I’ve led a wide range of service user involvement over the last 30 years, as strategic lead for service user involvement in national charities and by working with patient and public voice organisations including the National Association for Patient Participation and local Healthwatch organisations. And I have 10 years’ experience as a Non-Executive Director/Chair in the NHS.

In this blog I want to explore why co-production should matter in the NHS (and other organisations), and what the commitment to “doing co-production for real or not at all” can look like. And I’ll offer Ten Top Tips to effective co-production.

  1. Some basics

Language matters. And how we describe those who use services, particularly NHS services, matters particularly. I’ve spent time with many people on the receiving end of NHS services who’ve expressed passionate views on being called “patient” vs. “service user” vs. “citizen”, with some speaking as passionately for and against one as for the others! In this blog I’ll use the term “patient/service user”.

It helps to define “co-production”. I find the Think Local Act Personal definition of co-production as: “activity that involves people who use services being consulted, included and working together from the start to the end of any project that affects them”[i] is helpful.

  1. Why should co-production matter in the NHS?

From a policy perspective, the NHS Long Term Plan[ii] re-affirmed previous commitments, stating that “the NHS… needs a more fundamental shift in how we work alongside patients and individuals to deliver more person-centred care… Creating genuine partnerships requires professionals to work differently, as well as a systematic approach to engaging patients in decisions about their health and wellbeing.”

There is also evidence (e.g. Bombard et al[iii]) to support the belief that good patient/service user engagement can inform policies and enhance service delivery and governance. In practice, I’ve seen many examples where early, constructive co-production has led to better service design that works for patients/service users, staff, and commissioners.

And it is important to remember that public services are our services. We, and those who use our services, are already invested in them. Making involvement effective improves services.

  1. Do co-production for real or not at all – some key questions

A basic principle when looking at possible co-production is to consider how to make sure it is genuine, is ‘for real’. There are some key questions that are helpful:

  • Is this really co-production? If it is something like generating ideas or the design of a service, the chances are this can be a real co-production opportunity. If it’s about influencing a choice between options, it may be co-production, though is likely affected by how I present the options. If it is about agreeing or not with my own preferred option, it isn’t co-production.
  • When am I going to do this co-production? If it is right at the start of a piece of work, the chances are this can be a real co-production opportunity. If it’s part way through a project, then it may be co-production, depending on the impact the patient/service user can genuinely have. If I’m waiting until the work is completed, then it isn’t co-production.
  • Who am I going to do this co-production with? If it is with a current or potential patient/service user, the chances are this can be a real co-production opportunity. If it is with a carer or advocate, or a “patient/service user representative”, then it may be co-production, depending on their relationship with patients/service users (or if the focus of the co-production is specifically targeted at those other roles).
  • Am I open to making changes to my plans as a result of this co-production? If the answer is “No, this engagement has no chance of changing my plans”, then it isn’t co-production. If the answer is “It depends”, then it may be co-production. If the answer is “Yes, that’s the point”, then it probably is co-production.

It is good to actively review co-production with those involved. Questions like “How is it going for you?”, “What’s working well?”, and “What would be even better if?” are often helpful ways to test that the co-production is, and continues to be, meaningful to all involved.

It is important to show clearly where patient/service user voices have had an impact. And feedback on ideas that have not been accepted should be given, showing how they have been considered and the rationale for them not being taken further.

  1. My Ten Top Tips for involving patients/service users well in co-production

To summarise my thoughts on co-production I’ve developed the following tips:

  1. Ask, “Are we doing patient/service user involvement and co-production ‘for real’?” If the honest answer is “No”, then stop pretending.
  2. Assume programmes will involve patients/service users from the very start and design them accordingly. The best way of embedding this assumption is having to justify any decision not to involve patients/service users.
  3. Think about where decision-making power lies in your programme or project. If it would look different if the patient/service user shared the power, then consider changing the balance of power towards the patient/service user.
  4. Beware of using the same patients/service users every time just because they are enthusiastic, accessible, known etc. – it helps to seek a range of patient/service user views.
  5. Invest in patients/service users; ask them what they need to help them effectively contribute (e.g. time, relationship, expenses, support, training and development, etc.)
  6. Get to know the patients/service users involved in your co-production. The better you understand their motivation, life experience, frustrations, wants and needs, the better you can effectively engage them in your co-production.
  7. If you are missing an under-represented voice, go to where those voices are well heard (e.g. other groups or organisations) and seek to work with or through them rather than just expecting people to come to you.
  8. Set a clear framework and parameters for your co-production and check that the patients/service users you are involving share your understanding of them.
  9. Ask if you treat other contributors to your project (e.g. clinicians and representatives of other organisations) differently. If so, consider if that is valid (e.g. do you pay clinicians for “back fill” but don’t pay for childcare or other additional costs for patients/service users?).
  10. Regularly reflect with patients/service users involved in your co-production about “What works well” and “What would be even better if?” and use this to inform future co-production.

 

How Because It Matters Ltd can help you involve patients/service users well in co-production

If you want to discuss how I might be able to work with you on involving patients/service users well in co-production – e.g. through one-to-one coaching, through team/ Board development, or through advising projects – you can contact me via my website at www.becauseitmattersltd.co.uk

 

Paul Devlin

Director

March 2019

[i] Making it real: Marking progress towards personalised, community based support Think Local Act Personal (2011) London.

[ii] The NHS Long Term Plan NHS England (2019) London.

[iii] Engaging patients to improve quality of care: a systematic review Y Bombard et al, ‘Implementation Science’ (2018) 13:98