Effectively involving patients, carers and citizens in the development of services can help ensure solutions are more effective and sustainable, which is why co-production is increasingly being used to support service redesign. While there are many examples of projects using this approach to some degree, I am currently involved in a really ambitious use of co-production, where a whole system redesign is being tackled from the ground up.
In this two-year project, we’re working in partnership with social innovators, The Young Foundation to redesign services for patients with long term conditions. Working with Clinical Commissioning Groups, the local authority, community health services, hospital trusts and GPs across Worcestershire, the aim is to radically shift the culture and attitude of public sector partners. Rather than top down, prescribed solutions, it’s about designing services hand in hand with the people that are most affected.
Although the programme is ongoing, we’ve already developed a greater understanding of the needs of patients and have opened a dialogue that gives citizens the confidence to engage and shape services, while utilising third sector specialisms and expertise.
During the first phase of the programme, we held a series of workshops and surveys involving patients, carers and professionals, including interviewing people in their own homes. Professionals were encouraged to use their experiences as a patient, user or carer, rather than just as clinicians, in a bid to shift the balance of power so that patients are in the driving seat of the process. This exercise has helped us to build a deeper understanding of the issues people face, how they access and receive care, and their experiences of what has and hasn’t worked for them in the past.
Feedback has shown that there is an overwhelming determination by patients to lead independent lives but frustration that this is not always possible due to barriers including mobility problems, lack of transport, facilities or support. Many suffer feelings of isolation and bouts of depression.
Management of the long term condition itself is not necessarily the main issue. Often, the biggest impact on wellbeing is a combination of factors such as immobility, social isolation and reliance on family, as well as mixed experiences with GPs, health and social care. This sends a clear signal that long term conditions need to be managed in a holistic way, looking beyond medical issues to consider wider social, environmental and cultural factors.
Learning so far
From the work carried out so far, the key themes that have emerged include:
- The need to shift from ‘doing to’ to ‘working with’ patients
- Greater focus on prevention and early intervention, more support for self-care and mutual aid
- Integration between different services and providers
- Brokering a true partnership and shared responsibility between care providers and service users.
People want to see a simplified system with common language and processes, more efficient communication and information sharing as well as more effective multi-disciplinary working to reduce system blockages.
Taking the next steps
The initial stages have provided a launch pad to open up conversations about different ways of working. The knowledge gained as a result has challenged current perceptions of cultures, systems, processes and practices, which are now being used to develop new and improved ways of working.
We have developed a set of key recommendations to enable the health and social care economy of Worcestershire to foster greater empowerment, integration and relationships based on mutuality, including:
- Applying co-production in practice by establishing new ways of working, written protocols between parties and prototyping pilot initiatives
- Taking an asset based approach which values the skills and knowledge of a community, creating tools to underpin collaborative working e.g. asset based needs assessment
- Growing networks, ensuring services connect with individuals and provide forums for users and professionals to share expertise
- Working on culture and capabilities, building the skills of those involved and equipping local champions to act as catalysts of change
- Developing relationships which broker partnerships and shared responsibility.
The next phase will test out the viability of different ideas through further workshops, exploring the implications of new models of care; identifying key outcomes, values and the culture needed to embed co-production.
Our experience has demonstrated a groundswell of support for co-production as a vital, innovative and creative approach to support the effective management of long term conditions. One GP working with us has even gone as far as describing this process as his ‘road to Damascus’, with no turning back on how patients should be engaged with in the future. Although solutions may not be straightforward, this new way of working will deliver more sustainable, integrated service development which genuinely puts those most affected at the heart of service design and delivery. It’s an exciting project, which continues to surprise, challenge and reward those involved.
Read more about this project in our case study.