Starworks: Politics, Power and Expertise in co-producing a research, patient, practice and industry partnership for child prosthetics

Significant advances have been made in the field of adult prosthetic limbs. Conversely, paediatric limbs suffer from a ‘market failure’ situation; market forces are inadequate to stimulate product innovation. Children are left with inadequate limb provision at best aiming to minimize pain and discomfort rather than enable independence and quality of life. In 2017, the UK Exchequer announced £1.5M one-off investment in child prosthetics, as a result of lobbying by charities and a small number of parents of children with lower limb loss. Half this investment was dedicated to the provision of ‘activity limbs’ (eg. running blades) for children, and half dedicated to research and innovation over a period of two years. The authors took a lead in the latter, with the aim to re-structure the market forces, catalysing innovation for more appropriate paediatric prosthetics. NIHR Devices for Dignity MedTech Co-operative (D4D), supported by Lab4Living, established a network of key stakeholders based on principles of co-production (Greenhalgh et al. 2016). Details of the process, outputs and impact can be found elsewhere (Mills et al. 2019). This paper focuses on the politics, power and distinctive contributions defined by differing expertise, by which this collaboration was established, operated and sustained. We discuss the co-design methods that helped to achieve this and draw on evidence from the stakeholders and project outputs to demonstrate success of these methods. We conclude by suggesting meaningful co-production isn’t necessarily about including everyone in all decisions, provide some tips for managing political relationships and power differences, and highlight the importance of valuing stakeholders for their (unique) expertise.