The co-producers: Making users part of the solution
Tuesday, December 6, 2016
Involvement of children and families in shaping services can sometimes be tokenistic. Many organisations now use "co-production" to ensure genuine participation. Eileen Fursland investigates.
The term co-production could be mistaken for management-speak. Yet advocates believe this way of working has the potential to transform public services, including those for children and families.
Put simply, co-production means professionals and service users working together, as equal partners, to design and deliver services.
Making a contribution makes those involved feel more valued. Co-production enthusiasts believe it builds social networks and mutual support, helping reduce isolation and creating healthier and more connected communities.
It is easy to dismiss the idea as impossibly idealistic, yet it is being turned into practical action in many different settings with all kinds of services now delivered by the community or service users, supported by professionals.
For example, young people in Surrey, who have used local child and adolescent mental health services (CAMHS), are now supporting their peers and helping to recruit and train professionals.
In Tayside, Scotland, mothers volunteer to provide additional breastfeeding support to new mothers in the postnatal ward of a hospital.
In Glyncoch, South Wales, young people worked with Glyncoch Community Regeneration to co-design and co-produce a community garden last summer, spending four weeks of their holidays cutting down trees, building fences and planting. During that period there was none of the usual anti-social behaviour in the local area.
Meanwhile, across the UK, 150 schools and colleges have taken part in the Learn to Lead project which gives students the opportunity to co-produce their own projects in school and in their local communities, including keeping chickens and growing vegetables.
Professionals are increasingly accustomed to using a range of methods to engage with service users and the public and it is widely accepted that working with adults, children and families to make decisions gets better results.
Some of these attempts to consult with service users or get them to participate are more meaningful than others.
What makes co-production different is that power is shared between the people getting support and those supporting them. It is about doing things together, not just talking about things, and is based on the idea that everyone has something to offer.
In fact, the everyday experiences of young people, parents, families and other community members gives them a perspective and an insight into problems and issues that few professionals can ever have. They also have skills, talents and energy to bring to the table.
Sherann Hillman has three children with special educational needs and is the chair of Parents in Partnership Stockport (PIPS).
From October 2011 to March 2013 the SEND (special educational needs and disability) Pathfinder scheme in 31 areas of the country brought families of disabled children together with professionals to co-produce recommendations, plans, actions and materials collectively.
Hillman took part in co-producing the SEND reforms in Stockport, making strategic decisions with professionals.
She is also a north-west regional representative and on the steering group of the National Network of Parent Carer Forums - a network of local forums comprising around 77,000 parents, working to improve local and national services through participation and co-production.
"It's very empowering to be a parent rep," says Hillman. "We never talk about our own children because that's not what ‘strategic' is about. We are always listening to other parents and their concerns, and we take that back. We challenge the council constructively and are solution-focused."
PIPS has also helped Stockport Council to set up a young people's forum, and the young people will sit on work streams within the council.
Anna Wright, a consultant who trains public sector managers, has been involved in setting up co-production projects. Co-production requires a new mindset from professionals, she explains.
"Professionals can find it difficult to make the shift as they are trained in a particular problem-solving model which is ‘look at the needs, identify what's wrong, brainstorm the solutions and then commission services that will provide those solutions'," she says.
Under this approach local populations are viewed in terms of deficits or needs that require addressing by "experts".
"What the research says is that once you've started treating people as though they need to be rescued or fixed, you actually make them more dependent," says Wright.
"Whereas if you treat your service users as people with something to offer, they start to believe in themselves."
She believes co-production has the potential to set up really strong relationships between local authorities and the communities they service by breaking down barriers between "experts" and lay people. It also gives service users a better appreciation of the constraints on professionals.
Co-production does not always fit easily into existing systems and targets as it requires flexibility. For some professionals, this profound change can be hard to adjust to. They may feel service users are encroaching on their hard-won territory. So they - just as much as service users - need training in this new way of working.
Something that can sometimes go wrong in co-production, says Wright, is when a council tries to co-deliver services but then withdraws support, leaving service users feeling abandoned.
"People need to feel they are helping others but they shouldn't be made to feel responsible for things they are not responsible for," she warns.
What incentivises people to get involved in co-production and give their time?
Sometimes it is paid - for example parent-carers in the SEND Pathfinder project were paid an allowance for their time and expenses. There may be mutual benefits such as in the Time Bank model where people exchange skills and expertise but more often than not, there is no extrinsic reward.
The intrinsic rewards include feeling needed and valued, having a voice, engaging with others, improving your community, peer support and improved self-esteem. Some people acquire skills, training, confidence and an enhanced CV, which can help them gain employment. Their communities can also become nicer places to live, as strong and reciprocal relationships reduce social isolation and build social capital and resilience.
It takes commitment - and some passion - to set up a co-production project and keep it going plus there are additional costs involved, especially at first.
As well as someone to get things moving and host it, people may need to be supported or trained to play a full part.
"You have to involve more people, you have to give them cake, but it's not massively more expensive," says Ruth Dineen, founder of Co-Production Wales. Like others experienced in co-production, she points out that making decisions can take longer but the approach can save money in the long run because it prevents professionals making bad decisions.
