Foundations for self-directed support in Scotland
Foundations for self-directed support in Scotland

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Foundations for self-directed support in Scotland

2.10 The challenges of co-production

Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.

(Boyle and Harris, 2009, p. 11)

In their 2009 report The Challenge of Co-production , Boyle and Harris suggest that systemic or widespread change in the delivery of services will not happen if service users continue to be passive recipients, with their skills and experience ignored. How can we move towards co-designed and co-produced services in Scotland?

Activity 2.8: The panel event

(Allow about 20 minutes)

Listen to the panel discussion about examples of the benefits and challenges of co-production in Scotland. It considers what the limits of self-directed support are, and asks What if a service user does not want self-directed support at all? One aspect of co-production that the panel discusses is ‘ local area coordination ’. Local area coordinators work alongside communities to support them to be welcoming and inclusive, and with people with learning disabilities and their families to promote confidence and independence.

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Transcript

Willy Roe
So another important concept that’s come to the form of personalisation is the concept of co-production. And we have a question on that from Keith Etherington of In Control, Scotland. Keith?
Keith Etherington
Thank you. Principles of co-production – individuals and families being equal partners in designing and delivering systems and services and supports – is a key component of the strategy and the legislation in Scotland. Can the panel tell us what they think we’ve learned in Scotland about what works well with co-production and particularly any of those indicators to good practise again, the things that we would want to replicate in other places?
Willy Roe
Thank you very much. Going to go to Kirstein on this one and one of the other panel members in addition.
Kirstein Rummery
I think I’ll take it outside of Scotland, because I think Scotland can export some of these ideas but also can import some ideas of good practise from elsewhere. And that is that what we’ve learned that co-production in lots of different areas is that you need to really build in flexibility and support, but you need to be very careful not to go back in to old gratitude models of things. If people are signing up to deliver things, then there has to actually be mechanisms to say you’re accountable for delivering that particular part of it.
And in actual fact, it can be a means towards growing an economic sector. We’ve got lots of examples of organisations such as the one that Etienne has worked with. But I know quite a lot of examples, particularly in the Australian context, of mental health service users actually collectively starting to run services themselves and therefore actually acquiring really important skills and also growing the local care economy and it being a sort of a small step towards, in a particular area, urban regeneration and economic growth, rather than it just being the old let’s spread the jam as thinly as possible and move poverty around. It actually became an engine for a small enterprise to grow and had significant outcomes – both the people who were using the care services and developing the care services and doing it in that way.
But you need to start small and support it properly. You can’t just say, right, we’re going to bring in informal carers or family carers or community members or neighbours or friends and sign them up in some kind of formal way to a system that they don’t necessarily believe it or get anything out of. It needs to be done a little bit more creatively than that.
Willy Roe
John, you mentioned earlier another example of new resources being drawn in to this issue and a new kind of approach. What would you say to the concept of co-production as a director of social work service? Is this something which is an opportunity or a challenge or perhaps a bit of both?
John Alexander
I think it’s probably a bit of both, really. But I think the key thing that we’ve learned in Dunfries and Galloway from our experience as one of the three test sites was that, actually, the pace at which you move forward needs to be very much determined by the individual and the family that you’re working with. Initially, certainly, it took quite a while for personal plans to emerge. And I think it’s to the great credit of my colleagues who are doing the work at the front line that they had to patience to move at that pace and make sure that people felt a sense of trust in the process and that it was genuinely going to be something which they had an opportunity to have say in and have an equal say in.
Going back to my earlier comments about a legacy of professionals perhaps being seen as people who made decisions for individuals and families, who allocated resources on the basis of that professional assessment, to being a partner and a supporter and a facilitator, that does require quite a big shift in people’s thinking. And so I think patience was the thing that we learned we needed to have and move at that pace. And I think that patient approach has been born out because we are seeing a slow and steady increase in the numbers of personal plans. And I think they’re solid, and they’re sustainable because of that patience that’s been deployed by my front-line colleagues.
Willy Roe
Thank you very much.
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Use your learning log [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] to make notes on what you hear. What do you think might be the challenges of co-production in relation to your own experience of/employment in health and social care?

Discussion

Your notes will, of course, relate to your own experiences. A series of workshops in Scotland facilitated by Governance International and the Joint Improvement Team identified a range of challenges about co-production, including a lack of confidence in the ability of public sector managers to know how to enable individuals and communities to tackle their problems themselves. Their report of the events emphasises that co-production cannot be tokenistic:

The term co-production should be reserved for situations in which there are high levels of involvement from service users and communities, along with high levels of professional inputs. High involvement from service users or communities alone is not enough – when coupled with low professional involvement, this is simply self-help or self-organising and NOT co-production.

(Governance International/Joint Improvement Team, 2012b)

This is an important thought to hold on to. Co-production has, it can be argued, become a bit of a 'buzz word', and may be applied to a very wide range of types of relationships between service users and service providers. Co-production is not only about listening to people's views and taking them into account (though both are, of course, important); it goes much further, requiring the development of 'equal' and 'reciprocal' relationships between professionals and service users so that they can make things happen together.

We have emphasised co-production as an equal and reciprocal relationship between service user and service provider. You may also have thought about what happens when service providers and service users have very different ideas about, for example, somebody's safety? Or when service providers exert their legal powers to protect somebody from harm when that individual does not want a service? We explore these questions in more detail in Section 4 of this unit.

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