Co-production For All
Here is an excerpt from our Co-production and Involvement Best Practice Guidance:
Co-production, Collaboration, and Involvement: The Meanings and Differences
There are lots of ways that services and those that fund services are involving people with lived experience from designing to reviewing services. All of these ways of involvement are very welcome, however, sometimes, a service or those that fund services think they are co-producing when they are involving people or collaborating. As we would like to see co-production happening as often as possible and ideally be embedded in the culture of services and those that fund services as a way of working, it is helpful for everyone to know the difference.
It is important for people with lived experience to know if they are truly involved in a co-productive way or in another way entirely. The following section explains what Co-production, Collaboration and Involvement are and will help you to understand if you are working co-productively, collaboratively or are involved in a project.
Collaboration – often called ‘joint working’ or ‘partnership working’ happens a lot and works well to see what is missing from services or see if more than one service is offering the same support.
Collaborating means services are not working alone where no-one knows what they are doing. (sometimes referred to as silo working) It can help identify where services might be needed but are not being delivered, and also where people are delivering services already and what it is that they are delivering so work is not being duplicated. This in turn can result in money being saved so that it can be used in the best possible places where it is most needed.
Typically, collaboration will involve those who fund services and those who deliver services working together. There is likely to be a service or services representing lived experience.
Involvement is good because there are lots of different ways that people can be involved. (examples listed below) A service like The SUN Network can help services or those that fund services to use involvement in their work.
Involvement can be Encouraged and Supported by:
- Those that work in services and those that fund services can go out of their way to create opportunities for people to be involved.
- Understanding how important lived experience is and how it can help.
- Helping people be an important part of an on-going project.
- Making sure that opportunities are offered to everyone and that no-one is left out for any reason. Also, that the opportunities are accessible to all so that those who wish to be involved can be.
- Offering opportunities that are important to those involved, and that those people are happy with their involvement and feel a sense of pride or achievement.
- Being open to listening to other ideas and points of view and create opportunities for people to be involved based on how they would like to be involved, not based on how a service thinks they should be involved. Just because it hasn’t been done before, doesn’t mean it can’t be done now. Welcome the challenges and embrace change.
- It’s the right thing to do.
Types of Involvement Opportunities with Positive Practice Examples
There is a wide range of different ways to involve people, and we have listed some of the ways below and shared local examples of how these methods have been used to great effect locally.
Consultations – When services or those that fund services have conversations with carers and people with lived experience about those services, or a new service they are thinking about creating. The Recovery Coach service was developed after consultation with people leaving mental health support services, to find out what they needed next.
Meetings – People with lived experience and carers attending decision making meetings on a regular basis to learn about and have their say about the work. The SUN Network have people with lived experience at all decision-making mental health meetings in Cambridgeshire and Peterborough representing the voice of themselves and others.
Tender Scoring – When services are applying for money to run a service. People with lived experience and carers may ask them questions to see how they will run the service and give them scores based on how well they answer. The Cambridgeshire County Council invite service users and carers to participate in their tender panels through The SUN Network.
Workshops – Those that fund services, service staff, people with lived experience and carers attending workshops together to share ideas and move work along. The Exemplar mental health service project in Peterborough designed their services this way.
Blogging and Vlogging – Writing a blog or making a vlog (video blog) to raise awareness and inspire other people to be involved. Change, Grow Live (CGL) Cambridgeshire invite people to share their blogs, poems, recipes, art, photography and more.
Training (1) – Services and those that fund services offering training to support people with lived experience and carers to be involved. Illuminate Charity offer Confidence for Change training.
Training (2) – People with lived experience, carers, services, and those that fund services designing and delivering training together. The SUN Network and Recovery College East have both designed and delivered training together with people with lived experience.
Interview panels – People with lived experience or carers being a member of an interview panel when someone applies for a job. Asking their own questions, giving a score to the responses of all questions, and having an equal say to help select the best person for that job. All of The SUN Network interview panels have a lived experience representative on them.
One off Projects – Services and those that fund services offering different choices of projects and involvement opportunities so that people can select one-off projects that they are interested in. The Cambridgeshire and Peterborough Clinical Commissioning Group (CPCCG) ran a
series of workshops and leaflet design opportunities for the Eating Disorder service and asked people how they wanted to do the work.
