Patient and Public Involvement
“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.” (1)
Taken from ‘Right here, right now – taking co-production into the mainstream’ – a discussion paper’
Build co-production into the commissioning framework
When services are commissioned, bidders need to be asked to explain how they will build in the essential features of co-production, how beneficiaries will be helping to deliver services, how their bid will build mutual support and how it will prevent problems in the future. Bids will be assigned accordingly with these commitments embedded in service contracts so that these can be assessed along similar lines. Services should be commissioned and managed around their outcomes rather than outputs.
In addition, service organisations should be able to measure easily, and for themselves, how and how far they are engaging their beneficiaries as equal partners in the delivery of services. This requires:
- Developing and applying co-production audits to services to help professionals and other participants identify where they are already working in partnership, and where they can further shift towards co-production.
These defining features are what give co-production its transformative approach. It moves far beyond ‘citizen engagement’ or service user involvement in governance. It changes people from being ‘voices’ to being agents in the design and delivery of public services. The radically different nature of co-production is often best illustrated through examples that show just how different it is, and how it generates better outcomes and lower costs.
Positive effects of co-production:
- Co-production taps into priceless human resources – all the knowledge, time and skills, all the loving, caring and reciprocal relationships – that are present in everyone’s everyday lives. These human assets make up a much bigger pool of shared resources than can be provided through taxation, for meeting needs that people can’t meet on their own: so there is abundance instead of scarcity.
- By bringing people out of service silos and isolation, and by encouraging individuals to join forces and make common cause with each other, co-production helps to break down barriers between different kinds of people and build stronger networks and groups.
- It also helps to build up everyone’s capacity, including ‘providers’ and ‘users’, both individually and in groups, to help themselves and each other, so that the resource base can keep on growing.
- It brings into play the direct wisdom and experience that people have about what they need, how their needs can be met and what they can do with and for others. When these are combined with professional expertise, there are likely to be better outcomes.
- It minimises waste by developing solutions with users rather than doing things ‘to’ and ‘for’ them. For all these reasons, co-production helps to improve well-being and prevent needs arising, so that moving it into the mainstream would mean that the inflation in demand for public services that has prevailed since the 1940s can begin to subside.
- In addition, it can often reduce the costs of a service by shifting the focus towards person-led, community-involved, preventative services that relieve the pressure on more costly acute and specialist interventions.
In summary, this is what co-production can offer to a welfare system in acute crisis: by transforming the way public services are understood and conceptualised, designed and delivered, it promises more resources, better outcomes and a diminishing volume of need. That’s why now is the right time to move co-production out of the margins and into the mainstream.
(1) David Boyle, Anna Coote, Chris Sherwood and Julia Slay, NESTA, July 2010. ‘Right here, right now – taking co-production into the mainstream’ – a discussion paper