Coproduction of public services by service users and communities

The Coproduction of public services is the production of public services through the equal and reciprocal contribution of service users, communities and professionals, making use of their pooled resources, expertise and willingness to improve service processes and outcomes. Co-production in this sense is distinctively different from co-production between organisations; like for example between two media companies (see- coproduction (film) or between two public sector agencies – commonly referred to as 'partnership working'

The Emergence of Co-production

The term ‘co-production’ was originally coined in the late 1970s by Elinor Ostrom

Elinor Ostrom

Elinor Ostrom is an American political economist. She was awarded the 2009 Nobel Memorial Prize in Economic Sciences, which she shared with Oliver E. Williamson, for "her analysis of economic governance, especially the commons." She was the first, and to date, the only woman to win the prize in...

and colleagues at the University of Indiana to explain why neighbourhood crime rates went up in Chicago when the city’s police officers retreated from the beat into cars.[1][2] Similarly to Jane Jacobs

Jane Jacobs

Jane Jacobs, was an American-Canadian writer and activist with primary interest in communities and urban planning and decay. She is best known for The Death and Life of Great American Cities , a powerful critique of the urban renewal policies of the 1950s in the United States...

’ assessment of the importance of long-time residents to the safety and vitality of New Yorks old neighbourhoods, Ostrom noted that by becoming detached from people and their everyday lives on the streets, Chicago’s police force lost an essential source of insider information, making it harder for them to do their work as effectively.

What Ostrom and her colleagues were recognising was that services – in this case policing – rely as much upon the unacknowledged knowledge, assets and efforts of service ‘users’ as the expertise of professional providers. It was the informal understanding of local communities and the on the ground relationships they had developed with police officers that had helped keep crime levels down. In short, the police needed the community as much as the community needed the police.
The concept of the ‘core economy’, first articulated by Neva Goodwin and subsequently developed by Edgar Cahn, is helpful in explaining this further.

The core economy is made up of all the resources embedded in people’s everyday lives – time, energy, wisdom, experience, knowledge and skills – and the relationships between them – love, empathy, watchfulness, care, reciprocity, teaching and learning. Similar to the role played by the operating system of a computer, the core economy is the basic, yet essential, platform upon which ‘specialist programmes’ in society, the market economy and public services run. Our specialised services dealing with crime, education, care, health and so on are all underpinned by the family, the neighbourhood, community and civil society.

This understanding has helped to radically reframe the potential role of ‘users’ and ‘professionals’ in the process of producing services. Far from being passive consumers, or needy drains on public finances, people, their family, friends and communities are understood as important agents with the capacity to design and even deliver services with improved outcomes.
Professionals, for their part, need to find ways of engaging meaningfully with the core economy; helping it to grow, flourish and realise its full potential – not atrophy as a result of neglect or exploitation. Significantly, as the New Economics Foundation (nef) note:

“This is not about consultation or participation – except in the broadest sense. The point is not to consult more, or involve people more in decisions; it is to encourage them to use the human skills and experience they have to help deliver public or voluntary services. It is, according to Elizabeth Hoodless at Community Service Volunteers, about “broadening and deepening” public services so that they are no longer the preserve of professionals or commissioners, but a shared responsibility, both building and using a multi-faceted network of mutual support”.

What has emerged from this thinking is a new agenda; a challenge to the way professionals are expected to work, and to policy-makers who are setting targets as indicators of success; a way of helping to explain why things currently don’t work as well as they could; a call for an alternative way of doing things.

Defining Co-production

What co-production is…
There is currently no agreed-upon definition of co-production, though most definitions have one common feature: the role of people in public services.

This variety of interpretations is perhaps because co-production is in many respects elusive; as numerous practitioners often note, it is a mind-set, and not something that can be easily distilled in a sentence or two. Encapsulating its richness, diversity and flexibility of practice (the things that make co-production so successful), whilst also ensuring that it is not so loosely defined as to be rendered conceptually meaningless, has long been a key challenge.

In an attempt to strike this balance, nef, in partnership with the National Endowment for Science, Technology and the Arts (NESTA), have set out six key principles which help to frame what co-production is about, without being overly prescriptive. When co-production is effective all these principles are in action. These are;
Recognising people as assets: seeing people as equal partners in the design and delivery of services, not passive recipients of – or worse, burdens on – public services.

Building on people’s existing capabilities: rather than starting with people’s needs (the traditional deficit model), co-produced services start with peoples capabilities and look for opportunities to help make these flourish.

Mutuality and reciprocity: co-production is about a mutual and reciprocal partnership, where professionals and people who use services come together in an interdependent relationship recognising that each are invaluable to producing effective services and improving outcomes.

