What is co-production?
Time Banks UK background briefing No. 1
Why are our public services not more effective, despite the extra investment? Why after six decades of the welfare state is there still so much ill-health, school failure, and why is the social fabric of our neighbourhoods collapsing? Because the critical contribution required from ordinary people, their families and their neighbours, has been systematically ignored and finally forgotten. But without it, all professionals can make little permanent change.
Co-production offers an approach that goes beyond simple representation on boards, and focuses on clients as vital assets which professionals need to engage if they are going to make long-term, sustainable progress. That means involving people – often those who have normally been regarded as the ‘problem’ – in reciprocal activity that builds neighbourhoods, supports public service professionals, underpins their own development or recovery, and which is also measured and rewarded.
Why does co-production work?
Co-production was a concept coined first by development economists in the late 1970s to explain why development programmes seemed so difficult to sustain, and why they so often had exactly the opposite result to what was intended. The concept was extended to tackle the question of why the accepted model of service delivery, in education, police and housing – run by large centralised bureaucracies – was failing so disastrously on the ground.
But the truth behind co-production – that welfare and services only work effectively when they are jointly produced by professionals and beneficiaries – is not enough in itself to tackle the underlying malaise. We need a driver that can inject that reciprocity between clients and professionals that public services need for them to succeed.
The idea was refined and developed by the work of the law professor and co-founder of the US National Legal Services Programme, Edgar Cahn. His thinking provides a critique of large public programmes that reveal how they tend to impact only on day-to-day symptoms. Worse, that all too often the professionals are simply creating dependency – but a dependency of a peculiarly corrosive kind: one that convinces patients they have nothing worthwhile to offer, and which undermines what systems of local support do still exist.
Actually, the opposite is true. Pupils, parents, neighbours or patients are assets – with life experience and the ability to care, and often with time on their hands that they would only too willingly give if there were institutions that could manage it. Co-production means that – if professionals are going to succeed in the long-term – welfare programmes, policing or health, need to be partnerships between professionals and clients that respect what both sides need to provide.
That requires systems that can broaden our definition of work, and which allow the people who are normally the object of volunteering or health services to be actively engaged in providing mutual support – which can both broaden the way work is understood and be transformative for the people taking part.
How does co-production work?
Co-production is not intended as an ideal that professionals simply need to aspire to. Nor is it simply consultation with clients, or asking people's opinion, or even basic participation in decision-making. All that has been tried and it either isn't enough, or it is used as a method of further coercing patients and staff – or to tick the target that requires 'user involvement'.
It means in that clients and professionals have to be partners in the business of their own regeneration, and in the delivery of care – in such a way that they and others can be embedded into a new community that will be there when they need it, and can insulate them from further illness or problems.
Co-production gives responsibility to patients, and helps those patients feel useful and worthwhile when long-term illness sometimes categorises them as useless – and by so doing, changes their lives. Experience in health has shown this can have a dramatic effect both on their recovery and their need for medication.
It also requires systems that can measure and reward the efforts that people are making, so that the relationship between clients and professionals is genuinely reciprocal. Those systems are often – but not always – known as time banks, embedded in doctor’s surgeries, community centres or schools to provide them with a mutuality that is genuine.
Where is this happening?
There are examples of co-production all over the world – some that use time banks and some that do not:
Health: The Rushey Green Group Practice, in Catford, south London, includes a time bank where doctors refer patients they believe will benefit, and which can – by using a system of time credits –can also check on those being discharged from hospital, or support those who also have diabetes or asthma, and provide the kind of friendly neighbourhood face that professionals are unable to provide. Research shows that the more patients are involved with the time bank – as givers and receivers – the more likely they are to find real improvement in their physical and mental symptoms.
Schools: Some of the most deprived schools in Chicago now engage disaffected 16-year-olds by using them as tutors for 14-year-olds, and have achieved both major academic improvement for both, but major reductions in bullying. Similar schemes have also been effective in Tower Hamlets.
Youth crime: A quarter of all young people in Washington DC arrested for the first time for non-violent offences are now tried by juries of other teenagers – and must serve on similar juries themselves – and have achieved dramatic reductions in recidivism.