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  • Author or Editor: Michelle Farr x
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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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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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The first of a two-volume set, this book explores the need to put co-production and participatory approaches at the heart of responses to the pandemic and demonstrates how to do this. It 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.

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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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Open access