Co-Production in Hong Kong Community Services: Designing Support With People Rather Than For Them

A community service can be technically well designed and still feel wrong to the people who use it. Opening hours may not match family routines. Transport may make a centre difficult to reach. A rehabilitation programme may pursue clinical goals that have little connection with what someone wants to do at home. A new digital process may simplify administration while making access harder for people who need communication support.

These are not minor service-design issues. They illustrate why meaningful participation matters. Across the wider Hong Kong Ageing, Long-Term Care & Community Support Knowledge Hub, a recurring question is whether policy, rehabilitation and community infrastructure are genuinely built around the lives people want to lead. Co-production takes that question further by asking who gets to shape the service in the first place.

Hong Kong already has mechanisms through which people with disabilities and carers can influence policy and services. The Rehabilitation Advisory Committee advises the Government on rehabilitation policy, service development, resource use and implementation of the United Nations Convention on the Rights of Persons with Disabilities. Its membership includes representatives of persons with disabilities and carers, and that representation has been strengthened in recent terms. Public engagement also formed part of the development of the current Persons with Disabilities and Rehabilitation Programme Plan, while consultation continues through wider disability-policy processes.

But representation at advisory level is only one form of participation. The stronger operational question is whether people using community services can influence everyday decisions about service models, access, priorities, staffing, communication, digital systems, quality and outcomes. That is where consultation needs to become co-production.

Co-production is more demanding than asking for feedback

Services often describe themselves as person-centred because they ask people what they think. That is valuable, but feedback alone is not co-production.

Consultation usually means that an organisation develops a proposal and asks for views. Co-production moves decision-making earlier. People with lived experience help define the problem, shape the options, test the design and influence how success will be judged.

The distinction matters because many of the most important assumptions are made before consultation begins.

If an organisation has already decided that a service will be centre-based, asking people to choose preferred activities does not allow them to question whether the centre-based model is appropriate. If a digital portal is already procured, asking whether users like the colour scheme is not meaningful involvement in digital access.

Co-production therefore involves a shift in power. Professionals still bring clinical, operational, legal and financial expertise, but lived experience becomes another form of expertise rather than merely a source of opinion.

This connects directly with co-production, choice and control. The strongest model does not ask professionals to give up responsibility. It asks organisations to make clearer which decisions can genuinely be shared and which remain constrained by law, funding, safety or service specifications.

Hong Kong has an established participation architecture

Hong Kong's disability policy is not developed through a single organisation. The Labour and Welfare Bureau has overall policy responsibilities, while the Social Welfare Department administers and subvents a large range of rehabilitation and community services delivered by non-governmental organisations.

The Rehabilitation Advisory Committee provides an important bridge between government, service sectors, persons with disabilities and carers. Its formal remit includes advising on rehabilitation-service development, the use of resources, the respective roles of government and voluntary organisations, workforce training and implementation of the UN Convention on the Rights of Persons with Disabilities.

The Persons with Disabilities and Rehabilitation Programme Plan also reflects a deliberate engagement process. Its development included public engagement across several stages before the final plan was submitted to Government.

This creates an important foundation: participation is recognised at policy level.

The operational opportunity is to ensure that the same principle becomes visible inside individual services.

That means asking whether a person attending an Integrated Community Rehabilitation Centre can influence how support is organised; whether carers can shape respite models; whether people using residential or day services help define quality; and whether service users are involved when NGOs redesign programmes in response to changing demand.

The Integrated Community Rehabilitation Centre model creates space for shared design

The expansion of Integrated Community Rehabilitation Centres is particularly relevant to co-production because the model is intended to provide flexible, coordinated day and home-based support for people with disabilities living in the community.

The service offer can include case management, rehabilitation training, nursing care, personal assistance, transport, environmental assessment, day care, respite, meals, assistive technology and support for carers.

That breadth makes standardisation difficult.

A person recovering from stroke may need intensive rehabilitation and transport for a period before gradually moving towards community participation. Someone with severe physical disability may rely on personal assistance and respite. Another person may need home visits because travelling to a centre is exhausting or impractical.

The current expansion to 14 Integrated Community Rehabilitation Centres serving defined areas across Hong Kong increases the significance of these design questions. A district-based network can provide stronger local responsiveness, but only if service design is informed by the people living within those districts.

