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Background
There are an estimated 5,153 nursing homes and 12,525 residential homes in the UK providing care and support for 426,000 older people (Laing and Buisson, 2014) from which 59.2 per cent are aged 85 years and over (Office for National Statistics (ONS), 2014). Whilst only 16 per cent of people aged 85+ in the UK live in institutional care (ONS, 2014), this group constitutes one of the most medically and socially complex groups of people in the community (Scourfield, 2007; Finbarr et al. , 2011). The number of care homes has remained almost stable since 2001, despite a dramatic growth in the overall ageing population. Institutionalised care is however, predicted to remain a key provider of support for older people in the immediate future so improving the quality of provision and person-centred care remains significant (Fotaki, 2011). Improving public confidence in the safety and wellbeing of vulnerable older people living in care homes (Katz et al. , 2011; DEMOS, 2014) is also poised against a background of austere measures which have significantly reduced funding for the public and community services impacting on social care (Age UK, 2012).
Despite making some good progress, two major reports commissioned by the government (Abraham, 2011; Francis, 2013) documented that older people continue to experience unmet needs, poor quality support and unacceptable variation of standards in care settings resulting in a call for national action. A range of research findings have highlighted widespread systemic problems within the care home sector such as; lack of equality in health provision (Victor, 2010); the lack of diversity within the services that support older people (Knocker, 2012; Hafford-Letchfield, 2013); restricted access to community-based services (Edwards, 2014); inequity for self-funders and overly complex funding arrangements (Institute of Public Care, 2011); poor working conditions and lack of support for the social care workforce (Imison and Bohmer, 2013); the disenfranchisement of older people living in institutions from the political system, (Scourfield, 2007) and continuing widespread ageism in society (Kennedy, 2014). In response to this bleak picture, a strong movement towards co-production (Needham and Carr, 2009) has looked to older people and their representatives to collaborate with commissioners and providers and to work together for improvement of quality at a transformative level. "Co-production" describes a relationship where...