Peer support networks: engaging peer and personal networks alongside professionals as the best way of transferring knowledge and supporting change.

Blurring distinctions: blurring the distinction between professionals and recipients, and between producers and consumers of services, by reconfiguring the way services are developed and delivered.

Facilitating rather than delivering: enabling professionals to become facilitators and catalysts of change rather than providers of services.
From this nef/NESTA also offer the following definition:

“Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change”
What Co-production isn’t…

Another helpful way of thinking about what co-production means in practice is to be clear about what co-production is not. Co-production has emerged from a rich and diverse literature and practice; today it has parallels for example in asset based community development. However, there has been some confusion between co-production and service user-design, user ‘voice’ initiatives and consultation exercises. Although co-production encompasses all of these things, it cannot be reduced to any one of these approaches. To fall back on a well-worn cliché, the whole is greater than the sum of its parts.

At its most basic co-production is about ‘action’, for example people (including professionals and people who use services) coming together and producing a service or an outcome. In contrast many of the ‘voice’ based initiatives listed involve people expressing opinions and ideas but ultimately still only recognise professionals as capable of providing the work needed to deliver a service. ‘Voice’ based initiatives may be able to design better services than those that don’t engage with people, but ultimately they are not aimed at unlocking the practical skills and capacities of people who receive ‘services’

It is also important to note here the difference between co-production and ‘self-organised’ provision of support. Co-production requires a contribution in terms of time and resources from public service professionals as well as people who ‘use’ services. The way in which time and resources are contributed may well look different from more traditional service provision but it is essential that this contribution is present. In this way co-production is not a cover by which it becomes possible to withdraw professionals entirely from services.

Co-production in Practice

There are a range of practical examples from across the world which illustrate what co-production is and why it is potentially so transformative. Since co-production is a method, or an approach, rather than a specific tool, policy or programme, it has relevance to a broad range of services, and as such is characterised by a great diversity of practice.
Below are some examples by service area – although in practice many of them span across these categories and this list of services is by no means exhaustive;

Childcare

Family Nurse Partnerships are a good example of how early years childcare can be co-produced to improve long term, preventative outcomes. The original idea behind these partnerships came from early years psychologist David Olds, who became frustrated with the damage he saw inflicted upon young people in their first years by young, poor and often badly educated parents. Concerned with the importance of early years to a person’s long term development, Dr Olds saw an opportunity to improve the relationships between nurses, young mothers and their children. The young parents, who are often vulnerable first-time teenage mothers, are matched with nurses who, through regular meetings, build relationships with the parents and their children. In this way the nurse is able to provide on-going support and guidance – from breastfeeding to local employment opportunities – building the parent’s confidence and helping to establish a strong bond between mother and child.

Why is this co-production?

• Nurses do not provide services, they establish relationships, build confidence and explore opportunities

• They do not view users as an individual consumers, they engage with the abilities they find in all the families they work with, as well as their neighbours, to create learning and support networks

• There is a focus on collaborative learning. Nurses are not prescriptive; they teach as much through osmosis as instruction.

The beneficial outcomes of this service are impressive and well evidenced. By helping to change the behaviour of mothers in their early natal years, Family Nurse Partnerships have been shown to improve the wellbeing of children well into their early adult life. Levels of child abuse and neglect tend to fall and emotional and behavioural improvements are commonly reported – rates of anti-social behaviour in particular diminish. There is also evidence to suggest that the lives of mothers are also greatly improved; many smoke less, cook more nutritious meals and become less welfare dependant.

Criminal Justice

In Washington DC, as in many North American cities, youth crime and incarceration are high – particularly amongst young African American men. Levels of recidivism are also high, as many young people, now stamped with criminal records, struggle to find their feet once they leave the traditional criminal justice system. The great tragedy of this is that many of these young offenders are first time offenders whose crimes are non-violent. They are in effect being “hardened” by the criminal justice system, rather than supported.

The Time Dollar Youth Court system, pioneered in Washington but now spreading elsewhere, seeks to arrest this vicious cycle through a process of restorative justice; where first time offenders are tried by a jury of their peers and offered an alternative to incarceration and a criminal record. As the TDYC explain;

“Each Saturday at Youth Court, youth respondents are brought to court and judged by a jury of their peers. Youth jurors question a respondent about what led to their arrest and what activities and situations may have contributed to the problem. Jurors listen intently to both the respondent and family for indications that the young person:

1. Acknowledges the wrong and the part they played;
2. Understands the impact their actions may have had on the family, community and victim;
3. Recognizes the need to change; and
4. Is ready and willing to work toward improvement.

