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Co-production Around the World
The Co-Production Journey in Scotland
This new blog series highlights the current state of play of user and community co-production in public services. We will tell you who the movers and shakers are, identify cutting-edge innovations and showcase international best practice for your organisation to learn from. Join the debate and add your comments! This blog will be visiting your country soon...
© Nize Nicolai Schäfer
Like many other European countries, Scotland faces a significant increase in service demand during a time of demographic change and sustained decline in financial resources. In response the Scottish government has developed policies which specifically promote and fund co-production approaches in public services.
Sir Harry Burns, Chief Medical Officer for Scotland, has been highly influential in promoting this direction of travel through his championing of an assets-based approach to planning and delivering health and wellbeing. His vision was reinforced by the publication of the Christie Commission Report on the Future of Delivery of Public Services in June 2011. This highly influential report argues that it is necessary...to ensure that our public services are built around people and communities, their needs, aspirations, capacities and skills, and work to build up their authority and resilience.
The Scottish Government has recognised this challenge and together with the Confederation of Scottish Local Authorities (CoSLA) and other stakeholders, has developed a 10 year change programme for Reshaping Care for Older People, which promotes the development of co-production and community capacity building as key elements of public service transformation. Most importantly, the Scottish Government has invested to support the transformational change required by creating a four year older people's services Change Fund of £300 million in order to drive the necessary shift in service models and organisational cultures. Government funding has also been made available to adopt co-production approaches to deal with specific issues such as teenage pregnancies (e.g. through the Family-Nurse-Partnership Programme) and the limited access for older people to healthy food and supportive social networks (e.g. through the Food Train).
- Nicola Sturgeon, then Cabinet Secretary for Health and Wellbeing and Cities Strategy with a client of the FNP programme.
On an operational level, the Joint Improvement Team (JIT), which is co-sponsored by the Scottish Government, CoSLA and NHS Scotland, working in strategic partnership with the Third and Independent sectors, provides support to 32 locally based partnerships across Scotland (including NHS, council, third and independent sector organisations) to integrate co-production as an approach within health and social care. This work has been led by the two National Co-Production and Community Capacity Leads Gerry Power and Andrew Jackson working with geographically based JIT Associates. Activity to date has included:
- Awareness raising activities, such as the first Co-Production and Community Capacity-Building Conference in Dunfermline in January 2011, which was attended by more than 300 participants.
- Providing case study evidence that co-production works including the publication with Governance International of Co-production in Health and Social Care: What it is and how to do it, and the building of management and front-line staff capacity across local councils, the NHS, independent and voluntary sectors by rolling out training based on the Governance International Co-Production Star.
- Gathering good practice case studies from all of the 32 local partnerships in Scotland.
- Strengthening networking and the exchange of experiences through the Scottish Co-Production Network.
The change management strategy of JIT is showing signs of success as a number of councils have already started to take action to roll out co-production across their services. For example, Midlothian Council have adopted a Council wide approach to co-production enabling all council services in the county to make effective use of the Governance International Co-Production Toolkit. In addition JIT has provided coaching to assist the implement of action plans being drawn up by participants in the co-production training sessions. This process has uncovered good examples of co-productive practice already taking place in the Council which are being used as drivers to convince more colleagues to adopt this way of working and promote culture change.
Co-production is also being rolled out in other public services in Scotland. For example, Strathclyde Police and the national Violence Reduction Unit have been leading an assets-based approach in a highly deprived area in North West Kilmarnock, which was previously characterised by high crime rates. The project uncovered enormous reserves of creativity and energy in the community, which have helped to turn around the quality of life of local people in the area. The lesson which Chief Inspector Tony Bone took away from his involvement with this project was: You don't know what you need in a community until you know what you already have.
In other organisations, however, full buy-in remains to be achieved and work continues to demonstrate the value of this approach in delivering better outcomes and/or efficiency savings. For example JIT is currently working with a number of partnerships on Contribution Analysis to develop an evidence base which can demonstrate the economic utility of co-production and community capacity building as well as their impact on personal outcomes. It is recognised that embedding co-production and community capacity building in organisations and services will require whole systems change which spans commissioning of public services through to organisational and individual performance improvement. One example of how this might be achieved in future is by recognising the capacity and capability of front-line staff to co-produce with users and communities in organisational competency and performance management frameworks. This will support the principle of co-production by emphasising it is more rewarding for the service user, the professional and the provider organisation to solve problems together and not simply do things to and for service users.
