Co-production is a way of working that creates an equal partnership between those who receive treatment and care, and those who provide care and the communities around them. This partnership then influences and shapes how services are designed, delivered and evaluated. At the heart of co-production is the acknowledgement that individuals with ‘lived experience’ of a specific condition can provide valuable insight into the support and services that can positively impact their lives (NHS England, 2020).
A co-production partnership brings together the ‘lived’ experience of individuals with the ‘learnt’ experience of clinicians and professionals, sharing power equitably to improve care together. When done well, co-production is grounded in the principles of accessibility and equality and is the cornerstone of person-centred care.
Elysium Healthcare and co-production
Co-production is a priority focus for Elysium Healthcare across its entire organisation, but it is of particular importance within the CAMHS division. Ensuring that young people receive care that is relevant and appropriate for their individual needs is vital for achieving positive outcomes.
Over the past two years, the CAMHS team have achieved huge progress in embedding the co-production ethos and ways of working within the CAMHS services. In this CAMHS EveryExpert article, we speak with Colleen Fahy, Regional CAMHS Quality Manager, who was part of the core team that launched the co-production initiative in 2023.
Colleen worked alongside Priya Thakrar, Regional CAMHS Quality Manager, and organisational Group Service User Expert By Experience Sue Denison, and together they spoke with service users, parents and carers, experts by experience, staff and NHS commissioners, encouraging them to think about co-production and working together.
Through a range of workshops and virtual sessions, participants discussed and reflected upon the areas of co-production that were important to them, where good practice could be shared and what needed to be improved. Colleen explains their approach and some of their initial findings.
Colleen says: “The first part of our work was a benchmarking exercise on what the current experience of co-production was and what it meant to people. We took a holistic approach, working in each of our services and ensuring that we looked at the whole pathway of care and treatment, from pre-admission through to discharge.
“We found the responses were very different across the board. It highlighted gaps in understanding of what co-production meant and how it can be meaningfully embedded in our services. We realised we needed to go back to basics and educate everyone on what co-production means and how we can elevate it as a priority in the services.”
Engagement in co-production in CAMHS
The success of co-production depends on the people who use the services engaging in the process and expressing their views, so that they can shape decisions and influence what is happening around them. Colleen describes how they ensured the young people at each service engaged in the process.
Colleen says: “We realised that the key to engagement was to ensure whatever we did considered the perspective of the young person and how it would feel to them, rather than being clinically led.
“We asked everyone to participate, but we knew that in order for the young people who use our services to want to be involved, we needed to consider involvement from their perspective, rather than it being clinically led. In CAMHS, it’s vital to make things fun and energetic to get the young people on board.
“At first, some of the young people were reluctant to join in, but we persisted until we found a way to engage them in a way they felt comfortable. The last event we did was at Halloween, so we dressed up, played spooky games and had some fun together. That was really successful.
“What we learned along the way was that we had to constantly adapt and change to make sure we were meeting the needs of the young people, rather than just doing what we thought was right.”
The role of language in CAMHS co-production
A crucial part of encouraging engagement in co-production is using language that is accessible for everyone, because language can impact how people understand and participate in the process. For Colleen and the team, an important learning that came out of the events was around the term ‘co-production’ itself.
Colleen says: “Co-production was not a term that many young people were familiar with, and many didn’t initially understand what it meant. Therefore, we felt that we should use a term or phrase that they connected with more.
“We had a competition for a new name/slogan for the project and a new logo design. The winning logo and the slogan ‘Working Together’ came from a young person who attended our CAMHS Eating Disorder outpatient clinic at Cotswold Spa. Inspired by this logo and slogan, we changed all of our language. We try not to use the term co-production at all anymore, and we now call it ‘Working Together’.”
Standards inspired by Working Together
A number of recurrent themes and areas of discussion were uncovered in the workshops. This led the Working Together team to think about the importance of standardising the experience within CAMHS services, so that everyone had the same consistent quality of care and knew what to expect. Colleen explains how the standards of care and treatment were officially developed.
