Co-production – putting the people who understand centre stage

This blog is an extract from a longer blog by Professor Peter Beresford and Mark Harrison, who have agreed to an edited version for the Centre for Public Engagement. The full length blog can be found on the Labour Briefing website.

What is co-production? Does it really exist in practice? We often hear the terms co-design, co-produce, co-construct, but is it really possible to co-produce research and policy that truly engages different types of user?

In this blog we highlight what co-production means for improving the quality and efficiency of the social care system. We emphasise the value of user-led research, to improve collaboration and power relations in delivering a social care system. Despite the terminology being around for many decades, we believe actual examples of ‘real’ co-production in health and social care are scant.

A breakthrough in co-production

Finally, there appears to be a breakthrough for co-production. Twenty years into the new century all the gains made in social theory in the latter part of the 20th Century and the early years of this one are finally beginning to bear fruit. This is by no means universal but there are some clear examples emerging of meaningful involvement in policy, practice and user-led research to draw on that we can say are optimistic.

What is co-production?

Notions of co-production have been around for more than a decade (see for example INVOLVE). What started as a positive and optimistic alternative to the consultation culture with all its tokenism, quickly ground to a halt due to austerity, particularly in health and social care. Co-production provides a new paradigm for developing health and social care as illuminated in research by Dr Catherine Needham and Sarah Carr (SCIE, 2009):

“To act as partners, both users and providers must be empowered”

• Co-production is a potentially transformative way of thinking about power, resources, partnerships, risks and outcomes, not an off-the-shelf model of service provision or a single magic solution.
• Co-production requires a shift in culture within statutory organisations - with professionals able and confident to share power and accept user expertise, leading to ‘no decisions about us without us’.
• Co-production means involving citizens in collaborative relationships with more empowered frontline staff who are able and confident to share power and accept user expertise.
• Co-production can deliver service models which are preferred by the public, more cost effective and less wasteful.
• Co-production emphasises that people are not passive recipients of services and have assets and expertise which can help improve services.

A shift in power relations?

This approach – co-production – is important as it puts a shift in power relations right at the heart of the process. Politicians, policymakers and practitioners sharing power with community members, goes against the grain. It also goes against much professional training and qualifications where students have to demonstrate their knowledge and expertise in doing things to, for and on behalf of people they are paid to work with. Towards a culture that encourages sharing knowledge and power requires a radical, if not revolutionary, shift.

Unfortunately, over a decade on, finding examples of meaningful co-production feels like looking for needles in haystacks. There is also an economic argument for co-production, as well as being the ‘right thing to do’. The importance of ‘upstream engagement’ is emphasised because if you don’t get it right at the beginning of the process then it’s far more expensive to undo or remodel at a later stage. The example of the built environment is a case in point.

• Retro-fitting building with ramps and replacing stairs and lifts are expensive and a waste of money. Road traffic calming measures like shared space have become the new fashion and many councils have spent huge sums of money creating schemes that are dangerous for disabled people, particularly blind people, some of which are now having to be undone or modified to make them safe and compliant with other legislation. If only they had talked with a blind person and tested it out with their guide dog before spending the money!

The co-production ‘litmus test’

Here are a couple of examples which pass the co-production ‘litmus test’:

The Commission on Social Security represents a ground-breaking co-production initiative developing proposals for a better UK social security system. All the commissioners are people with lived experience and the proposed solutions have been developed by those with direct experience of the benefits system. Following a call for ideas for a better benefits system, which received over a thousand responses, the public are now being asked what they think about the ideas in a second wave of consultation.

What’s distinctive about the process is that it puts centre stage the knowhow of people who understand what it is like to be on benefits. Respondents were asked eight questions, ranging from how to make Universal Credit better, to the ideal level of benefit payment, to what best to do about benefit sanctions. The responses will inform a White Paper proposing improvements to the welfare benefits system. 

There is also another interesting development in Greater Manchester where Andy Burnham’s mayor’s office has engaged the local disabled people’s organisation (DPO), the Greater Manchester Coalition of Disabled People (GMCDP), to convene and facilitate a panel of disabled people to shape, challenge and influence policy affecting disabled people across Greater Manchester.

Yes, we must be cautious and watch out for the bear traps lying in wait for us, but at the same time there are real pressures in supporting the rising interest in co-production, user involvement and user-led research. We need to see these as the public policy equivalent of the current revolution in electric cars and bicycles. It's the way to go and we've just got to keep going to help everyone to make that shift! It’s not petro-chemical research that’s needed any more, but how we can work in flatter, more collaborative, equal ways to co-produce more sustainable futures.

Mark Harrison is director of Social Action Solutions, and Senior Research Fellow in Social Action at the University of Suffolk. Peter Beresford is co-chair of Shaping Our Lives, the disabled people's and service users’ organisation and network, and Professor of Citizen Participation at the University of Essex.