This abstract highlights how co-production ensures that one of the most vulnerable groups in society has their voices heard in shaping their health and social care. Co-production facilitated the creation of new partnerships, collaborations and alliances which have been fundamental in making the involvement of service users, families and staff relevant, embedded and sustainable.
Who is it for?
There are approximately 1700 individuals with learning disabilities in Belfast; they face many barriers to involvement in decisions that affect their lives, including a lack of social capital, networks and influence in society. They have poorer access to opportunities for social, educational, employability, health and wellbeing development. This work addresses a need to create pathways for involvement in LD services and to build the capacity and skills of service users, carers and staff for involvement and co-production.
In a climate of widening health inequalities, it was key to establish an involvement structure to address barriers that could not be addressed by any one group on their own.
What did you do?
• Belfast Trust decided to close Day Centres in north Belfast (then viewed as an outdated service), this was overturned following a protest from carers.
• The Trust gave a commitment to co-produce the future of Day Centres in Belfast.
• Appreciative Inquiry (AI) methodology was used which focuses on what is good about a service and how it can be improved. The traditional approach often focuses on what is not working.
• Provided training in AI methodology to 3 carers and 5 staff, who co-developed questionnaires and facilitated sessions involving carers, staff and service users on how the service should look to make it more user-friendly and progressive.
• The Learning Disability (LD) Forum was established (staff, carers and service users) to help shape the service.
• Findings were presented which resulted in development of priorities. Day Centres were kept open and action plans developed to improve the services and strengthen involvement.

What results did you get? What impact did you have?
• Strong partnership structures in place through the LD Forum. This has built positive relationships and trust.
• Service user and carer expertise valued as a positive to:
o Create solutions
o Provide evidence to support business cases for service improvement
o Improve common understanding of services and constraints

• Improved communication
• Carer Involvement Lead post created

What is the learning for the international audience?
Key learning on building and maintaining creative partnerships, collaborations and alliances in co-production:
• Develop skills for staff (including facilitation skills) to support partnership working
• Develop capacity of service users and carers as equals in co-production
• Champion co-production

o Embed co-production structures and assurance processes into core working practices
o Protect staff time
o Build co-production into the design of care pathways, service development and review/evaluation of services

What are the next steps?
• Continue to review involvement processes – regular feedback and accountability
• Strengthen and improve communication with families and LD services
• Share successes on what works

This paper will present the results of a national survey in England that assessed integrated care from the perspective of service users living with a rare neurodegenerative condition, Huntington’s Disease (HD). It is part of the Integrate-HD project that seeks to develop an integrated care model that responds to the complex needs of people and families living with this genetic hereditary disorder. The first phase of the project found a lack of evidence of integrated care in HD, despite this being one of the most complex neurological conditions, and a lack of information on people’s experiences with health and care in England.
Therefore, the purpose of the survey was to capture the experiences of adults at risk, gene positive, diagnosed with the disease, caregivers and former caregivers of people living with HD. The survey was tailored to assess people’s experiences and identify their unmet needs and, in this way, create a benchmark from which to prioritise, strategize and improve future care.
The survey was co-designed with people living with HD from two different patient and public groups: one recruited specifically for the Integrate-HD project, where people were more lay; and, HD Voice, from the Huntington’s Disease Association (HDA) England & Wales, with more experienced contributors. The survey domains were based on a previous systematic literature review, where findings were interpreted with patient and public involvement and from it, four characteristics were identified as key elements to successful integrated care programmes: expert knowledge, multisectoral care coordination, care continuity and a person-centred approach. The project was led by a Nurse PhD researcher and a team of researchers with expertise in mixed-methods, HD and integrated care. The survey was reviewed by third sector collaborative organizations.
Integrate-HD recruited for seven months using social media (e.g., Instagram account @integrate_hd), charities engagement and electronic communication. Patient and public contributors were spokespersons for the project, assisted with recruitment strategies and connected the researchers with gatekeepers.
More than 150 people participated. Analysis is undergoing and detailed key findings will be presented at the conference. From the perspective of HD service users in England, current care is fragmented. Using the person-centred care definition from National Voices, more than half of the people ranked care very poor, poor or had a neutral opinion. Few people reported agreeing with their care experience matching person-centred integrated care. The survey highlights “post-code lottery” and people’s unmet needs.
The survey benchmarks integrated care from the perspective of service users, pinpointing areas that are fragmented, but also identifies what is working well, gathering important knowledge that can be potentially translated to other contexts.
Next, interviews with service users and providers will be conducted, to explore different working models. Learnings will be used to design an integrated care model that addresses the needs of people living with HD.

