Tag Archives: #NHS70

Embedding co-production at all levels of care

Margaret DangoorMargaret Dangoor, member of C4CC’s co-production group shares her experiences of helping to deliver co-production at a local level in celebration of national co-production week (2-6 July 2018) #coproweek.

In all the fanfare around the 70th anniversary of our wonderful NHS, it may have been easy to miss that it’s also been National Co-Production Week.

In PR terms, it could indeed be seen as an unfortunate clash, but as someone who has been promoting the principles of co-production on both a national and local level for a number of years, I take the opposite view.

If the NHS and our social care services are to continue to prosper and improve for the next 70 years and beyond then we need to firmly embed the principles of co-production at all levels of care.

It’s a model for the future and I’m heartened to see that it is gaining traction within NHS England and in many different local authority areas.

I have been actively involved for nearly 30 years in the London Borough of Richmond upon Thames. Initially I was involved in the community and voluntary sector, then focused on the development and chairing of statutory patient participation groups.  On becoming a carer for my husband who developed Alzheimer’s disease I became particularly involved with representing the voice of users and carers within the local NHS and borough health and social care services, whether at strategic level, influencing commissioning – or monitoring provision.  I am also currently chair of a local health centre’s patient and public involvement forum.

I’m pleased to say that Richmond was an early adopter of co-production several years ago and marked the national week with publicity around the work that is being carried out, particularly with carers.

“Involving the users of care and support services, and their families and carers in making decisions about how their care is delivered empowers them to be able to live full, independent lives,” was a quote from Cllr Piers Allen, Cabinet Member for Adult Services and Health.  I cared for my husband Eddie for many years until he sadly passed away in January of this year and was grateful for good local support, particularly a specialist dementia day centre and a Caring Café supported by the local authority.

From personal experience, I found that being able to have a say and being listened to is so important in end of life care. Properly planning for the final few weeks, in liaison with the family GP practice, when medical intervention was limited but supportive was so beneficial.

Following a short stay in hospital and discharge, we made a conscious decision that it was not in my husband Eddie’s best interest and agreed a plan as to how he would see out his final days in the community, with compassionate care and dignity.

I firmly believe that having a good death is an important part of having a good life, and the principles of co-production are so relevant in this area.

I’m determined to carry on this work locally as chair of the health centre patient participation group and my other local health and social care involvement.  I am also involved with social care research, through the NIHR school of social care research and the personal social services research unit based at the London School of Economics and Political Science, as well as my national involvement on the C4CC co-production group and as a trustee of the Centre for Ageing Better.  I also volunteer for Carers UK and the Alzheimer’s Society.

I think it is true to say that NHS England can promote and support strategies around co-production, but it needs to work at a local level and that is happening both in Richmond and other areas across the country so it is great to get both perspectives; in fact, it is essential.

The benefits of collaborative working across the health and social care system and using community assets to deliver care are a fundamental part of C4CC’s Three Cs and are so important as we celebrate the past successes of the NHS and build a service for the future.


‘Co-production isn’t a one-night stand’

Mandy RudczenkoTo mark SCIE’s Co-Production Week, #coproweek, which runs 2 July to 6 July 2018, Mandy Rudczenko, member of C4CC’s own co-production group has written this blog post on the importance of co-production being a long-term relationship. Mandy’s post is timely given that this week we’re also celebrating 70 years of the NHS #NHS70. It highlights just how far we’ve come over the years in recognising the importance and value of co-production in health services.

Mandy is a former mental health nurse and adult education tutor and helps her son to manage Cystic Fibrosis. Mandy has become an active campaigner for co-production of health and social care services, person-centred care, and self-management of long-term conditions and has contributed to design and co-production of many NHS services. She has served as an Expert by Experience on the Five Year Forward View People and Communities Board, as a lay member on a Clinical Reference Group (CRG) and is a member of the East Midlands Clinical Senate Council Read Mandy’s full bio here.

I recently found myself using the phrase ‘Coproduction is not a one-night stand’. It seems quite a popular way of emphasising that ‘Coproduction is a long-term relationship’ (TLAP – Ladder of Coproduction, see below).

In my 5 years as a patient/carer representative, aka patient leader, aka patient ambassador, aka expert by experience, aka lay member, aka patient partner, the most important thing I have learnt about co-production is that it isn’t a new thing. I remember having a brilliant English teacher when doing my ‘O’-levels. She treated us like adults and we planned our lessons with her, as a class. I didn’t know at the time that we were co-producing. All I knew at the time was that, this teacher was popular because she realised that our contribution to lesson planning was of equal value to hers. She was brave enough to break down the hierarchical barriers and, as a result we more motivated and learnt more. To me this shows that the basic principle of co-production is that we treat everyone involved as an equal member of the team. Surely that should happen anyway? Why does it need a label?

In terms of health and social care, it gets tricky. I vividly remember my first meeting as a lay member, at a Clinical Reference Group, 5 years ago. I was terrified. I had to go to London, which felt like an expedition. I was able to claim back the train fare but wasn’t paid an involvement fee. I didn’t even know what an involvement fee was, and, to be honest, I felt honoured to be invited! During the discussions I felt like a fraud as I didn’t understand a lot of what was said. I managed to suggest a few things from a patient/carer perspective, so I walked away quite pleased with myself. It took 3 months to get the train fare back!

So, was I an equal member? I now know that I wasn’t, and that CRG’s and similar hierarchical committees, actually make coproduction impossible. I wasn’t an equal member of the  CRG for many reasons. I wasn’t involved in producing the agenda; I wasn’t able to access the medical information being discussed; I didn’t understand my role. Looking at TLAP’s Ladder of Co-production (below), I definitely felt coerced, and flattered, which is even worse!

