Co-production

When something is co-produced, power and influence are redistributed so that the people who stand to receive, benefit from, or deliver a service, are involved as equal partners. This presents an alternative to traditional ‘top-down’ approaches, where “decisions are made by a few people in authority rather than people affected by the decisions”.

In health and social care settings, co-production commonly means that the recipients of healthcare (such as patients, service users or people who use drugs) are involved in designing, implementing and evaluating services or interventions.

Co-production can also involve collaborations between researchers, policymakers, clinical staff, and treatment providers, as well as patients, service users and people who use drugs. The term can therefore be applied to a range of different contexts; policies can be co-produced, research can be co-produced, and interventions can be co-produced.

Co-production goes beyond consulting with or seeking feedback from people who use drugs. All parties should be involved in a way that shapes and determines the end result.

The Social Care Institute for Excellence (SCIE) suggests a list of principles for organisations wanting to pursue co-production:

• Equality: Co-production starts from the idea that everyone is equal, and that everyone has assets (e.g. skills, abilities, time and other qualities) to bring to the process, including people who use services, workers, practitioners, and managers.
• Diversity: Co-produced projects should seek out groups that are typically under-represented or excluded, including: people from Black and minority ethnic communities; people from lesbian, gay, bisexual and transgender communities; people who communicate differently; people with dementia; older people who need a high level of support; and people not affiliated to any organised group or community.
• Accessibility: Everyone should have the same access and opportunities so that they can participate in a way that works for them. This can refer to physical access as well as access to information and resources.
• Reciprocity: Treatment services should ensure that those who contribute ‘get something back’ in return. It is vital that people involved in co-production feel valued and needed.

When research is co-produced, it includes patients, service users or people who use drugs throughout all stages – from study design to writing up.

Key principles for co-produced research include ensuring that:

• the research is jointly owned, with people working together to achieve a joint understanding
• the research team includes everyone who can make a contribution
• everyone is of equal importance
• everybody benefits from working together

The report “Going the Extra Mile”, published by the National Institute for Health Research (NIHR), suggests that co-production could help improve public involvement in research.

Equality and diversity are at the heart of co-production. Co-produced projects actively address inequalities through involving marginalised groups in decision-making processes. The list of principles from SCIE provide more detail about how this can be best achieved.

It is important, when thinking about co-production, to address barriers to participation. For example, projects should ensure that meetings are held in locations, buildings, and at times that are accessible for the people who need to be there.

• Introduction to co-production and participatory research: workbook. Produced in partnership between Alain Thomas Consultancy and the Communities First Support Network. Published by Cardiff University.
• Innovating access to the nurse-led hepatitis C clinic using co-production. By Daniel Wolstenholme and colleagues. Published the Journal of Research in Nursing (2020).
• Beyond patient-centred care: a conceptual framework of co-production mechanisms with vulnerable groups in health and social service settings. By Sunggeun Park. Published in the Public Management Review (2020).
• Assessing the impact of co-production on pathways to outcomes in public services: the case of policing and criminal justice. By Elke Loeffler and colleague. Published in the International Public Management Journal (2020).
• Producing co-production: Reflections on the development of a complex intervention. By Mary Madden and colleagues. Published in Health Expectations (2020).
• Together we measure: Improving public service outcomes via the co-production of performance measurement. By Cherrie Yang and colleague. Published in Public Money and Management (2019).
• Co-production of a research and advocacy agenda for Inclusion Health. By Serena Luchenski and colleagues. Published in The Lancet (2019).
• Co-producing and re-connecting: a pilot study of recovery community engagement. By Michael Edwards and colleagues. Published in Drugs and Alcohol Today (2018).