# Co-production with marginalised workers: working with homecare workers and managers caring for people approaching end-of-life

## TL;DR

This paper describes a co-production process with homecare workers and managers to create training resources for end-of-life homecare, addressing a gap in workforce involvement.

## Contribution

The first successful co-production of end-of-life care training resources with underrepresented homecare workers and managers.

## Key findings

- Co-production workshops enabled power-sharing and created training resources tailored to homecare workers.
- Challenges included inconsistent attendance and engagement from some participants.
- The five co-production principles fostered inclusivity and enriched the final outputs.

## Abstract

Co-production is important due to its effectiveness in creating relevant and meaningful outputs for use in social and healthcare practice, however, frontline staff such as homecare workers (also known as aides, personal assistants or domiciliary care workers providing paid care within the home) are a key group within the social care workforce who are under-represented in this approach. Here, we report our coproduction process engaging with this workforce to develop training resources for workers providing end-of-life homecare.

To co-produce training resources with homecare workers and their managers to support and educate workers delivering end-of-life homecare using evidence from our larger qualitative interview study.

We conducted a series of 12 co-production workshops with UK-based homecare workers and managers (partners) to design training resources and recommendations for homecare providers informed by research findings. We adopted the five key principles of co-production: Sharing of power; Including all perspectives and skills; Respecting and valuing knowledge; Reciprocity; and Building and maintaining relationships. A co-production advisory group of homecare workers as well as the workshop partners gave valuable oversight throughout the workshop series.

77 partners (31 homecare workers, 46 managers) participated in 12 workshops (one face-to-face; 11 online). Our approach enabled power-sharing, inclusivity, respect, collaboration and reciprocity, relationship-building, and identification of effective flexible approaches to co-production. Specific forms of training resources were co-created. Training recommendations (content, delivery formats, access during working hours, etc.) were also developed together. Challenges were non-attendance and lack of engagement by some partners during sessions.

These workshops are the first, to our knowledge, to successfully co-produce end-of-life care training resources with homecare workers and managers, a poorly represented workforce in co-production. Challenges included inconsistent attendance and poor engagement by a minority of partners. The five key principles of co-production enabled true engagement with the process, thereby enriching the final outputs.

Access to personalised homecare is crucial for people wishing to remain in their own homes when approaching end-of-life. Most home-based care within the UK is provided by paid, unqualified (a standard professional qualification is not required) carers, often called homecare workers or domiciliary carers. End-of-life care addresses social, psychological, emotional, and physical needs but there is little training that is accessible or available to this workforce. In addition, this workforce is rarely, if ever, involved in the co-production of training resources.

We used an approach called co-production to partner with homecare workers and their managers to co-create end-of-life care training resources. The parent study for these workshops included interviews with care recipients and their families, health professionals, and homecare workers and managers and evidenced the key areas of training needed for homecare workers when delivering this type of care. We used this knowledge to co-produce training resources and a set of recommendations for training.

Several key aspects of this co-production approach were effective in engaging a workforce rarely considered in co-production activities. There were some challenges such as lack of engagement from some partners.

As far as we know, this is the first example of successful co-production work partnered with homecare workers and managers to co-create meaningful training material for use in the workplace. Our experience may be helpful for others wishing to conduct co-production work with rarely involved partners.