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27. March 2018

Co-production

Creating a Galaxy of Co-production Stars in Aberdeen!

Co-production? Isn’t this just the latest fad to take our attention away from council budget cuts, the increasing uncertainty surrounding public sector jobs, the ever greater risks of failure in our hard-pressed health services? Don’t we have something more important to talk about than bringing citizens into our health and care services, when we’re already up to our lives in change, change, change.

NO! A large group of staff in in Aberdeen City Health and Social Care Partnership – and some of their service users – have been demonstrating during the past year that co-production is something different. And something important for the future lives of people living in the city.

In the process, a number of stars have appeared on the horizon – indeed, a whole galaxy of stars! Over a hundred people have been taking part in training in the Co-production Star Action Learning Programme, a CPD certified training programme to give people the knowledge and skills to grow co-production approaches in the Aberdeen City Health and Social Care Partnership. The Co-production Star has been devised by Governance International, a non-profit organisation, which is one of Europe’s leading training providers in the field of co-production. Facilitators from Governance International led the training programme of workshops and Co-production Labs – but, of course, the key inputs came from the participants themselves. 

The feedback from those involved has been enormously positive – this has opened eyes about what co-production can achieve and opened doors to bring people together to change the quality of life in Aberdeen, especially for those people with high health and social care needs.

Just a reminder of what we are talking about here. Co-production means service professionals, service users and their communities making the most of each other’s resources and capabilities to improve public services and the outcomes which people experience. In other words, it’s about getting both public services and citizens to DO things together – whether it’s agreeing the priorities for future services (co-commissioning) or making services more tailored to the needs of service users and their carers (co-design) or using the talents and energy of local people to actually do more activities to improve public outcomes (co-delivery) or getting practical feedback on how good services and outcomes are and how they need to change (co-assessment).

Of course, co-production is not new. Service users and communities have always been making some contribution to public services and to improving the quality of life in the community. But systematically? Identifying where service users can do and are willing to do more? Making it easy for citizens to contribute in ways which are comfortable for them and don’t waste their time? Giving them some training and support, so that they can make the most of the efforts they put in to making public services better? No, it became clear during the Co-production Star programme that, up to now, co-production has been largely underestimated by public services, if not ignored completely. So its potential has not remotely been tapped.

And it has also become clear during the Co-production Star training programme that this potential is really high and must in future be taken much more seriously. To highlight what co-production could mean in Aberdeen City Health and Social Care Partnership, each of the four Localities explored how the co-production approach could be used to tackle at least one major health or social care problem facing their Locality. These were all important, serious and multi-faceted problems – they included living with diabetes, tacking loneliness and the conditions which it causes, falls prevention for the elderly, and turning a large residential home into a thriving community centre for the benefit of both the residents and the local community.

Of course, the big question is: what has the Co-production Star training achieved? So far, the main result has been the design of new approaches to tackle these specific health and social care problems and commitment to try them out, with a systematic and practical evaluation of where they are successful and where the approach needs to be refined. That has meant the launch of a number of Co-Production Labs to enable action learning.

However, the longer run achievements of the Co-production Star training programme seem likely to be much more significant than simply helping to make some current services more successful. Two changes in particular stand out from the workshops and Co-production Labs to date.

First, staff now understand that they have been largely ignoring the resources of service users and communities, even though these could potentially have a dramatic effect on local health and wellbeing, if properly mobilised and harnessed. This means a transformation of the role which staff see themselves as playing in helping local people to achieve a better quality of life.

Secondly, a group of staff and service users have emerged who are both expert in and committed to the co-production approach to health and social care. As yet, of course, this does not cover all of the hundred participants who have been involved - but it does include over 20 who have attended almost all of the workshops and Labs and who have been central to designing how co-production could help their Locality in practice. These ‘Co-production Stars’ haven’t just obtained CPD recognition for a rigorous and demanding training programme – they have worked out how to change their Partnership (and its constituent organisations). They therefore form a new Galaxy of change agents in Aberdeen who can bring citizens into public services.

This is not a fad, not a deflection from ‘core business’, not an attempt to hide from local people the increasing problems of local services – it’s a turning point in the way in which citizens and the public sector make the most of each other’s contributions to local life. Watch this space for future reports on the progress of co-production approaches in Aberdeen Health and Social Care Partnership!