At the close of each hearing, the peer jury decides which types of activities the respondent must participate in and complete to satisfy the offense, promoting a sense of responsibility and commitment to a better life for themselves and those around them”

Why is this co-production?

• Although a recognised judge presides over proceedings, young people try the defendant

• As part of their service to the community the defendant is encouraged to join a young person’s jury

• A long term relationship is encouraged between the TDYC system and young first time offenders

Health and Well-being

“Merevale House is a private residential home for people living with dementia which believes in and supports ‘person centred care’. The philosophy which underpins their work helps make coproduction a reality by recognising that ‘service’ isn’t always a one-way delivery, but a collaborative endeavour.

Merevale House has won awards for its achievements, which are based on the values that “there is no ‘us’ and ‘them’” in the home. Residents take an active role in all the day-to-day activities within the home, from preparing meals to recruiting staff and gardening. The give and take relationship between staff and residents is central to the success of the home; it allows residents to take control over their lives and fosters a collaborative and empowering sense of community. This is seen in very basic ways, for example people set the tables and eat meals together, rather than ‘staff’ servicing ‘residents’.

In a publicly funded setting – Merevale House is privately funded – there might be some public outrage at the idea that older residents living with dementia are expected to contribute towards the daily activities that keep a home up and running. But the national awards for excellence Merevale House has won would suggest otherwise: that fostering reciprocal relationships and eroding the boundaries between staff and residents genuinely empowers people. Weekly residents’ meetings and daily activities also build social support and focus on using people’s strengths and abilities to create the best possible care environment.”

Why is this co-production?

• Residents are seen as assets not burdens

• The distinction between staff and residents is blurred

• Residents are encouraged to design and deliver services

• Reciprocal relationships are fostered between residents, and between residents and staff

Housing

One of the most successful examples of how housing services can be co-produced is provided by Taff Housing, a community-based housing association in Cardiff. With homes located in some of the most deprived estates in the UK, Taff Housing managers, working with the social enterprise Spice, provide a refreshing model of how to work with tenants to improve residential life.
Taff and Spice do this by engaging differently with young female tenants, enabling them to volunteer their time to design and deliver a range of housing services. In return for their time, tenants earn credits which can be used to access a range of events and opportunities within Taff and the wider community.

Why is this co-production?

• Tenants are encouraged to design and deliver services, blurring the distinctions between ‘providers’ and ‘users’

• Tenants are recognised as having something (skills and time) to offer

• There is a reciprocal exchange in place between Taff and tenants

Challenges for Co-production

Co-production, as a method, approach and mind-set, is very different from traditional models of service provision. As has been shown, it fundamentally alters the relationship between service providers and users; it emphasises people as active agents, not passive beneficiaries; and, in large part because of this alternative process, it tends to lead towards better, more preventative outcomes in the long-term.

Because of its radically different nature, however, people wishing to practice co-production face a number of significant challenges. As nef/NESTA comments;

"Overall, the challenge seems to amount to one clear problem. Co-production, even in the most successful and dramatic examples, barely fits the standard shape of public services or charities or the systems we have developed to ‘deliver’ support, even though [in the UK] policy documents express ambitions to empower and engage local communities, to devolve power and increase individuals’ choice and control."

This misfit makes practicing co-production difficult, and mainstreaming good practice particularly so. Existing structures and frameworks work against, not with, co-production. In order for it to flourish as a viable alternative to the expensive and in many cases failing, status quo change needs to take place.

nef/NESTA highlight four areas where such change will be required;

• Funding and Commissioning: Commissioners of public money will need to change their established ways of doing things. Applying strict quantitative targets and stipulating rigid, short-term outputs with a mind to economic efficiency acts as a barrier to co-produced service models. In order to ‘commission for change’ narrow outputs need to be broadened and complemented by outcomes based commissioning.

• Generating evidence and making the case for co-production: The obvious reason why many commissioning frameworks favour outputs over outcomes is that they are simply measured, making it deceptively easy to evaluate success or failure. But real success is not easily measurable. Nor are many of the preventative benefits of co-production easy to quantify. Making the case for co-production and capturing its complex and myriad benefits is a key challenge.

• Taking successful approaches to scale: It is fair to say that the majority of examples where co-production is being successfully practiced take place at a local scale. To a great extent this has been instrumental to their success; they are rooted in local realities, have grown organically from the ground based on local assets and ideas and emphasise the importance of face-to-face relationships. There is a potential tension to be overcome here; ensuring that a service remains locally rooted, whilst simultaneously expanding the scope of coverage nationally. Where this has been achieved (see KeyRing, Shared Lives and LAC in Australia) the tendency towards replication and blueprinting has been strongly resisted. Instead of simplistically transplanting a ‘model’ in new regions, these organisations have taken forward a common ‘method’ that involves engaging with local assets and resources in a consistent way.