Co-production can therefore operate at several levels:

• individual planning around goals, timing and preferred support;
• service-unit decisions about opening hours, group activities and transport;
• district-level analysis of unmet need and access barriers;
• organisation-wide design of pathways, communication and quality measures; and
• policy-level engagement about how community rehabilitation should evolve.

The practical challenge is connecting those levels so that individual experience can influence wider design without assuming that every preference can become system policy.

Individual care planning is the first test of co-production

At the individual level, co-production begins with whether professionals are planning with the person or around them.

The ICRC model includes case management using an International Classification of Functioning, Disability and Health-informed approach. That creates an opportunity to consider functioning, participation and environmental factors together rather than focusing only on diagnosis.

But an assessment model does not automatically create co-production.

A plan can still be professionally dominated if goals are selected because they are measurable or convenient rather than meaningful to the person.

A physiotherapist may focus on walking distance. The person may care more about reaching a nearby shop independently. An occupational therapist may focus on upper-limb function. The person's priority may be preparing food safely without asking a family member for help.

Both professional and personal goals can be legitimate. Co-production is the process of connecting them.

This is why outcomes-focused and goal-led support matters. A meaningful plan should be able to explain not only what professionals are trying to improve, but why that improvement matters to the person's everyday life.

Operational scenario: redesigning rehabilitation around a real-life goal

A middle-aged man with neurological impairment attends a community rehabilitation service following hospital treatment. His programme initially includes strength, balance and transfer exercises. Progress is measurable, but he begins missing sessions.

Staff initially interpret the problem as poor engagement.

During a review, the case manager asks what he most wants to regain. He explains that before his illness he regularly met friends at a local restaurant but has stopped because the journey feels difficult and embarrassing.

The rehabilitation plan is reframed around that goal. Therapy still includes strength and balance, but the team also examines the route from home, transport options, wheelchair access, fatigue, transfers in a community setting and confidence when travelling without family.

His support worker and therapist agree how practice can take place outside the centre. The man decides which barriers matter most and what level of assistance feels acceptable.

The clinical work has not been abandoned. Instead, it has become connected to participation.

That distinction is important. Co-production does not mean the person dictates every professional intervention. It means expertise is combined around a goal that the person recognises as their own.

It also creates better evidence. Attendance improves because the programme has relevance, while outcome measures can include community mobility and social participation rather than therapy activity alone.

Accessible participation determines whose voice is heard

Co-production can become exclusionary if participation methods suit only people who communicate confidently in meetings or written consultations.

People with intellectual disabilities, sensory impairments, acquired brain injury, autism, communication difficulties or significant physical disabilities may need different routes into decision-making.

A formal committee meeting may work for some people. Others may contribute more effectively through one-to-one discussion, visual material, supported communication, short workshops, observation of service use or feedback gathered within familiar environments.

This is where accessible information and communication become part of governance.

If people cannot understand the decision being discussed, participation is symbolic.

The organisation therefore needs to make both information and influence accessible. That includes explaining what can change, what cannot change, what decision is being made and what happens after people give their views.

It may also require paying attention to language, literacy, fatigue and digital access.

Co-production should not be restricted to people who are already confident advocates.

Family and carer involvement needs careful boundaries

Families and carers hold valuable knowledge about daily routines, communication, health history and changes in behaviour. Their involvement can strengthen service design, particularly where they provide substantial unpaid support.

Hong Kong's community rehabilitation model explicitly includes support for carers, reflecting the reality that disability support often depends on family networks.

But co-production should not automatically treat family opinion as identical to the views of the person with a disability.

There may be genuine disagreement.

A parent may prioritise safety while the person prioritises independence. A carer may want longer centre attendance because they need respite, while the person prefers more home-based support. A family may resist assistive technology because they distrust it, while the person wants to use it.

Strong practice makes these interests visible rather than collapsing them into a single "family view".

This links to involving family and advocates appropriately. Families should be respected as partners where the person wants that involvement, while professionals remain alert to autonomy, privacy and potential conflicts of interest.

Operational scenario: respite design exposes competing priorities

A community rehabilitation service receives repeated requests from carers for longer weekend respite. Staff initially plan to extend centre-based provision on Saturdays.

