This year marked the 7th National Co-production week held 4-9th July. This annual celebration, promotion and sharing of good practice in co-production includes a range of events, activities and online resources. Co-production gives an equal say to people who draw on services, putting them at the heart of decisions made about them.
The theme for this year was ‘the impact of co-production’. We at the Social Care Institute for Excellence (SCIE) have a long history of co-production in social care and we believe that co-production offers the chance to transform social care and health provision to a model that offers people real choice and control. As part of Co-production week, SCIE published a report ‘Developing our understanding of the difference co-production makes in social care’ and held a webinar led by two of the report authors, Sharon Stevens and Patrick Wood. The report brought together evidence from the literature as well as analysis of four online sessions with people with lived experience and people who work in services, to consider what we know about the difference that co-production makes.
SCIE’s report focuses on co-production in the design and delivery of services, policy development and the care environment. It sets out what more could be done to better evidence the difference that co-production makes in social care. While not centred on the co-production of research directly, the insights and recommendations are of value to the social care research community, identifying evidence gaps that we could help to fill as well as a reflection on our own practice and how we too consider and evaluate the impact of co-production.
What do we mean by co-production in social care?
Co-production is about working in equal partnership with people using services, carers, families and citizens. The report highlights that co-production is more than ‘involvement’ and that shared power and joint decision-making are essential for successful co-production. The four principles of equality, diversity, accessibility and reciprocity (or getting something back for putting something in) are core values for putting co-production into practice and ensuring it is as inclusive as possible.
In relation to social care policy, the Care Act 2014 was the first piece of legislation in England to include the concept of co-production and suggested it should be a key part of implementing the Care Act in practice. More recently, the 2021 Adult Social Reform White Paper, People at the Heart of Care again highlights the role of co-production, particularly in relation to innovation in the sector.
SCIE’s report highlights that implementation of these recent policy commitments will provide opportunities for co-production to be used as an approach to:
- improve policy,
- improve service design,
- improve service delivery,
- improve the care environment.
The next step then is to understand the impact of co-production in these (and other) circumstances in relation to care outcomes for individuals, services and the wider health and care system. The evidence review undertaken for the report shows there’s gaps in this knowledge though and that there is currently more research available within the health sector about the impact and outcomes of co-production than within social care.
What do we know about the impact on individuals involved in co-production?
The evidence review found that much of the research on co-production in social care has focused on the benefits of the process for the individuals involved. This included:
- increased self-confidence, self-esteem and sense of empowerment, including feeling listened to and being able to ‘give something back’ were widely reported,
- better health and wellbeing, including increased understanding of their condition,
- increased engagement and trust towards the service provider/organisation including a higher levels of satisfaction with, and awareness of, services.
In the online sessions, people additionally talked about ‘softer’ outcomes such as opportunities for people to meet and work alongside people outside of their usual personal networks, including younger people meeting older people and learning from each other. Importantly, many participants agreed that rather than asking what services can do for people who draw on care and support and carers, we need to consider the question, ‘What can we do together?’.
Benefits for people who work in services
Fewer studies include the impact on staff involved in co-production, but the limited evidence suggests that their involvement results in positive outcomes, including:
- improved job satisfaction, motivation and practice, regarding co-production as mutually empowering,
- higher levels of trust and engagement, including involvement in future projects and dialogue with people who draw on care and support and carers.
Those participating in the online sessions described how co-production provides lifelong learning for professionals working in health and social care and helps with employability. They also felt it creates better leaders and encourages people to speak up in their roles. Workers also benefitted from the diversity in lived experience that co-production can provide.
Benefits for organisations
While there were some benefits to organisations identified, most studies did not include this as an aspect of their evaluation, with the report authors conclude that more needs to be done to evaluate the outcomes of co-production for social care services, providers and commissioners. Of the studies available, more were produced in the health sector than the social care sector. Benefits included:
- increased uptake of services,
- decreased hospital admissions and reduced non-attendance rates,
- changes in practice as a result of introducing co-designed outputs, including: consistency in clinical assessment and the identification of patient problems that were previously missed and changes to clinical pathways,
- capacity building within organisations, changes in service delivery and changes in the service development process.