For co-production to work, the public has to be equally involved in planning AND delivering services. TLAP’s Ladder of Co-production (below) clearly shows the importance of ‘doing with’.

Image showing TLAP's co-production ladder

In the last five years I have experienced some excellent examples of co-production. The most exemplary examples are those which involve ‘co-producing the co-production’. As a member of C4CC’s co-production team I was involved in co-producing its ‘Co-production Model’:

It was lengthy process, demonstrating the commitment to doing it properly. The process of co-producing it reflected all the values and behaviours within the model. The model wasn’t done to us or for us, it was done with us.

Similarly, I have recently been involved in an ‘Expert Advice and Ideas Session’ to co-produce the UCL Centre for co-production in Health Research:

In her blog, Niccola K Hutchinson Pascal (Project Manager) says:

“For me, it was critically important that the process of developing the Centre needed to be a shining example of good practice in co-production – after all, how could we show/tell people how to do co-produced research properly, if we weren’t doing it properly ourselves?!”

When I first started my journey as a lay member, I didn’t know what co-production was. I knew that, as my son’s carer, I was sick of us being ‘done to’. I now know that true co-production has to start on Day 1.

Mandy Rudczenko



‘Thank God for the NHS and Nye Bevan!’

Photo of C4CC co-chair Nigel MathersTo mark 70 years of the NHS, C4CC’s co-chair, Nigel Mathers, writes this blog post on why he owes so much to the NHS and what his hopes are for the future.

I owe so much to the NHS.

I had severe asthma as a child and without the NHS, back then in the early 1950s – in its infancy, it would have been very difficult to get a good quality of treatment.

After training at medical school, I spent my entire working life in general practice, a fulfilling and rewarding career.

And just last year it proved a life-saver after I suffered a major heart attack and collapsed in the street.

Fortunately, an ambulance crew arrived in only seven minutes and was able to resuscitate me at the roadside. I had just a five percent chance of survival and was rushed to the coronary care unit at our local hospital.

Thanks to the skill of the surgeons and the wonders of modern medical technology I pulled through and have made a great recovery with a good quality of life.

Of course, this is one of the major success stories of the NHS, survival rates from heart attacks, many forms of cancer, particularly breast cancer, and a host of other diseases have dramatically improved over the past 70 years.

Way back then, heart attack victims were prescribed prolonged bed rest, while my rehabilitation has been based around daily four to five mile walks – tough at first but necessary and now part of my daily routine.

So it is easy to see why I care so much about the service launched by good old Nye Bevan in 1948 and now having to adapt to the very different landscape of 21st Century Britain, with all the challenges that brings.

As a former Honorary Secretary of the Royal College of General Practitioners (RCGP) and as co-chair of the Coalition for Collaborative Care (C4CC), I have been campaigning to bring about the changes to the health system that I believe can help it thrive for the next 70 years and beyond.

The NHS and social care services are currently under immense pressure through a combination of an ageing population and over 15 million people living with complex long-term conditions.

C4CC believes that the answer to easing these pressures, and providing people with the high-quality care and treatment they deserve, lies in our Three Cs – Better Conversations, Co-production, and Stronger Communities and happily there is now general consensus that this is the way forward. This personalisation of care has captured the zeitgeist – ‘spirit of our times’

As I look back on my career in general practice, which spanned over half of the 70 years since the NHS started, many of us were already using or beginning to harness these key principles in our daily work.

When I started as a GP, consultations with patients lasted the grand total of five minutes, the relationship was much more formal, with nobody calling me by my first name, and conversation and interaction was strictly limited, not least because of time.

In my inner-city practice, we tried hard to break down these artificial barriers by dressing informally, having soft furnishings in the rooms and never sitting directly behind a big desk when talking to people we adopted a conversational style across the side of a desk for consultations.

It was innovative at the time, but is now seen as best practice and of course consultations can now last up to 15 minutes, giving the opportunity to get to the root of a problem, which may not require costly medical intervention.

Co-production as a notion has also been around for a long time, it was just not called it.

In the 1980s we talked about a meeting of experts, with people experts on themselves and what might work best for them, and doctors the experts because of their medical training.

This evolved into RCGP best practice around shared decision-making, designed to encourage the patient to be an equal partner in their own care, the basic principle of what is now called co-production.

I’m particularly proud that C4CC has developed a model for co-production that seems to work and which has been adopted by our partner NHS England in its planning in this key area.

Finally, we have always relied on community and the voluntary services to address the unmet needs of our patients and sometimes [sadly] to fill the gaps in health and wellbeing provision for our communities.

My practice and many others were prescribing exercise in the 1980s, organising bi-weekly walks from our surgery for those we felt might benefit.

We now call this social prescribing and whether it is running, walking, joining other community groups or simply volunteering it has been found that these non-medical referrals can relieve the burden on the NHS and tackle issues such as loneliness and social isolation, themselves major causes of illness.

So while our Three Cs may not be new, I believe they really have captured the spirit of our times and as the NHS looks to the next 70 years will play an increasingly important role in policy direction and strategy.

It’s about changing the culture – about helping people to become active participants in their own care rather than passive recipients of that care – to encourage them to be far more involved in their own care and treatment.

The staggering pace of scientific development will, I believe help play a major part to facilitate this.

Wearable technology such as Fitbits and other devices allow people to monitor their fitness and general health.

There will be far greater interaction with people and health professionals through the Internet and advances in genetic technology [eg individually tailored drug treatments] are another area that has such tremendous possibilities for everyone.

Despite the current challenges, I believe we can look forward to the future with optimism.

I know C4CC and our partners in the coalition have a key role to play in shaping that future and to lead this social movement for change in the way that we work with people to improve their care and deliver better health outcomes for all – ‘personalised care’ for all – right across our NHS.

Nigel Mathers, Co-Chair of C4CC