive Living on our Adult Care Trailblazer group which has done some brilliant work in creating the new apprenticeship standards for our sector.

These examples are illustrations that we are making progress and I am also aware there is more we can and must do.

That’s why I’m making a pledge this week to continue to drive our co-production work forward. Not only is it the right thing to do, it makes sense if we want to create products and services that actually make a difference.

Co-production in Jersey

Paul Michel and Sophie Holmes are both physiotherapists from Jersey General Hospital, who work within a newly formed co-production group where service users and staff members have combined forces, to drive positive user-led changes. Here is their summary of how the process is going so far:

Why did we start co-production?

As physiotherapists we feel we know what our patients want and always have done. We are empathetic, good listeners and keen to implement change. On the other hand however, we value patient feedback, and so we were keen to embrace a new way of working in partnership. Although initially daunting, we wanted to see what feedback we would receive, and were excited about the direction that would take us, in terms of shaping our future service.

how did we start the process?

In November 2017, we invited service users to our first ever co-production workshop. The day was a great success, we received training from the Social Care Institute for Excellence (SCIE), completed a variety of team bonding exercises, and co-produced our core values (see picture).  Many improvement ideas were generated and we formed a steering group with service users, who were kind enough to give their time to help drive change.

Where are we now?

We’re in the infancy of our group, 6 months in, enjoying tackling some of the main issues head on. It’s really interesting listening to what our service users truly want compared to what we previously perceived they wanted! We were told that co-production is challenging at our training, and it is, but my word is it rewarding!

Our values ensure we don’t get upset by what we hear, we respect that we don’t know everything and that’s not a bad thing. It’s no longer a ‘them and us’ mentality, it’s us all working with equal power together. The great thing is that the work we are doing and recommendations we are making are being fully acknowledged and supported by the physiotherapy Senior Management Team. This breeds confidence that change can and will happen. And that is exciting!

Co-production to improve services

By Hilary Oakley, Academic Liaison Librarian, University of Sunderland 

The Social Care Institute for Excellence (SCIE) is hosting a free two-part webinar called Breaking Down the Barriers to Co-production from 1400-1500 on 5 July.

The webinars are running as part of Co-production Week and are interactive.  Co-production Week promotes not only the positive impact of social care services, its users and carers collaborating on service provision and development but also focuses on  sharing best practice. Co-production Week has been running for three years and this year again asks you to:

• tweet about co-production by using the hashtag #coproweek
• share stories about it with the SCIE
• take part in the week by writing for the SCIE Co-production Week blog
• SCIE’s Co-production Network and SCIE’s Head of Co-production, Pete Fleischmann will be delivering the webinars. These will look at a range of different settings as cases of co-production in  local authorities, voluntary organisations and health care. The discussion will examine common problems in collaborating and suggest ways to overcome barriers.

As a webinar participant you will be able to take part through the ‘chatbox’ feature which will give you opportunities to answer questions and vote during the session.

If you would like to book a place on the webinar go to the Eventbrite page Webinar: Breaking Down the Barriers to Co-production. The webinar is also repeated from 1500-1600 on Eventbrite on 5 July so you can also book for that.

Ahead of the webinar the SCIE has also produced a handy guide on co-production entitled Co-production in Social Care: What it is and How to do It which includes practice examples. The guide is free to download.

This blog originally appeared on the University of Sunderland Library Blog

Where's Your Head At? The Importance of Expressing Emotions at Every Age

By Jolie Goodman, Programmes Manager for Empowerment and Later Life, Mental Health Foundation

A longer version of this article can be found on the Elder.org website 

The Standing Together Project aims to improve the emotional health and community connections of older people living in supported housing. Over the Project’s two-and-a-half-year run, it has facilitated groups in 19 different housing schemes. 

The Project was set up in 2015 as a partnership between the Mental Health Foundation and Housing & Care 21, a UK housing organisation providing social housing and support to people in later life, including those living with dementia.

Since then, we have run weekly self-help groups for periods of six months, in retirement and extra care housing (where the people are actually tenants in their own flats, but then buy in different quantities of care as needed) for those experiencing memory loss, mental health issues, learning disabilities and significant loneliness. Notting Hill Housing became an additional partner in the second year of the project.

My background is in working in adult mental health, but I was attracted to the job of managing the Standing Together Project because I felt it was a real opportunity to build connections between people - and also to find out about people’s identity, life stories and passions.

Obviously, the later life housing sector has undergone a lot of change and has born the brunt of cuts in local authority funding for care services. Loneliness and isolation are increasing across the generations, but particularly in later life.

In later life, there are many reasons for isolation. The front door can be a huge barrier for people; people might not get out of their flats that easily, and sometimes it is because of their frailty, but often it’s a psychological barrier. Another key reason is if someone has been with a partner for 60 years and they have died - then the whole balance of their life is changed.

Someone who has lost a spouse has to adapt to living a very different life, and that can make them feel lonely, so it was very positive to be able to do something that really addressed that loneliness.

