Co-production – a new relationship
Full report can be accessed from here http://www.ippr.org.uk/members/download.asp?f=/ecomm/files/capable_communities_web.pdf
There is a growing political consensus that the traditional model of public service delivery, predicated on people passively consuming services whenever they need them, is neither sustainable nor desirable (see HM Treasury 2009
and Conservative Party 2007). This is firstly because this approach puts the entire burden on the service provider, wasting the potential expertise and resources of the service user. For example, a teacher is less likely to improve literacy rates if children do not read with their parents at home. Secondly, it ignores the potential of resources that are not easily visible or measurable: a care service, for example, cannot help an older person overcome isolation without the use of informal friendships and networks. Thirdly, the approach fuels demand for services as they are only used when needs arise. For instance, doctors only help people once they become ill, rather than helping them to live a healthy lifestyle and prevent illness occurring in the first place. It is clear that on their own neither the Government nor citizens have access to all the resources necessary to deliver public goods. As the everyday examples above demonstrate, services work best when citizens are involved in producing them. The next wave of public service reform will therefore need to ensure that citizens are engaged as active partners in the process. There are many different forms of citizen participation in service design and delivery. For example, individuals can be empowered directly through being allocated personal budgets to choose between service providers. This is now beginning to happen in social care. Alternatively, communities as a whole could be empowered to get more involved in delivering services: for example the Conservative Party has outlined its plans for a ‘post bureaucratic state’ in which communities can come together to run local services such as schools (Conservative Party 2007). Another option is to change models of ownership,so citizens and communities actually have a stake in the way a service is run. Tessa Jowell recently launched a Commission on Ownership to see how business models such as the John Lewis Partnership and The Co-operative can be applied to schools, hospitals, housing and other services (Jowell 2009). These approaches have been developed into a philosophy of ‘co-production’, which aims to collapse the divide between service provider and service user even further: Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbourhoods. (Boyle and Harris 2009: 11) When citizens work in partnership with service providers there are a number of benefits, including:
Improved service outcomes for the citizen: co-production allows the resources that citizens can contribute (time, energy, social networks, knowledge and skills) to be brought together with those resources that the Government can provide (money, regulation, technical expertise, leadership and service professionals). This leads to better results for users. (Cabinet Office 2009a)
Empowered and more satisfied citizens: when citizens are involved in producing a service they are usually more satisfied with it. It also helps them to feel more confident, connected and able to influence decisions.
Better value for money: by mobilizing resources that do not cost the state, better outcomes can be produced for no extra cost.
Despite the small scale and informal nature of many experiments with ‘co-production’, there is a growing body of empirical evidence that shows the benefits of these programmes. The case studies below provide evidence of the benefits of co-production in two areas: health and justice. As well as delivering significant improvements in outcomes and cost reductions, engaging citizens and communities in producing services can help build social capital and a sense of empowerment. A recent review found strong evidence that it can ‘improve satisfaction with services, the degree to which residents feel they can influence decisions and their confidence and capacity’ (Young Foundation 2009:) Citizens and communities could therefore be considered the ‘missing link’ in public service reform
over recent decades. As a recent discussion paper urged the Government:… [C]o-production should be central to the government’s agenda for improving public services because of emerging evidence of its impact on outcomes and value for money, its potential economic and social value and its popularity. (Cabinet Office 2009)
Self-care (Health) By training patients with chronic conditions to provide themselves with a certain level of care, the NHS can both save considerable resources and enable patients to fit in their care at more convenient times. For the cost of a handful of classes and a booklet, one self-care skills training course for adults with asthma saw significant improvements in lung function, inhaler technique, asthma knowledge, and patients’ self-rating of their asthma. It also led to a 69 per cent decline in GP visits (Department of Health 2007).
Youth courts (Justice) Youth courts are a way for communities to become more directly involved in justice. Instead of being tried in formal courts, young people committing non-violent offences for the first time appear before a panel of other young people who have a range of non-custodial sanctions at their disposal. In Washington DC, where the courts were first introduced, the recidivism rate of those ‘tried’ in a youth court is now 9 per cent, compared with 30 per cent for young people processed in the mainstream juvenile system (see www.tdyc.org). Similar schemes have recently been introduced in parts of the UK (Rogers 2006).