Developing and growing the practice of co-production in children and young people’s services in mid and south Essex.

This report was compiled by Traverse on behalf of the Mid and South Essex Integrated Care System Research carried out between April to December 2022.

If you would like to save a copy of the report, you can download a PDF version at the bottom of the page.

Background and context

Mid and South Essex Integrated Care System wanted to work with children and young people to shape how they are involved in designing and improving health and care services. Working closely with A Better Start Southend (ABSS), they commissioned Traverse to deliver a programme of work to catalyse co-production with children and young people.

ABSS has been driving system change to improve health outcomes for children and young people in Southend. Sponsoring the development of the Children and Young People’s plan and supporting the Mid and South Essex Integrated Care System (MSE) has enabled ABSS to strategically work alongside key agencies in sharing system change work across the MSE footprint.

Traverse is a social purpose organisation which specialises in engagement and research. We talk with people from across the UK to find out about their unique opinions and experiences which we then feed back to the people we work with.

The programme was designed in two phases

1. Develop values and principles to underpin a co-production approach for mid and south Essex (April-July 2022)
2. Convene a Young People’s Panel to steward and catalyse co-production (July-December 2022)

A note on the purpose of this report

As Traverse’s role in this work comes to an end, we have drawn together this report as a record of the work that happened, what we learned, and recommendations for next steps.

We have brought together a summary of learning from the first phase of work – the Phase 1 report contains a fuller description of the activities and findings.

We then describe the approach we took to recruit and support the MSE Young People’s Panel to form over three initial meetings, sharing learning for colleagues within MSE ICS to carry forwards as they take on the facilitation and support of the panel into 2023.

Phase 1: overview and findings

[There’s] a bit of power from consultation but real power comes when young people are allowed to get involved in the physical change and participate in the process more than just a talk on initial ideas.

Young person during workshop

The first phase included the following steps

1. Desk review: 23 document, websites, strategies about co-production and engagement with children and young people.
2. Stakeholder interviews: 10 interviews with 15 professionals who work with children and young people in mid and south Essex.
3. Discussions with children, young people and parents: Online and in person discussion groups with 32 children and young people and six parents across mid and south Essex.
4. Children and young person co-production workshop: In person workshop with 28 children and young people and eight professionals.

Informed, inclusive decision-making: Involving children, young people and families

The findings from phase one fed into part of the broader Framework for Children and Young People in mid and south Essex. The following values and principles have been developed through conversations with children and young people:

1. Children and young people need to feel like they hold power and that they are being listened to throughout the whole process, from start to finish.
2. Close the feedback loop by telling children and young people how their input has made a difference and how professionals are acting on their involvement.
3. Have options for involvement so children and young people can participate in different ways that work for them, and importantly, don’t make any assumptions.
4. Be transparent, honest and open with young people so they can make informed decisions.
5. Think about the language that is used – for example, the phrase ‘shaping services’ did not resonate with children and young people. Be clear on what you mean and avoid using jargon.

Being herd = excitement and hope initially then when nothing comes back, being ignored feels invalidating like your ideas are stupid and worthless – young people give up trying to have a voice.

Young person during co-production workshop

The following questions can be used by those wanting to involve children and young people.

1. Are you communicating openly with young people about the work you are doing, and ways they can feed in? Is the language you’re using accessible to a diverse range of young people?
2. How can you hear from children, young people, and their families about their experiences, needs and ideas? Are there a variety of different ways for young people to share their views? Is there support in place to encourage and help them to do so?
3. How are children and young people’s views and experiences considered in design and decision-making?
4. How are you closing the feedback loop, to ensure children and young people understand the impact of their involvement and can see the outcome?
5. Is there an area where children and young people could play a role in, or have power and responsibility for decision-making?

[Co-production is] …improving services from a position of knowledge. Everyone’s experiences are different and you can learn from mistakes.

Young person during a co-production workshop

Phase 2: the MSE Young People’s Panel

Based on findings from phase 1 and the hopes of the young people who took part, the focus of phase two was to bring together a core group of 10 children and young people so they can be active partners in improving the way children and young people are involved in the longer term, sharing power and responsibility with Mid and South Essex professionals, and supporting the system to engage with a wider range of young people in the future.

The purpose of the group is to support the system to put the guiding principles for co-production into practice, to support continuous learning and greater accountability. What this looks like in practice will evolve through time, and will be shaped by the group itself.

Recruiting people to the MSE Young People’s Panel

Recruitment approach
We advertised the opportunity to all young people who took part in a small discussion group, or in the main workshop. 10 young people put themselves forward, and all are current members of the Mid and South Essex Young People’s Panel.

We decided to recruit from the pool of young people who had already been a part of the process, as we felt this would ensure young people were starting from the same level of understanding, and had already had a chance to meet one another and some of the adults involved as well.

