Dec 162013
Mike Spencer

Mike Spencer

Here’s a challenge. How do we best make sure patients get person-centred care at a time when resources in the whole of the public sector are being stretched? Part of the answer lies in co-production, something that is currently being widely talked about in Wales.

 If a part of the healthcare system is outdated, cluttered, or simply not providing person-centred care, among the first to notice this will be patients. When we’re working within an already established system, it can sometimes be hard to see how things could be done differently.

But a patient on the receiving end of treatment is in the perfect position to offer insight into how things could be improved, and, importantly, to help in redesign and improvement.

I recently attended a co-production master class at the National Learning Event, which helped to seal some of these ideas. Co-production sees citizens and patients as equal partners in a service, and acknowledges that “non-professionals” can provide skills, expertise and resources.

So, in practice, here’s how co-production in healthcare might work:

  • For Individuals: Patients with long-term conditions can be supported and empowered with shared decision-making and involvement in self-management.
  • For Services: Citizens and patients can be involved in commissioning, designing, delivering, and evaluating services.
  • For Communities: The resources (such as expertise, time and knowledge) in a community can be utilised to support and empower people to maintain their own health and wellbeing.

 It can seem alien for some to think about healthcare in this way and it does require a change in culture for professionals to share some of their power with people.

 Looking at examples like the Southcentral Foundation in Alaska, however, shows how these theories can work in practice. The transformation there from patients to “customer-owners” led to significant changes in the way their healthcare services were delivered.

 On a smaller, but no less impressive, scale, consulting and working with patients in the first instance can lead to smart, simple solutions.

Working with patients with learning difficulties on this NHS Wales Awards winning project meant that staff arrived at a solution that they know works for patients.

Co-production solutions can be delivered using many of the tools and techniques in Improving Quality Together, but there is also a need to use approaches more commonly found in non-health service settings. Some of these are outlined in the Tools for Improvement Guide Co-producing services – Co-creating health.

At the master class participants considered how the principles of co-production could be taken forward in the NHS in Wales. The consensus was that we should:

  • Find a way of collating and sharing the good practice that is already taking place in Wales
  • Work towards ensuring that there is a joined up approach between Health and Social care
  • Bring together a group of people who could influence and support the identification of key areas for co-production and help put co-production into practice

Do you agree with these? Do you think we’re already doing any of them? Is there anything you’d add? Share your thoughts in a comment below.

Mike Spencer is the 1000 Lives Plus Faculty lead for Ensuring Patient and Person Driven Care and a co-author of the The Listening Organisation and Co-producing services – Co-creating health.

  4 Responses to “Reflections on a Co-Production Master class”


    Such a simple principle with massive potential. Let’s make co-production the way we do things in NHS Wales and dispense with healthcare professional arrogance that we always know best.


      Thanks Joy, the key now is to put this at the heart of service delivery and all our improvement activities, rather than seeing it as a separate entity. How can we start to achieve this?

  2. Thanks for sharing the material. In principle, this is given and a matter of common sense. The challenge is to identify the factors that prevent us doing this…lack of resources, improper prioritisation of resources, poor attention to clinical requirements which is actually what is needed and too much satisfaction in counting numbers.
    I say the above as clinician, who treats patients respectfully and with a sense of duty of care.
    Mostly it boils down to one statement- Most troubles arise when you don’t do what you were supposed to do! This involves, ownership, leadership, selflessness, team working and a good measure of humility.
    Do i still need to go on the course?

    • No you probably don’t need to go on the course, but might think of running it!
      However, there is a key feature of transformative co-production which takes it beyond respectful working together and which is perhaps the toughest nut to crack…as CMO Ruth Hussey suggested at the recent Co-production Implementation Group meeting “People say ‘it’s partnership working, we’re doing it already.’ We’re not doing it already. This is about power.”
      That’s the toughest nut to crack – behaviour and systems change to shift power from state to citizens.

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