We have secured funding for a Welsh version of the project. This Autumn we will be launching a toolkit so that the housing sector can buy in our expertise in co-producing this type of  initiative, to address loneliness and improve wellbeing, in later life.

Co-production is the key to Health and Social Care Integration

By Laura Able, SCIE Co-production Network member 

Laura Able 

Since the 1990s there was a general agreement between professionals, politicians and people who use services and their carers that an integrated, joined up, often called “seamless” service is needed to create the best health and social services for everyone.  People don’t usually mind who provides services; they just want good quality. 

Is this a Change in Name Only?

This year the Health Department became the Department of Health and Social Care but is this change in name only?  I want to suggest the barriers to this integration can only be eroded successfully, if co-production is intrinsic to the process at every level and this is the only way that services can truly integrate.  Put simply this because services exist because of the service user.  Therefore services need to revolve around the service user and not the other way round.  A co-productive process is not about reducing cost for systems it is about creating better one.

User and Carer Involvement

Ealing User Involvement Project where I worked in the 1990s sent representatives to all types of meetings where professionals discussed services and made decisions; strangely enough when we were included there did seem to be improvements in communication between the different agencies.  

The assumed theoretical background and often differences of approach and language had to be reconsidered when the user/carers were there this enabled everyone to talk to each other more openly.  Moreover, service users and carers often hold the establishment to account and challenge if for example, the viewpoint of people who are often not heard is neglected.  

Our Life Journey

Perhaps this is a rose tinted view of the past, there wasn’t true equality or power sharing but there were still some real benefits.  User involvement and co-production recognises that everyone has skills and assets; it demystifies professionalism and reinstates the fact that we will all need good quality services for some reason, at some point, in our lives.  To provide a truly integrated health and social care system, which follows our life journey, we must incorporate at every stage of development diverse groups of service users and carers to co–plan, co–design, co–commission and co-deliver services.

My history in self advocacy

By Brian Stocker, self-advocacy specialist 

I have been in the self-advocacy movement for many years and this started at Lambeth People First where I was working as a volunteer. I then started working with People First (Self Advocacy), on their Management Committee; this was in the early 90’s.   

Myself and a few others set up Hackney People First as a user led group and I got a job as a project worker, I was also part of the team that set up Sutton People First after speaking to the local council.  I then got a job as a project worker at Sutton People First.  After that I joined a team which set up Newham People First and I worked there as a project worker and later as a manager.  I worked there for 17 years starting in 1994. I retired from Newham People First in 2012.

My original role at People First Self Advocacy was as a member and I then I was on the Management Committee. I then stood down from the Management Committee and People First have employed me since September 2013. My new job title is Supporting Each Other Equals Power Project Co-ordinator. 

I have a lot of knowledge and experience of working with user led organisations and campaigning for the rights of people with learning difficulties.  Self-Advocacy has been a big part of my life and it will always be.  Without Support it is very hard for people with learning difficulties to get what they want let alone need, if you do not get the right support it affects your health and wellbeing, both physical and mental.  Often for someone who has a learning difficulty, it can be a fight to be heard and get the support that you need.  

To be able to give this kind of support in the Supporting Each Other Equals Power project makes me really proud, it is easy for me to understand the difficulties of not having support because of my real life experience. This is why it is such an amazing project, because people with learning difficulties who have the experience run it.  I have often been in the shoes of the people that we see and support.

Supporting Each Other Equals Power is a free peer support project being run in Lambeth which aims to deal with loneliness and people with learning difficulties being left out of society.  It also looks to make sure people have the peer support that they need to have control over all parts of their lives.  We support people in any area of their life to get the services they need.    

I am proud of my story and what I have achieved, there are a lot of people with learning difficulties who want to do the same thing and can do the same thing if they have the right support. My life has gone through four stages. It all started in a long start hospital in South Ockington.  From there I went into a group home and day centres, this was boring and I could not be who I was.  

Next, I moved to supported living and employment training which was much better, but I was treated different and separate from rest of society. Now I am an independent person who has control over my life.  I have a good life, a paid job which is a real career and my own place to call home. People with learning difficulties can achieve anything in their lives if they want to. They just need people to listen to them and give them the right sort of support. 

We are more than 'the blue bobbles'

By Samantha Johnson, who is an expert in many areas (See below)

About me 

I am a young black woman aged 41 with learning difficulties. I go to church every Sunday expect for when I am away with the church or weekends away on holiday. Every month on a Sunday I go out with a group of people called the blue bobbles.  The reason why we are called the bobbles is because of the blue bobbles on the tube map showing which stations are accessible. They are accessible for wheel chairs, and people with mobility needs.  The blue bobbles are a group of people with Spinabifida and Hydrocephalus, we go out to accessible places (blue bobbles), I think it is important for us to get know each other to share our experiences and support each other.