Type 1 diabetes (T1D) is a complex chronic condition that contributes to various health complications, including mental health challenges. This is because the demands of the day-to-day management of T1D can take a psychological toll. This is especially true for young adults (18-29 years) who, in addition to the need to cope with the social, physical, and emotional changes of this age stage, are also learning to self-manage their condition more independently. Despite the importance placed on understanding the health issues of young adults living with T1D and offering more personalized care options, there are known challenges to engaging this population in health research. These challenges are attributed to several causes, including exclusionary and stigmatizing recruitment approaches, and skepticism about research due to unbalanced power differentials, historical misuse of data, and a lack of meaningful existing relationships. To capture the necessary voices in co-design work, one solution to overcome these challenges is to further engage people with lived experience in study processes, including recruitment.

Objective:
To detail an intentional approach to engaging individuals with lived experience of T1D and mental health challenges in the development and implementation of a recruitment strategy. This strategy was designed in tandem with the co-design of an innovative integrated care program that emphasizes the perspectives and experiences of these key stakeholders.

Methods:
Recognizing the need to design models of care to meet the complexity of living with both T1D and mental health challenges for young adults, a multi-phase mixed methods co-design trial titled Technology-enabled Collaborative Care for Young Adults with Type 1 Diabetes and Diabetes Distress (TECC-T1D3) is ongoing. Young adults with T1D have been engaged in project planning, prototype development, and in the design and testing of a structured, user-friendly, and scalable mental health intervention. While a co-design approach has been used since study inception, during the planning of the co-design phase of the project it was identified that there was further need for strategic recruitment of participants that reflect the diverse needs of this population. To do this, a Partner Advisory Council (PAC) made up of eight members led a sophisticated recruitment approach that included the use of established list-servs, community groups, and one-on-one connections.

Results:
Over the course of just a few months, the PAC recruited 19 young adults with lived experience to participate in one-on-one co-design interviews, and 4 young adults, 4 family and friends, and 4 health professionals and researchers to participate in two co-design events. The efficient recruitment of a diverse sample has provided invaluable insights into the nuanced challenges faced by this population, shaping the subsequent development of the integrated care program.

Next Steps:
An understanding based in the rich, varied, and complex lived experiences of those living with T1D contribute to the development of critically necessary community-based care solutions capable of addressing health disparities – especially for those living with co-occurring mental health challenges. Building on this success, PAC members will continue to play a pivotal role in the ongoing research process as co-researchers.

The Health Service Executive (HSE) Health Regions Programme Team established an Integrated Service Delivery (ISD) Workstream group to progress design of an ISD model for the Irish healthcare system and to propose a preferred set of regional and local organisational structural arrangements to underpin, enable and support the provision of integrated care.
The output of this work is for patients and users of health and social care services, service providers both HSE and partner agencies and the population as a whole.
Following thorough stakeholder mapping and analysis, an ISD Workstream group was established, consisting of 94 individuals, representing a broad range of voices with influence and interest in the Irish health service, from within and outside the HSE. Stakeholder planning ensured representation from across health and social care services including patients/service users, academics, multi-disciplinary healthcare staff and managers, and policymakers. A range of services including community, hospital, HSE, and non-HSE partner agencies were included from national services and from each of the six geographical areas that will become the Health Regions.
This process was led by the HSE Health Regions Programme team under the governance of the Health Regions Programme Governance fora.
A comprehensive engagement process was developed underpinned by:-
• Principles of co-production
• The Health Services Change Guide Framework
• Design Principles for Government in Ireland.
A thorough review of international integrated care models and literature informed the development of ISD design principles. Employing a co-design approach, the Programme Team conducted structured discussions, workshops, and semi structured interviews from May to November 2023. Engagements with members of the ISD Workstream Group were tailored to acquire the necessary outputs. This engagement process included 3 full workstream group events, 6 online engagements with 4 patient partners/service users, 31 in-depth interviews with 23 subject matter experts, 4 design workshops with 39 clinical leaders, operational managers and policy makers, and one multi-criteria analysis appraisal with 38 appraisers. The process yielded four high-level design options, presented to Health Regions Programme governance groups for consideration and decision making.
The outcome reflects alignment with Sláintecare reform, the Health Regions Implementation Plan, and IFIC Principles of Integrated Care, showcasing a comprehensive and participatory approach to healthcare transformation.
This collaborative process fortified relationships between key stakeholders and ISD design team and laid robust groundwork for detailed design and implementation, ultimately culminating in the identification of a preferred model for ISD which includes organisational arrangements to underpin, enable and support the provision of integrated care.
Engaging early and consistently fosters investment and shared purpose. Mobilising support through engagement is crucial for building relationships and is essential to co-design. Sharing power from interactions stimulates diverse viewpoints and encourages responsibility and readiness for change. Developing informed strategies for engaging priority group’s demands focus and planning. The IFIC 9 pillars offer a clear framework to discuss and promote understanding, ensuring alignment with integrated care recommendations during the design process.
Detailed design of the preferred model for ISD and implementation due to commence from June 2024