Reviewing services and apps – Carers and people with lived experience using a service or an app on their phone and sharing their experience to help others understand what to expect. David Lee who has lived experience of mental ill health reviewed the Lifeline service and CPSL Mind, and CPFT used this review in their communications strategy.
Feedback – Carers or people with lived experience offering feedback about a service that they have used. Rethink Carers support, The SUN Network, and Healthwatch Cambridgeshire and Peterborough work together to share their feedback at regular meetings with the those that fund services.
Surveys – People with lived experience and carers answering questions in a survey to share their thoughts and ideas Healthwatch Cambridgeshire and Peterborough regularly run surveys to hear what people think of local health services.
Telling Your Story – People with lived experience and carers sharing their personal journey including the good bits and the more difficult bits to help raise awareness and let people know they are not alone. Recovery College East offer training to empower people to tell their story. The SUN Network have a series of Addiction recovery Stories told by people who have experienced addiction.
Boards – Having people with lived experience or carers on the Director’s board or Trustee panel.
The SUN Network have a Directors board which has people with lived experience on it.
Other services offer similar opportunities (Lifecraft, CPFT, CPSL Mind etc).
Evaluations – People with lived experience and carers checking if a service is doing what it is meant to be doing by using a set of questions to hear the experience of staff in that service or people who have used the service. The SUN Network Five Values Patient Experience which was co-produced with The SUN Network, evaluates patient experience based on the Five Values chosen by people with lived experience and carers. (Empathy, Inclusion, Honesty, Working Together and Personalisation).
Innovation – People with lived experience or carers may have a fantastic idea that people who fund services or people that work in services can help bring to life. Kim Laidler who has lived experience of mental ill health raised the concept of a Toolbox Café and CPSL Mind developed the idea with Kim to make it widely available to others.
Co-production is not something that can happen overnight. It can use all of the involvement opportunities listed above, however, there is a depth to the work that cannot be captured through involvement alone. Co-production must start at the very beginning of any idea of a service, a review, or a consultation process.
Opportunities Need to be Planned in Advance to be Able to:
- Let people know that there are opportunities to be involved
- Put money aside to spend on co-production
- Learn about what co-production is and how to support it
- Get to know people and build positive relationships so everyone feels part of the team
- Let people know what the involvement opportunity is and how it has come about
- Make sure that there is enough time and opportunity to get it right
- Make sure the opportunities are open to all
- Find out if people need any support to be involved and provide that support
The Benefits of Collaboration, Involvement and Co-production
Benefits of Collaboration:
- Everyone works together, not separately, so people are not doing their own thing that noone else knows about
- If people share, we find out who is already doing what so people don’t do something that is already being done
- It can help us find out what works well and what doesn’t work so well by talking to others and sharing our experiences
- It helps us work towards a shared goal
- It can help people see the bigger picture and check if anything is missing or if there are people that need support, but that support isn’t being offered
- It can save money to support more people who need it
- It can make sure everyone is treated fairly, and included
- It helps people to work together to use money wisely and where it is needed most
- It doesn’t matter who you are. Those that fund services, service staff, carers, or someone with lived experience. We can all work together
Benefits of Involvement:
- Involvement can take place at a later stage of the planning process and even after a service has already been established
- Sometimes there isn’t a lot of time, so co-production isn’t possible, but there may still be time for involvement opportunities
- People with lived experience and carers can still have their say and make a difference
- There are lots of good reasons to be involved such as increased confidence, sense of achievement, or feeling heard
- Lots of people can be involved – there is no need to limit numbers
- People can have a choice of different ways to be involved
- People can learn about how decisions are made and why things happen the way they do
- With input from lots of different people’s points of view – a better decision can be made
- Helps those that fund services know what is important to those that use services
Benefits of Co-production:
Co-production includes all the benefits listed above and more besides. It is the ideal way to work.
Anyone from any sector can experience the following benefits of co-production, whether they are someone who funds services, someone with lived experience, a member of staff from a service, or the general public.