Tony Bovaird, Director, Governance International and Linda Smith, Public Health and Wellbeing Lead, Aberdeen City Health and Social Care Partnership


26. February 2018

Co-production

How commissioners can achieve better public value through community and user co-production

As a commissioner, you may currently be preparing for the next round of cuts of public services. As budgets get ever tighter, the danger of service failure grows greater. Traditional approaches to increase public service efficiency are clearly no longer sufficient.

The Governance International Public Value Model provides you with an asset-based co-production approach to work towards sustainable budgets.

We have developed an externally certified one day training workshop to support commissioners to achieve better public value. In particular, our Public Value model …

  1. focuses not just on services, but on public value;
  2. shows you how service users and local communities can help you improve public outcomes through co-production;
  3. identifies how public service providers can reduce their own resources by harnessing the resources of service users and local communities and reducing demand for public services;
  4. helps you identify better pathways to outcomes which improve user, service and organisational resilience;
  5. outlines a new social contract between the public sector and communities based on agreed standards for shared governance, setting out how ‘experts by experience’ and 'experts by profession’ will work with each other to co-produce better outcomes.

So let’s take you through our Public Value Model to give you an appetiser of what you will learn in our Training Workshop on Outcome-Based Commissioning. We start from the demands expressed by citizens. These have to be clearly determined and understood. Moreover, this can’t simply cover the demands of the most vociferous residents. Some demands are not publicly expressed – for example, vulnerable groups may not be able to make their voices heard. This is where elected politicians come in, with the responsibility of balancing different stakeholder interests. This requires consultation and negotiation with different stakeholders to prioritise those demands which are to  become recognised by the public sector as “needs”.

The conventional approach has been to respond to needs through commissioned services, partially supplemented by community support and services delivered by voluntary organisations. This is where an entirely new vision is necessary.

The Governance International Public Value Model proposes a ‘new quantitative and qualitative public value equation’, based on behaviour change and co-production.

Commissioners now need to focus on enabling behaviour change. By definition, behaviour change of citizens is not within the direct control of public services.  What they can and must do, however, is to put into place ‘strategies of influence’, which successfully get citizens to contribute to achieving their own outcomes and those of other citizens. For example, if disadvantaged groups who are most at risk of ill-health are enabled to adopt a more healthy lifestyle, they are less at risk of developing serious health conditions, which require costly medical interventions. Our case study on behaviour change through community health trainers in Manchester shows that there is a net cost of £4784 per QALY (Quality Adjusted Life Year). Anything under £10,000 is considered good value for money, highlighting the success of the programme. Behaviour change is at the heart of such long-term prevention projects, which have so far been given too little attention by public services.  However, behaviour change is also key to achieving short-term and medium-term savings, for example through digital services and minimising the effects of winter flu outbreaks.

However, behaviour change is not enough. Commissioners must also enable more effective forms of co-production, so that service users and communities make inputs which will directly reduce public sector inputs and/or lead to further reductions in the demand for public services. Many approaches to co-production also directly improve outcomes. For example, if former NEET young people are trained and supported to help other NEET young people this will improve their employability (and quality of life), which means less demand for public services from the local council and potentially also fewer costs to the police and the NHS.

Moreover, co-production also has a positive impact on the way in which the remaining public services need to be commissioned. Specifically, most services should now be co-commissioned, making use of the insights of service users and communities and getting their commitment to innovative service models. These co-commissioned services can be delivered by public, private or social sector organisations but co-commissioning is especially likely to embed innovative forms of co-production, whoever the service provider may be. Our case study on the transformation of young people services in Surrey County Council shows how extraordinary results both in terms of improved outcomes and cost savings can be achieved, if this is done effectively.

Innovative service provision models are not only able to produce better personal outcomes for individual service users but also better outcomes for the community and business. In the UK, we have neglected these collective outcomes, although they can be highly significant for local communities and can shape voting decisions.

