Rural engagement: practitioner experience of rural innovation projects and co-production of services in Wales

The discourse of change in the provision of health and social care services has shifted and with it new labels have been created for organisations and initiaitves that participate in the new strutcures: beacons, trailvlasers, and pathfinders.Alongside this there have been increased calls for accountability and a focus on achieving improved services and cost eficiencies through innovation. In Wales, a series of publications linked to public service reform has championed a citizen-centred model (the patient voice)that reinforces a move away from patients as passive recipients of services to that of engaged consumers and co-producers of services. Furthermore, the potential for rural community involvement in achieving Welsh Government aims for community cohesion and engagement is central to the Rural Health Plan, which has facilitated the development of a number of Rural Health Innovation Projects (RHIPs). Drawing on in-depth interviews with practitioners responsible for the design and deliver of RHIPs, this paper examines the processes of innovating in rural health and social care. We explore the strategic and operational issues that enhance or inhibit innovative practice. We suggest there are two key challenges to promoting co-design and effective co-production of new services in rural Wales. First, innovation processes can be seen to limit the potential for service user involvement. Second, practitioners' perceptions of their own and patients' skills and knowledge can act as barriers to meaningful engagement in, and chnages to, service design and delivery.