Co-production in local government:process, codification and capacity building of new knowledge in collective reflection spaces. Workshops findings from a UK mixed methods study

Background: Co-production of research evidence is valued by local government to improve effective decision-making about public services in times of austerity. However, underlying structural issues of power (so-called ‘dark shadows of co production’) challenge this ambition with limited evidence on how to embed research use sustainably. In this paper we reflect on mechanisms for increasing co-production in local government. Methods: This paper presents findings from a Health Foundation funded research project that explored how a culture of evidence use to improve population health could be embedded in UK local government. Five linked work packages were undertaken using mixed methods. In this paper, we report the views of UK local authority staff who participated in four workshops (n=54), informed by a rapid literature review and an online scoping survey. Results: We identified five themes that facilitate public health evidence use in local government: 1) new governance arrangements to integrate national and local policies , 2) codifying research evidence through local system-wide approaches and 3) ongoing evaluation of programmes , and 4) overcoming political and cultural barriers by increasing absorptive capacity of Local Authorities to embed co-produced knowledge in their cognitive structures. This requires adaptive governance through relationship building between academic researchers and Local Authority staff and shared understanding of fragmented local policy making, which are supported by 5) collective spaces for reflection within local government. Conclusions: Creating collective spaces for reflection in between government departments allows for iterative, interactive processes of co-production with external partners that support emergence of new governance structures to socially action the co produced knowledge in context and build capacity for sustained evidence use

‘It is not a quick fix’ structural and contextual issues that affect implementation of integrated health and well-being services: a qualitative study from North East England

Objective The objective of this article is to examine the factors affecting the design, commissioning and delivery of integrated health and well-being services (IHWSs), which seek to address multiple health-related behaviours, improve well-being and tackle health inequalities using holistic approaches. Study design Qualitative studies embedded within iterative process evaluations. Methods Semi-structured interviews conducted with 16 key informants as part of two separate evaluations of IHWSs in North East England, supplemented by informal observations of service delivery. Transcripts and fieldnotes were analysed thematically. Results The study findings identify a challenging organisational context in which to implement innovative service redesign, as a result of budget cuts and changes in NHS and local authority capacity. Pressures to demonstrate outcomes affected the ability to negotiate the practicalities of joint working. Progress is at risk of being undermined by pressures to disinvest before the long-term benefits to population health and well-being are realised. The findings raise important questions about contract management and relationships between commissioners and providers involved in implementing these new ways of working. Conclusions These findings provide useful learning in terms of the delivery and commissioning of similar IHWSs, contributing to understanding of the benefits and challenges of this model of working

A rapid review of children and young people's views of poverty and welfare in the context of Universal Credit

Children and young people's (CYP) life chances depend heavily on family resources. This paper reports a rapid review of qualitative/mixed method studies about Universal Credit undertaken with CYP in the UK; subsequently expanded to include additional descriptors of economic disadvantage. Sixteen studies were reviewed; narrative synthesis was used to explore themes. Most recruited CYP with experience of economic disadvantage; none explicitly reported perspectives of CYP experiencing disability or rurality. Findings show growing up in poverty has significant, negative impacts on health and well‐being, causing feelings of exclusion, shame and unfairness; raising important questions about the adequacy of welfare support in the UK

Mobilising knowledge in public health:Reflections on ten years of collaborative working in fuse, the centre for translational research in public health

Background: Fuse was established in 2008 as one of five public health research centres of excellence in the UK funded by the UK Clinical Research Centres collaboration. The centre works across five universities in the North East of England. This is an innovative collaboration and enables the pooling of research expertise. A prime focus of the centre is not just the production of excellent research, but also its translation into usable evidence, a dual focus that remains uncommon. Aims/objectives: This practice paper outlines Fuse's approach to knowledge exchange (KE) by reflecting on ten years of collaborative research between academics and policy and practice partners in the North East of England. We will describe the principles and assumption underlying our approach and outline a conceptual model of four steps in Fuse's KE process to develop collaborative research and achieve meaningful impact on policy and practice. Key conclusions: Our model describes a fluid and dynamic approach to knowledge exchange broken down in four steps in the KE process that are concurrent, iterative and vary in intensity over time: awareness raising; knowledge sharing; making evidence fit for purpose; and supporting uptake and implementation of evidence. These steps support the relational context of KE. Relationship building and maintenance is essential for all stages of KE to develop trust and explore the meaning and usefulness of evidence in a multi-directional information flow that supports the co-creating and application of evidence

Understanding the life experiences of people with multiple complex needs: peer research in a health needs assessment

Background Multiple complex needs (MCN) describe a population experiencing a combination of homelessness, substance use, offending and/or mental ill-health. Using peer researchers, this study aimed to explore the perspectives of individuals with lived experience of MCN with regards to (i) issues leading to MCN and (ii) key intervention opportunities. Methods As part of a health needs assessment in Gateshead (North East England), trained peer researchers interviewed 27 adults (aged ≥18 years) with experience of MCN, identified using purposive sampling methods. Peer researchers designed a topic guide for interviews which were audio recorded and thematically analyzed. Results Interviewees reported adverse childhood experiences leading to MCN including abuse, bereavement, parental imprisonment, family break-up and inadequate support. Mental ill-health, substance use, poverty, early experiences of unstable housing and acute homelessness were identified as major precedents for adulthood experiences of MCN. Between 16 and 20 years, access to housing, social and mental health support was perceived as having the potential to prevent circumstances worsening. Individuals perceived removing barriers to mental health, housing and welfare and financial supports could help. Conclusions This study highlights the perceived role austerity, adverse childhood events and current service provision have in current and future experiences of MCN. Individuals expressed a need for future interventions and support to be judgement free and provided by workers who are educated about MCN and related adversity. Involving peer researchers and individuals with experience of MCN in future research and service provision could ensure appropriate measures and supports are put in place

