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Undertaking involvement

There are a number of levels of involvement and many different ways to involve people.

The ‘ladder of involvement’, is based on work originally undertaken in 1969 by Sherry R Arnstein. This helps to understand the different levels of power and stages at which people are involved in making decisions. Involvement at every stage is important.

At the top of the ladder, co-production is seen as the pinnacle of involvement, where power is shared with service users, carers and the public in the decision-making process. Moving down the ladder, the level of influence in relation to the decision-making process reduces.

When involving people, it is likely that a range of approaches will be used to reach out and involve those who will be affected. For example, a change in a service may be co-produced with a small number of service users and carers but engagement with wider groups will take place via consultations or involving people to help to develop information or communication about the change to the service.

Check out a range of involvement levels below.



Co-production has been defined ‘as a way of working that involves people who use health and care services, carers and communities in equal partnership and involved at the earliest stages of service design, development and evaluation. Done well, co-production helps to ground discussions in reality, and to maintain a person-centred perspective’. (Coalition for Collaborative Care). Co-production shifts power towards people and can best be achieved with people, through equal and reciprocal relationships. Co-production is the pinnacle of involvement.

Connecting and Realising Value Through People” is the new Co-production Guide for Northern Ireland which was launched by the Department of Health on 31 August 2018.  Click here for further details and a link to the Co-production Guide.

A model for co-production, developed by the Coalition for Collaborative Care and its partners, provides a useful overview of co-production.

Check out some of the methods to co-produce below.


Co-design focuses on sharing decision-making power with people and working in partnership to understand and improve patients’ experiences of services as well as the services themselves. It involves sharing decisions with people to design a new service or undertake a change to a service. This means that people’s voices must be heard, valued, debated, and then – most importantly – acted upon (New Economics Foundation).

Some of the methods to co-design are listed below.

Engage and consult

Engaging is seen as involving people within parameters which are set by health professionals. At this level, services are often designed by professionals with the recipient’s best interests in mind, but people’s involvement in the design and delivery of the services is constrained. People are only invited to be heard and not given the power to make sure that their ideas or opinions shape decision-making (New Economics Foundation).

Engaging also includes consultation, which is a process to gain the public’s input on matters affecting them. This usually includes a range of options already developed and the public are engaged to share their views.

Some of the methods to engage people are listed below.

Inform and educate

Informing and educating describes the giving of information on a particular topic. This may involve sharing information with a group or the public about a particular topic with little to no input in the development or delivery of the information.

Some of the methods to inform and educate are listed below.

Check out the key steps to getting started which will help you develop an involvement plan to clearly outline why you are involving and how you will undertake this work. The range of involvement tools will help you determine how to involve people and may be accessed here.