Things to think about before creating a Service User Engagement or Co-Production Role in your Community Service

Once people have used your service, they’ll naturally reflect on their experience and that’s a vital source of insights for improving your service.

For a service to be both efficient and effective, it needs to offer what people need, when they need it and in the way they need it.

And the only people who really know what your service users need, when they’ll need it or how they’ll need it are obviously your service users. So service user engagement is about learning from their experience, and co-production is about working with service users as equal partners, to improve your service.

But neither are the kind of job where you just hire someone and they get on with it.

Or rather, you could just hire someone - and many organisations do - but if your organisation isn’t ready to apply what they learn, it’ll be an unethical, tokenistic waste of resources, that will likely damage your reputation with the community and probably burn out your new hire if they don’t quit at the first opportunity. (Ask me how I know!)

My personal view is that if you want to do service user engagement at all, you have to be ready to make wider changes to do it properly. Here’s what I mean.

Where are you now?

Before you get started with service user engagement or co-production, it’s worth giving some thought to your current relationship with service users, and get a feel for how big a change it would be to start engaging people in the way you run the service.

Think Local Act Personal’s National Co-Production Advisory Group has developed ‘the Ladder of Coproduction’ describing the steps an organisation can take towards being able to co-produce their services with the community. On the bottom rung organisations have let’s just say a one-sided relationship with service users - the organisation doesn’t consider their input at all.

At the top of the ladder, our ideal goal of co-production requires an equal relationship between the service and the community. At this level, you aren’t involving service users in your decisions, the decisions are shared. You’re working together on the same team.

They’ve made this brilliant video to explain it. It’s focussed around health and social care, but I can’t think of any community service the concept isn’t relevant for.

It’s rightfully a big buzzword in community services, because - well, just imagine what it would be like if all the services you use as a citizen worked the way you need them to!

But as you’ll know from the services you use in your own life, most community services are quite a way off. But we have to recognise where we are, in order to move forward.

So I’m going to focus on the “Engagement” level in this post. There are enough resources out there on co-production but I think with the buzz around that word, there’s a danger that services can become embarrassed to admit we’re still struggling way down on the first rungs of the ladder and it stops them making progress. Instead there’s often a lot of things called “Coproduction” that really aren’t.

In my experience, ‘Engagement’ is more realistic goal for many community services. And I think if you can do Engagement well, it’s the key to moving further up the ladder because it’s where the mindset shift and the cultural change happens.

The difference between ‘Informing’ and ‘Consultation’ is just the difference between telling and asking. There is still one party dominating the conversation.

But when you get to Engagement, you’ve stepped up to a more level footing, and I think that’s the hardest thing to do in the historically paternalistic, often hierarchical world of community services.

But once you can let go of that ‘us and them’ mindset and engage with service users as fellow humans, the path to Co-design and Co-production is just a matter of developing the skillset and resources.

Changing the Way Your Service Makes Decisions

If you want to step up the Ladder of Coproduction to the Engagement rung, it’s important to recognise that you’re not just doing a new activity, you’re changing the way you run your service, and potentially changing your organisational culture. Treat it like an organisational change project.

That’s because service user engagement has two parts:

1. Interacting with people who use the service, and other key stakeholders like carers and families, to understand what it's like to use the service, what's important to them, what's going well, what needs to change.

2. Using those insights to inform the way you run the service, the decisions you make about what the service does and how it works.

You can create a service user engagement role to do the first part, but the second part will take some planning and agreement from the rest of the service. How are decisions currently made? Who is involved? You’ll need to redesign those ways of working to accommodate service user engagement, and ensure everyone’s on board.

Don’t rely on good intentions, embed service user engagement in your service’s culture and ways of working.

Your new ways of working should be a two-way process, establishing an equal relationship between the service and the community:

• When the service notices challenges or opportunities where service users would be impacted, the default response should be to engage with service users to understand what’s important in a solution.

• When service users notice a challenge or opportunity where they’re impacted, there should be a recognised way to let the service know, and share what’s important in the solution.

An important part of your service user engagement person’s role is to facilitate this relationship.

