We spoke with Fiona Dite and Carrie Grainger who are collaborating on this case study to showcase the work they do around Maternity and Neonatal services. This example is a little different as up until now we have showcased how VCSE organisations work with Co-Production but this one showcases NHS examples, so exciting to be able to demonstrate working across the Integrated Care System.
1. What does your organisation do and who do you work with? What is your role?
Fiona – Co-chair of Buckinghamshire Maternity and Neonatal Voices Partnership (MNVP). We are an independent multidisciplinary NHS working group made up of women, birthing people and families, clinicians, commissioners, public sector and academic representatives – all who have an interest in transforming maternity and neonatal services.
Carrie – Equity and Prevention Lead for the BOB Local Maternity and Neonatal System (LMNS). The LMNS is the maternity division of the BOB Integrated Care Board and brings together partners across the system. Our partners include MNVP’s and other service user voices and community groups, maternity and neonatal service providers (ie Trusts), commissioners, Public Health, Local Authorities and others. We all work together along with our NHSE regional colleagues to transform maternity and (soon to include) neonatal services across the BOB geography. This also includes quality assurance, surveillance and governance for maternity and neonatal service providers.
2. Why is Co-Production a priority in your work?
Fiona – Listening to women, birthing people and families forms the basis of all of our work. The MNVP provides a mechanism to ensure that their experiences and feedback are used to both celebrate where things are going well and also identify areas for service improvement or change. People who have used maternity and neonatal services are best placed to help clinicians and commissioners design them, and co-production provides a way for them to feel valued, respected and that they can actually make a meaningful difference, no matter what their experience of care.
There are three MNVP’s across the BOB geography, one for each provider Trust and we all work both locally with Trusts and regionally with BOB LMNS as well as nationally when required. The level of co-production does vary depending on the project or work being undertaken, but there have been significant strides up the ladder of co-production and many projects are now truly co-produced from start to finish.
Carrie – It is crucial that service users are involved right from the beginning of service improvement to be able to ensure that services provided meet the needs of the local population. This has been recognised within several NHSE policies including the recent single delivery plan for maternity and neonatal services which highlights the importance of listening to and working with women, birthing people, families and communities.
Getting people who actually use services involved in developing them ensures in the long term, services are effective equitable and sustainable and co-production is one of the best methods to do this. Meaningful co-production can break down barriers between service providers and people using them and can provide critical insight that may be missing from a provider perspective. There is a wealth of knowledge sitting in our communities which can add depth and value to service design and improvement – if we don’t get people involved, we miss out the opportunity for shared learning and solutions.
I truly think that co-production should be an underpinning driver for change across the NHS and in maternity I believe we are leading the way – we don’t always get it right, but co-production allows us to grow and learn together.
3. How do you currently involve users to create and develop services?
Fiona – Service users are involved in many different ways! We collect feedback via in person listening clinics, attendance at community events, online surveys, focus groups, and via social media channels as well as via email. All of the feedback we collate is then used to identify areas for further focus eg infant feeding support or perinatal mental health. A large proportion of the MNVP team is made up of lived experience service users and they work hand in hand with the provider Trusts and LMNS in a variety of ways. This includes representing service user voice in many maternity forums and meetings, visiting maternity care environments to highlight potential improvements, being a ‘critical friend’ for ideas and much more.
Carrie – The local MNVP’s are woven into the fabric of the LMNS and are included in all core meetings such as safety and governance, equity and LMNS project groups, the Stakeholder Assurance Group and the LMNS Board. We also engage with other community groups who may not be directly involved with the MNVP but who have a shared interest in improving maternity and neonatal outcomes. Service user voice should always be at the centre of service development and we endeavour to provide every opportunity to listen and act upon that voice – it’s not always what we want to hear but that is part of the process!
4. What organisational benefits have you had from Co-Production?
Carrie – The benefits of co-production to an organisation are huge! Working with the communities that we serve really helps us understand what is important to them which then helps us focus the priorities to where they are needed rather than presumed, making us more efficient.
Within the NHS we are often stretched for resources, but using co-production and the wealth of expertise within our communities who already know what works and what doesn’t helps us spread resources in the most effective way.
Co-production can be messy and lengthy – and doesn’t work in every situation, but if used effectively, with everyone on board the benefit far outweighs not involving people and producing services that don’t work.
Having fresh eyes from outside of organisational constraints gives us new ideas, new solutions and constructive feedback on everything from leaflet and communication production through to system level change.
5. What top tips would you share with an organisation that wants to involve users in shaping their services?
Fiona – It is crucial to ensure that you are listening to a representative view from across your community, including those groups you don’t usually hear from – and that you are genuinely listening, not just box ticking.
- Make co-production accessible by going out into the community rather than expecting them to come to you and explore different ways to facilitate this. Can you use peer researchers? Do you have interpreters available? Can people get involved in a multitude of ways – ie face to face/telephone/online.
- How are people being valued for their time and involvement? Consider incentives/childcare/travel/food and drink/other expenses, but bear in mind that direct incentives can have an impact on certain benefits.
- Let people know what has happened as a result of their feedback – this doesn’t have to be immediate change, but an acknowledgement of their views and information about any plans makes people feel valued and that they can make a difference.
- Accept that co-production takes time and can be messy – and sometimes involves going right back to the beginning and starting again!
Carrie – Great co-production is about great relationships and these only happen at the speed of trust, so organisations need to make sure there is time for those relationships to build and thrive – it doesn’t happen overnight, which can be at odds with the program deadlines and deliverables. Be open to discovering what is important to the community rather than setting your own agenda and having expectations about what you are going to hear. Make sure that people are empowered to speak up in an environment of mutual respect – everyone’s voice is important. Bring people in from the very beginning – right at the ideas stage as it can save time and money in the long term – co-production is not consultation so provide adequate training for staff of all levels to ensure understanding. Aspire to have co-production as an underpinning value of all work which then creates a shared value for all.