Co-production in social care … a need for systems change

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By Rebecca Jackson

One of our most popular member briefings has been our 2014 introduction to co-production in public services. In fact, it was so popular that we made it freely available to download from our website. For those who don’t know, co-production is an approach to improving or developing services by working collaboratively with the people who use those services. It has become increasingly popular within many types of public services in the UK, but especially in health and social care.

The components of co-production

But what does co-production actually mean in practice? Although every case is different, generally it can be broken down into several processes:

  • Co-design – the planning of services
  • Co-decision making – with regards to the distribution of resources and the allocation of services
  • Co-delivery (of services) – including outlining the role of volunteers and the third sector, and including them in the process if necessary
  • Co-evaluation (of services) – assessment of the outcomes and whether they have been successful for all parties involved.

Legislation and implementation

The 2014 Care Act was one of the first pieces of UK legislation to include co-production as a concept in its statutory guidance, stating that:

‘Local authorities should, where possible, actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ”Co-production” is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered.’

Co-production is now a key part of the implementation of health and social care strategy across the UK. It provides service users with an input on which elements of services are of most use, and which could be altered to make them more effective – particularly important at a time when local authorities are under pressure to deliver more efficient and cost-effective services.

Co-production relates to other strategic priorities such as prevention, wellbeing, a focus on outcomes and the personalisation agenda. It allows people who use services to have a direct input into the design of care services and care plans, so as to create more effective programmes of care.

Implementing co-production can be a difficult transition and requires a whole system approach to change. This means that organisations, such as local authorities, must adopt change at every level to encourage meaningful participation and to embed co-production in day-to-day practices.

Managing change

The SCIE co-production guidance uses a jigsaw model for management of change which may be a helpful way to identify the elements of an organisation which must be altered to effectively incorporate co production.

jigsaw 3The guidance provided by the Social Care Institute for Excellence (SCIE) recommends that:

  • organisations must change at every level, from senior management to front-line staff,  if they want to achieve meaningful participation
  • participation should become part of daily practice – and not be a one-off activity
  • participation operates at different levels, as there are many ways to involve people who use services in different types of decisions

Social care co-production in practice

  • The project PRESENT is a joint initiative between East Dunbartonshire Council, the local Dementia Network, the Joint Improvement Team and Governance International, which uses co-production to engage people with dementia and enable dementia sufferers to make a positive contribution to their communities.
  • Islington Council has developed a Framework for Involvement in Adult Social Care to provide a solid base for co-production that is accessible, inclusive and has impact. The council worked with people who use services and carers to produce the Framework. Local statutory and voluntary sector organisations, including the Making it Real Experts by Experience and Project Team, and Healthwatch Islington, were also involved.
  • A report produced in 2013 by the Scottish Co-production Network, Governance International, the Scottish Joint Improvement Team and the Social Care Alliance,  also provided comparisons between the approaches to co-production in social care between Scotland and Sweden.

These are just a few examples of innovative practice, more of which can be found on the SCIE website.

The potential of co-production

Co-production has the potential to transform the way social care is delivered in the UK. However, implementing co-production approaches into existing organisations, with their own culture, structures and operating procedures, as well as their own expectations about services and how they should be created and delivered, remains a challenge for commissioners, the third and private sectors, politicians and the public.

In order to be successful and to produce sustainable and effective relationships, total change will be required and it will take a huge commitment and long term vision to ensure its success. Once implemented, though, it is clear that co-production has the potential to contribute greatly to prevention, personalisation and outcomes-focused service delivery – which are all key agendas in the current health and social care policy climate.


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