In recent times, co-production has gained popularity in the fields of health and social care. This concept involves a collaborative approach where professionals and people with lived experience collaborate as equals, offering a promising transformation of services. Essentially, co-production focuses on sharing authority and decision-making, utilising the unique perspectives and expertise of lived experience and diverse stakeholders to shape and enhance services. Despite its lofty goals, co-production often does not meet expectations. Many initiatives end up as superficial gestures, where people’s lived experience is sought but not truly valued. This blog explores the reasons behind the frequent shortcomings of co-production and suggests ways to overcome these challenges.
Understanding Co-Production
True co-production represents a significant departure from conventional service delivery methods. It entails individuals who have first-hand experience with a service collaborating with professionals to design, deliver, and evaluate services together. This method acknowledges the invaluable experiences of individuals, placing them as authorities in their own regard. When executed properly, co-production can result in services that are more adaptable, efficient, and tailored to individual needs. It has the potential to empower service users, build trust, and cultivate a shared sense of responsibility and ownership among all involved parties.
The Allure of Tokenism
While the concept of co-production may seem promising in theory, its execution frequently lapses into tokenism. In this scenario, tokenism involves making only a surface-level or symbolic attempt to involve people with lived experience without truly valuing their contributions. This can take different forms, like inviting people to attend meetings without granting them real decision-making power or engaging them in consultations that do not impact actual policy or practice modifications.
A major issue is that organisations sometimes adopt co-production for its appearance rather than its substance. The pressure to be seen as inclusive and participatory can lead to a “box-ticking” mentality, where the mere presence of people with lived experience in discussions is considered sufficient. This is compounded by the fact that true co-production requires significant time, effort, and resources, which many organisations are either unwilling or unable to invest, especially when co-production involved people with lived experience of learning disability or autism.
I have had to delay many tasks over the last few days due to people with lived experience not being available to contribute and shape a project we are working on. I could have easily just sent in the report based just on my thoughts, but that would be breaking the true essence of co-production, so the task will be completed next week instead. The work may take longer but it will be so much better for it.
Case Studies of Tokenism
Several studies highlight the tokenistic nature of many co-production initiatives. For instance, a report by the King’s Fund in 2016 found that while many health and social care organisations claim to engage in co-production, the reality is often different. The report revealed that service user involvement was frequently superficial, with limited impact on decision-making processes. Participants often felt their contributions were undervalued and that their presence was merely for show.
In a recent study published in the British Medical Journal in 2022, researchers investigated the incorporation of co-production in mental health services. The study revealed that despite promoting partnership and collaboration, service users frequently felt excluded. Meetings were primarily controlled by professionals, with decisions often finalized before involving service users. This resulted in service users feeling frustrated and disheartened, as they believed their personal experiences were not fully recognized or utilized.
Why Tokenism Persists
Numerous factors play a role in the perpetuation of tokenism in co-production. A major obstacle is the power dynamics at play. Professionals, typically viewed as the authorities, may hesitate to relinquish control or involve people with lived experience in decision-making processes. This reluctance could arise from a sense of superiority or a fear of losing power and prestige, often linked to the medical model as opposed to the social model of care. Consequently, input from lived experiences is frequently side lined or disregarded, maintaining conventional hierarchies. Their needs to be a move to a strength based practice culture where we welcome the voice of people with lived experience as equals and central to the whole process.
In addition, institutional Inertia, a reluctance to change, also plays a significant role. Numerous health and social care institutions have longstanding practices and cultures that are difficult to alter., and there can be no bigger institution than the NHS. Embracing genuine co-production demands a change in perspective and a readiness to adopt fresh approaches. This transition can be challenging and face opposition, especially without a clear motivation or directive for change.
The Impact of Tokenistic Co-Production
Tokenistic co-production can have several negative consequences. For people with lived experience, it can lead to feelings of disempowerment and frustration. When their contributions are ignored or undervalued, they may become disengaged and lose trust in the system. This can also undermine the credibility of co-production initiatives, making it harder to attract genuine participation in the future. Self-advocacy charities feedback that members have post co-production trauma as once again they feel like they are second rate citizens.
For organisations, tokenism can result in real missed opportunities for improvement. By failing to fully leverage the insights and expertise of experts with lived experience, they may continue to provide services that are not fully aligned with users’ needs and preferences. This can lead to poorer outcomes and a lack of user satisfaction, ultimately impacting the effectiveness and sustainability of services.
Moving Beyond Tokenism
To move beyond tokenistic practices, health and social care organisations must commit to genuine co-production. This involves several common key steps recommended by organisations such as Nesta:
- Commitment from Leadership: Organisational leaders must demonstrate a genuine commitment to co-production, both in rhetoric and action. This includes allocating the necessary resources and creating a culture that values and respects service user input.
- Capacity Building: Both professionals and people with lived experience need to be equipped with the skills and knowledge to engage in co-production effectively. This may involve training, mentoring, and creating supportive environments that encourage collaboration.
- Sharing Power: True co-production requires a shift in power dynamics. Professionals must be willing to share decision-making authority with service users and to value their contributions as equal partners.
- Meaningful Engagement: Lived experience involvement must be meaningful and impactful. This means involving them early in the process, genuinely considering their input, and ensuring that their contributions lead to tangible changes.
- Evaluation and Accountability: Co-production efforts should be regularly evaluated to ensure they are meeting their goals. Organisations should be held accountable for their commitment to co-production and for the outcomes of their initiatives.
Examples of Successful Co-Production
There are examples of successful co-production that can serve as models for others. The “Living Well Network” in Lambeth, London, is one such example. This initiative brings together service users, carers, and professionals to design and deliver mental health services. The network has been praised for its genuine commitment to co-production, resulting in services that are more responsive to the needs of users and that foster a sense of community and mutual support.
Another example is the “People Powered Health” program by Nesta, which supports health and social care organizations in the UK to adopt co-production practices. The program has led to significant improvements in service delivery and outcomes, demonstrating the potential of genuine co-production to transform health and social care.
Other examples are available via the SCIE link
Conclusion
Co-production could hold many innovative solutions for health and social care, but it requires more than just good intentions. To move beyond tokenistic gestures, organisations must commit to genuine, meaningful engagement with people with lived experience This involves a willingness to share power, invest in capacity building, and create a culture that values and respects the contributions of all stakeholders. Some of the good examples shared in this blog also adopts an innovation fund to allow people to build on an idea and bring it into action. By doing so, they can harness the full potential of co-production to create more effective, responsive, and person centred.
Co-production, when done right, is not just a method but a philosophy that can transform how we deliver and experience health and social care. It’s time to move beyond tokenism and embrace the true spirit of partnership and collaboration. Self-advocacy organisations need to challenge bad practice in co-production and offer training for organisations to ensure co-production tokenism becomes a thing of the past.
For further reading on the challenges and potential of co-production in health and social care, consider these sources:
- The King’s Fund report on co-production: The practice of co-production in healthcare
- Nesta’s People Powered Health program: People Powered Health: Co-production
- Coproduction with Autistic Adults: Reflections from the Authentistic Research Collective
- Coproduction ethic guidelines when working with people with a learning disability. Wiley
- Research on co-production in mental health services: Co-production and involvement: An overview
- Co-production and strengths based practice.
Sean Ledington, Project Lead at Shout Out Academy, our training motto is designed, developed, and delivered by experts by experience.
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