- Save time, money, and other resources getting it right first time
- If a service is based on all the different people’s input, the service is likely to last longer
- Co-production can pull everyone together with a shared vision
- Making sure that the service delivers what people want and need can prevent costly redesigns or service closures
- A positive co-production experience can boost confidence in the process and in people, meaning you will most likely do it again
- There can be a feeling of being equal and creating something together
- Everyone benefits by supporting the process and each other
- There are no sides because everyone works together
- Positive and effective communication means people become better connected
- People can feel empowered to make shared decisions and share their own opinions
- The decisions made make sense to everyone as they are joint decisions
- The process can help people in charge make the right decisions
- It can be an inspiring, creative, and motivating experience for all
- Hearing from people who use services can help people who fund or deliver services understand how it feels to receive support from that service
- It can help people continually look to make things better than before
- People feel happier with the service they use if it has been co-produced
- People are happier in their work as they feel they are doing a better job because people using services are happier
- Co-producing services means that people stay well for longer because the service is helping in a way that is needed
- It can be a really positive experience to listen to and understand different perspectives and ways of thinking
- People feel like they are creating something together
- People are creating new relationships and connections
- Everyone feels a part of something and is there from the start
- Hearing what people who use a service think of that service
- Learn about the needs and wants of people who use services
- Services and those that fund services can learn about all the benefits of co-production
- It can be a way for people with lived experience and carers to say thank you for the support they received from services
- People can feel important and valued and know that someone cares
- Carers and people with lived experience can speak on behalf of others who may have had a similar experience
- People will follow in the footsteps of those involved and consider getting involved themselves
- People can use personal skills they already have and learn new ones
- People may feel like they want to be involved in other things if they have a good experience
- There may be recognition for people’s time and input
- Confidence may grow and people may want to volunteer or look for paid work
- There is a feel-good feeling because people are achieving something together
Differences Between Collaboration, Involvement, User-led and Co-production
Co-production, Collaboration, User-led, and Involvement overlap one another, and it can be easy to confuse them and not be entirely sure which one you are doing. Below are some explanations of how they differ.
Understanding what they all mean should help you to recognise the differences between them and see whether the work or project you are doing is co-produced, collaboratively produced, you are involved in a different way, or it is a service user led project.
The Power of The Lived Experience Story
It is really hard to fully understand what having lived experience of mental health challenges, a learning disability, or a drug or alcohol addiction must feel like if you haven’t experienced it yourself.
Possibly it may be difficult to feel empathy for those that have or are experiencing it.
It is possible to form judgements or assumptions about people or stigmatise them without meaning to, based on what little we know about them.
It can be easy to work in a job supporting people for so long that you don’t attach as much feeling to your work and become quite business-like in the way you work with people. Especially if there are time limits to your work.
The SUN Network have always encouraged people to share their stories to help others gain a better understanding of what it is like to access a service, or sit in front of a member of staff, or even contact that service in the first place. What it feels like to not get help and wonder if there is help out there.
Also, what it is like to receive help and support and possibly a diagnosis. What impact does this have on someone’s feelings? Their relationships? Their Life?
We have heard some truly inspirational stories about people’s experiences and how their lives have improved beyond recognition both by becoming unwell and also by becoming well again.
We’ve heard about tragic losses, and joyful gains, the real rollercoaster journey behind the person, and facilitated lived experience involvement sharing experiences or telling their story in the Eating Disorder pathway, Severe Mental Illness Specialist Health Care Assistants, Crisis Care Pathways, Dual Diagnosis meetings, Trauma Informed Care and many more. Always to really positive reviews from all involved around the value of the experience of telling or listening to the story.
Measuring Progress and Success
The Feedback Loop
It is common for services or those that fund services to ask for feedback to find out what is going well and what is not going so well. This feedback is then used to shape the service and make changes to improve things where needed.
If a service or those that fund services are asking people for feedback on behalf of their service, it is good practice to let people know how their feedback is making a difference to how the service works. The feedback wheel below shows how this could look in a ‘You said – We did’ style.
Feeding back to people to let them know how their feedback has made a difference to services means people will feel listened to and valued and will encourage future participation.
If a service or service funder is unable to use the feedback offered, then they should let people know that they haven’t used the feedback and why they haven’t been able to use it. It’s important to be honest and transparent.
All feedback is good feedback. With ever evolving needs from people who may need a service, the services will need to evolve too. This means accepting and reflecting positively on feedback that is not so good and looking at whether there are any themes emerging and what the potential solutions could be. Quite often, the people with the best solutions are the people who use or need the service. Hence why co-production is so important.
Feedback also helps services and those that fund services to see what is working and celebrate successes.
