Comment Blog 13 March, 2019

Co-production: putting the public back into public services

For over a decade, government has sought to place service users at the heart of public services.

From 2007, when David Cameron first spoke of making public service users “active agents of their own life”, to 2018 when Theresa May called for the “building [of] an NHS around the needs of the patient”, successive governments have supported a shift away from one-size-fits-all, depersonalised, and often costly models of public service design.

As the push for personalised public services reaches new heights, it is crucial to understand what is meant when we talk of personalisation and co-production. We need to recognise not only the potential benefits, but also the additional challenges this new approach can present to commissioners, providers, and professionals on whom the responsibility for effective and efficient public services fall.

Defined as “a collaborative relationship between the people who use services and the practitioner (be it a social worker, personal assistant, teacher or housing officer)”, co-production seeks to ensure that the service user has a voice in the decisions made about their public services. Taken to extremes, this might mean enabling them to purchase some services themselves in the shape of a personal budget (explored in Reform’s latest report).

For co-production to improve public services, the current balance of power between service users and professionals requires a fundamental change. In most traditional models of public services, the service users have their needs assessed by professionals who then design and allocate a service that should meet those needs, particularly when those public services are heavily professionalised, like healthcare. Whilst this is an easy response to the growing demands on public services, it also paints citizens as passive users of a service.

Co-production challenges this view and insists that “people who use services are hidden resources […] and that no service that ignores this resource can be efficient.” The lived experiences of service users must be given equal footing to professional expertise when designing solutions to the complex or long-term needs of those individuals. Doing so actively involves the service users with the design and delivery of their public services, and challenges “top-down” models of service design, potentially leading to significant improvements in outcomes and increasing the value-for-money these services can deliver.

However, the principles of co-production have proved challenging to implement in practise. On the organisation side, these challenges have included:

  • the “[in]compatibility of public organisations to citizen participation” (manifested through poor communication infrastructures, or low-capacity for new training schemes);
  • administrators and front-line staff who are reluctant to involve citizens as “valuable partners” for reasons including uncertainty around the capabilities of citizens to make informed decisions and an unwillingness to relinquish control;
  • the “risk-adverse culture of public-sector organisations” which make fundamental shifts in the current structures difficult to embrace by senior management and front-line staff.

Yet service users have also remained reluctant to fully embrace co-production, particularly due to their own personal situation and abilities, and their often low social capital expressed through their capacity to “create sustainable relations” with public organisations.

Two previous blogs I’ve authored on the digital and personal approaches to information dissemination have argued that a personalised approach to public services works only if the individual is given the necessary support, guidance, and information to make informed decisions. Yet what is apparent is that staff and professionals will also need to embrace the shift and relinquish some of their control to the very people they are trying to help.

Evidence about improved outcomes and user-experiences will help catalyse these changes. But it is in the value-for-money arguments which may persuade commissioners and providers as to the benefits of co-production. “Using the experience of those who use services can reduce and re-direct wasteful spending which is not having an impact,” argues one report by the New Economics Foundation, a view echoed by the Cabinet Office.

Taken alongside the potential for improved outcomes, co-production could radically improve how public services are designed and delivered. Putting the public back into public services may be a challenge, but it is one worth overcoming.