The members of the MSE Young People’s Panel

▪ The young people range in age from 13 to 21, there’s a mix of genders and ethnic backgrounds.
▪ Three of the young people have additional needs – 1 is autistic, 1 is dyslexic, and 1 has a long-term health condition.
▪ They have links with the following groups: Multi-schools Council, Southend Youth Council, School clubs, Sports teams and clubs, English Speaking Union, Beavers, Community projects, Young Essex Assembly, Saint Vincent de Paul, Young Commissioners Youth Strategy Group, YMCA, Regional Youth Climate Assembly, National Citizen Service.

Meeting design and facilitation approach

The first three meetings were focused on achieving the following aims:

1. Supporting young people to get to know one another and form trusting relationships.
2. Supporting young people to develop their understanding and skills, so they feel more confident interacting with health and care professionals and stakeholders from the ICS.
3. Supporting members to shape the purpose and priorities of the Young People’s Panel

The meetings take place on Zoom on weekday evenings. They are two hours long so that there is enough time for people to arrive and settle, then go into some different activities and conversations, and take a break in between. The sessions are online to make them accessible to a wider range of people. We used the online whiteboard tool, Mural, for interactive and visual activities.

The first meeting included:

• Hopes and fears for the group.
• Ways of working for the group.
• The skills the young people want to develop, and the topics young people want to know more about.

The second meeting included:

• Jargon busting: key terms and acronyms in health and care.
• The changing NHS – what is an ICS?
• What is MSE ICS?
• Skill session: Public speaking.

The third meeting included:

• What impacts on young people’s health?
• The Panel’s collective network and ways of engaging with other young people.
• Prioritising future discussions for the Panel.
• Feedback on the process so far.

Session design considerations

Based on feedback from young people and facilitator reflections from the first 3 meetings, the following design considerations have emerged:

The group is as strong as the relationships within it.

• Don’t underestimate the value of warm up and cool down activities – this shouldn’t feel like school young people want to be comfortable, to enjoy the sessions and get to know one another, which will support group forming.
• Spend 15-20 mins at the beginning of each session warming up/ getting to know each other /catching up – depending on how long the group have been formed.
• Spend the last 5 minutes of the session ‘cooling down’, as a wrap up – it doesn’t need to be a conversation about what we’ve discussed.

The group’s needs will evolve over time – learn and iterate.

• Prioritise time at the end to ask for quick feedback: what did they like in this session? What could have been better? What would they like to see next time?

Follow the energy and let young people lead.

• Be guided by the young people – ask questions, what do they find interesting, what would they find valuable
• Be flexible on timings – don’t worry too much if one activity takes longer than expected – go into the session prioritising one or two activities, so you can make sure you get value out of those, even if it takes longer than expected.
• Don’t overpack the session! Have some breathing space, and a chance for young people to take a break, especially if working online.
• Breathing space also allows you to give time to questions or ideas that young people come up with during the session, allowing them to lead more of what they’re doing.

Have fun with it to create an engaging experience

• Try and use a mix of activities in your design – a mix of individual working/ thinking time and group discussion activity. Be visual where you can.

Facilitation approach

The following principles underpinned the approach to facilitation for the group.

• Always have at least two facilitators; one can lead the session, the other can support with tech, check that nothing in the chat is being missed, provide direct support to young people where needed.
• Provide the agenda in advance so young people who would like to can prepare their answers/thoughts.
• Provide choices for young people to engage –some people prefer typing, others would rather talk.
• Always reiterate at the start of the meeting that people can communicate how they feel comfortable: verbally, via the chat, via private message to the facilitator.
• Make sure you understand the support and additional needs before the session – it will help you be a better and more considerate facilitator, as well as ensuring participants are more engaged if you have catered for their needs.
• Be clear concise and break things down so young people can understand what you are asking them –don’t overcomplicate things – keep questioning direct and simple.
• Don’t give more than one instruction at a time; give young people time to process what you’ve asked.
• When asking for someone to get involved/answer a question always add “Remember you can say no / not do it”; you don’t want to create a pressurised environment
• Try to avoid using complicated hypothetical situations; work in the concrete and practical.
• Don’t be overly formal – have a warm and personable approach, laugh along with them.
• Give people the option to have cameras on or off –some young people are used to keeping their cameras off from online teaching at school, and may prefer this.
• Model introductions or activities where you can, so that young people know what to do.

Ways of working

The group was supported to form their own ways of working, recognising that this will shift and evolve as the group builds confidence and gets to know each other better.
The facilitation team wanted to ensure we were also bringing in the co-production guiding principles in the way we were working with the young people.

• Young people need to feel like they hold power and that they are being listened to throughout the whole process, from start to finish. We will proactively seek opportunities to give the young people power in this process.
• Close the feedback loop by telling children and young people how their input has made a difference and how professionals are acting on their involvement. We will make sure the group members are clear on what’s happening next following each session, and their role in that.