In the online sessions, participants observed that it can sometimes be difficult to pinpoint the difference that co-production makes to services. They highlighted the role co-production has to play in scrutiny, governance, regulation and workforce recruitment. There were a number of examples of the role of co-production in supporting change, including within the development of social prescribing.
Evaluating co-production in social care
The authors of the report highlight the need for a universal understanding of co-production, based on the four principles. This would support greater consistency in what is meant by co-production, enabling more meaningful evaluation. These principles still allow for flexibility so that changes can be made to accommodate people as needed.
Given there are gaps in the existing evidence and it was found there was more impact evidence for co-production within healthcare than in social care, what are some of the barriers and enablers to evaluation that we could learn from?
- resourcing of evaluation, including resourcing staff time and training,
- skilled facilitators to lead the co-production process including evaluation,
- the involvement and support of management to enable the impact of co-production to be measured,
- shared outcomes considering the impact on the people who use services that have been developed through participation.
- difficulty of defining co-production and the comparability of evidence,
- difficulties determining evaluation outcomes, such as a tension between quantitative and qualitative approaches, including how qualitative evidence is viewed and the applicability of some quantitative approaches,
- the complexity of data,
- resourcing issues, including a lack of staff, a lack of staff time and a lack of funding.
What next and how can researchers be involved?
The findings of the report highlights that more needs to be done to realise the full potential of co-production in social care, including increasing our understanding of the difference co-production makes. There is limited understanding of the impact on people who work in services and on organisations when this type of information could be essential in encouraging more organisations to take a co-production approach.
In the report, SCIE sets out 11 recommendations:
- Evaluation of the impact of co-production in adult social care should be undertaken as standard for relevant projects and programmes of work, including focusing on people who are underrepresented in the current evidence base, for example people from Black, Asian and minority ethnic (BAME) communities and unpaid carers.
- Evaluations of co-production in social care should be refocused onto assessing outcomes and impact and move away from the co-production process and output.
- A more universal understanding of co-production should be developed.
- Greater consistency in co-production in social care.
- More investment in resources for the evaluation of co-production, including resourcing for staffing, staff time, remuneration for people with lived experience and the provision of training.
- People with lived experience should be involved in identifying the outcome measures to be considered in co-production evaluations.
- Skilled facilitators should be used to lead the co-production process (including evaluation) and build relationships and support communication between different groups of stakeholders.
- Managers and leadership should be involved and provide support to enable the impact of co-production to be measured.
To co-produce evaluations fully, SCIE also recommends the following when undertaking evaluations with people with lived experience:
- Greater flexibility in the evaluation process, recognising that, at times, things can change at the last minute, and it is important to make changes to accommodate people.
- Access needs should be properly addressed and managed, to ensure evaluations are accessible.
- Evaluations should be conducted in a safe space that protects everyone involved, and appropriate training should be provided.
Many of these recommendations are highly relevant to social care research. In particular, the 2nd recommendation that evaluations refocus on assessing outcomes and impact rather than predominantly on the process and output of co-production. Talking with those involved in co-production and as a researcher who has been involved in co-production, there is wealth of knowledge and experience regarding pitfalls that were avoided, new areas that opened up and important insights only achieved due to the co-production of research. Those outcomes and impacts are less often evaluated and shared though, with more consideration as to how the process worked for those involved.
There is a role here too for researchers to consider how to support organisations in undertaking such an evaluation in a way that supports the principles of co-production, allows flexibility, considers ease and limited resource, but contributes to the wider evidence base. Anything to help and support putting people who draw on services in the driving seat when it comes to decisions made about their lives.
Wood, P., Stevens, S., Mitchell, D., Rahman, T., and Arikawe, A (2022) Developing our understanding of the difference co-production makes in social care. Published by SCIE. Available at https://www.scie.org.uk/co-production/understanding-the-difference