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Our project idea is…

The Critical Friends Network (CFN) is a group of volunteers who are all committed to working alongside staff at Yorkshire Ambulance Service (YAS) to improve the services we provide to our patients. At the moment the group consists of 15 members all from different backgrounds who contribute their feedback into improvement projects at YAS.

Our goal is to thoroughly embed coproduction into YAS creating a culture whereby patients and staff work collaboratively to improve the services YAS provides. We want to encourage and support the CFN to be involved in the planning and design stages of projects, any changes to service delivery and support us to undertake audits to ensure services are working as we expect they are.

Coproduction challenges the assumption that patients are passive recipients of care and recognises their contribution in the successful delivery of a service. Evidence shows that setting up co-productive relationships may have positive implications in social and health circumstances (Boyle, Clarke and Burns, 2006a)

To do this we would like to support the CFN to become self-directing whereby the members of the individual local groups appoint a ‘Chair’ of their group and YAS attend their bi-monthly meetings. The CFN would lead on discussions and agenda items which they wish to work alongside YAS to achieve and work together to identify improvement projects for coproduction. In order to develop engagement and develop mutual understanding between staff and service users we would host CFN visits to our emergency operations centers, ambulance stations and hospitals sites across the county to enable opportunities for development of ideas to progress improvement projects which the CFN may be interested in co-designing. As an example when a CFN visited the EOC, and spent time alongside the Frequent Caller Team, they had the idea that YAS having a system for signposting to peer support for those who were deemed frequent users of the service might lead to improved care for these users and a reduction in calls. Service users bring a unique perspective to quality improvement projects and should not be excluded from idea generation but included from the outset. 

We will support all of our CFN members to undertake Quality Improvement (QI) training which will be provided by Yorkshire and the Humber Improvement Academy supported by the QI fellows employed by YAS. This will fully equip our volunteers with the knowledge of QI methodologies and the confidence to use these.

We are also focused on building a diverse network consisting of members from different backgrounds, ethnicities, genders, religions, sexual orientations, ages and areas of Yorkshire, who all have a shared passion for improving the care and services we provide.

In order to allow for the CFN to develop further current members have stated they would like an online platform to communicate via as many members find it difficult to attend meetings in person and the pace of developments could be improved if we use a virtual platform.

As part of this project we will co-create a virtual space with the CFN. This space could then be utilised to share ideas, feedback and encourage discussions on projects or potential quality improvement needs within YAS.

What we will use the money for…

With the funding part of this would be used to create this virtual space with the CFN as well as hosting additional recruitment activities, hosting more events for the CFN, expanding their knowledge through additional training and ensuring that coproduction is at the centre of our service developments to get the best outcomes for patients.

How you can contribute

  • Share learning from coproduction experiences.
  • Share ideas for developing networks especially where projects are similar.
  • Critique on the idea being submitted and recommendations for strengthening.

Further information

Q Exchange – Proposal FINAL (DOCX, 22KB)


  1. I like this idea Claire. Congratulations on how far you’ve got so far. I like the idea of “blanket” and bespoke training for all your volunteers (and also like the “critical friends”terminology.

  2. Hi there! I really like this project - it's great learning for us in NI Ambulance Service and for Ambulance Q members! How did you recruit your Critical Friends?

    1. Hi Sarah, to begin with we used word of mouth from contacts with our Expert Patient, but now we have expanded and are using a variety of methods. We sent out promotional posters and application forms to all General Practice surgeries, we send invites out with all response letters from 4C's process but we are also undertaking some targeted engagement work to reach groups that don't so readily engage or have additional needs; for example we are doing in-reach work to an established Dementia support group. We attended one of their existing sessions to ask what areas would they like to work on with us and determine how best to take that forward. We have also attended various community events to promote the work we are doing. At the moment we are keen to keep the Critical Friends Network small but very active, and allow it to grow organically so it produces meaningful outputs -  like being able to coproduce improvement work with us. It's about quality not quantity at this stage. Further down the line we hope to have regional groups that become active in their geographical location, and service line groups, for example PTS Renal patients having their own Critical Friends Network. Happy to share - will get one of the team to send you the engagement materials we have developed so far.

  3. Great idea, don't forget patient participation groups for GP practices. There is so much they could do to support primary care health care delivery for example carers etc.