Background and short Introduction
“Implicit in a prudent approach to health is the need to redraw the relationship between citizen and the state, so that professionals and the public can work together as equal partners; co-producing new services that best fit their needs and empowering people to gain greater control over their own lives”. This is the vision set out for Wales by the Bevan Commission in 2016. Now more than ever we need to make this vision a reality.
The miners’ institutes of the last century provided for the wellbeing of Wales’ industrial communities. They focussed on self-improvement, peer support, and co-operation. Our project seeks to reinvent contemporary healthcare in the image of the old ‘stiwts’. It replaces the current emphasis on therapeutic interventions for sick people, with a focus on self-management, wellbeing, and community capacity. It also softens current boundaries between service providers and recipients. We have named our service the Niwrostiwt.
Who is it for?
The Neuro-Stute has been led by our Acquired Brain Injury (ABI) Team alongside colleagues in our stroke Early Supported Discharge (ESD) and Life After Stroke services.
Who did we involve and engage with?
All aspects of the Neuro-Stute are codesigned and are co-delivered by experts by training and experts by experience (i.e. people living life after stroke or brain injury). Converting the latter from passive patients to valued collaborators and inspiring peers.

What have we done?
The Neuro-Stute is organised into 3 faculties - the Living Well; Community & Communication; and Physical faculties. Each faculty offers co-constructed and co-delivered psychoeducation modules. These modules have provided opportunities for staff employed by the health board and service recipients to learn from and with each other.
What has been the impact?
Evaluation of the social and economic returns from the Neuro-Stute indicate significant gains in terms of improved efficiency; enhanced capabilities in both the community of practice and community of people living life after stroke and brain injury; and, added value in terms of the quality of relationships and impact on what matters most to key stakeholders.
What are the next steps?
We are keen to explore the scalability of the Neuro-Stute model across geographical, service and diagnostic boundaries. We are also curious about how we can do this in a way that has integrity to the underlying principles of the Neuro-Stute.
What is the message for an international audience?
There are ways of working that provide greater value and reduce the burden on overstretched service through awareness and utilisation of the full range of available resources and assets - including the wisdom of lived experience. In this model more people means more assets, not simply more demand.

People in prison have a larger burden of disease than the general public. The high prevalence of disease in this population is recognized as a significant public health issue. Given the high turnover of the prison population, prisons present a complex challenge for public health. Addressing the health needs of the prison population can also have a positive impact on the wider community.
SEHSCT has the remit to provide Healthcare in Prison in the 3 Northern Ireland Prisons for a population of approximately 1600 people. A multidisciplinary team provide primary and secondary care. The Health Engagement team are providing support to health and wellbeing. The time of committal into custody is recognised as a time of high risk for many. In-depth interviews were conducted with 160 people entering custody the regional survey 10000 Voices was adapted for a prison The survey highlighted the need for improved communication at the time of committal about the accessing healthcare services, the prison regime and how to keep well in prison.

In 2019 Healthcare Peer Mentors were introduced to HMP Maghaberry. Their initial role was to navigate people towards healthcare services and support people in their time of entering custody.

Ask HIM (Health Information Mentor) Peer Mentors connect with people in the first 48 hours of entering custody, focusing on those first time in prison, helping navigate complex prison systems. Mentors lead induction sessions, health information groups and are a rich source of referrals across all Healthcare in Prison (HiP) services. They have had over 2000 engagement encounters since the pilot resulting in more than 1100 healthcare referrals.

To systemise the peer mentor network it was essential to establish an inter-agency Peer Mentor Hub. The steering committee included NI Prison Service governors, in-reach agencies, people in custody, HiP clinical and support staff with senior management sponsorship to support and operationalise plans. A mapping exercise was conducted to understand the current status of mentoring and an iterative design process was adapted to establish the Hub. This has developed a new way of working across organisations, coproducing the Peer Mentor Hub with the mentors themselves.

Peer Mentor Hub Core Pillars:
• Standardised Recruitment process for all agencies mentors
• Training Courses in advocacy and mentorship by Belfast Met College.
• Supervision of mentors with the HiP psychology team
• Monthly mentor sessions to meet share food and relax

Outcomes of Peer Mentor Hub
A robust evaluation measurement plan includes:
• Quality of Life Measures
• Impact on Incidents
• Impact on Complaints
• Mentor Qualifications

The Peer Mentor Hub and Network have been evaluated and are evidencing the improvement of the committal time of custody, reducing risk, demystifying the regime and increasing access to care. The impact on the mentors has been positive with reported increase in confidence, qualifications and hope. A Peer Mentor Network is a challenge to cede power and challenge to command and control hierarchy, in a prison it take braves leadership to recognise the potential of social capital.