Ruth Dineen says we must end state services that define people as unemployed, homeless, ill or infirm
Anna Coote of the New Economics Foundation believes that the traditional model of public service delivery “has disempowered those people who are most in need of care”. She suggests that unless we “re-align the relationship between the state and citizens, we will be left with both in disarray: an unsustainable system and citizens who will have to fend for themselves”.
Arguably that prophecy is already coming true. The traditional approach to public services tends to be deficit-based. People (and communities) are defined by their deficiencies – as unemployed, homeless, ill or infirm. We expect public service professionals to fix people’s problems, casting individuals in the role of passive and inadequate recipients with little or nothing to contribute. The result is an increase in both dependency and need.
This is problematic in its own right. However, at a time of economic decline, an ageing population, welfare reforms and increasing social inequalities, it is catastrophic. So what’s the alternative?
Let’s imagine a different future. One where all care homes are lively, loving places where residents have choice and autonomy in their everyday lives. Where young homeless people help to solve problems of anti-social behaviour and generational conflict in their own neighbourhoods, and where high school pupils work in partnership with a national children’s charity to raise awareness of domestic and sexual violence. Where mental health patients collect stories from their peers and use their expertise to improve the service they receive.
Imagine a community whose members contribute over 30,000 hours of ‘official’ voluntary work each year – and many more hours in an unofficial capacity. Imagine a substance-misuse initiative where former service-users run a highly effective peer-mentoring scheme. Or imagine a local authority who co-commission children’s services with the help of the children themselves.
This imaginary future already exists in Wales. It’s called co-production and it offers a sustainable, evidence-based response to the crisis in our public services. Co-production is about citizens and professionals pooling their knowledge and experience to identify and solve problems. Its use results in more effective and more relevant public services. It also increases engagement, builds stronger communities and improves wellbeing across the board. It’s not the Big Society. It’s a return to the Welsh traditions of co-operation and community. In Nye Bevan’s words, it’s “collective action to lift all of us together”.
Co-production principles can be applied to all public services and in every sector. This is not about imposing yet another simplistic model or chasing the latest neoliberal chimera. It’s certainly not a modish quick-fix. It’s about creating the conditions for people of all ages to be valued within their schools, homes, neighbourhoods and communities. It’s about appreciating who they are and what they can offer.
It’s not doing it for people, but doing it with people. In a co-production scenario, service-users and their communities are involved in defining the need or problem, designing the solution and delivering it, either with professionals or independently, or anything in between. This approach demands longer-term engagement by service-providers but leads to profound and sustainable change.
More challengingly, co-production requires both a shift in power from service providers to citizens. It also requires a cultural change from mechanistic, risk-averse forms of delivery to relationship-centred approaches. We need to re-think what we mean by professionalism in health and social care and re-examine our ideas about risk management and professional boundaries. We need to move away from procurement and quantitative targets to co-produced, outcomes-based commissioning. As a UK Cabinet Office report put it last year, the potential prize is “enhanced, more cohesive communities; services that are more efficient and responsive; and increased opportunity and influence for individuals”.
All in this Together, the campaigning body for co-production in Wales, aims to make co-production the primary approach to our public services. We are working with public service professionals, civil servants, commissioners, academics and citizens to raise awareness of co-production, to share best practice and build the evidence base.
What’s needed now is a clear, visionary lead from the Welsh Government. As part of our campaign, tomorrow we are sending an Open Letter to the First Minister and the rest of his Government, asking that co-production principles are placed at the heart of public services in Wales. The Open Letter has 250 signatories from individuals and organisations in Wales.
We will also forward the many letters of support we have received from co-production advocates from USA, Australia, England and Scotland. They include:
- Edgar Cahn, American civil rights lawyer and a founding father of co-production;
- Philip Colligan of Nesta’s Innovation Lab;
- Anna Coote of the New Economics Foundation;
- Dr Simon Duffy of the Centre for Welfare Reform; David Robinson of the Early Action Task Force;
- Will Norman of the Young Foundation;
- Sarah McDonnell of the Office for Public Management.
- Eddie Bartnick, Western Australia Mental Health Commissioner.
If co-production principles are embedded on the face of all relevant legislation, regulation and codes of practice, this would act as a powerful catalyst, helping to consolidate the shift already evident in Wales towards equal and productive state-citizen relations, based on reciprocity and trust.
There is ample evidence of co-production’s capacity to deliver this vision, creating more humane, more effective, and more sustainable public services. There is also ample evidence to suggest that if this opportunity is not grasped, our future will be characterised by “an unsustainable system and citizens who will have to fend for themselves”.