A key issue in co-production is that some of the benefits which it brings do not accrue directly to the public service which supports the co-production, but to partners and other stakeholders who are only indirectly involved. For example, the intensive co-production of Services for Young People in Surrey CC not only saved 25% of the budget of the County Council but also reduced  by 90% the number of young people becoming first-time entrants to the criminal justice system, with significant reduction in policing and court costs. These police savings were not able to be recouped by the local authority. However, our Public Value Model highlights these indirect benefits of co-production. By modelling the full range of pathways to outcomes, the model helps commissioners to develop effective partnerships, with sharing of both benefits and costs, to achieve collaborative advantage.

Our Public Value Model demonstrates how some outcomes are directly produced by behaviour change and by co-production, without requiring public services. Embedded within the model is our portfolio of ‘influence strategies’, which show commissioners how to mobilise more contributions by service users and local communities to improve priority outcomes. In turn, the impact of behaviour change and co-production on service users, communities and business determines determine the level of future demand by citizens for public services.

All public services entail a level of risk, to service users and to the commisisoners and providers of those services. The transformation of the commissioning cycle which is outlined in our Public Value Model requires commissioners to work towards appropriate risk enablement strategies, rather than crude risk avoidance. It shows how to strengthen system-wide resilience in order to reduce the negative consequences of risk in case of system failure, whether that occurs in traditional or co-produced services.

Finally, results are not the only thing that counts.  The way in which the results are achieved is also important in the public realm.  Commissioning based on public value must embed agreed standards for shared governance. These public governance principles are key in managing expectations and creating a framework for organisational learning. Our Public Value Model gives you a template for a Co-production Charter to which all stakeholders can be invited to sign up and which can inspire a commitment by your stakeholders to behaviour change and co-production, signalling an entirely new way of improving your priority outcomes.  

So, if you’re interested in achieving better public value through co-production with your organisation or partnership, we’re happy to get you started. We suggest you begin with our one-day in-house Outcomes-Based Commissioning Workshop. All delegates will be issued with a CPD certificate of the CPD Standards Office, which can be used as a formal CPD record or as evidence in a CPD audit by a professional institute or regulator.

Check out our offer on Outcome-Based Commissioning Training.

Contact: tony.bovaird@govint.org to discuss how to tailor the inhouse training to your needs.


17. March 2017

Co-Production

How the Round Tables in Kehl enable refugees to have a voice and to co-produce innovative solutions

The members of the Refugee Council of the neighbourhood Kreuzmatt in Kehl

The social and labour market integration of refugees requires new solutions through co-production

Kehl is a multi-cultural town with 35,000 inhabitants at the border to France. Being a border town means that historically the residents of Kehl have always been used to flows of migrants. Even within living memory in the city, there have been occupations and evacuations, so that some families have members who themselves have experienced what it means to be a refugee.

In 2015 Kehl received about 500 refugees from the Near East and Africa. Local citizens wanted to provide help, so they founded a citizen-led initiative. They were supported by two Refugee and Social Integration Managers, including Raya Gustafson, who took up her post in Kehl City Council in March 2016. In June 2016, the local council approved a Social Integration Plan. This plan emerged from a broad participation process, including residents and refugees, as well as representatives of education, employment and economic development services, young people’s services, social care and other local services. The plan includes projects related to issues such as participation, culture, education, employment and housing. Social integration is understood as a reciprocal process, which enables people of different cultures to live together and to contribute valuably to society, with the objective of achieving an inclusive society, in which each individual can participate and contribute as an equal.

In order to facilitate the social integration of refugees and to enable their participation a new perspective was needed: To see the situation through the eyes of refugees. Nanine Delmas, the Head of Social Services of Kehl City Council decided to set up “Round Tables” with refugees in November 2016 to ask refugees about the challenges of social integration and their needs.

The initiative “Round Tables“ with refugees in Kehl

In a first step, the Refugee and Social Integration Manager Raya Gustafson invited refugees to take part in four “Round Tables”. The first one was part of a city-wide event – a so-called Café International, which was organised by a third sector organisation (Diakonisches Werk) and supported by the Red Cross and the local citizen initiative for refugees. This was followed by three Round Tables specifically with refugees at neighbourhood level. In total, 170 people participated at these events, including 160 refugees.

