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This chapter analyses collaborative forms of participation that involve both users and front-line staff in the process of creating public service improvements and innovations. Often called co-production, co-design or co-creation, these participative mechanisms are designed to promote and value the experience, skills and knowledge of users, developing partnerships between service users and public service staff to redesign and produce services that promote dignity, welfare and well-being. The analysis investigates how and why these processes might prompt changes, the management practices needed to support these mechanisms, the influence of contextual conditions, power relations and the impact of collaboration. This is achieved using a realist synthesis of co-production, co-design and co-creation cases and expert interviews with facilitators and managers who have been involved in such projects. The chapter draws on research conducted within local government and health service settings. It concludes that whilst co-production does not have the same independence and political character of autonomous action by service users and is thus not able to address broader human rights issues, it can be an effective means of achieving change within organisational boundaries.

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Volume 2: Co-production Methods and Working Together at a Distance

EPDF and EPUB available Open Access under CC-BY-NC-ND licence. Groups most severely affected by COVID-19 have tended to be those marginalised before the pandemic and are now being largely ignored in developing responses to it.

This two-volume set of Rapid Responses explores the urgent need to put co-production and participatory approaches at the heart of responses to the pandemic and demonstrates how policymakers, health and social care practitioners, patients, service users, carers and public contributors can make this happen.

The second volume focuses on methods and means of co-producing during a pandemic. It explores a variety of case studies from across the global North and South and addresses the practical considerations of co-producing knowledge both now - at a distance - and in the future when the pandemic is over.

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Volume 1: The Challenges and Necessity of Co-production

EPDF and EPUB available Open Access under CC-BY-NC-ND licence. Groups most severely affected by COVID-19 have tended to be those marginalised before the pandemic and are now largely being ignored in developing responses to it.

This two-volume set of Rapid Responses explores the urgent need to put co-production and participatory approaches at the heart of responses to the pandemic and demonstrates how policymakers, health and social care practitioners, patients, service users, carers and public contributors can make this happen.

The first volume investigates how, at the outset of the pandemic, the limits of existing structures severely undermined the potential of co-production. It also gives voice to a diversity of marginalised communities to illustrate how they have been affected and to demonstrate why co-produced responses are so important both now during this pandemic and in the future.

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In this chapter, we share our experiences about a project that aims to improve access to primary care services within GP (general practitioner) practices for women who have experienced trauma and have complex needs – the Bridging Gaps project. This chapter is written by some of the women in the group in their own words. It is a combination of our different experiences and thoughts about the project. As some of the Bridging Gaps group would rather not share names, this has been written anonymously.

Bridging Gaps was started by a group of Bristol women with personal experience of trauma, including addiction, homelessness, mental health problems, sexual exploitation, domestic and sexual violence, and poverty. Women who have faced extensive trauma often have low engagement with mainstream health services. They can experience extreme health and social inequalities, and have complex needs that are not always understood, or met, within primary care services.

Bridging Gaps offers health professionals who work with women with complex needs a greater understanding and awareness of complex needs and trauma via a one-hour training programme led by a group of women with lived experience of these issues. The women involved in our group range in age, ethnicity, and expertise including doctors, health professionals, support workers, researchers, and most importantly, women with lived experiences who are experts in their own traumas. These experiences include genuine, honest, and extremely raw hardship that they deal with, or used to deal with, on a day-to-day or week-to-week basis. Collectively, we aim to work collaboratively with health services so that they can identify, engage and work in a meaningful way with women who face many barriers to seeking and engaging with treatment.

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In this edited collection, our aim was to illustrate the value and means of co-production or, more specifically, why it is valuable and how it can be done. It is worth noting that our starting point for achieving this aim was reflecting on who has been disproportionately disadvantaged by the pandemic and how discrimination, marginalisation, and exclusion increased their vulnerability to both the COVID-19 virus (in terms of mortality and morbidity) and the implications of responses to its spread (in terms of relative access to resources, support, and involvement in key decision-making processes in research, policy, and practice). Our attention then turned to how we could ensure this book became a platform for these people, groups, and communities to share their experiences, insights, and expertise. As was outlined in the introduction to this volume, co-production has over time been defined and conceptualised in different ways. What our ambition for this book reveals is that central to our conceptualisation and practice of co-production in health and social care research, policy, and practice is an egalitarian imperative. That is, our primary interest in and advocation for co-production is as a means to ensuring that collaborative endeavours that explicitly address inequities in power can support marginalised communities, citizens, patients, and services users to create, shape, and improve health and social care research, policy, and practice.

Collectively, co-production endeavours must actively seek to promote health equity, by addressing inequity, diversity, and exclusion, and recognise the significant role that the social determinants of health have in creating and perpetuating inequalities in health and access to care.

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In the introduction to this volume, we outlined how the COVID-19 pandemic has highlighted the need to better understand and utilize co-produced responses to improve public policy, political responses, and health and social care research and practice. However, there are extensive constraining social structures that inhibit working in this way. The experiences of the most exposed, marginalised, and discriminated – in short, those who are systematically excluded in our societies – rarely directly influence the policies and practice that are ostensibly created for their protection. Crucially, given the disparities in the risk and outcomes of COVID-19, why are these people and communities not considered best placed to create and implement sought-after solutions for effective management, improvement, and research of pandemic responses?

Through this book, we wanted to:

  • explore how so many people are ignored, disempowered, and discriminated against in health and social care research, policy, and practice;

  • address how and why more collaborative, diverse, and inclusive responses could lessen the toll of this pandemic and future health emergencies, as well as more generally improve health and social care research, policy, and practice;

  • illustrate how and why collaborative ways of working can help to address the social wrongs and power imbalances that we need to right.

In particular, this volume set out to explore: (1) the impact of existing structures on ambitions and efforts to work in more participatory and collaborative ways in health and social care research, policy, and practice, and (2) how the pandemic has highlighted and exacerbated existing inequities and marginalisation both in practice and research. The collection has demonstrated through a diverse range of examples the impact of the pandemic on people’s lives and ways of working.

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Since the first lockdown I have spent my days as a welfare rights worker on the phone supporting people to claim the benefits they are entitled to, or if their claim has been rejected, helping them to appeal against this.

Although understandably the COVID-19 pandemic has resulted in a focus on health and public health policy, income maintenance policy is no less important. In the UK for example, numerous policies have been introduced since lockdown to deal with the two big interrelated problems any such pandemic poses – making people ill and damaging the economy. Fear of spreading infection has resulted in more and more people being temporarily unable to work, furloughed, losing their jobs, or being made redundant as well, as self-employed people losing their income and often their businesses. In such cases in the UK, people may claim universal credit. If they become sick, they may claim employer or statutory sick pay, although as we shall see, the small print gets more complicated.

This means that there has predictably been a massive increase in the numbers of people reliant on UK state benefits. Historically when that happens, for example, during the last World War, with the blitz injuring and making people homeless, or in times of depression and massive unemployment, it often leads to improvements in benefits policies as many more people discover for themselves that living on welfare is far from the easy option that the right-wing media often portray it as.

COVID-19 has happened following just such a moral panic with the harshest of ‘welfare reform’ policies in operation now in the UK for more than a decade.

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