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Service User Engagement and Co-production

Policy Context

The government wants to see service users and patients in control of their care and support, and able to buy a range of personalised services that will meet their needs and desired outcomes in a holistic manner. Where necessary, the government expects people to be supported to do this.

Service users and patients should be satisfied that the service they buy is flexible, meets their needs, is delivered at the right cost for them and is of good quality. This is only possible through effective engagement between commissioning and providing organisations and the people and communities who have needs and require services. Service user and patient input is vital to developing good quality and responsive services.

The government has also emphasised the need for public bodies and providers to facilitate communities and people to harness their own qualities, strengths and resources to contribute to public health, well-being and services. This involves working with people to spot, source and assist them to meet the outcomes and needs of their communities. Such responses can encourage more authentic and efficient services because they are developed by the very communities and people that require them:

People have enormous amounts to give to their communities in enthusiasm, ideas, experience, time, skills, talents and leadership. We want to make it easier and more attractive for everyone, regardless of age or ability, to contribute to their communities and provide a helping hand to those who need it.

Supporting active and inclusive communities, and encouraging people to use their skills and talents to build new friendships and connections, is central to our vision for care and support. Strong communities can improve our health and wellbeing, and reduce health inequalities. There are many different examples of this approach, such as local area coordination connected care or asset-based community development. We want to build on these examples, so that approaches that promote support within communities are strengthened and developed across the country

Furthermore under the Public Services (Social Value) Act 2012 public bodies have to consider the social value, not only cost, of a potential contracted service ahead of procurement. This means that the social, economic and environmental impacts of a service are to be considered when commissioning and procuring services. Consultation must be considered by the local authority to develop input in regard to the social value of a potentially procured service/intervention.

Engagement with service users, patients and communities is fundamental to realise reform and co-production approaches are becoming more relevant to all stakeholders in public care.

What is co-production?

Co-production approaches recognise that there is a ‘core economy’ of social and family relationships that provide a lot of care, nurture, trust and support. All public services rely on an underpinning operating system which is the ‘core economy’. Public services do not operate in isolation.

The reason today's problems seem so intractable is that public services, and technocratic management systems, have become blind to the most valuable resource they possess; their own clients and the neighbourhoods around them. When these assets are ignored or deliberately side-lined, then they atrophy. This is the key message inherent in the idea of co-production.

If genuine outcomes are to be met public services need to tap into people’s and communities resources effectively. Co-production is about improving, invigorating, rebuilding and realising the potential of the ‘core economy’. This is achieved by building relationships with people and their communities so assets and resources are brought together to meet outcomes.

The National Co-production Advisory Group defines co-production as follows:

Co-production is not just a word, it is not just a concept, it is a meeting of minds coming together to find shared solutions.

In practice, co-production involves people who use services being consulted, included and working together from the start to the end of any project that affects them.

When co-production works best, people who use services and carers are valued by organisations as equal partners, can share power and have influence over decisions made.

What does this mean for commissioners and providers?

  • A distinct change in the relationship between commissioners and providers with individuals, communities and groups. This inevitably requires a change in how commissioners and providers work together.
  • Individuals, communities, groups, and service users are considered experts in their own circumstances.
  • Commissioners and providers are required to support communities and people to make decisions and have more control over their lives and services.
  • Co-production means that commissioners and providers are not fixers of problems but facilitators who work with people to find solutions.

SCIE Model of Co-production

There are several models of co-production, of which the SCIE model is one that can be used as a starting point when thinking of co-production approaches. This model frames co-production as a spectrum of engagement:

Engagement through input is:

  • Making existing commissioning and procurement practices more open to collaboration.
  • Starting the process of change and dialogue with all relevant partners.
  • Gathering input to affect services.
  • Examples include questionnaires to service users, carers and providers asking for comments on needs or services, reviews of service user suggestions in regard to the planning and design of services, a service user and carer advisory panel to feed into decision about wards of contracts.

Engagement through contribution:

  • Recognises that individuals, communities, groups and agencies have both needs and assets that can be capitalised on to ensure mutually beneficial quality services and resource efficiency.
  • Sharing and swopping assets.
  • Examples include involving groups of people in analysis of existing provision or working with groups of people to assist with design specifications or reviewing impacts of services.

