Co-production: an introduction

Classification: Official
Publication reference: PAR1498_i

“Co-production really is better; just try it”

This is one of the things Don Berwick (President Emeritus at the Institute for Healthcare Improvement) says about co-production with people with lived experience in a short film which is one of the resources you can access here.

A 2018 Care Quality Commission report ‘Quality improvement in hospital trusts‘ describes co-production with patients and with staff as a central element in undertaking effective quality improvement and key to aligning quality improvement and experience:

  • “Putting the patient at the centre of the quality improvement (QI) journey sharpens the focus on delivering high-quality patient care and aligning improvement activity to outcomes and experience for patients. To deliver this, patients must be involved and enabled as true and equal partners for QI.”
  • “There are several trusts that are further along the journey to embedding improvement culture, where effective improvement-focused leadership has engaged, empowered and enabled staff, patients and carers in improving services. We have seen this approach reflected in achieving outstanding ratings.”

Co-production: a critical ingredient for change

Co-production is not new but until now has (at least in England) mostly been employed in social care and mental health services. It has not been the way we consistently do things in NHS services.

A national co-production model that includes a definition of co-production and identifies five values and seven practical steps to making co-production happen was published in 2016 and updated in 2021.

Early in 2021, a national review of changes in response to the COVID-19 pandemic was endorsed by NHS England’s (then NHS England and NHS Improvement) Quality and Innovation Committee, recommending ‘co-production as default’ with people with lived experience as a critical ingredient for change in implementing changes based on learning from, and recovery from, the pandemic.

What would good co-production look like?

  • We always start from what matters most to people who use and work in services.
  • We work with people who have relevant lived experience (patients, service users, unpaid carers and people in paid lived experience roles) and with staff, in everything we do to directly connect with multiple and diverse voices.
  • We build equal and reciprocal partnerships with people who have relevant lived experience and staff, including with those from disadvantaged and minority communities, from the very start of, and throughout, all our work.

Background to the development of this resource

Between 2017 and 2019 the Mandate from the Government to the NHS in England included the following two relevant overall 2020 Patient Experience goals:

  • Improve the percentage of NHS Staff who report that patient and service user feedback is used to make informed improvement decisions.
  • Ensure that patients, their families and carers are involved, through co-production, in defining what matters most in the quality of experience of services and improving the quality of NHS services.

A specific methodology for improving experience of care through co-production, Always Events®, has been used in the NHS since 2015. Always Events is a registered trademark of the Institute for Healthcare Improvement (IHI), and is now used in many organisations in England as a quality improvement approach.

Discussions were held with provider organisations in 2018 about existing challenges in the way that experience of care, improvement and co-production are delivered, and what would support change. These discussion indicated that:

  • mostly, experience of care and improving quality were undertaken entirely separately in provider organisations
  • people who use care services, unpaid carers and front-line care staff were not consistently involved in improving either experience of care or broader quality improvement work.

A national project was established in 2019 to identify what NHS organisations should do to align experience of care, improvement and co-production. The project consisted of two elements:

  • a literature review of ways in which co-production is used to improve the quality of services and people’s experience of care.
  • a qualitative exploration through visits to six (acute, community, mental health, primary care) NHS organisations that had made progress in aligning experience of care, improvement and co-production of what steps they had taken that could be useful to others.

The site visits were undertaken in late 2019, early 2020 and people with lived experience part of the team that did the site visits. The organisations we visited were:

  • East London Foundation Trust
  • Humber Teaching NHS Foundation Trust
  • South Eastern Health and Social Care Trust (Belfast)
  • South London and Maudsley NHS Trust
  • Tower Hamlets CCG
  • Western Sussex Hospitals Trust.

We are excited to share these resources which will support people to co-produce quality improvements together. These resources have been developed in partnership with We Coproduce, the improvement team and the experience of care team at NHS England. Together we modelled the new way of working described in the resources, with collective leadership and sharing power to foster culture change to improve care together.

An advisory group included:

  • people with lived experience
  • WeCoproduce
  • NHS provider staff
  • Health Foundation
  • The King’s Fund
  • Co-production Collective (formerly University College London Centre for Co-production).

The resource was initially developed as a vehicle to share the outputs from the project, but we recognised the value of building a wider repository by also referencing/signposting to other useful co-production related resources and we will add further to it over time.

These resources are being shared to help people who want to co-produce improvements in health and care services. The resources include the following:

  • co-production introduction
  • literature review
  • co-production resources guide
  • a series of films and animations
  • QI Venn diagram
  • co-production postcards.

These will be published here on the NHS England website and on the NHS Future Collaborations Site Co-Production (Including Always Events) – FutureNHS Collaboration Platform.

Further information

For further information please contact the team at

See also the Experience of care webpage.


Knocking on doors at the Barkentine Practice, Isle of Dogs with Meera Kapadia and Salvador Goncalves

In conversation with Prof. Don Berwick and We Coproduce about communities and healthcare systems

Our co-production journey – South London and Maudsley NHS Foundation Trust

The world of co-production and quality improvement