This involved a needs and capability assessment of refugees, based on a method developed in Kehl. At all events, refugees were invited to sit around tables where they could speak in their own language. At each table a volunteer (who spoke both the relevant language and German) facilitated the discussion around two questions, using images of everyday issues such as children, learning, sports and work-related activities. The first question focussed on the needs of refugees: “What do you currently need in Kehl in relation to the issues shown on the images?” The second question was: “What can I do in relation to the issues shown on the cards? What can I contribute?” Each question was followed by a discussion at the tables. The results were written up on cards which were presented by each table to the plenary session. For example, the refugees discussed issues such as the provision of childcare or leisure activities for older children during their language classes, continuous learning and access to employment.

It was easy for the participants, who mainly came from Syria, Afghanistan and Eritrea, to identify their needs. However, participants thought it was challenging to identify their strengths and assets, given that this meant a change of perspective to perceive themselves as active contributors to society.

Possibly, this step in the process was taken too fast for participants to work out specific ways in which their capabilities might be better used to enable them to make a contribution. In terms of needs, participants identified that they would like to become a member of sports clubs, to benefit from music offers, to get in touch with Germans, to take part in language training and support classes for their children and to find a job in the German labour market. Moreover, they expressed a general desire to show their gratitude to the people of Germany and to demonstrate their willingness to make a contribution and to give something back, although they did not find it easy to pinpoint exactly how they might do this.

The role of the volunteer interpreters from the various language communities was key to the success of the Round Tables. They played the role of a socio-cultural mediator and a person of trust who could act as a bridge to the refugees.

The interpreters invited the refugees to the Round Tables. Given that they were already in touch with the refugees, this triggered a high participation rate. Moreover, the knowledge of the interpreters about the culture of refugees ensured that the events could be tailored to the needs of the participants.

In the final Round Table, all results achieved were presented. The needs identified included:

  • housing
  • space to study
  • counselling on labour market issues and trainin
  • information about language training, childcare during language classes
  • support classes for children
  • access to cultural and sports offers
  • counselling on health issues
  • contacts with Germans.

One specific idea which had been put forward was to found a Refugee Council at neighbourhood level, consisting of refugees. This idea was developed further by the participants of final Round Table, who discussed the objectives proposed by the Refugee and Social Integration Manager Raya Gustafson. The 25 participants of the Round Table agreed that a Refugee Council should have the task of improving the quality of life of ‘language communities’ in Kehl. In particular, a Refugee Council should provide a voice for the different language communities, and act as a bridge to the local people of Kehl. It should also deliver refugee-led projects with material provided by the local City Council. The project-specific costs might involve up to 1000 Euros in the first year, but could be increased in the following year, if the project proved to be successful.

Consequently, in January 2017 the first Refugee Council was elected, consisting of six persons from the Afghan (dari) and Eritrean (tygrinya) language communities. It was amazing that a lot of Afghan women wished to run as members of the Refugee Council, so that they could represent women and children and promote their issues. Indeed, two Afghan women were elected to seats on the Refugee Council. The second Refugee Council was set up in the parish of Kork due to the initiative of the local citizen initiative for refugees and the support of the parish councillor. The Kork Refugee Council consists of a 19 year old Afghan woman and an Arab-speaking Syrian who have been elected by both language communities in Kork in a full meeting.

The first meeting of the two Refugee Councils showed that improvement of basic needs had priority. For example, the hygienic conditions in the refugee accommodation were seen as inadequate. After three working meetings, an article in the local press and consultation with the provider of the accommodation, the Refugee Councils managed to agree a joint cleaning plan. This involved intense conversations with the more than 90 inhabitants from six different language communities in a local refugee accommodation, resulting in a trial cleaning plan for a test phase of four weeks: The plan is that each Sunday two volunteers from different families will be cleaning the toilets and showers on two levels. If the plan does not work, a full meeting will be convened to appeal to all inhabitants to help out over the weekend. At the time of the publication of this blog, the delivery of the cleaning plan is still in the trial phase but it is already obvious that not everybody is contributing. Therefore, it is likely that a full meeting of all residents in the refugee accommodation will be called for to discuss how to make it work.

