Co-Producing Care Plans with People with Physical Disabilities: Moving Beyond Consultation to Shared Control
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Co-production is a core principle of person-centred planning, yet in physical disability services it is often reduced to consultation rather than shared control. People are asked what they want during assessment, but decisions about how support is delivered are shaped by service convenience, time constraints or risk aversion. The result is care planning that appears person centred on paper but feels provider-led in practice, particularly where routines, visit times or methods do not reflect the person’s priorities.
This article explores what genuine co-production looks like in physical disability care planning and how providers can embed it safely and consistently. It should be read alongside Co-Production, Choice & Control and Involving Family & Advocates.
Why co-production matters more in physical disability services
Adults with physical disabilities are often experts in their own bodies, conditions and daily management strategies. Many have spent years navigating health systems, adapting routines and problem-solving barriers. When care planning ignores that expertise, support can unintentionally undermine independence, increase frustration and create unnecessary dependence.
Co-production is therefore not a “nice to have”; it is central to delivering effective, efficient support. Plans that are co-produced are more likely to be followed, adapted appropriately and reviewed proactively because the person understands and owns them.
Commissioner and inspector expectations around co-production
Two expectations are particularly clear in physical disability commissioning and inspection contexts:
Expectation 1: Evidence that the person has real influence over how support is delivered. Inspectors and commissioners look beyond signatures. They expect to see that preferences around timing, methods, pacing and risk are reflected in the plan and observable in practice.
Expectation 2: Co-production must be safe, inclusive and capacity-aware. Where people have fluctuating capacity, pain or fatigue, providers must evidence how consent is revisited, how advocacy or family input is used appropriately, and how decisions are reviewed when circumstances change.
From “asking questions” to shared decision-making
Token co-production often involves asking the right questions but retaining control over decisions. Genuine co-production requires providers to share decision-making about how outcomes are achieved, not just what the outcomes are.
This includes choices about:
- Visit timing and sequencing across the day
- How tasks are supported (prompting, set-up, hands-on)
- Use of equipment, adaptations and assistive technology
- Risk enablement strategies for community access and independence
Operational example 1: Co-producing daily routines around fatigue
A provider supporting a person with a progressive physical condition found that staff were routinely delivering personal care early in the morning to fit rota efficiency. The person reported exhaustion and cancelled activities later in the day. Through a co-produced review, the plan was redesigned so that personal care was delivered later, with shorter morning check-ins focused on set-up rather than full assistance.
The revised plan balanced the person’s energy levels with safe staffing, reduced missed outcomes and provided clear evidence that routines were shaped by the individual rather than the rota.
Co-production where risks are present
Physical disability services frequently involve risk: falls, skin integrity, manual handling, medication and lone working. Co-production does not remove risk; it requires transparent discussion about it.
Providers should explicitly record:
- What risks the person is willing to take and why
- What safeguards are agreed
- What would trigger a review or escalation
This approach supports positive risk-taking while protecting both the person and the provider.
Operational example 2: Co-produced risk enablement for independent transfers
One service supported a person who wanted to transfer independently at certain times despite an increased falls risk. Rather than prohibiting this, the provider co-produced a plan outlining when independent transfers were acceptable, what equipment must be used, and when staff intervention was required.
Daily records captured the person’s decision-making and outcomes rather than “risk avoided”. This created defensible evidence that the service respected autonomy while managing risk proportionately.
Governance: assuring co-production is real
Co-production must be visible to withstand scrutiny. Effective governance includes:
- Audit prompts that test whether delivery reflects stated preferences
- Review templates that require evidence of shared decisions, not just updates
- Supervision discussions that explore how staff negotiated choice and risk
Operational example 3: Review triggers linked to loss of confidence
A provider introduced review triggers not only for incidents, but also for loss of confidence following health setbacks. Where people withdrew from activities or independence reduced, a co-produced review was completed to reassess support methods and rebuild autonomy safely.
This prevented gradual restriction from becoming normalised and demonstrated responsive, person-centred management.
Embedding co-production as a service standard
In physical disability services, co-production must move beyond consultation to shared control over how support is delivered. Providers that embed co-production operationally, manage risk transparently and assure practice through governance are better placed to evidence quality, meet commissioner expectations and deliver support that genuinely reflects people’s lives.
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