Co-Production With ICBs and System Partners: Making It Work in Practice

Co-production is now an expectation, not a buzzword. Integrated Care Boards increasingly expect providers to shape services collaboratively with people, families, carers, frontline staff, system partners and communities — not simply respond to decisions after they have already been made.

For providers working across NHS community pathways, reablement, discharge support, mental health, learning disability, autism, physical disability, complex care or integrated neighbourhood models, the challenge is making co-production meaningful, proportionate and operationally useful. This article forms part of the NHS Integrated Community Services Knowledge Hub and connects closely with outcomes and impact measurement and working with ICBs and system partners.

Effective co-production only matters when it changes decisions, pathways, practice or outcomes.

Why co-production matters to ICBs

ICBs operate across complex systems where health, social care, voluntary sector support and community assets need to work together more effectively. Traditional consultation is no longer enough. Commissioners increasingly want evidence that service design is shaped by people who use services, families, carers, frontline staff and partner organisations.

Co-production helps ICBs and providers:

• Understand lived experience more clearly.
• Identify barriers that performance data may miss.
• Improve pathway design.
• Reduce avoidable escalation or service breakdown.
• Strengthen trust with communities.
• Design services that are more accessible and realistic.
• Improve outcomes rather than only activity.

What co-production looks like at system level

At system level, co-production is broader than individual care planning. It may involve people, families, providers, commissioners, clinicians, voluntary sector partners and operational teams working together to improve services or pathways.

Examples include:

• Pathway redesign workshops.
• Service reviews with lived-experience input.
• Joint problem-solving around access, flow and discharge.
• Community engagement around unmet need.
• Reviewing outcomes data alongside personal experience.
• Testing new service models before full implementation.
• Improving information-sharing and handover processes.

Co-production should influence decisions. It should not be used merely to validate decisions already made.

Moving from consultation to real influence

One of the biggest weaknesses in co-production is confusing consultation with influence. Consultation asks people what they think. Co-production involves people in shaping what happens next.

Real co-production requires clarity about:

• What is genuinely open to change.
• Who is involved and why.
• How feedback will influence decisions.
• What constraints exist.
• How decisions will be communicated back.

If people give time, experience and emotional labour but never see what changes, trust is weakened.

Operational example 1: redesigning a discharge pathway

An ICB is reviewing a discharge pathway for people with complex needs. Delays are increasing, families report poor communication and providers say referrals often arrive without enough practical information.

Rather than redesigning the pathway internally, the ICB brings together people with lived experience, family carers, acute discharge teams, community providers, therapists, social care leads and voluntary sector partners.

The group identifies several common issues:

• Families are unclear who coordinates discharge.
• Providers receive incomplete risk and medication information.
• Equipment delays create unsafe starts.
• People feel rushed rather than prepared.
• Follow-up after discharge is inconsistent.

The pathway is then redesigned with clearer handover requirements, a family communication checklist, provider readiness criteria and a 72-hour post-discharge review point. Co-production works because it changes the pathway, not just the conversation.

Common problems providers face

Providers often support the principle of co-production but struggle with how it works in practice. Common problems include:

• Unclear objectives.
• Unrealistic timescales.
• Meetings that are too broad to produce decisions.
• Lack of clarity about who has authority.
• Frontline staff being invited without capacity protection.
• Lived-experience feedback not being acted upon.
• Co-production being treated as a one-off event.

These problems lead to frustration and disengagement. Good co-production needs structure, scope and follow-through.

Making co-production operationally useful

Providers can make co-production more effective by linking it to real delivery decisions.

Before participating, providers should clarify:

• What problem is being addressed?
• Who needs to be involved?
• What decisions can be influenced?
• What evidence will be reviewed?
• What constraints exist?
• How outcomes will be fed back?

This keeps co-production focused and credible.

Linking co-production to clinical pathways and MDT working

Co-production is particularly valuable when pathways involve multiple organisations. People often experience systems as fragmented, even when each organisation believes it is delivering its own role correctly.

This is why co-production links closely to clinical pathways, MDTs and integrated practice. It helps partners understand how pathways feel in reality, not just how they appear in process maps.

Useful questions include:

• Where do people feel lost in the pathway?
• Where do handovers fail?
• Which professionals are missing from decision-making?
• Where does communication become unclear?
• What causes avoidable escalation?

Involving frontline staff safely

Frontline staff often hold the clearest insight into what works and what does not. They understand where people struggle, where pathways slow down, where handovers fail and where system decisions create operational consequences.