Next steps: Refugee Councils at Neighbourhood Level

So far, two Refugee Councils have been set up, one in the neighbourhood of Kreuzmatt and another one in the parish of Kork, which is a village in Kehl. It is planned to set up Refugee Councils in other neighbourhoods in Kehl as well. Furthermore, the local job centre and agency for foreigners of Kehl City Council and Kork Parish Council are planning an event with local business to join up job seekers and offers in the local labour market. Possibly, in the future, some refugees in Kehl may found a Council for Social Integration in order to enable participation by all people who have migrated to Kehl at some stage.

The authors:

Raya Gustafson is a Refugee and Social Integration Manager of Kehl City Council.

Nanine Delmas is the Head of Social Services of Kehl City Council.

Raya Gustafson
Nanine Delmas

30. January 2017

Co-production

What can co-production do for me? New opportunities for commissioners and providers to achieve better outcomes

 

 

This January we’ve already had lots of enquiries from local councils, social care and health partnerships and third sector organisations about our training and consultancy offer in user and community co-production of public services and outcomes.

So it’s becoming clear that more and more people now understand that it is no longer good enough just to talk about co-production – it’s time for public services to take action to strengthen co-production with specific service user groups and at neighbourhood level. This is the good news.  

The bad news is that there are still many people working in local councils who believe that co-production has nothing to do with them. After all, service users will simply have to take what (reduced) services we decide to given them. And, obviously, “communities are an issue for the third sector”. Wrong on both counts!

However, this is symptomatic of how outcomes-based commissioning has often been diverted away from the big issues. In theory, it offers great opportunities for enabling communities to improve outcomes. However, many commissioners perceive it as a service planning concept, internal to their organisation. Furthermore, many commissioners and service managers are facing (continuous) restructuring, often involving major disruption, so they become absorbed with internal processes, while neglecting what their job should be all about: Better citizen outcomes.

This is not just a public sector issue – many third sector organisations working in health and social care still embrace a ‘clinical model’ of health, whereas co-production promotes a social model of health, with a focus on wellbeing rather than illness. Some third sector organisations have indeed embedded co-production principles in their work - the Mosaic Clubhouse in London and Community Catalysts are good examples. However, in an era of permanent austerity, third sector organisations need to be able to demonstrate the social value that has been added through co-production. The recent evaluation of the Balsall Health Neighbourhood Forum in Birmingham by Governance International demonstrated a positive cost-benefit ratio from investing in co-production in community safety and revealed new opportunities for making co-production even more effective.

So how can co-production champions in local councils, the NHS and third sector organisations motivate and incentivise colleagues, who are not directly involved with local communities or people accessing services, so that co-production becomes their business, too, not just the agenda of some ‘engagement bods’ and ‘community nerds’?

Here are some new arguments for key stakeholders to get buy-in (literally) for co-production:

 

  1. Heads of strategy and finance: Co-production can be used as a budget management strategy, using the right mix of substitutive and additive co-production to achieve short-term savings while also releasing public sector investment in communities so they can help to  improve outcomes.  
  2. Integration Leads working in health and social care: Co-production can be used as a driver to promote the integration of health and social care, as it focusses more on outcomes rather than services and brings in communities who tend to be ‘sector-blind’.
  3. Commissioners interested in behaviour change: While there is increasing interest in ‘design thinking’ and ‘nudges’ to trigger behaviour change of specific target groups, the Governance International Co-Production Star shows that co-design is only one element in pathways for better outcomes. Governance International case studies, such as the peer training of learner drivers by young offenders in Austria or the Community Health Trainer Scheme in Manchester, show the potential of peer support, peer learning and peer training for sustainable behaviour change. 
  4. Open data officers: While there has been a lot of attention on how to open up governments so citizens can find out what they want to know, the big unresolved issue is what do (local) governments really know about local communities? Of course, there is a lot of talk about ‘big data’, usually as a top-down exercise, but this has so far not given governments that understanding of everyday behaviours of their citizens that many firms in the private sector have established, often with significant profit implications, through their monitoring of people’s purchasing patterns. There has also been some interest in asset-mapping, as evidenced by the group work in a recent West Midlands Co-Production event, but there are surprisingly few practical examples of asset-mapping leading to systematic mapping of community needs to community capabilities. So, it’s time for open data officers to engage with colleagues, especially those working in personal services, to drive the open data agenda from the bottom-up. We’d be very interested in working with commissioners and providers in further pilots of Governance International’s ‘See What You Can Do’ Toolkit to map individual capabilities, link them to the needs of service users and others in the community, and bring people together to improve personal outcomes.