Leading co-production in five UK collaborative research partnerships (2008–2018): responses to four tensions from senior leaders using auto-ethnography

Background: Despite growing enthusiasm for co-production in healthcare services and research, research on co-production practices is lacking. Multiple frameworks, guidelines and principles are available but little empirical research is conducted on ‘how to do’ co-production of research to improve healthcare services. This paper brings together insights from UK-based collaborative research partnerships on leading co-production. Its aim is to inform practical guidance for new partnerships planning to facilitate the co-production of applied health research in the future. Methods: Using an auto-ethnographic approach, experiential evidence was elicited through collective sense making from recorded conversations between the research team and senior leaders of five UK-based collaborative research partnerships. This approach applies a cultural analysis and interpretation of the leaders’ behaviours, thoughts and experiences of co-production taking place in 2008–2018 and involving academics, health practitioners, policy makers and representatives of third sector organisations. Results: The findings highlight a variety of practices across CLAHRCs, whereby the intersection between the senior leaders’ vision and local organisational context in which co-production occurs largely determines the nature of co-production process and outcomes. We identified four tensions in doing co-production: (1) idealistic, tokenistic vs realistic narratives, (2) power differences and (lack of) reciprocity, (3) excluding vs including language and communication, (4) individual motivation vs structural issues. Conclusions: The tensions were productive in helping collaborative research partnerships to tailor co-production practices to their local needs and opportunities. Resulting variation in co-production practices across partnerships can therefore be seen as highly advantageous creative adaptation, which makes us question the utility of seeking a unified ‘gold standard’ of co-production. Strategic leadership is an important starting point for finding context-tailored solutions; however, development of more distributed forms of leadership over time is needed to facilitate co-production practices between partners. Facilitating structures for co-production can enable power sharing and boost capacity and capability building, resulting in more inclusive language and communication and, ultimately, more credible practices of co-production in research. We provide recommendations for creating more realistic narratives around co-production and facilitating power sharing between partners

Exploring the mental health effects of Universal Credit: a journey of co-production

This article offers reflections and experiences of public engagement in a National Institute for Health Research funded study about the mental health effects of Universal Credit. PJ’s poem powerfully illustrates his experiences of Universal Credit (UC). In this article, we outline our approach to public involvement and engagement (PIE) in a mixed-method, multi-site study about the mental health effects of UC funded by the National Institute for Health Research (NIHR). Public involvement in research is defined by NIHR as ‘an active partnership between members of the public and researchers in the research process’. We view public engagement as a social practice of dialogue and learning between researchers and the public;1 at its heart is the core value of social justice, shaped by wider societal developments towards realising citizen empowerment.2 We adopted the term PIE in preference to the more commonly used patient and public involvement, given that our study involves citizens/people with experience of UC and staff supporting them. Deciding who our relevant ‘publics’ are, and how we meaningfully involve them in the research is evolving over time. Here, we describe and reflect on the ongoing process of PIE in the context of this four-year research project

Leading co-production in five UK collaborative research partnerships (2008-2018): responses to four tensions from senior leaders using auto-ethnography

BackgroundDespite growing enthusiasm for co-production in healthcare services and research, research on co-production practices is lacking. Multiple frameworks, guidelines and principles are available but little empirical research is conducted on ‘how to do’ co-production of research to improve healthcare services. This paper brings together insights from UK-based collaborative research partnerships on leading co-production. Its aim is to inform practical guidance for new partnerships planning to facilitate the co-production of applied health research in the future. MethodsUsing an auto-ethnographic approach, experiential evidence was elicited through collective sense making from recorded conversations between the research team and senior leaders of five UK-based collaborative research partnerships. This approach applies a cultural analysis and interpretation of the leaders’ behaviours, thoughts, and experiences of co-production taking place in 2008-2018 and involving academics, health practitioners, policy makers, and representatives of third sector organisations. ResultsThe findings highlight a variety of practices across CLAHRCs, whereby the intersection between the senior leaders’ vision and local organisational context in which co-production occurs largely determines the nature of co-production process and outcomes. We identified four tensions in doing co-production: 1) idealistic, tokenistic vs realistic narratives, 2) power differences and (lack of) reciprocity, 3) excluding vs including language and communication, 4) individual motivation vs structural issues.ConclusionsThe tensions were productive in helping collaborative research partnerships to tailor co-production practices to their local needs and opportunities. Resulting variation in co-production practices across partnerships can therefore be seen as highly advantageous creative adaptation, which makes us question the utility of seeking a unified ‘gold standard’ of co-production. Strategic leadership is an important starting point for finding context-tailored solutions; however, development of more distributed forms of leadership over time is needed to facilitate co-production practices between partners. Facilitating structures for co-production can enable power sharing and boost capacity and capability building, resulting in more inclusive language and communication and, ultimately, more credible practices of co-production in research. We provide recommendations for creating more realistic narratives around co-production and facilitating power sharing between partners