Vale People First, a local self-advocacy group for and by people with learning disabilities in Vale, organized their own conference, pictured here with the Mayor
Co-production in Public Services: a Welsh Story
Back in 2012, we started a research project on the co-production of public services. It soon became a political campaign and has now developed into an organisation, Co-production Wales, actively influencing at all levels of Welsh public services. Who are we and how did we do it?
The Start of our Journey
At our very beginnings we didn’t know much about co-production at all. We are Noreen Blanluet (that’s me) and Ruth Dineen – Ruth’s background is teaching art and design, mine is healing, coaching and personal/professional development. Ruth started the ball rolling at the end of 2011 in response to her son Ben asking her to put together a co-production resource. She was semi-retired and wondering what to do with the time that her grannying duties left her with. Ben was (and still is) head of Spice Innovations in Wales, a social enterprise setting up Time Credits networks – a most co-productive way of engaging and empowering citizens, and enabling them ultimately to shape the public services that support them. At the time, there was no resource for people interested in co-production to find out more, access case studies, connect with others,… so following Ben’s prompt, that’s what Ruth set out to build.
She spoke to nearly a hundred practitioners across the world – in the USA, Canada, Australia and New Zealand, and of course across England, Scotland and Wales. She gathered a wealth of information – so much information that she asked me to bring my organised brain and my Excel powers to support her research for a couple of weeks. I’d known Ruth for a few years through our Action Learning set (… a lengthy story in itself), and this is where I joined the co-production story. It was the start of 2012.
I never looked back. The more I found out about co-production, the more excited I became about it, and the more I saw how it could make a big difference in Wales. We started putting on small conferences, supported by Cardiff Council who kindly lent us venues, to tell others about co-production and its potential.
What is Co-production?
The term “co-production” was coined in the 1970s by political economists at Indiana University, but for a full understanding of the concept it needs to be combined with human rights lawyer Edgar Cahn’s articulation of the ‘core economy’.
The core economy is made up of the usually informal, rarely monetized, and often overlooked skills and services that people exchange as a matter of course: contributing time, energy, experience, knowledge and skills, because they care about their family, friends and neighbours – by looking out for others, watching over them, teaching, learning, sharing. Without these human relationships and interactions, there would be nothing to support the monetary economy and it would collapse – including society generally and our public services specifically. Services addressing issues in justice, education, health and social care, etc… are all underpinned by the unrecognised contributions of the families, neighbourhoods and communities that they serve.
This means that the people usually known as “service users” seen as passive recipients of the expertise and resources of the professional service providers, actually have much to offer in terms of their own knowledge and experience, and their capacity to design and contribute to services that respond to their needs more effectively. This is where the core economy ties into co-production.
“Co-production enables citizens and professionals to share power and work together in equal partnership, to create opportunities for people to access support when they need it and to contribute to social change.” This is the definition we work with. It is underpinned by six principles of co-production as laid out by Edgar Cahn. We deliberately chose a ‘Cahnist’ stance because it applies to human interactions in general and not merely public services, and also because it’s radical enough that it doesn’t lend itself to being corrupted or watered down.
- Principle – Value all participants as assets and build from their strengths.
- Principle – Recognise the importance of the core economy and of core economy work.
- Principle – Develop dynamic peer-support networks.
- Principle – Build relationships of equality and reciprocity.
- Principle – Create transformative change through shared power and shared responsibility.
- And last but certainly not least… Raise hell!
Rather than a sector-specific model, these principles are really a set a guiding values – which echo elements of the Human Rights Declaration. They intergrate models of practice from most sectors, for example restorative justice, relationship-based systems of care for health and wellbeing, person-centred planning in social care, or asset-based community development. That’s the beauty of it: it can exist in every type of public service.
And it goes further than that. Based on the growing body evidence we are gathering, we see that co-production is not just a way to create and deliver public services that are better quality and cost less – it also creates meaningful social change. Once people realise they have a voice, and that results in choice, control and self-determination, they start speaking out about what works for them and especially about what doesn’t. And this leads step by step to participative democracy and a different way of being as an entire society – hence the sixth principle… And *that* is why we feel so passionately about it.