In the traditional system, money is locked into set services. Taking a co-production approach may reveal those services are not what people want or show their needs could be met in other ways, allowing services to be changed so they are better used and better value for money. Using co-production can unlock assets and resources within a community or group to provide more help and support without having to find extra funding.
In the London Borough of Lambeth, for example, a group made up of mental health service users and professionals are providing community-based support which has resulted in a significant reduction in referrals to hospital care.
Local Area Co-ordination (LAC) is one model of co-production where people with disabilities or mental health needs and older people are seen not just as passive recipients of care but as people with gifts and strengths they can use and share. According to the LAC Network, costs can be 35 per cent lower in areas where the approach is used compared with non-LAC areas.
Wales appears to be further along the road to co-production than the rest of the UK in terms of influential support. "The difference in Wales is the context - it simply couldn't be better," says Dineen.
Community activists have found strong support from the Welsh government. Finance minister Mark Drakeford, previously minister for health and social services, Children's Commissioner for Wales Sally Holland and others are enthusiastic advocates of co-production.
Co-production Wales has just been given Big Lottery funding to establish a network for sharing good practice and ideas.
"The hope is we can join these dots and really embed this way of working," says Dineen. "The outcomes are fantastic and sustainable, and people are excited and proud. It changes the world."
Housing scheme shows co-producton in action
Bron Afon Community Housing is a housing association operating in Torfaen, South Wales. A youth housing scheme masterminded by the organisation's youth forum is an "extraordinary" example of co-production in action, according to Ruth Dineen of Co-production Wales.
A few years ago, more than half of all young people's tenancies broke down in the first year for reasons such as antisocial behaviour, an inability to budget, or loneliness.
"Youth forum members wanted to look at alternative housing for young people," explains Maria Jones, Bron Afon's young people and families manager. "Some were previously homeless or had come through the looked-after system. They did a lot of research to see what was out there and what would work best in Torfaen."
The young people said going into their own tenancies straight from care or complex family backgrounds was too big a leap - they wanted a form of transitional housing, bridging the gap between 24-hour hostel support and fully independent living. They didn't want to live in bedsits and wanted their own front doors.
They came up with a scheme called Own2Feet Living and did a presentation to Bron Afon directors, who agreed a derelict building could be used for new accommodation.
The young people worked with architects to design the layout and turn it into eight one-bedroom flats for tenants aged 16 to 24. Some worked on the build, learning new skills while others planned the fixtures, fittings and decor. The building - called Ty Cyfle - opened in 2014.
"The young people were heavily involved in designing the management policy and tenancy agreement," explains Jones. "They were adamant that if people wanted to live there they had to be in education, employment, training or volunteering. I thought it was a bit harsh but that's what they wanted, so we ran with that."
A management committee of young people runs the project and deals with most of the issues, such as minor anti-social behaviour by tenants.
The building also features two large rooms on the ground floor for community use and is home to employment projects and various programmes devised by young people.
Despite the fact the facility houses young people with complex and multiple needs, there have been no evictions in its first two years and no tenants are in arrears. The young people involved in setting it up gained confidence and aspirations, with some going on to get jobs or go to university.
The rise of co-production
Co-production is the brainchild of US civil rights lawyer Edgar Cahn, who also pioneered the concept of Time Banking.
He argued service users should be seen as assets, with talents, skills and energy - rather than people with deficits - who could work with professionals on solutions to problems.
The concept has gathered momentum in the UK amid growing recognition in both statutory and voluntary sectors that service users should be involved in decisions affecting them.
There are now many projects that embody the principles of co-production in youth services, social care, housing, health and education while a wide range of organisations offer consultancy.
The Care Act 2014 encouraged councils to adopt a co-production approach to service design, delivery and commissioning. Meanwhile, recent Special Educational Needs and Disability legislation required local authorities to work with parent-carer forums to make strategic decisions.
In some places the culture is changing. For example, in its poverty plan for 2015-20, Cornwall Children's Trust said it wanted all services to be co-produced with young people. The London borough of Lambeth has also embraced co-production in all services.
In Wales, co-production is slowly becoming an expected way of working in the public and voluntary sector. The requirement to involve citizens in designing, commissioning and delivering services - first in social care and now in health - is written into legislation by the Welsh government.
A Guide to Co-producing Children's Services
Practical guide published by the New Economics Foundation and Action for Children.
Think Local Act Personal
National partnership aiming to transform health and care. Resources include two films on co-production available online.
Co-production Practitioners' Network
Run by the New Economics Foundation, an online forum for frontline practitioners keen to take a new approach to the delivery of public sector services.
Scottish Co-production Network
Forum for learning, debate and new ideas.
Also known as All in this Together, it publishes a monthly newsletter and hosts the Co-production Network for Wales.
Co-production Catalogue from Wales
Interactive catalogue, produced by Public Health Wales and Co-production Wales, featuring case studies and resources.
Learn to Lead
Community interest company, facilitating co-production projects for young people.