But a key challenge for many organisations is making sure the rest of the organisation recognises this as their role. In many roles, your job title describes the chunk of work you do for the organisation, that nobody else has to think about because you’ve got it covered, right?

So it’s natural for people to see ‘Service User Engagement’ and think the role is to have a relationship with the community on behalf of the service.

And without taking steps to formally embed service user engagement in the way decisions are made, it can actually do more harm than good to hire a service user engagement role. Because people can be less likely to think about engaging with service users once it’s someone else’s job!

So think about how you can carve out space for your service user engagement officer to perform their ‘facilitation’ role.

If you have formal planning processes, you might add sections for service user engagement to your template documents to ensure it’s not forgotten. There might be relevant policies, procedures and other documents like Terms of Reference for meetings that you’ll want to revise to formalise your commitment to engaging service users in your decision making.

(There will certainly be operational policies and procedures needed to facilitate safe and effective service user engagement, but I’ll leave that topic to more qualified organisations like NCVO, SCIE and NHS England)

The important thing I want you to consider is how to establish service user engagement as not just one person’s job, but a normal, expected and vital part of running your service. Because it’s a new way of working, people will naturally forget, or even resist the change, and the quickest way to burn out your new service user engagement professional is to put them in the position of having to fight for every opportunity to do their job!

Why does service user engagement require organisational change?

What I’m advising in this post is quite a bit of work, so I should probably explain why I feel it’s justified. I mean, why bother with a whole organisational change approach, when we see so many organisations just hire a Service User Engagement Officer or Co-Production Lead and leave them to it?

Have you come across the Parable of the Blobs and Squares? If not, enjoy this video, it explains the mindset shift beautifully and why it’s important.

The thing is, like I’ve said, the move from “consultation” to “engagement” is more of a change of culture than a change of activity. So if you hire someone ‘blobby’ to do the activity, but the rest of the service still runs in ‘squarish’ ways, you’re setting them up to fail.

So there’s a lot of reasons I think the wider work is valuable, but here’s the bottom line:

1. It’s unethical to ask service users to undergo the emotional labour of sharing their lived experiences without having the structures in place to take meaningful action as a result.

2. It’s unethical to recruit staff to a role doing the above on behalf of the service. Moral injury can have a significant impact on staff wellbeing.

3. It can harm to your service's reputation when people contribute their insights and see nothing change. Also if people continue to have poor experiences that they’ve highlighted and you've not addressed.

4. It can harm future attempts you might wish to make to engage meaningfully with the community. People won't trust your organisation, and they'll have good reason. You'll call them "hard to reach".
   
   

Is your organisation ready?

I don’t think any of the organisations who do create independent service user engagement or coproduction posts without embedding them into the wider organisational culture actually intend for this work to be tokenistic. There are some real barriers that stand in the way of the wider organisational change required to make service user engagement meaningful. In some organisations, it can turn out this way regardless of the positive intentions, effort and resources put in.

The problem is that good service user engagement requires sharing a little power, tolerating a little uncertainty, and investing a little time.

These are things that can't be afforded in an organisation that is:

1. Very heirarchical

2. Risk averse

3. Highly pressured

Because service user involvement means:

1. Listening to as many perspectives as possible to get a fuller picture, and prioritise the perspectives of people with lived experience. That’s a clear threat to management in a hierarchical workplace where you’re expected to defer to the judgement and expertise of your seniors.

2. Leaning into uncertainty by working with stakeholders to explore a problem or opportunity with an open mind, before deciding on the solution. Spending time and money on a project without a clear idea of your intended output and how it will work won’t fly in a risk averse workplace culture.

3. Investing resources solving problems that ‘only' affect a minority of service users, or ‘only’ improves the quality of the service or people’s experience. In any project you can only choose two out of quick, cheap and good, but in a highly pressured service, there’s only ever quick and cheap.

So it’s worth taking a moment to consider whether any of these barriers apply to your organisation.

If they are, I don’t think that means you shouldn’t try to do more service user engagement, but I do think it will be challenging enough that you probably shouldn’t create a role where it’s anyone’s entire job to fight that uphill battle. Especially not if they’ll be the only one doing it.

Perhaps consider creating a working party to work on patient engagement together, or offering training for interested staff to be service user engagement champions within their existing roles?