How Will You Know if You Are Being Involved or Co-producing?
If you look at the participation jigsaw picture below created by the Best Practice guidance group, the pieces show you how involved you are in co-production. If there is no engagement, or if you are being given information, you are still not being very involved. If you are offering feedback or being involved, you are having more of a say. If you are on the last piece of the jigsaw, you are coproducing. These jigsaw pieces match up with the co-production ladder for services and those that fund services. (below)
How do services and those that fund services know if they are co-producing?
Services and those that fund services can see where they are on the Ladder of Co-production. The higher up the ladder they are, the closer they are to reaching good levels of co-production.
It is fair to say that most services will be somewhere between steps one (No Engagement) to step three (Involvement) the majority of the time.
The key words to ensuring co-production is embedded into the work of services and those that fund services are valuing and understanding.
By understanding the importance, benefits, and role of co-production, services can then value the process of co-production and the individuals within.
If we value something, then it becomes a priority for us. If services and those that fund services value co-production, then it will become a priority for them, and they can ensure that it is embedded in the culture of the service and service staff, so that when a staff member joins, the service instils the importance of co-production in the new member of staff. It’s a cultural thing, not a personal thing.
Services and those that fund services should not be asking ‘Why would I co-produce?’ They should be asking ‘Why would I NOT co-produce?’ There is no good reason not to co-produce.
Being honest and identifying where a service is on the ladder of co-production can help that service identify what needs to be done to ensure co-production is happening. The fears and barriers above can assist in identifying any issues, and the steps to success can support steps towards ensuring co-production is embedded.
Working on one project co-productively is great, but if it is just one project, then your service will still be between rungs three and four on the ladder. The aim is to reach the top of the ladder and stay there.
Those that fund services can really lead by example. They can use co-production throughout their own work, and also make it a contractual obligation for all funded services to utilise co-production and for those service to be prepared to pay for it, and evidence their ongoing use of co-production.
Asking the following questions can support a service journey up the ladder:
- Where do we currently sit on the ladder?
- What is the current staff knowledge and confidence of using co-production? (maybe do a little staff survey or quiz)
- How many co-production or involvement opportunities have we completed in the last year?
- Did we have any successes that we can learn from or celebrate?
- Are there any barriers to us using co-production? (If yes, analysis for solutions) On a scale of 1-10 how committed have we been do far to embedding co-production?
- Are we prepared to pay for co-production?
- Who do we know that we can work with to facilitate co-production?
- How can we address cultural attitudes towards co-production?
- Where do we want to sit on the ladder?
The Ladder of Co-production
You can read more of our Co-Production and Involvement Best Practice Guidance here:
Examples of Co-Production:
The Sanctuary crisis support are based in Cambridge and Peterborough and are open between 6pm and 1am every day, all year round. With a telephone-based service is available between 11am and 6pm.
They provide a safe, warm and welcoming environment in which visitors receive practical and emotional support from friendly mental health professionals without judgement.
If you’re experiencing emotional or mental health distress, please contact the NHS First Response Service by calling 111, Option 2. The team will then see how we can best support you and decide whether a visit to one of the Sanctuaries would be helpful.
The Sanctuary service was co-produced from start to finish. It was decided by those with lived experience that they wanted the sanctuary to feel like a home, as if you were in your own living room, where you could make a cup of tea and some toast if you wanted, and all staff take their shoes off when they’re at work and wear slippers. We’ve always received positive feedback from people accessing the service.
The adults Keep Your Head website has several pages with information and support for those who may be living with an eating disorder and those who are caring for someone with an eating disorder. This piece of work was co-produced from the start as we were asked to create information for eating disorder individuals and carers to help inform those waiting for support. This request came from a co-production group discussing the eating disorder pathways in Cambs and P’boro.
This work has been recognised by NHS England as an example of best practice in co-production and they have also encouraged their trusts throughout the country to use and adapt the information we created to suit the provision of care in their area – Kent and Medway CCG has already approached us to request use of our work.
The H.A.Y Peterborough website was co-produced with the purpose of being a hub of information on local wellbeing community support.
You can view more about it here.
Healthwatch Hertfordshire put together a report titled ‘Carers’ needs and Involvement in Mental Health Inpatient Service Discharge: Report and Action Plan‘ which was a project that was co-produced with carers.