Enabling Co-production
1 Introduction
1.1 Background
One of the key recommendations of The Five Year Forward View for Mental Health called for the development of evidence-based approaches to co- production in commissioning.
Since then, the NHS Long Term Plan has also committed to ‘doing things differently’ throughout the healthcare system, backed up by increased funding for mental health care. It encourages collaboration among people, primary care and community services, commissioners and clinical commissioning groups (CCGs), and between services and trusts. The NHS also promotes co-production in mental health care through personalised care plans, which give people more control over their health and care. Overall, the NHS Long Term Plan’s pledge to ‘do more to develop and embed cultures of compassion, inclusion and collaboration across the NHS’ means that co-production in mental health care commissioning is vital and achievable.
The National Collaborating Centre for Mental Health (NCCMH) was commissioned by NHS England to build an evidence base for co-production in mental health commissioning using both documented and undocumented case studies.
1.1 Purpose and scope of this document
By setting out the evidence, including examples of positive practice, this document aims to improve local strategic decisions about, and the provision of, current and future mental health services for children, young people, adults and older adults. This includes people who are not in contact with mental health services, because of existing barriers to access or for other reasons. This
document also talks about co-production with people who are in at-risk populations, including those who have an increased risk of being detained under the Mental Health Act 19833 (amended 20074 and by the Policing and Crime Act 20175) and people who may face discrimination because of their protected characteristics (see Section 1.5 for more information on protected characteristics and inequalities).
The recommendations from this document are aimed at commissioners of mental health services, and will also be relevant for the following in mental health:
• drug and alcohol (addiction) services
• health professionals and other staff in contact with people with mental health problems within healthcare settings
• physical health services including acute, primary and secondary care
• people who need mental health support, and their families, friends and carers
• service providers
• voluntary, community and social enterprise (VCSE) organisations.
This document will support commissioners in end-to-end co-production, providing guidance and tools for co- produced commissioning, practical recommendations for each step and ways of measuring the effectiveness of the process. It includes key co-production principles for creating measurable standards, describes the existing evidence gaps and identifies examples of positive practice.
1.3 Current context for co- production
Public involvement has been central to NHS ambitions for many years.6 The NHS Constitution for England holds public ownership in high esteem, declaring that the NHS is accountable to the public and that those who may need to use NHS services should be involved in their development and improvement.7 In addition, the Children Act 2004,8 Health and Social Care Act 2012,9 Care Act 201410 and NHS England’s Patient and Public Participation Policy all require CCGs, local authorities and NHS England to embed public involvement and
consultation in the commissioning of health services. Section 3.2 discusses levels of participation in co- production in England; although these efforts rarely reach the level of genuine co-production, they provide a strong foundation and tradition on which to build.
1.3.1 Current levels of public engagement
A review of patient and public involvement showed that many clinicians consider patient satisfaction questionnaires part of co-production,12 and that these kinds of consultation exercises are the most commonly reported method of engagement.12,13 However, such consultation represents a low level of involvement
and does not constitute a co-production partnership (see Section 3.2). Also, this method does not allow organisations or commissioning bodies to explore ways to modify their practice. Using this method alone also excludes people with unmet needs, especially those who are not in contact with mental health services.
These different understandings of engagement and co- production may have contributed to the development of different co-production models (see the helpful resources in Section 6), which in turn may have caused confusion around what constitutes best practice. This document uses existing models and available literature to clarify the key aspects of best practice and to provide the basis for a common understanding