However, involving staff must be done safely and proportionately. Providers should:

• Protect staffing capacity.
• Clarify staff roles in co-production activity.
• Support staff before and after difficult discussions.
• Ensure staff are not expected to speak beyond their authority.
• Feed learning back into supervision and practice development.

Co-production should not create burnout or place frontline staff in unsupported conflict between organisational expectations and system pressures.

Operational example 2: using frontline insight to improve crisis prevention

A community mental health pathway is experiencing repeated escalation into crisis services. Performance data shows increased referrals, but does not explain why people are reaching crisis point.

The provider supports a co-production review involving people with lived experience, frontline support staff, clinicians, care coordinators, voluntary sector partners and ICB representatives.

The review identifies that people often ask for help earlier, but pathways are unclear and lower-level support is difficult to access before crisis thresholds are met. Frontline staff also report uncertainty about who to contact when concerns increase outside normal review cycles.

The system response includes:

• A clearer early escalation pathway.
• Improved signposting to community support.
• Earlier review triggers.
• Better guidance for staff on emerging risk.
• Follow-up monitoring of repeat crisis use.

This links co-production directly to prevention, population health and early intervention, rather than treating participation as a separate engagement exercise.

Using outcomes evidence in co-production

Co-production is strongest when lived experience and outcomes evidence are considered together. Data can show patterns, while people explain what those patterns mean in real life.

Useful evidence may include:

• Outcome measures.
• Service user feedback.
• Family and carer experience.
• Complaints and compliments.
• Incident themes.
• Access and waiting time data.
• Health inequalities data.
• Staff feedback.

The value comes from asking: what does this evidence tell us, what needs to change, and how will we know improvement has happened?

Co-production with families and carers

Families and carers often understand pathway gaps before professionals do. They see the cumulative impact of delayed decisions, repeated assessments, inconsistent communication and unclear accountability.

Providers should involve families and carers in ways that:

• Recognise their expertise.
• Respect confidentiality and consent.
• Avoid placing unreasonable burden on them.
• Clarify what can and cannot change.
• Feed outcomes back clearly.

This is particularly important in services involving learning disability, autism, dementia, complex care, mental health or long-term conditions.

Operational example 3: co-producing communication improvements with families

A provider and ICB receive repeated feedback from families that they do not know who to contact when community support changes following discharge. Families describe receiving different answers from different professionals, creating anxiety and repeated calls to services.

A focused co-production group is formed with family carers, discharge coordinators, community providers and ICB pathway leads.

The group agrees that the issue is not lack of effort, but unclear ownership. A simple communication standard is developed, including:

• Named contact for the first 72 hours after discharge.
• Clear escalation route for urgent concerns.
• Written explanation of provider and family roles.
• Follow-up call after the first weekend.
• Feedback route if communication fails.

The revised process is tested, reviewed and then adopted across similar pathways. This demonstrates co-production leading to practical service improvement.

What ICBs value in co-production

ICBs value providers who engage constructively and consistently. They do not expect providers to agree with every proposal, but they do expect honest participation that improves decision-making.

System leaders value providers who:

• Represent operational reality honestly.
• Bring evidence and examples.
• Involve people and staff proportionately.
• Focus on outcomes rather than organisational preference.
• Demonstrate how feedback changes practice.
• Stay engaged beyond the initial workshop.
• Support implementation after decisions are made.

This strengthens long-term influence because the provider becomes known as a constructive system contributor.

Common pitfalls to avoid

• Calling consultation “co-production” when decisions have already been made.
• Inviting people with lived experience without explaining scope or influence.
• Using broad workshops that do not lead to decisions.
• Failing to protect frontline staff capacity.
• Collecting feedback without acting on it.
• Allowing professional voices to dominate.
• Not feeding back what changed.
• Separating co-production from governance and delivery planning.

Practical actions providers can take

• Create a simple co-production planning template.
• Define what decisions can genuinely be influenced.
• Agree who needs to be involved and why.
• Use outcomes data alongside lived experience.
• Protect frontline staff time for meaningful involvement.
• Feed learning into service improvement plans.
• Report back clearly on what changed.
• Review whether co-produced changes improved outcomes.

Conclusion

Co-production with ICBs and system partners is most valuable when it leads to real changes in pathways, practice, communication and outcomes. It should not be treated as a symbolic engagement exercise or a final-stage consultation.

Providers that approach co-production with clarity, evidence, operational honesty and respect for lived experience can strengthen relationships with ICBs, improve service design and build long-term influence within integrated care systems.

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