Proven practice: Co-production and adult social care

The government has committed itself to personalising social care. The Putting People First concordat seeks the transformation of adult social care through the involvement of users and carers at every stage. This shift of policy focus towards collaboration and social capital is the essence of co-production.

Adult social services have always required some input from the people using them but there has recently been a swing towards service users’ active involvement in development and delivery.

Co-production describes approaches to adult social care that recognise and utilise the expertise of service users in shaping their own care and encourages their involvement in improving the services on offer. It challenges the dominant role of the professional and shifts the service user from the role of a passive recipient to that of a valued participant in the process on an individual and collective level.

CO-PRODUCTION IN ADULT CARE SERVICES

Co-production can be described as a collaborative relationship between people who use services and the service provider. It demands dialogue and negotiation between these frontline staff and the people who use services. Another model sees co-production taking the form of mutual aid between people who use services. In both cases the key is that care and support become something users of services are actively involved in.

Some co-production already occurs in adult social care services such as when people who use services, service commissioners and providers negotiate individual care packages.

But when co-production is used more extensively, the people who use services can be involved from planning and designing to managing and evaluating provision. Their involvement should be an integral part of service design and delivery.

Participants in co-production bring their skills, time, and activity while some service users may bring more intangible factors, for example contributing to the “culture” of a service.

Co-production also redefines the idea of the expert with the users of services recognised as possessing expertise that can be shared with providers.

THREE LEVELS OF CO-PRODUCTION

The extent of co-production varies but it can be organised into three tiers:

Compliance (descriptive): Co-production takes place at the stage of service delivery, as carers and people who use services collaborate to achieve results. People using services make contributions at each stage of service provision but they are not involved in implementation. Despite the awareness that care services cannot be produced without input from the people who use services, the compliance tier offers little opportunity for real change by or for the people who use services because it is about complying with an existing regime.

Support (intermediate): The intermediate level of co-production recognises and values the many people who come together to co-produce care services. It acknowledges the input and value of service users, utilises existing support networks and improves channels for people to be involved in the shaping of services.

It may include new or more involved roles for users in the recruitment and training of professionals and managers. Also it may see responsibilities being shared with the people who use services.

Transformation: The most effective methods of co-production can transform services and create new relationships between the people who use them and staff. This transformative level of co-production takes “a whole life focus”, incorporating quality of life issues as well as simply clinical or service issues.

At this stage the service user becomes an expert. Professionals and people who use services and their carers come together to identify and manage risks. There must be trust and respect on both sides. To reach this stage there must be reallocation of power and control through user-led planning, delivery, management, empowerment and governance and collaboration must be entrenched. It involves often requires organisational change.

STRENGTHS OF CO-PRODUCTIVE MODELS

Added value: Co-production can access assets that were previously under-used and can also deliver greater satisfaction for people who use services.

Using the expertise of service users: Service users value approaches in which the professional assists them in achieving aims they have determined themselves. Co-productive approaches can also contribute to the development of mutual support systems which address issues before they become acute.

Practical skills: Some co-productive models, such as time banks where participants share skills and companionship, can provide practical advantages such as formal and informal skills and learning.

Heath benefits and prevention: Co-production has been found to have a positive impact on health with a link found between time banks and reduced levels of hospitalisation. Certain co-production schemes could contribute to the wellbeing and prevention agenda in health and social care.

Social capital: Schemes that build supportive relationships and increase the confidence and activity of participants have positive benefits for social capital. In addition to the benefits felt by the users of services, service providers and the wider community can benefit from these approaches.

LIMITATIONS TO CO-PRODUCTION

There are limitations to co-productive models and issues are raised which should be addressed. They include:

Building social capital: It is possible that co-production schemes can sideline already marginalised groups as there are limits to the extent that some people can co-produce without support. Issues of social exclusion, equality and diversity need to be taken into account. There is also an awareness that co-production should not be a method for government to dump its problems on the community and service users.

Challenges to existing frameworks: Statutory authorities tendency to risk aversion, as well as tax and benefit regulations, can create problems for co-productive initiatives. Also, accountability can be threatened as private and public, formal and informal, budgets that were previously separate become entwined.

Security and independence: There can be concerns about the long-term sustainability of projects as many co-production initiatives want to be independent, relting on funding that is often short-term and unstable.