Before making the change, the service involves people using the service as well as carers.

The discussions reveal a more complicated picture.

Several carers do want longer centre-based respite because weekends are the only time when other family members are home and household responsibilities increase. Some service users, however, say they do not want to spend another full day in a centre. They would prefer support that allows them to go shopping, visit community facilities or remain at home while their carer takes a break.

The service therefore tests a mixed model rather than simply extending the existing programme.

Some respite remains centre-based. A smaller number of home-based and community options are trialled where staffing and individual needs allow. The service measures take-up, satisfaction, staffing impact and whether carers actually experience meaningful relief.

This is co-production because participation changes the design.

If the service had merely consulted after deciding on longer Saturday opening, the underlying assumption would have remained unchallenged. The stronger process reveals that "more respite" does not necessarily mean "more centre hours".

Self-help organisations add a different form of lived experience

Hong Kong also has an established network of self-help organisations representing people with disabilities, people with chronic illnesses and carers.

Public funding has been used to support many such organisations, reflecting their role in peer support, community participation and advocacy.

These organisations can contribute something different from individual feedback.

A person may describe one experience. A self-help organisation can identify patterns across many experiences, including recurring barriers in transport, employment, service access, communication or family support.

This makes them potentially valuable partners in policy development and service review.

However, representative organisations should not be assumed to speak for every person with the same disability. Disability experience varies by age, gender, income, housing, family circumstances, impairment, communication and geography.

Co-production therefore works best when organisations combine several forms of evidence: representative groups, direct service-user feedback, carers, complaints, operational data and professional expertise.

Feedback becomes valuable only when the organisation closes the loop

Many services collect satisfaction data. The governance weakness often lies in what happens next.

If people repeatedly say that transport is unreliable, managers need to know whether the issue was investigated and what changed. If carers say appointment times create difficulties, the service should explain whether scheduling can be altered. If a request cannot be met, the reason should be visible.

This is the difference between collecting feedback and creating a feedback loop.

A strong loop has four stages:

• people are given an accessible way to express their experience;
• the information is analysed alongside operational evidence;
• someone has authority to decide whether change is required; and
• people are told what changed, what did not change and why.

Without that final stage, repeated consultation can reduce trust.

This connects with service-user feedback and co-production. Organisations examining their own arrangements can use the Quality Dashboard Builder to combine experience measures with access, waiting, outcomes and operational performance. The tool does not define Hong Kong service standards, but it can help prevent feedback from being separated from the management information used to make decisions.

Funding and service specifications influence how much flexibility is possible

Co-production does not happen in a vacuum. Services operate within funding arrangements, staffing models, premises, eligibility rules and subvention requirements.

The Social Welfare Department subvents a substantial NGO rehabilitation sector, while some services also involve user charges within established arrangements.

This means service operators cannot promise unlimited personalisation.

A person may want support at a time when the service has no workforce capacity. A group may ask for an activity outside the organisation's approved scope. A home-based model may cost more than centre provision because staff travel between users.

Meaningful co-production is therefore not the same as agreeing to every request.

It requires transparency about constraints and a willingness to test whether those constraints are genuinely fixed.

For example, a funding rule may be fixed, but a rota may be changeable. A building may have limited capacity, but appointment sequencing may be flexible. Eligibility may be set centrally, but communication about the pathway can still be redesigned.

The strongest organisations make that distinction visible.

Workforce culture determines whether co-production survives daily pressure

Community services can adopt co-production language without changing frontline practice.

Staff may still decide what is best, select goals before the review, control meeting agendas and treat disagreement as non-compliance.

This is partly a workforce issue.

Professionals are trained to assess need, manage risk and apply expertise. Co-production requires them to retain that expertise while becoming more comfortable with shared authority.

Workers therefore need skills in facilitation, supported communication, conflict, goal-setting and listening to people whose preferences may differ from professional recommendations.

Supervision is also important.

Staff need space to discuss situations where choice, family views, risk and organisational constraints pull in different directions. Otherwise, co-production can disappear whenever a case becomes complex.

This connects directly with workforce skill mix and practice competence.

Organisations examining whether participation is embedded beyond policy can also use the Governance Maturity Assessment to test whether lived-experience evidence reaches operational and strategic decision-making rather than remaining within isolated engagement activities.