MSE Young People’s Panel: Ways of working.

• Have options for involvement so children and young people can participate in different ways that work for them, and importantly, don’t make any assumptions. We will offer flexible ways of participating in sessions.
• Be transparent, honest and open with young people so they can make informed decisions. We will not withhold any information from young people, and will support them to make informed decisions as part of this group.
• Think about the language that’s used –for example, the phrase ‘shaping services’ did not resonate with children and young people. Be clear on what you mean and avoid using jargon. We will take time to understand each other’s needs, and ensure communication, meetings, and events are all accessible, so that everyone can participate fully.

Bonus principle:

• Feel comfortable with uncertainty – to support the other principles, there needs to be room for things to emerge organically from the group, and through the process, which means outputs and outcomes can’t be set from the beginning but are co-created along the way. Also, there may be points where there is a clear recommendation from the group that can’t be actioned or responded to – this needs to be acknowledged and explained.

Volunteer agreement

The young people on the panel all signed a Volunteer Agreement which covers:

• Who supports and facilitates the meetings
• What being involved in the panel means
• Who can be involved
• Details about the meetings, including timing, dates, format and thank you payments
• How the group will work together
• Safeguarding and support
• What they agree to by signing up

Template agenda

Notes:

• Making a safe space for the young people where they are comfortable to ask for reasonable adjustments/support needs.
• Provide options for taking part to account for support needs but also tech capacity. Always have a way people can take part without following a link etc.
• If there are questions/topics you are going to talk about, send these in advance so the young people can prepare if they would like.
• Giving young people a bit of time to think and work independently before having a discussion can work well towards the end of a session, where energy might start to flag

Next steps

Conversations to continue with the Young People’s Panel

In meeting 2, we shared information about the changing NHS and MSE ICS. Whilst the young people who attended did engage, the session being so focused on information provision didn’t feel right. In future, we would suggest that key information about the health and care system is attached to practical projects, or shared in a more interactive way such as through a Q&A with MSE staff.

In meeting 3, young people shared their “health promoting places”. These included: school, local café, online spaces, home, parks, the local library. This conversation highlighted the importance of online and physical spaces that are free to access, that are safe, that give people an opportunity to see their friends and talk, to meet different types of people, to learn new things. The young people mentioned other factors including access to staff promoting mental wellbeing, relaxing atmosphere (not too busy, not overwhelming, a nice place for a long conversation), places to have fun, to relax and think.

Young people also discussed the things they feel impact on young people’s health and wellbeing. They explored both mental and physical health and how they influence each other. They didn’t organically mention health and care services, and instead focused on the wider determinants of health. The key themes that came up included: school, family and friends and romantic relationships, sex education, self-esteem and confidence in talking about things you’re struggling with, self-care and time to do things you enjoy, mindset, social pressures, vaping, climate change, cost of living.

It felt like we only scratched the surface, and that the young people had lots more to say about the things that support their health and wellbeing. Our feeling is that projects centred in young people’s lives – their community, their school, their home – might appeal more (at least initially) than projects centred around specific health and care services.

Potential projects and activities for the Panel to focus on in 2023

The following ideas for tangible projects and activities for the Panel to focus on in 2023 have emerged from the first three meetings, and conversations with stakeholders:

1. The Panel expressed an interest in engaging with other young people about health and care related topics – either to gather ideas or feedback. This could be in collaboration with Rachel Brett of the Essex Council for Voluntary Youth Services.
2. To build their confidence in advising on co-production and engagement with children and young people, the group could start with one project, such as helping to shape involvement with young people around a specific area that they’re interested in, such as vaping.
3. The Panel is still keen on their initial idea to run their own event to train up professionals in how to work with children and young people. They also liked the idea of meeting and/or interviewing Mac, potentially in relation to this event. They also felt that the event would be likely to surface more ideas for future projects.
4. Stakeholders suggested that the Panel members could have a say in how the remaining budget for the project is spent – they could apply to MSE ICS for micro-grants for their own initiatives (e.g., to meet as a panel in person, to run a small project, to deliver their event)

Next steps and communications with the Panel

• Traverse will email the group during the w/c 28th November, sharing the notes from the previous meetings and sharing MSE ICS contact details. All thank you payments will have been sent to young people for the first three meetings.
• MSE ICS should send an email to the group before the end of term (20th December 2022), letting the group know how to be in touch, and sharing a doodle poll to find a time for the next meeting in January.

Appendices

Demographics of young people on the panel

Age

• 13 – 2
• 14 – 4
• 15 – 2
• 17 – 1
• 21 – 1

Ethnicity

• White British – 5
• Indian – 1
• Pakistani – 3
• Other ethnic group – 1

Gender

• Male – 4
• Female – 6

MSE Young People's Panel – final report November 2022 (951kB pdf)