Strategic Commissioning: Co-production and the compelling case for change Diana Hekerem, Sarah Currie, Des McCart, Thomas Dodd, Thomas Monaghan Strategic Commissioning: Co-production and the compelling case for change
Today’s presentation • What is co-production? • How you develop your provider partner relationship (art of the possible) • Using your existing market differently • A different set up altogether - ingredients in the market place Strategic Commissioning: Co-production and the compelling case for change
What is co-production? • A completely different way of thinking – puts users on an equal footing with providers Co-production is a relationship where professionals and citizens share power to design, plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities (Slay and Penny, 2014) Strategic Commissioning: Co-production and the compelling case for change
Where did it come from? Academics and think tanks Social movements Legislation/policy Strategic Commissioning: Co-production and the compelling case for change
What is co-production? • Already exists in various contexts across Scotland • But…not just about: – Involving, engaging and empowering people and communities – Allowing individuals, communities, third sector to take on responsibility for areas usually deferred to state • Occurs in ‘ critical middle ground ’ combining strengths and resources of people and communities and professional skills and knowledge Strategic Commissioning: Co-production and the compelling case for change
Guiding Principles • Recognise people as assets • Build on people’s existing capabilities • Mutuality and reciprocity • Peer support networks • Break down barriers • Facilitate rather than deliver Apply where relevant! Strategic Commissioning: Co-production and the compelling case for change
Responsibility for service design Professional are sole Professionals and No professional role service planner users/community as co- in planning planners Professionals as sole Traditional professional Professional provision Professionals as sole service deliverer service provision but with deliverers Responsibility for service delivery communities/users involved in design Professional and User co-delivery of Full co-production User/community user/communities as professionally designed delivery with little co-deliverers services professional User/communities as User/community User/community Self-organised sole deliverers delivery of delivery of co-planned community professionally planned services provision services Boyle and Harris (2009) Strategic Commissioning: Co-production and the compelling case for change
Responsibility for service design Professional are sole Professionals and No professional role service planner users/community as co- in planning planners Professionals as sole Traditional professional Professional provision Professionals as sole service deliverer service provision but with deliverers Responsibility for service delivery communities/users involved in design Full co-production Professional and User co-delivery of User/community user/communities as professionally designed delivery with little co-deliverers services professional User/communities as User/community User/community Self-organised sole deliverers delivery of delivery of co-planned community professionally planned services provision services Boyle and Harris (2009) Strategic Commissioning: Co-production and the compelling case for change
A range of participative approaches Developing equal and reciprocal relationships Coercing Educating Informing Consulting Engaging Co-designing Co-producing Doing To Doing For Doing With trying to fix people engaging and in an equal and who are passive involving reciprocal recipients of services people partnership Adapted from Slay and Penny (2014) Strategic Commissioning: Co-production and the compelling case for change
There is a huge appetite within communities across Scotland to get involved 96% think people should be involved in making decisions about how local services are planned and run 81% think people should be involved in making decisions about how money is spent on different local public services 86% think local people should be able to volunteer alongside paid staff to provide public services 2015 Scottish Social Attitudes Survey
Why co-production? ‘Evolving’ evidence base suggesting potential for improved: • Citizen outcomes : health and wellbeing; human and social capital (improvements in personal competencies, personal and practical skills, social networks and inclusion) • Public service outcomes : efficiency savings • Democratic outcomes : citizens more socially and civically aware and may become involved in other aspects of democratic action Strategic Commissioning: Co-production and the compelling case for change
Co- production works best when… • There are real choices and new ideas • It is the start of a development process • There is enough time to involve people properly • Outcomes are agreed and there is a clear understanding of shared aims • You recognise that other organisations might be better placed than you to meet needs Strategic Commissioning: Co-production and the compelling case for change
Overcoming the challenges Translating theory into practice • How can genuine power, choice and control be devolved to people and communities, alongside front-line professional staff? • What happens when relationships breaks down? How can we ensure robust and viable relationships able to withstand disagreement? • Moving beyond pockets of innovative practice to expand coverage and scale • Appropriateness of co-production for different groups and within different policy areas Sufficient authorising environment • Encouraging and enabling professional culture that values involvement and contribution of people and communities • Considering implications for accountability Evidence and measurement • Generating evidence about impact and cost-effectiveness Strategic Commissioning: Co-production and the compelling case for change
What does co-production look like in practice? • No set guidance or manual • Highly relational and local context vital • Diverse public services Questions to consider: • Nature and degree of change being sought? • Types and extent of input required? • Who initiating and facilitating change? • Who holds power to make decisions? • Who is currently involved? • What perspectives have not yet been considered? • What stage should co-production take place? • What opportunities are there for greater participation? • What are the barriers to this? Strategic Commissioning: Co-production and the compelling case for change
What does co-production look like in practice? At national level: • Creating the conditions for co-production to thrive -National policy frameworks -Promoting transparency and openness -Creating incentives and opportunities • Developing and implementing policy in open and participative way Collaborating and co-designing with people and communities At local level, common methods of collective co-production: • Reciprocal exchange systems (time banks, service credit schemes, complementary currencies) • Peer support networks (mentoring, befriending, community navigators) • Participatory budgeting • Citizen justice panels • Local area co-ordination Strategic Commissioning: Co-production and the compelling case for change
Three ways to do improvement 1. Don’t listen very much to people who experience our services and we do the designing 2. Listen to our service users then go off and do the designing 3. Listen to our service users and then go off with them to do the designing Strategic Commissioning: Co-production and the compelling case for change (Professor Paul Bate 2007)
Collaborative commissioning practice Doing things differently Des McCart ,Healthcare Improvement Scotland Strategic Commissioning: Co-production and the compelling case for change
Competition versus Collaboration Competition Collaboration • • Misguided regulation anxiety Assesses needs, aspirations and assets • • Is of real value and meaning to all An over focus on needs • Collaboration is the default • Lack of useful, reliable and up-to-date local intelligence • Positive competition is used to drive collaboration towards achieving better outcomes • Risk averse commissioning reduces opportunities for real innovation • Actively shapes markets • Commissioning and procurement as a reductive • Specifications are iterative and change over time to process best meet the needs and assets • • Collaborative principles define and assess all Short-term and static specifications and contracting interactions . • Collaboration is weak • Outcomes and impacts are assessed dynamically, using diverse methods • Orthodoxy to create economies of scale produces static markets • Accountability panels to challenge and spread co- production • “We already do co - production” • Is a shared learning process that builds expertise and holds onto it Strategic Commissioning: Co-production and the compelling case for change
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