Operational scenario: people challenge a digital-first referral process

An NGO introduces a digital-first process for enquiries and appointment changes. The aim is reasonable: reduce telephone queues, improve administration and create clearer records.

Initial performance appears positive because staff process requests more quickly.

Service-user feedback reveals a different experience.

Some people with physical disabilities use smartphones confidently and prefer the new approach. Others find the interface difficult because of motor impairment, visual accessibility or cognitive fatigue. Several older carers rely on telephone contact and worry that they will miss important information.

Instead of abandoning the digital system or insisting that everyone use it, the organisation involves users in redesign.

Accessibility changes are prioritised. Telephone access remains available. Confirmation messages are simplified. Users test changes before wider implementation. Staff record which communication route people prefer so that digital contact does not become the default simply because it is administratively convenient.

The result is not less digital innovation. It is better-targeted innovation.

This demonstrates why digital inclusion should be part of co-production from the start. The Digital Transformation Readiness Assessment can help organisations structure comparable questions around digital strategy, workforce readiness, access and governance before technology becomes embedded in service delivery.

Co-production should influence quality definitions

Professionals and organisations naturally measure what they are accountable for: service volume, waiting time, attendance, incidents, staffing and financial performance.

People using services may define quality differently.

They may care about whether staff arrive when expected, whether they see familiar workers, whether they can leave the house, whether therapy reduces fatigue, whether personal care is respectful or whether support helps them sustain relationships.

Neither perspective is sufficient on its own.

A service can be popular but unsafe. It can also achieve excellent compliance metrics while failing to improve people's lives.

Co-production strengthens quality assurance by bringing these different evidence sources together.

That is particularly important for community disability services, where outcomes are often multidimensional. Independence may mean using less formal support, but it can also mean using the same amount of support more effectively so that the person has greater control.

Quality measures should therefore include participation, choice, continuity and meaningful outcomes alongside operational performance.

Representation needs to include people who are rarely heard

A common weakness in participation programmes is that the same small group of articulate and experienced representatives becomes responsible for speaking on behalf of everyone.

Their contribution can be valuable, but it should not become the only route into decision-making.

People with profound disabilities, complex communication needs or unstable health may be less visible in advisory structures. Families under severe pressure may not have time to attend meetings. People who are dissatisfied may disengage rather than join consultation groups.

This creates a governance requirement to seek evidence actively.

Organisations may need outreach, supported engagement, observation, individual interviews or partnership with trusted community groups.

Participation should also be reviewed for representativeness. If every advisory group consists of people who already use services successfully, the organisation may never hear from those who cannot access them.

This is where equality, diversity and inclusion become relevant to service design rather than simply organisational values.

Operational scenario: redesigning transport after people stop attending

A district-based rehabilitation programme notices declining attendance among several wheelchair users. Individual records describe missed appointments, but the pattern is initially treated as an engagement problem.

During a user forum, several participants explain that transport has become the central barrier. Pick-up windows are wide, journeys are tiring and delays affect personal-care routines at home.

The service examines attendance data alongside those accounts and discovers that missed sessions are disproportionately concentrated among people dependent on assisted transport.

A working group involving service users, carers, operational staff and transport personnel examines possible changes.

Not every request can be met. Dedicated individual transport would be unaffordable. But routes can be reviewed, appointment times can better reflect journey length, some rehabilitation can move into the home and remote follow-up can be offered where clinically appropriate.

The service then monitors whether attendance and reported fatigue improve.

This is an example of co-production creating operational intelligence. The initial administrative data identified non-attendance. Lived experience explained why. Joint redesign produced a practical response.

Without both forms of evidence, the service might have blamed users for a system problem.

Governance should show where lived experience changes decisions

For co-production to become credible, leaders need evidence that participation affects decisions.

This does not require every suggestion to be accepted.

It does require traceability.

An organisation should be able to show what people raised, what evidence was considered, who made the decision, what changed and what will be reviewed later.

This makes participation part of quality assurance and governance rather than an engagement activity sitting outside the main management system.

Boards, management committees and senior leaders within NGOs should therefore receive more than satisfaction percentages.

