Contextualising co-production and complex needs: understanding the engagement of service users with severe and multiple disadvantages

Much has been written about co-production in mainstream services but less is known about its applicability to service users with severe and multiple disadvantages (SMD). Given the sometimes-precarious relationship between providers and users with SMD, the paper argues that co-production should not be approached in the same way as conventional user engagement because of the degree of marginalisation, stigma and exclusion users with SMD face. Through a thematic analysis of evidence systematically collated via a rapid evidence assessment, the author proposes a co-production framework comprising a series of organisational principles to create an enabling environment for co-production with vulnerable service users. The application of the model is encouraged across a range of sectors and settings so that all service users can become empowered participants in the design and delivery of services that affect their lives.