Staff support: For co-production to work effectively staff and service users must be empowered.

Some in the sector believe that this approach requires specific skills and new roles should be created for individuals who help staff overcome their unwillingness to share power with users. Even if this is not the case there is a need for training and staff development to support co-productive approaches. There should be clear support for positive risk taking and staff should be encouraged to seek out opportunities for collaboration.

There is also a greater focus on relationships in this approach so staff continuity is important.

FURTHER INFORMATION

● Scie: Research Briefing 31 Co-production: an emerging evidence base for adult social care transformation

● Report 20: Personalisation: A rough guide, Social Care Online

● Putting People First Personalisation Network

● Cummins, J. and Miller, C (2007), Co-production, social capital and service effectiveness, Office for Public Management

Practice messages

● Co-production describes approaches to adult social care that recognise and utilise the expertise of service users in shaping their own care and encourage their involvement in improving the services on offer.

● Co-production is a potentially transformative way of thinking about partnerships, power, resources, risks and outcomes.

● In its most extensive forms co-production provides scope for new frontline relationships and approaches to service delivery. This approach can transform services but only when collaboration is entrenched and users of services are recognised as experts who can contribute fully to their care and support.

● The types of working involved in co-productive approaches can be challenging for staff who are used to traditional service delivery models. Training and development are important to ensuring staff satisfaction and the success of initiatives. They should be empowered to feel confident sharing power and supported in positive risk-taking.

● Co-productive working can increase value for money in adult care services. It can use the knowledge of service users and increase their sense of satisfaction and help them to build skills. But there are problems with regulations, funding and accountability.

● To embed co-productive working it will be necessary to develop new bodies and commissioning and regulatory structures.

Research abstracts

Author: HUNTER Susan, RITCHIE Pete

Title: Co-production and personalisation in social care: changing relationships in the provision of social care

Reference: Jessica Kingsley, 2007, 167p

Abstract The theory and practice of co-production in social work and related fields is explored in this work. The contributors give examples of methods and services based on co-production are given such as housing initiatives where the users rather than professionals provide support to each other.

Author: BOYLE David, CLARK Sherry, BURNS Sarah

Title: Hidden work: co-production by people outside paid employment

Reference: York: Joseph Rowntree Foundation, 2006, 84p, bibliog

Abstract The UK’s first comprehensive research investigates how co-production recognises and develops the vital contribution people not in paid work make to their neighbourhoods. In keeping with the concept of co-production, people not in paid work in each of the local communities received training, enabling them to work as researchers on the project.

Author: NEEDHAM Catherine

Title: Realising the potential of co-production: negotiating improvements in public services.

Reference: Social Policy and Society, 7(2), April 2008, pp.221-231.

Abstract A case study involving social housing users and providers, conducted as part of the National Consumer Council-Unison Shared Solutions project, is used to illustrate the need for collective dialogue and deliberation between co-producers rather than transactional forms of co-production.

Author: Department of Health et al

Title: Putting people first: a shared vision and commitment to the transformation of adult social care

Reference: Department of Health, 2007, 5p

Abstract This ministerial concordat establishes the framework for collaboration between central and local government, the sector’s professional leadership, providers and the regulator. It sets out the shared aims and values that will guide the transformation of adult social care, and recognises that the sector will work with users and carers to transform people’s experience of services.

Author: BOVAIRD Tony

Title: Beyond engagement and participation: user community co-production of services

Reference: Carnegie United Kingdom Trust, 2007, 24p, bibliog

Abstract This report develops our understanding of how communities can support services in rural areas. One way in which this might be achieved is co-production – where users work alongside providers in order to design and deliver services.

Author: GANNON Zoe, LAWSON Neal

Title: Co-production: the modernisation of public services by staff and users

Reference: Compass, 2008, 42p

Abstract Co-production recognises mutual interests and has the strong moral purpose of building communities and social networks based on “what works”. This pamphlet explores through case studies how co-production is a practical method for improving services.

Author: STEPHENS Lucie, RYAN-COLLINS Josh, BOYLE David

Title: Co-production: a manifesto for growing the core economy

Reference: London: New Economics Foundation, 2008. 22p.

Abstract This manifesto describes how the beneficiaries of charity or statutory services should be instrumental in the design, planning and delivery of services as a way of improving the service and rebuilding the community.