Co-production also suits smaller organisations (traditionally those in the third sector) that are more used to working in less structured and hierarchical ways. This is something that large public sector structures are much less used to doing. If co-production is to be a mainstream way of working across public sector services, a structural and cultural shift will also need to take place.

• Developing required professional skills: Years of working to narrowly defined roles and job descriptions has understandably led to many public service professionals seeing their ‘clients’ through circumscribed lenses; as patients that need to be cared for, rather than people who could be enabled. It can also be difficult for any professional to relinquish control and ‘hand over the stick’; not only does this challenge occupational identities but it also confers a greater sense of risk – co-production can be ‘messy’ and is inimical to rigid control. If the hearts and minds of those delivering services on the ground cannot be changed, and if the necessary skills associated with relinquishing control are not embedded, co-production is likely to be constrained.

Criticisms and Responses

• It makes additional demands of people who rely on services and who are by definition already ‘in need’. However, a response to this is that the active engagement of people who have previously been seen as passive recipients is largely positive, enabling them to make services work for them, growing their own confidence and capacity. Nevertheless, in co-production approaches it is important to consider equality around the burden placed on people’s time.

• It is a cover for the withdrawal of services and minimises the accountability of the state; blurring the lines of responsibility for the quality of service. If co-production is done for the wrong reasons this can be the case. It is a question of means and ends. The key here is to emphasise that ‘co’ requires input both from people who deliver services and people who have been seen as ‘recipients’ of them. They are likely to play different roles and power will be distributed differently in co-produced services but contribution from both is essential, otherwise services become ‘self-organised’ which is a different thing entirely.

• Co-produced services will lead to a postcode lottery for service users: It is true that services will look different in different areas but that is to be expected as the assets, resources and needs identified by communities in different areas will also look different. There is still the need for a central role to be played to ensure consistency in approach and to be clear that everyone is enabled to play a role in co-production but the assumption that identikit services produce the best outcomes for people is questioned by co-production.

• Its just ‘participation’ by a new name: Co-production is different from ‘voice’ based interventions as it recognises that it is critical for people to play a role in the activity of delivering services, not simply to contribute ideas to shaping new services that rely on professionals to deliver them.

External links

http://www.neweconomics.org/

http://lx.iriss.org.uk/content/co-production-public-services-new-partnership-citizens
http://docs.google.com/viewer?a=v&q=cache:4eIwxgRCdYMJ:www.tsrc.ac.uk/LinkClick.aspx%3Ffileticket%3DC0BepcEHGVY%253D%26tabid%3D617+coproduction+of+public+services&hl=en&gl=uk&pid=bl&srcid=ADGEESgN_PABjif8p09NGKz4yaI9jg_ajDG-Etdng8gsx4-xPGI_5dsCkwILm16XnbiuUz0KUmEloyMbSaNJxwkI78kdxySgZ7RBpnZqzmA0ew7WPB6TQvwMMO2_y8ZDviKvCwaFvU2e&sig=AHIEtbR-h7XmcrAErvCCq6-mH58tKT2sqg
http://www.valueforpeople.co.uk/co_production
http://webcache.googleusercontent.com/search?q=cache:G0iCWFdKysUJ:fieryspirits.com/profile/FrankieHineHughes+Coproduction+of+public+services+by+service+users+and+communities+USA&cd=3&hl=en&ct=clnk&gl=uk&source=www.google.co.uk
http://www.publicservice.co.uk/feature_story.asp?id=15861
http://www.inlogov.bham.ac.uk/staff/Bovaird_publications.shtml
http://docs.google.com/viewer?a=v&q=cache:4eIwxgRCdYMJ:www.tsrc.ac.uk/LinkClick.aspx%3Ffileticket%3DC0BepcEHGVY%253D%26tabid%3D617+Coproduction+of+public+services+communities+America&hl=en&gl=uk&pid=bl&srcid=ADGEESgN_PABjif8p09NGKz4yaI9jg_ajDG-Etdng8gsx4-xPGI_5dsCkwILm16XnbiuUz0KUmEloyMbSaNJxwkI78kdxySgZ7RBpnZqzmA0ew7WPB6TQvwMMO2_y8ZDviKvCwaFvU2e&sig=AHIEtbQDI2-pJ-AmH534_yW3kjWVSZnTOw