Co-production in health and social care – the challenges and opportunities for local government

LGiU and Governance International have published a book on Co-production in Health and Social Care. You can download the book for free here.

The following blog post is based on a chapter from this book. We are launching the book on 25 June at the LGiU. To come to this event you can sign up here: lgiu.org.uk/event/book-launch

We know that how public services are provided in the UK is changing fundamentally. A range of factors such as the drive for ‘localism’, the fiscal context and long term changes in society, such as demographics and technology, are contributing to this. In the immediate term local authorities must find very significant savings in expenditure, and in the longer term must fundamentally change aspects of how services are delivered. There is much talk of the different approaches to delivering services differently, such as the ‘commissioning council’ or the ‘co-operative council’ – both with the emphasis on service users taking greater involvement in shaping and delivering their own services – co-production. In health and social care, this approach is crucial.

Co-production in health and social care is not about service users looking after themselves; it’s about them giving their time and using their skills to run their own care with professionals. There are many reasons to believe that the co-production approach to public service delivery is essential – particularly if we are to tackle some of the big issues facing society today. Local authorities have a huge opportunity to transform their services – with citizens at the centre.

The co-production approach can bring real innovation directly from the service user, who has the in depth knowledge of what their requirements are and the best way to meet them. Co-production can also encourage citizens to take more responsibility in their own communities and for their own health. Citizens have to take responsibility for co-producing services, including their own care, if we are to find a sustainable way of delivering these services in the future.  Local government has a key role in enabling and influencing co-production, by providing opportunities for participation. 

The Localism Act provides many of these, in the shape of: the General Power of Competence, Community Right to Challenge and Community Right to Bid. Using the commissioning process in a different way and adopting a community budgeting approach also offer local authorities a way to involve communities, provide opportunities for them to participate and shape the priorities that are set. Councillors are intrinsic to the process of co-production. Councillors are community facilitators and leaders of place; people who have the access and ability to bring together diverse sections of their communities to understand priorities and concerns.

Councillors are the direct link between the local authority and community – as such, they are ideally placed to coordinate and facilitate opportunities for their communities to have meaningful involvement in the process of co-production. Local government should let the community understand what possibilities are available to them. Unless people know what their options are, including; examples of where involvement has led to something worthwhile, and information about the process of involvement in co-production, it may be difficult for people to fully understand the opportunities that involvement in co-production may bring.

Of course, the other side is that we in local government need to be open to suggestions that may be presented by the community and service users. Not all suggestions will be great ones, but some will be gems, and you need to be willing to listen to them when they come along.   While there are many opportunities to adopting the co-production approach, it would be remiss to present it as an easy solution to a series of complex problems – we know that it’s not so simple and that actually taking co-production forward is challenging. There are a series of things that local government and citizens will have to confront and work through in order for the co-production approach to flourish. These are not insurmountable challenges, but they are challenges that will take thought and consideration to work through.

The future delivery of health and social care services is changing; it has to transform in order to meet the needs of future generations. There are some big questions that still need to be confronted – not least future funding. But there are steps that local authorities, councillors and communities can take now in order to start this transformation process. Co-production is one of these steps; and working through the challenges and opportunities above will enable councils to move forward.