Nobel Prize winning political economist Elinor Ostrom coined the term ‘co-production’ in the ‘70s, to describe the role of individual choice on decisions influencing the production of public goods and services. Her work emphasised that people who use services have assets that can help to improve those services, rather than simply needs which must be met. Since then, co-production has developed substantially and is specifically included in the Care Act 2014.
It’s still a slippery concept though, and interpretations range from user involvement to actual co-creation of the service, its management and accountability. In particular it gained currency since the public services were struck by funding crisis. Birmingham’s own Professor Emeritus Tony Bovaird charts the growth of co-production among service providers ‘not simply in order to improve service quality by “bringing the user in” but also in order to cut costs, by making the user do more for themselves’.
Co-production continues to be a valuable tool for disabled people. It provided momentum to challenge the expectation that they should live in institutions and to assert their right to live in the community. It enabled the independent living movement to change how social care was delivered – from a system driven by services to one where people had greater say in the decisions that affected them. It has led to the development of personalised services including individual budgets.
Yet despite the significant gains, health and social care sectors continue to provide rather than serve. Although some power has leached away to users, control rests firmly with the institutions. With almost half (40%) of adult social care rated inadequate or requiring improvement, prospects for co-production do not appear promising. Impending funding cuts will put even greater pressure on leadership and quality of staff. Doing more with less invariably squeezes service levels leaving people and their families left with more of the responsibility and less of the resource.
In order to prevent co-production becoming a sop for austerity, it must develop in parallel with power-shifts. Collaboration necessitates a sharing of power and this demands a redistribution of resources and decision-making so that people using the service retain self-determination.
This reciprocity in engagement is at the heart of the new framework of Contingent Capacity. It’s an approach to establish and embed a culture of co-production based on the gifts, assets and aspirations of people using the service. Embracing this way of working requires leaders to be prepared to transfer power to people who use the service. Five key levers across their organisations will help leaders understand where power is located and how much of it they are prepared to share. Identified as the 5P’s these include:
- People – among all the stakeholders how much status and priority is afforded to the people who use the service.
- Politics– whose interest is being served?
- Profitability– are resources aligned with ethos?
- Principles – does the internal culture, skills and attitude respect people?
- Partnerships – are links with other organisations optimised for the people?
The implications of shifting-power can be profound. It may require a new calibration of social value, one that recognises the worth of community based care. In many cases, this will require the development of new service delivery models. It may involve the emergence of a new tier of brokers between people and traditional service providers. There is a rich seam of innovation to be mined here.
Whatever possibilities emanate, talk of co-production should be symbiotic with the practice of power-sharing. The culture of control that dominates health and social care sectors is unsustainable. As the Care Act suggests, co-production should be used to develop preventative, strength-based services that support assessment, shape the local care market and plan information and advice services. It’s not an excuse for simply passing on costs and risks to people who use the service.
Sukhvinder is a lay member of the University of Birmingham Council, and Managing Director of Engage-Building Contingent Capacity; providing strategic and management consultancy to enable organisations to be more responsive to the people they serve.
Building Contingent Capacity, a report by The Barrow Cadbury Trust, Collaborate, Engage - Building Contingent Capacity and The University of Birmingham launched yesteday.