Side By Side Complex Needs, our co production journey

coproduction image 2.jpgWhen people have good social support networks, are involved and included in their communities and are valued for their contribution they experience better health.

We know within Mersey Care we don’t have all the answers and we want to work with the service users, patients, carers, staff, and communities to improve the quality of our services and tackle inequalities.

We want co production at the heart of service plans, development, design and evaluation. This means being genuine equal partners and co creators in how we work together to shape our services rather than staff making decisions alone or in isolation.

There are different levels of co production:

  • Our staff working with people that use services to work towards their goals
  • Our staff working with people that use services to recruit new staff
  • Building new relationships between our staff and people that use our services. People who use our services are recognised as experts in their own right. They are truly respected for sharing their experiences and views and valuing their contributions to the process.

Coproduction image 1.jpg

Over the last year, our staff have worked side by side with a group of service users and carers with complex needs to explore their experiences and help improve our offer. The term complex needs means users of our services with a combination of long term physical health, mental health and social needs. 

From our collective learning with the group, we’ve produced some useful resources and a broad step-by-step guide to co production which would be useful to any team.

We want to share our learning journey and hope our resources can help others to make sure the voices, experiences, and feedback of those who use services are truly embedded. This approach encourages openness and transparency about what and how things are done.

Our purpose was to reimagine the support available for people with complex needs, feedback highlighted the need to put wellbeing of the person at the centre and make sure they are treated with kindness.

The below outlines our journey together to documenting experiences, reimagining how services could respond differently to people with complex needs, and making some practical on-the-ground changes to the way our Integrated Care Teams respond to people with complex needs.



As part of our discussions and learning, we refined and agreed a set of co production steps and must do actions:

  • LISTEN all the time
  • Take time to build relationships openness and trust. This can’t be rushed.
  • Recognise the strengths that people bring to working side-by-side
  • Don’t be judgemental – abandon your preconceptions
  • This is not ‘us and them’ – respect that everyone is equal in co productions. Don’t try to find all of answers yourself
  • Build shared understanding of what is meant by co-production and of the language and terminology you are using
  • Develop a shared purpose – be clear about what you want to achieve together
  • Keep focussed on this and check on your progress regularly
  • Remember learning is a two way process.

We also developed a list of simple tips on what good looks and feels like for those who use our services.

  • I am listened to and understood
  • I feel equal and I am not judged 
  • I am given time to build openness and trust with those I am working with
  • My strengths are valued
  • We have a shared understanding of the language we are using
  • The expectations we have of each other are clear
  • I have worked with others to agree what we are trying to achieve together, and we are clear about how we will measure what we have achieved
  • My contribution is recognised.

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Watch our short animation which gives an overview of our ten top tips of co production.

Side-by-side: Complex needs - A summary of our work

You said We did
We want to share our experiences of complex needs, how we have experience services and how we would like services to respond in the future

We produced three films (in varying formats) to share our experiences and provoke action for change, on the themes of:

  • Humanity and relationships
  • Care coordination
  • Building on strengths


We want to raise awareness amongst staff about the needs of people with complex needs.

We held conversations with Mersey Care’s organisational effectiveness and learning and development team; communications teams and executive nursing team to discuss how our films can be used in:

  • Inductions for new staff
  • Staff development
  • Trust wide communications
  • In support of team quality review assessment and continuous improvement projects.

Making on the ground changes within the assessment pathway of Integrated Care Teams.

See the below for the detailed ‘we said…we did’ summary.

Side-by-side with the Integrated Care Teams -  caring for people with complex needs

You said We did

Improve the information provided to service users about how their information is shared, consent and confidentiality and the role their GP will continue to play.  This should be available in an accessible format and address frequently asked questions.

New information leaflets have been developed and are currently being reviewed by the communications team to check they meet Mersey Care standards.  The draft leaflets were circulated to our side-by-side team for comments as they were being developed.  There will be three new leaflets; one for patients in the care of the ICT; one for professionals referring to the ICT; and one in easy read format.


Take better account of accessibility and neuro-diversity aspects of the assessment process, for example communication needs, sensory needs and reading ability before, during and after the assessment. This should also include time of assessment, environment, conversational style and use of language.

The core members of the Integrated Care Team have all accessed learning disability and autism awareness training.  A learning disability and autism champion (with lived experience) has been identified in the team.

It would be better if the M-gate assessment process could be split sections/ steps to make it more manageable for the service user.

Changes are being made to the electronic M-gate tool to allow it to be completed in stages (previously it had to be completed in one go to ensure information entered was saved). 

Offer a summary or copy of the assessment to the service user and ensure they are clear about the next steps following the assessment.

A template letter to be sent to the service user summarising their assessment and next steps has been developed. To allow for accessibility issues, a follow-up phone call will be offered as an alternative to a letter.

Improve the use of trauma-informed approaches and training for staff in the Integrated Care Team. Build learning from other practitioners and training of new staff in the development of the team. 

YMCA have been commissioned to provide training for staff with a focus on trauma informed approaches within the service user/ practitioner relationship (working in a way which is sensitive to the traumatic experience). 

10 ICT Coordinators are being trained in the first instance and then we will look to roll this out to other members of the ICT.

Working with yourselves and the group has been such a good journey to go on, I’m used to codesigning with other services and putting projects through Quality Improvement, having service users involved has on reflection added the missing part of that plan. Listening to their journeys through our systems has often left me with admiration that they have been so willing not just to share but engage and trust us to take these steps with them.

It is very rewarding after working in the coproduction team re complex needs to see changes for the positive happening. Being a valued member of the team has helped me tremendously in my recovery from a high-level trauma.

I have learnt so much from working side by side with my service user colleagues. Particularly, that for true co-production, we should start with a blank page together as equals – I don’t need to (and can’t!) have all the answers! 

Appreciate so much everyone's support, to take care and learning strategies to cope better.  Hope to keep with me wellbeing is important to grow and the importance for encouragement.

Working with the group has reminded me just how privileged we are to work with people in their most vulnerable moments and how, if we don’t treat people in the right ways, we can inadvertently cause harm.  That vulnerability may lead to people feeling that the power in the relationship is not in their favour.

In terms of the process, I have learned so many practical skills that I am excited to use in my new role, we don’t need to know everything, every day is a school day, and our service users can be our biggest teachers if we respect them as human beings with life experience.

Being actively involved in meaningful co-production is my small way of helping to improve the quality of service, which, in turn, improves the mental and physical health of its users.  I enjoy this work because I see that positive changes are now beginning to take place.

For further information please contact:

Michael Crilly, Director of Social Inclusion and Participation ​​​​

Helen Bennett, Deputy Director of Strategic Planning and Intelligence