Engagement through shared control:

  • This is a relocation of power and control so there is equal control in analysis, planning, securing and the review of services with service users.
  • This level is the most transformative of the levels.
  • Examples include people purchasing their own services through direct payment, service users having equal roles on tender evaluation panels, user groups given budgets to purchase community and support services. Other examples include local area co-ordination, building, supporting or funding mutual support networks for individuals and communities. This could include time-banking, co-housing and community dementia initiatives.

Other models of co-production

The Governance International Co-production Tree uses a tree to describe characteristics of provision including traditional service delivery, self-help organisations and co-production. This model shows how to map current and potential co-production and pathways effectively; where to focus efforts, and how to resource and develop co-production further.

A useful model to assess the use of co-production methods in your own organisation is Roger Hart’s Ladder of Participation (1992). The ladder has eight rungs with the lowest rung representing the least engagement and the highest representing the ideal form of engagement in line with good practice principles. This model is for children’s services however it can be adapted and applied to any client group.

Examples of co-produced approaches

An organisation called ‘Commonground’ worked in partnership with Age UK Hackney to assist men in their 50s prepare for later life. They worked with existing service users of Age UK Hackney and developed a co-productive initiative. Click here for more details.

Esk Moor Care Community and Housing was set up as a result of a group of older people getting together and deciding what they needed in relation to their care and housing requirements. The group researched what type of community they wanted to live in and worked with Help the Aged, North Yorkshire County Council and Abbeyfield to develop the housing scheme they wanted.

Experience Based Design is a health-based approach to service design that encourages and supports patients and carers to ‘tell their stories’. This enables commissioners to use these stories to establish parts of the care pathway where the users’ experience is most powerfully shaped. These are known as 'touch-points’. It is hoped this focus will help patients, carers and frontline staff to redesign these experiences rather than just systems and processes.

Making It Real is a Think Local Act Personal and National Co-production Advisory Group co-produced framework to check the progress of LAs and their partners towards delivering good personalised services that deliver on outcomes. Making it Real is based on ‘I’ statements and covers: information and advice, active and supportive communities, flexible integrated care and support, workforce, risk enablement, personal budgets and self funding.

Sources of further help

The Liveable Lives Study: Understanding Everyday Help and Support May 2014. The Joseph Rowntree Foundation (JRF) commissioned ScotCen Social Research to write this report as part of their programme on risk, trust and relationships. This research looks at ‘low-intensity support’ in three areas in Glasgow and tries to understand what is happening at an interactional level when everyday help and support occurs. It looks at how we view informal, everyday help and what barriers prevent the giving or receiving of this type of support. This report provides rich qualitative data and is useful for commissioners when thinking of facilitating low level support and co-productive initiatives.

Think Local Act Personal (TLAP) is a national, cross sector leadership partnership. It focuses on driving personalisation and community-based social care. TLAP has many resources on good practice, particularly in regard to engagement and co-production.

The National Co-production Advisory Group (NCAG) comprises individuals who have experience of using health and social care support; including people who access support, carers, family members and citizens. The group assists organisations and provides information about how to co-produce, co-design and co-operate.

Investing in Shared Lives, July 2013 (Social Finance, Community Catalysts, MacIntyre, RSA 2020 Public Services and Shared Lives Plus). This report sets out the case for the expansion of the Shared Lives schemes for people with learning disabilities and mental health needs. Shared Lives is an alternative to care homes and home care as it can deliver both quality outcomes and significant financial savings. The report includes a breakdown of costs for Shared Lives schemes comparing these to other forms of care. It also includes details of the newly launched Shared Lives Incubator, which will provide a combination of upfront investment and organisational development to expand Shared Lives schemes across the country. The potential role of social finance for these schemes is significant.

Co-production: A Manifesto for growing the core economy, 2008, New Economics Foundation. Describes the core economy, looks at components of co-production, what isn’t co-production and considers the future of co-production. It has a foreword by Professor Edgar Cahn who coined the term ‘core economy’.

Adult Services Report 61: Co-production and participation: Older People with high support needs, October 2012, Social Care Institute for Excellence (SCIE). A review of literature and research on the participation and co-production of older people with high support needs. Benefits and barriers to participation and co-production are identified and examples are given.

Governance International is an organisation that works with agencies to deliver on outcomes through effective public governance. Co-production resources are published on their website.