Table 3 Summary of themes

Perspectives on co-design

• Participants used different terms to describe community involvement– co-design, co-production, co-creation– reflecting different levels of involvement

• Co-design was viewed positively by all participants

• Co-design was thought to create more suitable services, increase engagement, and potentially reduce inequalities

Building relationships for co-design

• Building relationships with communities was critical for co-design

• This took time and could not be rushed, especially in communities where trust had previously been damaged through lack of action

• Case studies demonstrated different ways of building relationships with communities e.g., partnering with a local charity, commissioning a private provider, or using in-house resources and connections

Funding for co-design: opportunities and harms

• Funding for co-design is often short-term and ad hoc

• Opportunistic funding pots can allow for innovative approaches to be tried

• However, small amounts of funding and short time frames can hinder co-design plans

• Relationships with communities can be damaged if funding is cut

Evidence, effectiveness and evaluation

• Commissioners recognised co-design lacks a strong evidence base

• Tight budgets can favour ‘evidence-based’ programmes over co-designed approaches where effectiveness is unknown

• Co-design can be hard to evaluate using traditional approaches and pre-specified outcomes measures

Commissioning for ‘true’ co-design

• Co-design may not easily fit with current commissioning practices

• Commissioning for co-design may require a “a different way of thinking”

• Co-design involves a level of uncertainty requiring commissioners to be “brave” and embrace the possibility of failure

• Facilitating true co-design requires working with partners who share your vision and values