I am delighted to announce that Co-Production of Health and Wellbeing in Scotland, the second booklet on co-production and community capacity building in Scotland, produced in association with Governance International and other partners, will be launched by Mr Alex Neil, Cabinet Secretary for Health and Wellbeing, at the National Co-Production and Community Capacity-Building Conference on 20 February 2013 in Edinburgh. This publication includes updated and new chapters covering the background to co-production, case studies and good practice from within Scotland and from our learning partners in Sweden. This I hope will help to demonstrate the great strides that have already taken place in making co-production and community capacity building a key part of the strategy and the practice of public services in Scotland and encourage you further to making these approaches central to the way you plan and deliver services.
This guest blog has been written by Dr Margaret Whoriskey.
Director, Joint Improvement Team
Co-production
Co-producing wellbeing: Getting ready for welfare reform
Why public service co-production is now needed on a mass scale
Elke Loeffler and Frankie Hine-Hughes outline a transformation strategy for local councils to manage demand on public services by unlocking the strengths, assets and resources of service users and communities.
In the light of current financial austerity and the long-term demographic changes we are facing in the UK, co-production is no longer just a good idea - it has become a necessity. This applies in particular to health and social care but it is also true in other local services such as community safety and environment. As the case studies in our new book with LGiU 'Making health and social care personal and local: Moving from mass production to co-production' demonstrates, co-production is already recognised as an important element in the transformation of councils. While this is most vividly being promoted by the network of Co-operative Councils and the six councils participating in the NESTA people-powered health project, there are now actually scores of councils across the UK which are embracing co-production as core to the transformation of their services.
However, the picture is still patchy. The panel debate at the recent book launch event at the LGiU in London showed that involving service users and communities in the commissioning, design and delivery of public services is still sporadic rather than normal, and piecemeal rather than systematic. Why is this? One of the key barriers to systematic co-production, as the debate highlighted, continues to be the 'we solve the problem for them' culture of service providers and commissioners. Of course, highly qualified and motivated professional staff, backed up by competent and committed managers will always remain vital to excellent local services. However, the lesson from successful co-production case studies, as showcased in the book, is that these are simply not enough in 2012. Unless service users and their communities also contribute their strengths, assets and resources to services, real excellence is not possible - and costs will higher than necessary. So, the focus in co-producing councils is now on giving guidance and support to citizens as co-producers of services, recognising that improving outcomes is a joint responsibility, not just something that councils can achieve by themselves.
Of course, not all citizens are ready to co-produce - and not all staff know how to unlock the potential in services and citizens. So what needs to be done in practice to help councils to tap into the strengths, assets and resources of service users and communities?
New ways of collaborating with users and communities in local services
Governance International, a social enterprise based in Birmingham, has been working on these issues for more than five years with councils in the UK and Europe. We have developed a practical transformation approach for public services. While many councils in the UK have involved their users in consultation exercises, co-production goes way beyond consultation. As Dave McKenna of the Better Swansea Partnership put it: Co-production leads us away from "You said, we did" to "We talked, we did together". For Governance International co-production is about 'public services and citizens making better use of each other's assets and resources to achieve better outcomes or improved efficiency'.
Actually, there are lots of different ways of involving users and communities in public services. They include:
- Co-commissioning public services - shifting the focus from services that councils think people need to outcomes that local people themselves believe to be priorities, e.g. through neighbourhood budgeting.
- Co-designing public services - using the customer journey approach to look at how the service process can be improved from the user?s point of view. The outcomes and efficiency savings from the re-design of the Stockport social care website 'My Care, My Choice' show how powerful co-design can be.
- Co-delivering public services - identifying who is willing to do what and how, e.g. through capability assessments (as we are currently piloting with Walsall Council) and community asset surveys.
- Co-assessing public services - training citizens to carry out service inspections and scrutiny, often through the use of social media or online ratings. The case study of citizen-led inspections in West Lothian Council shows that citizens have an important role to play alongside professional inspectors.
The Co-Production Star gives a clear visual portrayal of these four Co's of co-production. Using this tool, councils and their partners can map the current level of collaboration between local councillors, managers, front-line staff and citizens. And they can spot areas where more co-production could be tried in the future.
