Public Sector Case Study
Co-producing Service Changes
Working with an NHS Trust, we were tasked with co-producing potential changes to their service. We worked through existing barriers and helped to balance effective engagement across stakeholders.
We focused on the humanity of the co-production process in order to rebuild trust. This allowed fractured relationships to be restored, forming a stronger and more resilient service. The lives of the service residents has been improved, and their needs more thoroughly met through the implementation of these changes.
Client: NHS Trust
Sector: Public
Service: Co-production
Date: 2019
Our client for this project was an NHS Trust delivering a long-stay mental health inpatient facility for individuals with severe learning disabilities and Autism. As well as this we worked with the multiple Clinical Commissioning Groups funding residents in the service.
This ‘Specialist Residential Service’ represented one of the few long-stay mental health hospitals in the country.
The Brief:
Design and deliver the co-production of potential changes to the service.
We were tasked with designing and delivering the co-production of potential changes to the service based on long-standing concerns about its ability to meet all of the residents’ needs.
Given the complex history of the service (see challenges below), we were tasked with ensuring the effective engagement of a broad range of stakeholders including families/carers, Trust-based hospital staff, specialist community-based staff, independent advocates (on behalf of residents) and local authority-based care coordinators.
The Challenge:
Work through pre-existing attitudinal, legal and accessibility barriers to ultimately improve the lives of the service's residents.
This project provided a real opportunity to improve the lives of the service’s residents through co-production. However, there also existed some significant barriers to creating meaningful change, including:
Individuals within the service, whose ages ranged from early 40s, to late 80s, had lived within a mental health inpatient hospital setting for most of their lives.
The majority of residents were non-verbal and all were deemed not to have the capacity to make complex decisions about their own care.
Previous attempts to make changes to the service had ultimately been thwarted by legal challenges from family members who were understandably concerned about the potential impact of any changes upon their relatives.
Given the traditional nature and complex history of the service, many stakeholders, from families to staff to care coordinators, held strong, often emotionally-charged, and opposing views about what change would mean for residents, and what kind of service would best meet residents’ needs.
Many years of back and forth about closing the service and/or moving residents on had left many stakeholders cynical about the possibility of any change taking place.
We were tasked with coproducing changes to the service itself, rather than the care of individuals. However, the residents were necessarily different individuals with different needs and wants, for whom a ‘one size fits all’ solution was unlikely to work.
Our Approach:
Focus everything back to the humanity and transparency of the co-production process.
Against this complex backdrop of practical and relational challenges, we worked with the NHS Trust and commissioners of the service to understand the important role of transparency and humanity in the coproduction process, which hinged on rebuilding trust between different stakeholder groups, in particular between families and the local commissioning and care coordination teams.
In order to ensure that the service provider and myriad commissioning teams were fully aligned at the start of the project, we worked with them to create a ‘Co-production Briefing Document’: this document set out the rationale, objectives, opportunities and limitations of the co-production process, and the extent to which power would be shared. No steps were taken in the co-production until this was fully approved by all parties.
We then designed and delivered a co-production process which placed emphasis on the bringing together of individuals with differing expertise, in order to better understand each others’ point of view and create a solution based upon all of this valuable resource. The process took place in two phases.
In phase 1, workshops were undertaken with different stakeholder groups to explore what concerns existed about the possibility of change, what they felt was working well, what changes they believed might improve the lives of residents and why. Each family had their own workshop with one of our consultants so they could speak freely and have the space to ask any questions they had.
These workshops were followed by a comprehensive report setting out all of the views expressed, highlighting the commonalities and conflicts that emerged, and setting out a list of priorities for commissioners to consider in phase 2.
During phase 2, individual meetings were held focussing on each resident within the service, bringing together families, commissioners, care coordinators and staff. Within these meetings, the findings of phase 1 were discussed and debated, followed by a discussion about what kind of services and care might best suit the resident in question, along with the pros and cons of each.
Finally, a report was produced which set out which kinds of service would potentially suit the majority of residents and the details of these.
The Results:
Fractured relationships were restored allowing for positive future developments.
This extensive coproduction process brought together more than 150 individuals with different relationships with the service and residents to create a truly coproduced consultation paper setting out the commissioners’ proposed changes to the service.
During the coproduction process, the previously fractured relationships between many families and local commissioners and coordinators began to be restored through the consistently open and honest conversations facilitated by Inclusion Unlimited in the workshops and meetings.
Alongside the relational benefits, the extensive record keeping, minute taking and reporting of every stage and every communication in the coproduction process, the transformation team gained a wealth of evidence to support their consultation proposals and any legal challenges that may take place in the future.
