a pinch of SaLT

Improving Outcomes Through Co-production

All too often, asking a young person “What do you want to be when you grow up?” is seen as including their voice, and choice, in an Education Health and Care Plan (EHCP). In most cases, this is simply a tokenistic nod to co-production. How should we include the voice of the young people we work with? How can we make sure they are equal partners in their care? How can we engage in meaningful co-production and encourage other professionals to follow suit? In this blog post, we’ll explore this concept, why it is important, some of the practices around it and the potential it has to improve outcomes for children and young people.

Co-production is not a new concept, and it exists beyond systems of health, education and care. In theory, to co-produce is to work together to find personalised solutions. In practice, it means working in partnership with service users from conception to delivery, on the understanding that those who use a service are best placed to help design it.

Communication is a vital element in this process. Meaningful communication has three key components: an effective way to communicate, a reason to communicate and opportunities in which to do so. Enabling the means, reason and process through which people can communicate what is important to them and what is important for them, is the first step in engaging in genuine coproduction. Without these components, we risk loitering around the ‘informing’ or ‘consulting’ level of the snazzy diagram above, and as experts in communication, I don’t think that’s a place for us to loiter.

As speech and language therapists, many will already be co-producing on a regular basis. For those of you who are, great! For anyone who has never stumbled across this term before, let’s look at it in a bit more detail. Figure 1 shows that as meaningful participation increases, the relationship between the practitioner and the service user also changes. That is, we move from engaging with passive recipients of our service, to engaging in an equal partnership. When I use services, like going to GP or counselling, I know which end of the scale I would want to be on.

Navigating healthcare for people who have fewer barriers can be relatively easy compared to those who do not share the same degree of privilege. This is in part due to the institutions being designed for white, male, cis-gendered, neurotypical, non-disabled and heterosexual people. This means that these people are more likely to access services in relatively equal partnership. They are allowed the ‘luxury’ of making choices about the care they receive, planning the steps to achieve the goals that are set and having opinions that carry some weight!

For those without strong communication skills, available resources and those from marginalised groups in society, we need to reflect on whether these people are treated as equal partners. Whether this is by us, or others. Do practitioners make decisions with them? Or can they find themselves in a position where their voice is not seen as equal, the choices about their care are not theirs to make and the process of planning their treatment is something for others to talk about behind closed doors. I wonder, if all too often, that is the position that young people with special educational needs find themselves in, and I believe, as speech & language therapists we need to push the agenda for change.

In order to progress beyond ‘doing to’ or ‘doing for’ (see Figure 1) we must engage in an ongoing, meaningful dialogue, in which the young people that we work with are equal partners in the discussions about their care. The diagram below captures this process as a cycle of co-production, a continuous flow of partnership working. While I may be preaching to the converted, or worse, trying to teach our readers to suck speech-therapy-eggs, this is not the aim. This is merely an opportunity to share my reflections with a wider audience, and to galvanise some support for this approach to planning treatment.

On an individual basis, as SaLTs we need to do more than listen to our service users. We need to actively seek out their opinions and work with them to provide the means to communicate these to ourselves and others. Beyond our own practice, we can label ourselves as agents of co-production and strive to amplify the voice of our service users by facilitating conversations with other professionals who are involved in their care so that they are equal partners in the discussions about their care.

So, on to the important bit, and I apologise that it has taken a double side of A4 to get here, resources!

Below, I have included the references of some helpful websites that provide some wonderful instruments of co-production. These are easy to use, and more importantly, free! Hurrah.

Stay tuned as we plan to share more about effective co-production and please drop any questions you have below.

Coproduction Literature:

The following links will take you to some useful articles that you can use for your CPD, and to increase your understanding of the theory.

Coproduction Resources to share with colleagues:

If you need to sell co-production to your colleagues or commissioners, the following resources may help you to do so. These helpful infographics break down what co-production is, and how to achieve it.

Coproduction resources for therapy sessions:

Finally, the following links will take you through to some helpful, printable resources that you can use to help you on your co-production journey.

References

Elwyn, G., Nelson, E., Hager, A. and Price, A. (2019). Coproduction: when users define quality. BMJ Quality and Safety.

www.thinklocalactpersonal.org.uk. (2015). What makes co-production different? [online] Available at: https://www.thinklocalactpersonal.org.uk/co-production-in-commissioning-tool/co-production/In-more-detail/what-makes-co-production-different/ [Accessed 15 Feb. 2021].

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