Co-production: defining the future of social care
Dr George Peat (University of York)
Co-production is increasingly seen as central to social care but evidence on its application in research is still relatively scarce. In this blogpost Dr George Peat, NIHR SSCR Career Development Award holder, describes the start of his co-productive journey with a group of young people with neuromuscular conditions.
An appetite for change
There is a growing appetite and need to change the way social care is delivered. A major House of Lords Adult Social Care Committee report recently called for a ‘fundamental reset’ in attitudes to social care, ‘replacing top-down and paternalistic approaches’. Underpinning this change is the notion of ‘co-production’.
While definitions vary, there is collective understanding that co-production in the context of social care aims to move towards a process where decisions about a person’s care are made collectively and equally, grounded in the recognition of people as experts and active agents in their care, as opposed to passive recipients. While there are notable examples of co-production in practice (e.g. The Wigan Deal), to realise its potential requires developing evidence on how we might seek to apply co-production both in social care practice and research. At present there is relatively little evidence on ‘co-producing’ social care research.
In April 2022, I was fortunate enough to receive an NIHR School for Social Care Research Career Development Award. The award would support me to develop an NIHR Advanced Fellowship application, drawing on the findings of my doctoral work, exploring the online and offline lives of young men with Duchenne Muscular Dystrophy; a life-limiting neuromuscular condition. Integral to application development would be the co-production of the study component. Prior to receiving the award, I had little applied understanding of co-production and therefore I, as well as the project, started from a relatively blank canvas.
Beginning with a blank canvas
My first port of call was to attend a 5-day workshop on co-production, run by Dr Liz Ellis at the University of Highlands & Islands. The course was both informative and transformational in that it grounded my understanding of co-production as a process that ‘can lead to different and sometimes unexpected forms of knowledge, values, and social relations’ (Filipe et al, 2017). This realization pushed me out of my relative comfort zone of predetermined aims/objectives drawn from previous findings, and neat literature reviews; to an openness to developing research outside of these familiar parameters.
Leaving Scotland with a clear understanding of what co-production ‘should be’ I looked to recruit a group of individuals to share the project with. Utilising social media and the advertisement pages of charities such as Pathfinders Neuromuscular Alliance and SMA UK, I was fortunate enough to be joined by Suzanne, Catia, Grace, Steven, and James who you can read more about here.
Marking the canvas: definition development
As a group of relative strangers, it was important that we were able to anchor our ‘getting to know one another’ to an activity that supported and laid the foundation for our work. Initial conversations over Zoom led us to the conclusion that none of us really understood or grasped what ‘social care’ really meant. This realization was likely both the product of the fragmentation and diversity of services that may fall under social care, and indeed the lack of a universal definition or identity of social care alluded to elsewhere. We therefore set about discussing and identifying a collective understanding of what we felt social care meant, based on the group’s experiences. Terms such as ‘unheard’, ‘health before social’, ‘tickbox’, and ‘medicalised’ were gathered. Drawing on these keywords, we sought to write our own definition of social care as experienced:
‘Social care as a disabled young adult means engaging with a system that fails to adapt to our needs as we transition from child to adult services. Engagement with adult services can feel patronizing on account of engaging with a system where I have to repeatedly justify my needs as a young adult. Initial engagement with social care services, such as in the form of a needs or health assessments can feel as if I am a number, with a need to reach a certain score to ‘qualify’ for care. Post-assessment, it feels like money and cost come before all else, including my needs. As a result, reviewal of my care package can be scary, stressful, and anxiety inducing, characterized by a continuous need to fight for my care, with the ongoing threat of my individual choices and needs being prohibited by a system that should be championing them’.
Aspirations for social care
If the above definition reflected the groups experiences of social care now, how might we imagine a future social care system for disabled young adults? Reengaging in the same exercise, we identified keywords and phrases including ‘willingness to engage’, ‘focused on what we can do’, ‘enabling’, and ‘being known’. Collectively, we formed the following definition of a future social care for disabled young adults:
‘Social care for disabled young adults means a system that consistently delivers to the changing needs of the person as they go through young adulthood in a manner that is informed, approachable, and coordinated. This starts from an initial assessment of needs that accounts for the present needs of the individual, but also enables them to make long-term decisions about their care. Delivered care and support is therefore proactive as opposed to reactive, and goes beyond ‘eat, sleep, repeat’ to care experienced in a way that is meaningful to the individual. Reviewal of care is geared towards ensuring individual needs continue to be met with a care package that responds to such needs’
Towards a brighter future
Both definitions serve to illustrate where we are now and where we hope to be. It is my sense from my early encounters with co-production, that it is crucial to us realizing the definition described above and the wider vision for social care outlined in the House of Lords report. You can read more about our co-production journey here.
G Peat (2023) Co-production: defining the future of social care, NIHR School for Social Care Research Blog, 14 February 2023