So now over to you. In this blog, we have explored the potential benefits of co-production to four different stakeholder groups, who up to now have been talking about co-production but not grasping the nettle and making it central to their approach. We have also suggested ways of convincing each of these stakeholders that they need to take co-production more seriously. What about your organisation and your local area? Who are the sceptics whose hesitation is holding back co-production in your work?  What arguments do you suggest might convince them? What evidence would be needed to give these arguments real force with those stakeholders?

We’ll publish the best arguments, with your name (if you agree) and the chance for others to comment and build imaginatively on them. 

In this way, we want to turn this blog into a ‘What Can Co-production Do For You’ Resource – a stakeholder-specific list of co-production benefits.

We look forward to hearing from you.

 

 


21. November 2014

Outcomes

From NEET to PETE: Join our #govint fishbowl on outcome-based commissioning for young people

© Collage (using picture from aka, fotolia.com)

Outcome-based commissioning is high on the agenda of many local public services. Yet it is still not well understood nor systematically managed. The #govint #fishbowl invites you to discuss with national champions and experts in young people services how to make outcomes-based commissioning work in this field. So join the debate on Friday 21 November at 12.00 and share your experiences, achievements, questions and proposals!

So what’s a fishbowl? Like Twitter it is a facilitation method for discussing topics within large groups. Typically, four to five invited speakers form an ‘inner circle’, with a chair left empty for other participants to come forward and join in the discussion – but every time a new participant comes forward, someone has to leave the fishbowl voluntarily to free up a new seat. In our virtual fishbowl, of course, it’s even easier - all Tweeps can join in the discussion simultaneously, without pressuring anybody to leave their chair or interrupting anyone!

So who’ll be sitting inside the fishbowl to discuss with you? We’re very pleased that Garath Symonds and Chris Tisdall of Young People Services in Surrey County Council, Andy Moreman, CEO of the Young Lambeth Coop, Diane Evans of the National Youth Agency and Suzanne Thompson, CEO of the Restore Trust, an inspirational multi-award winning organisation  delivering skills & employment rehabilitation services, have agreed to share their experiences and views.

And our topic? The motto of our twitter debate “From NEET to PETE” is the brand of the recent transformation project which has achieved remarkable outcome improvements for Young People’s Services in Surrey County Council, providing many learning points for local councils and other organisations both in the UK and internationally.

The extraordinary results from this transformation have been highlighted in the external evaluation of the recommissioning of Services for Young People by @inlogov at Birmingham University and @govint Governance International, as well as in the case study produced by Chris Tisdall for the Governance International Good Practice Hub.    

Another highly innovative and unique commissioning model for Young People’s Services in the UK is the Young Lambeth Coop (YLC), which is a membership organisation for residents in Lambeth to decide how services for children and young people are run in Lambeth. Anyone over 11 years old who lives, works or studies in Lambeth can become a member, as long as they have a genuine interest in what happens to youth and play services and believe in its core values. YLC has two types of membership - community members and youth members.

We’re also looking forward to hearing the views of the National Youth Agency, Restore Trust and other experts in young people’s services, and of, course, the views of young people in the UK and internationally – but especially we want to hear from YOU!

We suggest the following questions for kicking off the debate:

  1. Does focusing on outcomes make a big difference? Why?
  2. How can we design an outcomes framework with young people? How do we make sure we identify the 'right' outcomes?
  3. Whose outcomes? What if different groups of stakeholders prioritise different outcomes?
  4. How can we help young people to co-produce the outcomes for themselves and others that they most care about?
  5. How to build outcomes into commissioning, procurement, contracting?
  6. Barriers to outcomes-based commissioning?
  7. What works in outcomes-based commissioning – success factors?

The Governance International team is very excited about our first #fishbowl debate. Thanks to all #bigfish for making it happen!


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