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!