They need thematic evidence showing where experience reveals recurring barriers, whether those barriers are being addressed and whether people can see the resulting changes.

The same principle applies at system level. Government departments and advisory bodies need to distinguish between participation that informs policy and participation that merely records stakeholder views after direction has already been fixed.

Co-production can strengthen service innovation

Innovation is sometimes presented as something professionals or technology companies create and users later adopt.

Community services often work better when that sequence is reversed.

People experiencing a problem can help define what innovation needs to achieve before a solution is chosen.

A person who cannot attend rehabilitation because of fatigue may not need a new digital platform; they may need shorter sessions at home. A carer struggling with multiple appointments may need coordination rather than another app. Someone with limited hand movement may benefit from assistive technology only if the interface works with their existing equipment.

Co-production therefore improves innovation by testing usefulness, not just novelty.

This matters increasingly as Hong Kong expands assistive technology, community rehabilitation and digitally enabled support.

Technology should be evaluated against participation, accessibility, workload and human outcomes.

The strongest model connects individual voice with system learning

Individual care planning and policy consultation are often treated as separate activities.

The stronger model connects them.

If one person's transport difficulty appears during a review, the service responds to that individual. If twenty people report the same problem, the organisation should examine service design. If the same issue appears across several districts, it may require system-level consideration.

That progression turns lived experience into structured intelligence.

The same principle applies to waiting, communication, respite, digital access, workforce continuity and transitions between hospital and community support.

Organisations can use the Commissioner Evidence Builder as a general framework for structuring evidence around service commitments, delivery and outcomes where this is useful. It is not a Hong Kong funding or regulatory instrument, but its underlying approach can help organisations demonstrate how experience and performance evidence connect to service improvement.

Hong Kong's next opportunity is participation with visible influence

Hong Kong already has important elements of participatory disability policy: formal advisory structures, public engagement, self-help organisations, user and carer representation and community rehabilitation models intended to respond flexibly to changing needs.

The next opportunity is to deepen the relationship between participation and decision-making.

That means moving beyond asking whether people are satisfied.

People with disabilities and carers can contribute to questions about service design, access, quality, technology, workforce, respite, rehabilitation goals and community participation.

The strongest organisations will make that influence visible.

They will be able to show where lived experience changed a pathway, altered an opening time, redesigned communication, challenged a digital assumption or exposed a service barrier that performance data alone had missed.

Co-production becomes credible when people can recognise their contribution in the service that emerges.

International learning lies in sharing expertise rather than transferring control

Hong Kong's institutional arrangements are specific to its own welfare, rehabilitation and NGO sector. Other countries should not assume that the Rehabilitation Advisory Committee, subvention system or ICRC model can simply be replicated elsewhere.

The transferable principle is more fundamental.

Services are stronger when professional expertise, operational evidence and lived experience are treated as complementary sources of knowledge.

Co-production does not require professionals to abandon accountability or agree to every preference. It requires organisations to involve people early enough for their knowledge to alter the design.

That distinction is internationally relevant.

A consultation can confirm a decision. Co-production can improve one.

Conclusion

Co-production in Hong Kong community services is ultimately about whether people with disabilities are participants in service design or only recipients of decisions made elsewhere. Hong Kong already has foundations for stronger involvement through the Rehabilitation Advisory Committee, public engagement, self-help organisations, carer representation and increasingly integrated community rehabilitation services.

The more difficult task is operational. Participation needs to influence individual goals, service models, access, digital systems, transport, respite, quality measures and improvement priorities. That requires accessible communication, workforce capability, clear decision rights and governance that tracks what changed because people were involved.

Co-production should not be romanticised. Services remain constrained by funding, safety, workforce capacity, legal responsibilities and infrastructure. People with disabilities, carers and professionals may legitimately want different things. Strong participation does not remove those tensions; it makes them visible and creates a more transparent way of resolving them.

For Hong Kong, the strongest forward direction is therefore not simply more consultation. It is a deeper feedback loop between lived experience and operational authority. When individual experience is aggregated into evidence, when representative voices include people who are harder to hear, and when organisations can show how participation changed decisions, co-production becomes part of service governance rather than an engagement exercise.

That shift matters because community support is most credible when people can recognise themselves not only in their own care plans, but in the design of the services on which their independence depends.