Stories of Co-production in Action
- Brynsiriol is a residential care home in the Neath area in south Wales. The changes they started with were tiny – staff and residents taking meals together instead of eating separately, using the same bathroom facilities instead of having staff and residents’ toilets. The message this sent was huge: it’s no longer “us and them”, we are all in this together – we who live and work here. They are constantly developing ways of working and being together based on principles of self-responsibility, self-determination, and making positive risk-assessments – a radical move in a traditionally risk-averse environment, to ensure that they do not cosset people out of the fullness of living and learning.
- Community Lives Consortium in Swansea supports people who have learning disabilities. They decide what activities they want to take part in or organise, and they are now well used to choosing what works for them, and speaking up when things don’t. They’re beginning to comment on regulations and policies that don’t meet their needs and to become politically active.
- Cardiff University’s Doctoral Programme in Clinical Psychology is the first to have appointed a service user to the post of Service User Coordinator. The programme involves service users and care providers in the recruitment of PhD candidates, and in the teaching sessions. The students report very positive learning outcomes from the personal stories they are exposed to. The service users and carers are remunerated for their contributions, but beyond that their feedback is full of satisfaction and pride – they are contributing to forming the future practitioners in the services that support them and their families.
- The Welsh Ambulance Service Trust is applying a transactional analysis model to redesign its services and create adult-adult and coach-creator relationships with colleagues, partners and patients. (“Change our behaviours and we change patient outcomes.”) They have developed approaches that build on the wisdom of crowds and move the organisation away from parent-child and rescuer-victim relationships. All stakeholders are invited to join selection events to help provide feedback on what they noticed about candidates and how they made them feel during the selection processes. All colleagues are invited to contribute to new staff orientation sessions. Workshops are in place to support them to develop necessary and useful skills.
- ACE (Action in Caerau and Ely) is a community in west Cardiff whose residents’ activity and involvement has grown through a local timebank. Recently, the NHS (National Health Service) in Wales joined forces with ACE on the redesign of the out of hours telephone service (NHS Direct), and ran a few co-design sessions at the community’s Healthy Communities events. The NHS staff involved are experiencing a fair amount of anxiety from relinquishing the usual control and experimenting with working in this new way, outweighed by enormous excitement at the results and the potential for future developments. In the wake of the co-design events, the ACE community members offered to attend the NHS Urgent Care event to share their experiences and ideas as service users, with health professionals. Five women went and absolutely stunned the suit-clad male-heavy gathering of 70 officials. Their confidence and outspokenness has created a ripple of possibility across the organisation, and more bridges are being built between NHS and community members so that co-produced initiatives start to become the norm.
- The Wallich is a Welsh homelessness charity which has recently completed the development of its ‘Reflect 2 Perfect’ quality assessment framework, involving service users. It’s resulted in a complete review of the whole organisation, the development of even more co-productive ways of working, and incidentally in five of the 15 participants moving into employment with The Wallich itself.
- Connected Communities started off as one health visitor’s mission in Falmouth (England), in one of the most deprived, dangerous and neglected housing estates in the country. With only a handful of families on board to begin with, the Beacons Estate has now become of model of co-production practice: the performance indicators (through research carried out in collaboration with Exeter University) show educational attainment rocketing, a drastic drop in unemployment, smoking, drug use, crime and health issues, and the disappearance of unwanted teenage pregnancies. Beyond solid quantitative evidence, the human stories that underpin the numbers tell of people with raised aspirations and a transformed vision for their own future.
- A similar story played out in Pontypridd in the Welsh Valleys, where co-producing a two-year Strategy for Safety in a deprived area of the community, with all stakeholders involved, resulted in the crime rate dropping to zero – to the delight of the residents who like to boast that their neighbourhoods are safer than the more affluent areas.
Leadership and Heart-Centred Practice
Every one of these stories – and there are many more I could have shared – speaks to me of two things. Firstly, someone, somewhere, decided to take action and make a change. That is often a courageous move in the face of systems ill-suited to a person-centred approach. Co-production requires passionate leadership, by which I don’t mean someone in a position of traditional power, but someone who is able and willing to inspire others and lead by example.