How to manage the transformation to more co-production
The inner ring of the Governance International Co-Production Star highlights the changes that a council needs to make in order to roll out co-production in public services. It outlines a five step change management model. It recognises that co-production is nothing new - but that we need to change the culture of organisations and partnerships in order to make the most of what we are already doing. And we need to seek out change pro-actively to identify new ways of working between councils and citizens. This may already be working well in some of our services but real transformation will only come when co-production is identified, managed effectively and rolled out much more widely. This involves the following five steps.
Step 1: 'Map it!'
We typically find in our training and briefing sessions that participants quickly recognise that co-production is already happening in every organisation - but only here and there, in pockets. This means that it's really important for councillors and staff to map the way in which they collaborate with service users and communities, so that they can build on what works to avoid re-inventing the wheel. Our Co-Production Explorer supports this self-audit - identifying clearly what is already being done, so that it can become the basis for learning and development - and what is NOT being done, so that new co-production approaches can be devised.
Step 2: 'Focus it!'
After mapping what is happening - and not happening - councils need to prioritise their efforts to take co-production further. Our Co-Production Priority Matrix is a simple technique to rate current and potential coproduction activities - distinguishing priority projects to be taken on, and those to be dropped or put on the back burner. 'Quick wins' (high impact, low effort initiatives) are self-evidently the optimal starting point - establishing success, to catalyse further co-production.
Step 3: 'People it!'
Here we need to ask: how can we involve the right people in the community and in the agency to contribute to improved public services and outcomes. The Governance International Community Asset Survey helps identify what local communities are already doing and how they want to get involved more. The Capabilities Assessment which Governance International is currently piloting with Walsall MBC identifies service users and carers who are already doing interesting activities that could help others and who would like to widen this out, to enrich their own social lives and make the most of their own capabilities by helping others. Having identified these key people who want to help make co-production really work, it is important to bring these citizens together with key staff in 'co-production labs', so that together they can design how these activities can really succeed through citizens and staff working together.
Step 4: 'Market it!'
Having reached this stage, we have to make it simple for people who want to be involved to actually get involved and stay involved. This stage is often missing from current co-production approaches. Incentives and nudges are really crucial to encouraging the inputs of both citizens and professionals. There are lots of different kinds of incentives: psychological incentives, which reinforce an individual's 'feel good factor' with appreciation or other informal rewards; or more formal mechanisms like 'recognition awards', which could include prizes (or even monetary incentives). Another way of encouraging individuals to take part in co-production is to agree co-production charters that outline explicitly the roles, responsibilities, and conflict mechanisms for staff, citizens and service users. These can provide an effective framework to show people what responsibilities they are committing to - and what the statutory agency is committing to provide by way of support to those who work with it.
Step 5: 'Grow it!'
Once the co-production ball is rolling, the momentum needs to be kept up and even increased. Co-production can be scaled up across an organisation by showcasing 'champions' or developing a business case. It is vital that performance management and human resource management systems are aligned to co-producing - it needs to become clear that co-production is actually a central part of the job of all staff.
Next steps
Finally, it is not important what a local council calls this new way of working with users and communities. Some will be happy with the label 'co-production'. Others may want to call it 'co-operative working'. Yet others may want to label it 'partnership with users and the third sector'. Fine. What is important is that councils recognise how patchy and sporadic has been their practice up to now in promoting genuine co-production. And then deciding that they want to start the real transformation process now.
Clearly, collaborative ways of working, based on mutual respect, power-sharing and a focus on outcomes, requires courage and risk-taking. Many councils are now at the stage where they have recognised this. But it is not enough. To make the transformation real, investment in training and change management is necessary. And an understanding that many of the steps towards culture change won't work immediately - experimentation is needed, and therefore patience and flexibility. Even more alarming - some budget will need to be spent to learn which approaches to co-production really work in your area - and which don?t. Effective co-production is not free - but the spend that's needed could be the most cost-effective investment that a council undertakes during the next decade.
In any case, what are the alternatives? If councils do not start now on the path of co-production with their users and citizens, their only alternative to deal with the current financial pressures will be significant cuts to local services. Then they will find that service users and citizens REALLY want to get involved - but usually in a negative, destructive way. To avoid this, pro-active approaches to co-production are essential NOW.
We said we had a five step model towards co-production of public services and outcomes - but actually this was not quite the whole truth. There is a sixth step, probably most important of all - START NOW!!!