How co-production creates better population health

We hear from Darzi Fellow, Dr Lindsay Ip [pictured below], on how delivering public services as a collective between professionals, service users and their families strengthens our population’s health.

“We are all in this together” seems to be the most comforting and appropriate phrase that keeps us going and staying hopeful in this COVID-19 pandemic.

From more than 750,000 volunteers signing up to volunteer for the NHS to help care for the vulnerable, to the government working together with academic and commercial partners to make ventilators in creative ways, to captain Tom Moore raising millions for the NHS, there is no doubt that the power of the collective can bring about a much greater impact than any single entity or sector alone.

Indeed, disasters often lead to a spike in altruism and solidarity, in part because there is a clear, imminent and shared purpose of survival. Few would argue against the fact that our priority is to save lives now. When things return to “normal” however, how do we ensure people are continually empowered? How can we support collaborations across sectors, in order to create well-being outcomes that matter to users? How do we maintain a partnership between volunteers, our population, patients and the NHS in a way that is mutually beneficial and that promotes equality?

Co-production and its value

Advocates of a community paradigm for public services will recommend using a co-production approach in all areas of public, health and care services, particularly when solving wicked and complex issues such as health inequalities, poverty, obesity and mental health, where there is no obvious solution.

The most widely accepted definition of co-production is by the innovation foundation fund, Nesta, and the New Economics Foundation (NEF):

Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.

Co-production is far from simply giving service users or citizens a stronger voice or more choices for services. Instead, service users and professionals work together throughout a project - from the initial stages of identifying a problem, to coming up with solutions to change it and finally making sure it works properly, by evaluating its impact.

Theoretically, implementing this approach should be one of the biggest value propositions. It is designed to create services that are more fit for purpose and reduces cost to the NHS due to shared responsibility with the rest of society.

In fact, co-production is aligned with the fifth wave of public health approach – developing a “culture for health". Cultures are co-created by all players in society and not healthcare alone, therefore it is essential we engage all of society for improved population health.

Co-production and its challenges

Co-production is not without its challenges. Amongst several challenges, including difficulty showing empirical evidence, one of the biggest obstacles is that our systems exclude people through its power structure. Yet, information has no hierarchy, and the information we need to resolve complex problems is everywhere in the system.

The main challenge is therefore designing systems that enable co-production and the equality it promises. What settings and processes enable candid conversations with people from diverse backgrounds and addresses the problem of power differentials? What routines in healthcare services enable conversations about what matters to patients? Who should we include in policy making and commissioning to make incentivising co-production a priority?

Co-production in practice - creating a diverse network of “parent champions” in Southwark

This year I embarked on a Darzi fellowship co-hosted by King’s Health Partners and Our Healthier South East London (the south east London integrated care system) to explore some of the aforementioned questions.

One of my projects looks at how we can create a more supportive and healthier culture for parents living in deprived areas, especially those undergoing high-pressure during this pandemic. Through interviews and observations to understand the needs, strengths, influencers and context of parents in these areas, the relevant people who can directly or indirectly help create a better culture for them were identified and invited to be “parent champions”.

Conversations were facilitated through co-production meetings, which was held over Zoom given social distancing measures. Despite the less than ideal conditions, a total of about 45 champions from 10 different sectors attended over two sessions so far. These include other parents, family members, primary care staff people from churches, schools, charities, the council, communications, arts and culture, mental health as well as entrepreneurs in tech and hygiene

These collaborative sessions resulted in a deepened understanding of issues that matter to parents, with 85% participants reporting that they would do at least one thing differently for their community as a result. More than 10 change ideas and new collaborations were formed from each session. For example, distributing helpful coping resources for new mothers through routine care pathways, expanding a computer bank for those digitally deprived, working towards sharing responsibilities for home teaching, and creating more effective communication platforms between primary care and community assets.

Each session was complete within two hours and follow-up sessions will continue regularly for champions to discuss implementing change in their area, including working together with their local GP surgeries.

Conversations about how to link up the parent champions’ work with other community initiatives in order to coordinate volunteers for COVID-19 response and its aftermath have also begun. This includes working together with the local GP Federation and primary care networks, Clinical Commissioning Groups, local authorities, Altogether Better, and creating appropriate decision-making structures and feedback loops between citizens, professionals and governing bodies.

Next steps

If you’d like to learn more about or join the parent champions network, please email me at the Lindsay.ipATnhs.net.

Meanwhile, if you are interested to learn more about how you can apply principles of co-production, take a look at Nesta’s catalogue on people powered health co-production.