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The opening two decades of the 21st century can arguably be characterised as a period of continued technocratic consensus about the need for a better articulation between evidence and public services, alongside rising contestation about how that relationship should be realised. This has been accompanied by an increase in the range of data that are amenable to analysis, synthesis and use (see Chapter Ten) and a broadening of notions of evidence that are seen as legitimate (see Chapter Eleven). At the same time, however, there has been some disillusionment – itself informed by a growing body of knowledge – about the feasibility of a straightforward path from evidence generation, through policy formation (the challenges of which are articulated in Chapter Two) and into implementation in service delivery (the focus of this chapter).

We explore these developments with a particular emphasis on evidence-informed service delivery. First, we describe traditional ‘top-down’ approaches to the dissemination and implementation of evidence. Despite rhetoric to the contrary, these approaches remain important in many public services, backed by sometimes rigid and powerful regimes of audit, inspection and rating. However, their limitations are increasingly acknowledged, and the second section outlines critiques of such approaches and describes ‘bottom-up’ alternatives that rely on more localised evidence generation and utilisation, often with a view to incorporating wider forms of knowledge. In the third and fourth sections we consider approaches to the sharing of knowledge and evidence within and across public service organisations, and the challenges in so doing, and then highlight a number of cross-cutting challenges to the use of evidence in service delivery.

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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 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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Our title quotes what British Prime Minister Boris Johnson reportedly said when comparing his COVID-19 experience (which required intensive care) with cabinet members who had mild symptoms. It is suggested that Johnson’s brush with mortality profoundly impacted him – it was followed by public declarations to lose weight and policy shifts he previously would have likely dismissed as nanny statism. While it is politically convenient for Johnson to link the severity of his illness (and by inference the impact of the virus more generally) with factors popularly promoted as within individual control (for example, bodyweight), he is not alone in exploiting this pandemic to promote simplistic and stigmatising ideas about bodyweight and health.

Although not popularly known or accepted, in recent decades research, advocacy, and activism has made significant progress in demonstrating the complexity of relationships between bodyweight and health, the multifaceted and interrelated biological, psychological, and social causes of ‘obesity’, and how common (mis)conceptions and prejudice ultimately promote discrimination of people who variously identify as (among others) Fat, higher weight, and living with obesity. Responses to the COVID-19 and Body Mass Index (BMI) link have largely ignored this. The urgency of a pandemic, and opportunism of those with vested interests in over-emphasising personal control and responsibility, create a perfect storm for harming people across the weight spectrum – particularly those above and below what is considered ‘healthy’. We consider evidence that has been ignored and ways this pandemic is disproportionately harming those who transgress medically and/or popularly ‘acceptable’ bodyweight and eating norms – drawing on personal experiences of transgressing these norms, providing healthcare to those with eating disorders, and academic expertise (including that imbued with related ‘lived experience’).

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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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