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Co-production needs to take us out of our comfort zone in order to work

Fiona McLaughlin

Co-production should be both straightforward and challenging. We should be outside our comfort zones, moving away from 'us' and 'them' and working towards 'we'. Read what Fiona McLaughlin has to share on what makes co-production work.

I am a patient, a former carer and a volunteer.  I spend more time than I could ever have imagined possible, thinking, talking and writing about how the Northern Ireland health system works. Sometimes I get heard. Somtimes I get cross.

A huge talking point and area for development these days is "co-production". Its all part of the Delivering Together agenda that our politicians agreed on before they decided to disagree on other things.

Co-production should be straightforward and challenging.  We should be outside our comfort zones, moving away from "us" and "them" and working towards "we".

A bit like Pilates, if we're not uncomfortable sometimes we're not doing it right. It requires all of us to work differently and, ultimately, to produce better results for all.

Co-production is where power is shared, different expertise and experiences are valued and considered in the development and delivery of public services, and trust and partnership working are at the core to improve outcomes.

It will only work if there is a fundamental recognition of the power relationships that accompany the process.

We should remember:

  • Plain English is preferred. Exclusive jargon (yes, "mutuality" and "reciprocity", I mean "you") should be avoided.
  • Dont just talk about 'working differently'; choose to work differently.
  • Patients and carers give up their time to participate in co-production and other Personal and Public Involvement activities on a voluntary basis.  It is not enough to provide coffee, sandwiches and bus fares.  Time needs to be well spent - bored or ignored people will not return to the work.
  • Everyone involved should have access to practical support, such as training and mentoring.
  • Co-produced work should be valued and recognised. It should not be consigned to the shelf or "redone" for no apparent reason.

We each have our own experiences. We may have been bruised by previous engagements with 'them'. Trust doesn't develop easily, and wishing won't make it so.

We need to deliberately build relationships based on openness, transparency and shared decision-making.

Co-production has the potential to transform our health and social care systems for the better.  The same people, continuing to talk to each other in closed spaces, will not be co-production.

Bringing new people 'to the table' is not enough.  We need to move the table and encourage everyone to join in as equal partners.

Of course its challenging.  Everything worthwhile is.


Do you have any examples of when co-productioin has worked well and when it hasn't?


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Previous comments ...

Christine Morgan 24-Apr-2017 at 20:20 hrs

My best example I when a group of disgruntled patient & carer people/activists got together & Alison Cameron talked to Helen Bevan form NHS Horizons to see if we pull off a 'People's Transformathon' which was led by patients and carers and who co-productively invited clinicians and professionals to work with us. This was sponsored by the People & Communities Board, using their '6 Principles for engaging People & Communities' as a framework - and made technically possible by Helen and the Horizons team. We broadcast live for 8 hours in November 2016 and the broadcasts are available along with additional resources on The Edge website see link:

I do know how easy it is to do co-production badly or even worse people think they are doing it but they're not! It takes a real mindset shift I think to get it right and a lot of planning and preparation with everyone taking part. I also work as a co-production member with the Coalition for Collaborative Care and co-chaired a group who worked up a 1 side of A4 model as a starter for 10 which is endorsed by NHS England. For information here's a link to how it came about and the model can be downloaded from it if useful to people.


Carol McCullough 23-Apr-2017 at 15:54 hrs

Thanks Fiona. Over the years calls for improved partnership working, engagement, PPI, coproduction or whatever language is used has not changed. Surely still talking about the need ‘to do’ rather than ‘just talking about doing’ demonstrates that barriers to coproduction still exist- years on.
Key features of coproduction include: defining people who use services as assets with skills and breaking down barriers between people who use services and professionals. This can happen, in any instance, where service users and professionals work together to improve services. My most successful examples of improving care relate to working with my own health care providers. It has enhanced personal experience. It has also resulted in improved services for others. Seeking advice of international rare disease experts laid foundations for revitalised and successful partnership with regional professionals. I have also, in the past, contacted a clinical chemistry lab, and with the help of guidelines and an international experts’ advice, this led to re-evaluation of analysis for a testing technique and correction of the range for a copper study investigation. Proof that people can work together!! There have been other successes. Building partnerships with your health care providers is at the core of improving patient experience and much can be learnt about improving ‘coproduction’ in all other areas from the patient’s personal experience of health care.
A negative personal experience (failure) was due to becoming involved in the complaint’s system. I had insisted that I did not want to make a compliant but it was the only option offered. People who know me will understand my concerns about patients, and other vulnerable groups, being pushed into what is a negative, bureaucratic process that can result in alienation and a ‘them and us’ situation. My own experience of the complaints process is also proof of how patient safety can be compromised rather than being a priority. I am known for my persistence where patient safety is concerned and if people work with me I shall work with them. If barriers are put in place I ask why. I shall continue to ask why the complaints system creates barriers to coproduction, learning and patient safety.
Language used depends on circumstances; including the capacity to understand and personal preferences. What is jargon? I do not believe medical terms should ever be labelled jargon; and we need to be careful that the experience of patients who are happy to learn medical terminology is not diminished because some people do not like it. Understanding medical terms can actually enhance the patient/ professional experience and improve care. Furthermore, if we want to research an illness online, very important where rare disease is concerned, we need some understanding of the language used in publications etc. We also need to be able to differentiate the reliable from the unreliable on the Internet. To sum up language used needs to be flexible to cater for diversity and this flexibility should filter through to all areas of coproduction.


S Thompson 22-Apr-2017 at 00:19 hrs

Bravo and hear hear and yes yes yes.