My history in self advocacy

My self-advocacy journey started in 1994. This was with speaking up and supporting people with learning difficulties to get the services they need.  Here are some examples of work I have done: 

• I am qualified to train people with learning difficulties to speak up 
• I helped set up a self-advocacy group called Safety Net People First in 2000, this was with Mencap’s director in Hammersmith and Fulham. I was also Co-Chair for Safety Net People First when it was first set up back in 2000
• I have Co-chaired Hammersmith and Fulham’s Partnership Board for people with learning difficulties to speak up so they can have their voices heard 
• I am also now one of the Trustees of Hammersmith and Fulham Mencap 
• I have done a lot of speaking up training with service users from ifferent London Boroughs as well as outside of London 
• I have worked with the DWP for a year as an administrations officer
• I was involved in making a film about GPs working with  service users in Hammersmith and Fulham
• I have co-chaired the Valuing People Partnership Board
• I have done training and given talks to doctors, nurses, reception staff at GP surgeries, medical professionals and psychologists around meeting the needs of people with learning difficulties   
• I have done a lot of work about getting the right type of housing for people with learning difficulties and given training to housing staff
• I have also done a lot of work around people with learning difficulties getting a personal budget or a heath budget so that they can make their own decision and choices
• I have been involved in the consultation that helped set up the Friends and Family App which asked how your doctor’s appointment was.

Why is Supporting Each Other Equals Power so important?

It is such an important project because it is helping people with learning difficulties to live independent lives with the right support.   For people with learning difficulties not getting the right support can be one of the biggest barriers in their life.  This project is also important because we support people to speak up for themselves and support those people who feel they do not have a voice to speak up or are not listened to.

It is all about “Nothing about us, without us” Often decisions are made for people with learning difficulties and our voices are not listened to.  This project is about having the peer support to have control over our lives.

Film-making and co-production barriers to overcome

By Sybil Ah-mane, Flexible Films 

In our line of work, we think it makes sense to co-produce all film projects. This means that clients have influence on the style, feel and main messages of the completed film. It also means they are proud of it and have real ownership. 

Whilst we have the film-making skills, our clients have the expertise and knowledge of their area so having meaningful involvement from them helps shape the project and enhance the process.

Sometimes, we come across barriers to co-production. This can happen when those leading the project are not entirely convinced of the benefits so it can start with attitudinal barriers. They may not prioritise what's needed in the planning stages and this can result in mixed messages. Poor communication can lead to trust being broken down and people feeling that they are not being heard. Not having enough time or resources can also affect the process. It's a shame when this does happen because working co-productively is not only satisfying but also logical. 

One of our best co-produced projects was when we facilitated a mental health filmmaking group for 11 years. CanDo Films was initially funded by Oxleas NHS Foundation Trust. We taught the group all aspects of filmmaking including directing,  interviewing, editing and filming. They produced lots of films and many of these were used for staff training and public information. Their knowledge of mental health services meant the films produced were insightful and innovative. 

The group received the Oxleas Recognition Award for Best Practice and were runners-up in the National Health and Social Care Awards in 2005. This illustrates how succesful working co-productively can be.

Unite with us against dementia. We get it and – together - we will do it, help people live better with dementia!

By Lindsey Ambrose, Dementia Voice Lead, Alzheimer's Society. 

Alzheimer’s Society recently had our first ever “Dementia Action Week” – a wonderful celebration of co-production and public involvement! A bright, credible and optimistic event demonstrating how, more and more, we are working together – united! - with people affected by dementia as active partners and consultants, wherever they are in their dementia journeys.

It’s a time of fantastic change, with great commitment to including people, sharing power, and learning from experts by lived experience in recruitment, training, campaigns, fundraising... In 2017, our bright, optimistic, branding was launched thanks to people affected by dementia across the UK. The voices of people affected by dementia decided our dementia statements – confident, clear, rights-based, expectations used in our ongoing campaigns work to Fix Dementia Care.

For Dementia Action Week 2018  Marketing & Communications colleagues shaped flagship communications and literature working in partnership with, and learning from, over 500 people affected by dementia across the country, finding out important small actions people take every day that make a big difference to living well with dementia.

We have ‘dementia voice’ opportunities all year including:

Our Research Network: around 270 volunteers who are former and current carers, and/or people living with dementia. No scientific knowledge or research experience required. They help researchers learn to talk to the rest of us about their work. They help decide what gets funded, monitor projects, and do lots more too, if they want! Interested in joining? We’d love to hear from you!

-       

    Want to join us? Please contact Jamie Tulloch email: ResearchNetwork@alzheimers.org.uk

Focus on Dementia Network: about 60 groups of people living with dementia, across England, Wales and N. Ireland. They work:

• with staff from Alzheimer’s Society: improving processes, products, publications,… ; and
• helping organisations – theatres, leisure centres, hospitals
• Network members have co-produced their service specification, resources for members, facilitators and people wanting to work with them. 

We also welcome volunteers to help us continue to build “dementia voice” into our work.

Want to join us? Please contact Kim Nguyen email: yoursay@alzheimers.org.uk.