    1. Hi Hein,

      This project is specifically for the Critical Friends that represent patients who have experienced care given by Yorkshire Ambulance Service, mostly because that is where we all work currently. Happy to talk more widely about patient participation in more general terms and share the learning we gain from running this project with you and others in the Q community. If you do want to see this project going forward please click support on our project.

  4. I fully support this idea. It covers some key elements to our idea - – Make a change heroes network

    Looking forward to collaborating as this does make a lot of sense

    1. I think it does make sense for us to collaborate! Especially as we are in the same geographical patch - I am not the lead for this programme Chioma, Rebecca Mallinder is, she is on leave this week (and next) but let's talk soon we? I support your project idea too!

  5. I really like this idea, which provides a systematic approach to engaging patients and staff together in quality improvement.  Are you going to link into existing improvement or transformation work via your project management or PMO function?

    1. Hi Ruth, yes we are linking in with PMO function in YAS and the Improvement Academy, but we really want the Critical Friends we have already to help us co-design a QI programme and CFN platform that works for them - understanding that their needs, current knowledge  and perspectives are different to those of staff. It's really going to be coproduction in its true spirit. We have been looking at different ideas about how we can structure our engagement events so the service users can take the lead, but also so we work in innovative ways. I have joined the Liberating Structures SIG and Coproduction SIG so we hope to be able to bring some if these to the CFN group to inspire them!

  6. Hi Rebbeca

    I seem to be following Robin today going to other ideas that are similiar to ours. I would be grateful if you could also look at this project and again if you would like to collaborate at all please lt me know.

    Many thanks, Jono

    1. Hi Jonathan

      I think it's a great idea to get patients involved in QI, especially giving them additional skills & knowledge to be able to contribute effectively. We might be able to do something joint further down the line as we would like to give our CFN members some QI training.




  7. Sounds like a great idea.  Getting the patient / service user at the heart of our redesign and quality improvement is vital.    I think there is two sides to good codesign - creating the space and support for patients to be able to contribute AND supporting healthcare providers to be comfortable and skilled at working with patients in this way.   There are some great links with this proposal    We need to make sure we join up and share the learning.

    1. Hi Robin, thanks for your comment and really interesting reading up on that proposal as many links with what we are trying to do. We are just launching our QI Strategy at YAS and have linked with our patient group to get their views but they do play a really important part in improvement projects and we want to do more of this going forward. I would be really keen to share ideas from our projects.

  8. I think this is a great project. I fully support co-productive practice in health & social care.

    You might want to look at some great examples/case studies in Wales by getting in contact with Working With CIC, Spice, The Coproduction Network and others.


    1. Thanks Deborah we will certainly follow up on those. We have been working alongside other healthcare providers and organisations to get some ideas, but always welcome more.

  9. I was wondering whether you are planning to reimburse the CFN members for their time? I really like the idea but I'm mindful that more will be asked of the patients where professionals would be salaried to undertake this work. If we are talking about co-production in its truest meaning, patients should be paid. I hope that helps?

    1. Thanks Patricia for your comment and this is something we have considered and something we continue to look at ways we can 'reward' the members. Having considered payment, this was not a popular option due to its affects on the benefits of those who are CFN members. At the moment we offer full reimbursement of all expenses and provide lunch and refreshments for any events, which has worked well so far. We have an 'Expert Patient' at the Trust who we continue to work with around this matter to make sure our CFN members are well looked after. With the funding we are hoping we could build on this further.

  10. Great to hear about this inspiring project. Worth telling the Q Coproduction SIG about it (join our Zoom call at 12.30 today!): and tell the Sarah Williamson and the Q Ambulance Services SIG too - though they use conference calls rather than the online space:

    I hope the meetings of the CFN won't be stuck in the traditional unengaging formats. The 'Liberating Structures in healthcare' Q SIG is sharing some good examples of better ways to do things, and will be having some really interesting SIG calls soon where we can learn more:


    1. thanks Matthew. I have joined all your recommended SIG's. Really excited about the Liberating Structures SIG as this will be a really good fit with our CFN developments. We don't want meetings for them!

    2. Thanks for your comment Matthew. We have been trialling some different ways of engaging with the CFN in its infancy. Some more traditional approaches by the way of meetings but our virtual engagement has proven really successful and also our mock CQC inspections that the group can get involved with and other visits to sites.

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