Emerging practice tells us that, for ‘place-based’ health and care to be effective, it’s best to co-produce it with local communities. Tina Coldham, trustee at the Social Care Institute for Excellence (SCIE) and Ewan King, director of business development and delivery, SCIE, give their views:
Impersonal. Task-based. The ‘hotel model’. This rather gloomy picture can be painted about some care homes that provide dementia support.
But a short film and report on our website shows how staff in a care home in Swansea are challenging these assumptions. It’s a model of shared living that builds on the strengths and contributions of people living with dementia, their families and staff. It uses the values and practices of co-production.
This is co-production in a nutshell: It’s about using people who receive care, and their carers, as unique consultants when designing services and finding out what people really want. It joins professional experts with experts-by-experience to produce the best outcomes and experiences for those who receive care and support. There’s a guide about it on our site.
The Swansea example is of co-production taking place in one care service – and that has been far from easy to deliver. What would it entail to embrace co-production across a whole health economy?
Increasingly, this is what policy demands – in relation to the new NHS planning guidance and Better Care Fund plans. To work for whole communities, plans need to be ‘place-based’, reflecting the views of a broad range of organisations and stakeholders, but with the views of patients, service users, carers and citizens too.
In the past, visions for local service development – even those held in high regard at the beginning – have often collapsed because the public were never properly involved, at the right time, in shaping the way forward. Co-production, happening at the systems level, can help us avoid some of these problems.
There are places that are trying to deliver co-production on this scale, and we need to give them support and encouragement. It’s great to hear of co-production happening on the ground, one step at a time:
- Stockton. A group of people, working with the Integrated Commissioning Programme are trying a new approach to care and support planning.
- Lincoln. A brand new co-production group has just been formed and they’re meeting up for the first time shortly.
- Birmingham. They have established citizen-led quality boards. One looks at assessment and support planning services.
- Somerset. Community conversations, workshops and user involvement share a vision for integrated, personalised, and preventative care.
So there are emerging examples of co-production delivered at the strategic level, across whole systems and communities. But there are not as many as there should be. One purpose of a new programme the Health Foundation is funding us to deliver, on the role of community wide, citizen-led constructive conversations and New Models of Care, is to unearth more examples of good practice. And more importantly, to identify what practical steps can be taken to ensure that people are meaningfully involved in decisions about whole system change.
The examples in places like Somerset, Swansea and elsewhere, show what can be achieved when initiatives like the one on place-based health and care are put into practice.
We at SCIE are keen to champion the role of co-production, not just in how it can potentially play out, but also by showing how it is already doing so. That way people’s outcomes and experiences can be improved. That’s the point of policy initiatives, after all, isn’t it?
Tina campaigns for a better understanding of mental health issues in society, and works to improve service provision. She describes herself as having enduring mental health problems, having used mental health services over many years. Tina has worked in the voluntary sector, across disability, in academia, with regulators and governing bodies as a trainer, researcher and consultant. In 2001 Tina joined the Centre for Mental Health Services Development England (CMHSDE) at King’s College as a project coordinator, working on the successful national pilot to implement direct payments in mental health. Since 2003, she has worked for the Health and Social Care Advisory Service (HASCAS) on various national projects including direct payments work, service reviews, independent investigations, and MARD – the review of user and carer involvement in NIMHE (CSIP). Tina also chairs the SCIE co-production network.
Ewan King, Director of Business Development and Delivery
Ewan King joined SCIE in September 2014 and is responsible for ensuring the delivery of SCIE’s contracted work, attracting new commissions, and supporting co-production with people who use services and carers. Ewan has been Director of Business Development and Communications at the OPM Group, an employee owned research organisation and consultancy. A social researcher and policy analyst by background, Ewan was previously Director of the research team at OPM and led several large scale national evaluations, policy development projects and research studies for organisations including NHS England, Communities and Local Government, Department for Education, Department of Health, CQC and numerous national charities. Before joining OPM, Ewan worked as a researcher for the Rt Hon Tessa Jowell MP. Ewan is a Trustee of the Charity Penrose, which seeks to re-integrate ex-offenders and people with mental health conditions into society, and was educated at the London School of Economics and Warwick University.