Secondly, and that is where co-production echoes human rights and equality principles, everyone has a right to a voice, even and especially the people who are usually perceived as incapable of having an opinion or making a decision because they are considered too old, too ill, too disabled, too uneducated or too poor. Professionals may have a role to play to facilitate understanding, but given the right tools and context, everyone knows what a good life looks like for them, and what makes them happy. This is speaking to the universal human needs that we all have to be recognised, valued, and appreciated; and to have choice and control over our own destiny. co-production creates empowerment.
These examples are stories, not models, because there is no one-size-fits-all with co-production. You just have to start somewhere, usually small but not always. Invite everyone to be involved from the very start (not everyone will join you right away, but when they are ready they will); and listen to what people know. Be brave and make it up as you go along. It’s a slow process, but strongly democratic and very sustainable. Coming to a consensus takes longer than making an autocratic decision but the solutions last and more importantly, are embraced by everyone.
I’ve hardly mentioned the savings, although the economic argument is obviously not unimportant. When service providers listen to what their users actually need, rather than designing a programme from the remoteness of a manager’s office, the result is a more relevant delivery – and that ultimately means less resources wasted on unsuitable and ineffective programmes, and substantial cost savings. But this requires a long-term vision and commitment, because co-production doesn’t happen overnight and the social change that results isn’t measurable at the scale of annual budget renewals.
A Three-Pronged Approach
That is why the work we are doing to change the political and legislative landscape in Wales is so important. There are grassroots projects in abundance, and a growing body of evidence that co-production works. But until the national policy and regulations support rather than impede a person-centred, co-productive approach, its application will remain marginal – brilliant despite the system, and struggling for recognition.
We became a campaigning organisation somewhat by enthusiasm rather than by design. By the third event we ran in 2012, interest had grown so much that we upgraded twice to bigger venues. In her closing words, Ruth suggested to the audience – a mix of public service, professionals, civil servants, voluntary sector, citizens, carers and service users – that we could send an Open Letter to the First Minister of Wales asking him to make co-production happen officially and at a national level. The response was overwhelmingly positive, and the majority of the audience committed to signing it.
On the 1st May 2013 we delivered the letter to the First Minister, with copies to every Minister and the leaders of the other parties, along with 256 signatures from citizens, professionals and organisations; and with 25 letters of support from co-production practitioners and champions around the world – including one from Edgar Cahn himself. The response we received was thoughtful and encouraging, and since then we have been invited to take part in the processes shaping the Social Services and Well-being Bill, and the Future Generations (Sustainability) Bill. Influencing the policy and legislation landscape in Wales – and particularly our current focus, commissioning for outcomes and social value – is now a crucial part of our approach.
While we still consider ourselves citizens rather than professionals, which gives strength to our campaigning voice, we have accrued valuable expertise and extensive networks. Our two other areas of work are supporting the network of co-production practitioners in Wales by facilitating connections, events, and disseminating information through the blog, a monthly newsletter, and delivering training sessions and consultancy at organisational level. Several national organisations have pronounced themselves willing to switch to a more co-productive way of working, but their size and systems make it a cumbersome process. Co-production requires a willingness to take risks, embrace the unknown that comes with innovation, and relinquish power – a challenge in many ways. However, we have encountered so many wonderful people in every different setting that are equipped with passion and energy, working in the same direction with common values, that we feel optimistic about the future.
What the Future Holds
Considering we started off as researchers, inadvertently became campaigners, and are now being consulted as co-production experts, we figured it was time to give ourselves some structure and means to broaden our reach. So far all our activity has been on a voluntary basis, save for the occasional speaking engagement, training session or consultancy project. Most of our time is spent on campaigning and influencing, and supporting the network. Our personal finances, and part-time employment for me, have enabled us to pursue our mission until now.
We have dedicated 2014 to getting established as an official organisation, and to accessing funding so that we can do even more in the next few years. We have a vision for a comprehensive set of resources, a more active Wales-wide network, for flagship projects in every sector, for a programme of training and consultancy that links in co-production with action learning, appreciative inquiry, and systems thinking. 2015 will be a year for partnerships, growth, and for Co-production Wales to spread its wings.
Our current focus is on transforming public services through public sector and third sector organisations. Who knows where this will lead? We are facing an exciting but unformed future, which we are co-creating as we progress. I couldn’t tell you where we will be in 5 years’ time – I can but hope that the political and social context would have changed so much in Wales that things will look very different. I will report back when we get there.
To learn more or get involved, check out Co-production Wales.