Lorraine: One of our aims in hosting this blog is to take a ‘warts and all’ approach to discussions. In order to do this one of the things we need to do is to take an objective look at the challenges faced by those trying to adopt coproduction – this week’s blog fits the bill perfectly and we look forward to a lively debate!
Dr Jenny Morris has written many books about both feminism and disability. Prior to retiring in 2010 she worked on disability policy for 25 years, including leading the Labour government’s Independent Living Strategy and working on the Right to Control. She writes a blog at jennymorrisnet.blogspot.co.uk. Here is her blog on co-production.
Most initiatives which use the term in the context of health and social care in the UK are not co-producing anything. But here’s an example from 1996, in fact before the term was adopted in this country:
Newham People First, a group of people with learning difficulties, supported by a worker funded by Newham Social Services, inspected the group homes in the Borough. Based on what people living in these homes told them, they then developed a set of standards that they said group homes should abide by. Working together with those commissioning the group homes they put these standards into the contract for the services.
So people with learning difficulties and commissioners jointly produced a new contract.
The problem is that co-production has been introduced in the context of:
- political pressure (both within and outside government) to increase the marketisation of public services
- reducing budgets leading to…
- an increased role for professional discretion in determining and controlling how resources are spent.
Progress has been severely curtailed by the fact that what is called ‘co-production’ is now entangled with the government’s aim of reducing the size of the state. This is particularly clear in the case of ‘personalisation’ of social care.
Personal budgets and direct payments do not in themselves create co-produced responses to people’s needs. In fact their implementation all too often means that:
- professionals devise ways of determining budgets which lack transparency
- assessments are of eligibility rather than of what is required to produce good outcomes
- budgets and direct payments have conditions attached to them which relate to bureaucratic requirements rather than what is required to deliver user-defined outcomes
- the whole system is underpinned by a lack of trust and very little acknowledgement of the individual’s expertise in determining how best to meet their needs
- rather than working with individuals to facilitate and empower, professionals introduce conditions which mitigate risk to their organisation while transferring other risks to the individual and their family.
So an idea which was truly radical in its origins has been subverted and is thereby open to legitimate criticism from those who should be our allies. This is the result of the conditions of its implementation being completely at odds with the original aim – to put control in the hands of those who need support.
My own local authority says that, if you choose to have a personal budget rather than a direct payment, you can only use the one service provider they have chosen (a multi-national company with no history of operating in our area). Which, they say, “will give you more choice and control over how your care and support is delivered” (sic). The commissioning policy which created this situation was certainly not co-produced.
Health and social care services are experiencing a financial, and political, crisis. Perhaps the only silver lining is that crises potentially present opportunities. There are many people working within health and social care systems who are truly committed to enabling choice and control, and to working with disabled and older people’s own organisations. Our only hope is that the crisis opens up opportunities to create radical innovations which lead to real change. But such change will not come about unless meaningless rhetoric becomes reality.
So please don’t use the term co-production unless you are actually working together to jointly produce solutions which deliver choice and control.
choice and control.