Colleen says: “So that every person connected with a CAMHS service could have a consistent experience, we began a piece of work called ‘Care and Treatment Standards’. We held workshops with service users, parents and carers, plus family ambassadors, to find out what their experiences were and where they believe things could be improved. We had a really good response from the young people – around 30 attended a virtual team meeting to join the discussion.
“We had to adapt our approach with the parents and carers as they had lots of other commitments, as you would expect. The family ambassadors supported us in doing a survey that went out to all the parents and carers. By getting them to support us, and with them writing the communication around why we were doing the survey and the impact it could have, we got a very good response. We used those responses, alongside the young people’s input, feedback and recommendations to develop the standards.
“When complete, we reviewed the standards with experts by experience for service users, families and carers to check if the tone and levels were right. Often, we’ll think of things at quite a high level, when actually what matters are the smaller details of personal experience, like making sure there’s a cup of tea in the room when a young person and their family get there. The little things matter. So the family ambassadors scrutinised our work and we made more changes until we were satisfied that everyone’s needs and perspectives had been included.”
Launching the standards
The ‘Care and Treatment Standards Service Users’ and the ‘Treatment Standards for Families and Carers’ were launched on 18th September, the day before Youth Mental Health Day. The standards outlined the quality levels that Elysium Healthcare, collectively as an organisation, pledges to strive to meet at all times. Colleen shares how the fully co-produced standards, a sector-first for CAMHS, were launched.
Colleen explains: “Each site had their own launch event, which was advertised using posters that were co-produced between our young people and multidisciplinary team (MDT) members.
“When we launched the standards, we turned them into animations rather than presenting them in a document. Our feedback told us that young people, parents and carers were getting too many big welcome packs and lots of information presented in a way that wasn’t helpful.
“So we worked with our marketing team to create snappy animations which told you what standards we were striving to achieve in pre-admission, admission, care, treatment and discharge. This ensured the young person, their parents and carers would know what standards we’d set at each stage of the care journey.
“Working together with the service users, we created posters that explained what each MDT member does – outlining each role and what the young person should expect them to do. The posters are now displayed in the admissions area of all our services so everyone can see them. Everything we produced displays our ‘Working Together’ logo, and we also have the logo on t-shirts to prompt conversations about how we work together.”
Post-launch – what’s next for Working Together?
After a successful launch, Colleen and the team did not rest on their laurels but continued to look for ways that the experience of young people and their families could be improved across the CAMHS division. Excited about the opportunity and potential of Working Together, Colleen tells us what is coming next for the innovative project.
Colleen says: “After launching the standards, we completed a benchmark assessment with all our services to see where they currently sit against the standards and then where we need to get to.
“For the first quarter of 2025, we’re focusing on the pre-admission service – how services work with pre-admission service users and families and carers to support them as they come in. For example, we are looking at a buddy system (the name is likely to change as our service users say they don’t like the name) – the buddy will be involved in the pre-admission process to support the young person to feel less anxious and know what to expect.
“Plus, we’re revising our 24-page welcome booklet so that it is more accessible, and we have recently employed our first peer worker in one of our services, so we’re looking at that, seeing what would work well in different services and how that can be standardised. The timeline for this piece of work is flexible because we need to get it right rather than meet a deadline. It may be a slow process, but that’s because it must be genuine and not a box-ticking exercise.
“Finally, we’re having our ‘Working Together, Better Together’ awards ceremony in November at the Hilton in Elstree. It will be an event that the services can come to, and also service users, parents and carers. We want the services to tell us what they are excelling at, and how their service users and parents/carers are involved in their services, and we want to celebrate those achievements.”
References
NHS England and NHS Improvement and Coalition for Personalised Care (formerly Coalition for Collaborative Care), (2020), A Model for Co-production. Online.