Co-production may sound like a simple concept, but it couldbecome a “radical idea” if public services were to apply it, said MatthewHorne, managing partner of The Innovation Unit Ltd., a not-for-profit socialenterprise based in London, England that works with U.K. government.
Presenting the co-production paradigm to a gathering ofCanadian federal, provincial and municipal delegates in a keynote speech on Day2 of the Lac Carling Congress in Niagara-on-the-Lake, Ont., Horne made the casefor co-production in public services through examples of projects from aroundthe world.
Co-production is the “delivering of services in an equal andreciprocal relationship between professionals, people using those services,their families and their neighbours,” said Horne. The concept has been aroundin the U.S. and the U.K. for 30 to 40 years and based on a set of four values,he said.
First, it recognizes the strengths, assets and capabilitiesof all citizens, he said. Second, it promotes and values reciprocity, whichmakes public service a “two-way street.” It also “values work differently” byrecognizing that the care and support provided among families and communitiesis a core part of the economy. Lastly it “builds on social networks,” whichcreate the bonds that make collective action possible, he said.
Co-production could “create a very different paradigm forpublic services,” said Horne. The paradigm is one where power, knowledge, riskand responsibility are “truly shared” between public services and the peoplethey serve, he said. This changes citizens from consumers of services to theproducers of heath, education, care and safety of communities, he said.
“The success of public services in this world would not bemeasured by the business of professionals or the speed of service, but theprevention of social problems through the growth of the core economy,” he said.This core “would be measured by the self-sufficiency of those families andthose communities,” he said.
While co-production is not a solution to every problem, itis very relevant to particular types of long-term social problems that Westernsocieties face, such as childhood obesity, chronic disease and elderly care,said Horne.
And while the practices of co-production look very differentwhen dealing with health care versus education versus social care, for example,the problems it tackles share a similar set of characteristics, occur on amassive scale and require collective action, he said.
Not only is co-production relevant to some of these socialproblems, there is evidence that co-production does make a difference onoutcomes, said Horne.
The Family Intervention Project, based in Manchester, England,is designed to address anti-social behaviours by fostering pro-socialrelationships in families, he said. The project provides multi-agency supportand sees dramatic reductions in anti-social behaviour in 85 per cent of thecases, he said.
The Expert Patient Programme, another U.K.-based project, isa six-week course for patients with long-term conditions. A form of patienteducation, the program is designed to help patients self-manage theirconditions and is delivered by trained tutors who have the same conditions,said Horne.
National Health Services has seen outpatient visits decreaseby 10 per cent for participants of the program, visits to the emergency roomdecrease by 16 per cent, pharmacy visits decrease by 18 per cent and 38 percent of participants report a reduction in symptoms six months after finishingthe program, he said.
Family Nurse Partnerships, modeled on a U.S. program, isanother example of co-production that has nurses work with young mothers frompregnancy through to the first two years of the child’s life, said Horne. Thenurses provide advice on areas such as smoking, drinking, sexual health,breastfeeding support, parenting education and life skills, he said.
Economists estimate the benefits are five times the cost ofthe program and deliver a net saving of $41,000 per child, said Horne. Resultsinclude a 48 per cent reduction in child abuse and neglect and 61 per centreduction in teenage arrests for children who went through the program, hesaid.
According to Horne, co-production programs can also helpaddress the financial constraints of public services.
The Patient Hotels project, based on a partnership between ahospital and hotel chain in Sweden, built a dedicated building for cancer andmaternity patients who don’t need intensive medical supervision, he said. Thebuilding is staffed with nurses, run like a hotel and includes a restaurant,health club and swimming pool.
The hospital is currently running 900 beds in the building,which includes patient rooms and rooms for overnight visits from families. Anight at the hotel is 60 per cent cheaper than a night in an oncology ormaternity ward, said Horner. The hotel generates income for the hospital andpatients not only want to stay there but report better well-being, he said.
Another example, the Ubudehe project in Rwanda, translatesfrom Swahili to “community working together to dig fields in preparation forthe rain,” said Horne. The project has villages take responsibility for theirown poverty reduction, reaches 1.4 million people and won a United Nationsaward for accountability and transparency, he said.
Co-production is also something that the public want and arewiling to contribute their time towards, according to Horne. A survey of the U.K.health service found that 90 per cent of patients want to be more active intheir self-care, he said.
Another survey cited by Horne found that 28 per cent ofpeople are willing to contribute a few more hours per week to improve theirhealth, neighborhood and environment and 43 per cent are willing to contributea few more hours per month. The remaining respondents, he said, were notwilling to contribute more hours.
One important question to ask is whether citizens actuallybelieve they can make a difference in their own health, the safety of theircommunities and their local environment, he said. Research from the EuropeanUnion suggests yes, he said.
Horne said there is evidence that people do want tocontribute, create, produce, support others and give more of their time – anddon’t want to be treated the same way as they are in the private market. Butpublic services are often “very timid and very shy of asking our citizens to dothings for us and for other citizens,” he said.
And while the “technology is here” to help empower citizens,figuring out how to use technology to support relationship services remains achallenge, he said. The keynote included a break-out question among tables todiscuss how technology can support an “equal and reciprocal relationship” betweenpublic services and citizens.
The problem that public services face is not that they failto support citizens, but that public services “need to do that more and moreevery year,” said Horne.
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