Bernd Sass, Anna Denham, Disability Rights UK

The principles of co-production were at the heart of ‘Getting Things Changed’, recognising that good disability research must have disabled people at its core. In the same way, UK social and health care policy have recognised since the 1970s that user participation is essential to public services; the concept of co-production now underpins person-centred care and personal budgets. In health care, the Expert Patient programme introduced a model of patient participation in their own care and this theme is now reflected in mechanisms such as Healthwatch introduced in 2012. The statutory guidance for the 2014 Care Act defines and promotes co-production, introducing the concept into every part of the social care process.

However, one of the problems in co-production is that there is little agreement on its definition. For instance, it can be seen simply as involvement in producing public services, but many would emphasise the regular, long-term relationships between parties in the co-production process. At all events, equality and reciprocity are at the core of what it should mean. 

“Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours” (Boyle and Harris, 2009)

Despite the policy drivers, the rhetoric of co-production is easier to articulate than the reality. We know for instance that co-production requires a power shift in the way things are done. We also know that not all disabled people will want to take up active roles in co-production, in the same way as not all non-disabled people are active participants in civil or political society.

This project set out to conduct an appreciative inquiry of ‘user-driven commissioning’, with an action approach to supporting disabled people’s organisations (DPOs) in order to achieve deep level changes in local authority practices. The plan was to identify specific projects which DPOs wished to undertake, and in areas where there was agreement from the local authority to go forward with shared goals to achieve change in commissioning practices. The central purpose of this project was to learn lessons about how disabled people can effect changes on the systems, outcome measures and attitudes of professionals, as well as their own personal life changes. The specific research questions were:

a) How can interactions between disabled people and commissioners best be understood and modified, both in mainstream commissioning and innovative approaches such as user-driven commissioning?

b) What happens in the process of ‘letting go’, that is when practitioners and commissioners learn to place trust in the insights that disabled people have in their care and support, and does this change over time?

c) What are the impacts on well-being of both disabled people and staff, and on health outcomes and independent living of disabled people?

Ethnographic data were collected in six sites, with at least three others which were approached for initial discussions. In all, five sessions of engagement or consultation were observed, and 16 interviews were conducted face-to-face, four with local authority commissioners or directors; nine DPO members or young disabled people; one local councillor, and two workers or facilitators. In addition, documents relating to commissioning specifications were collected and analysed as well as email communications between the partners.  In two of the DPOs, a specific intervention was put in place, with an independent facilitator to support the DPO in gaining confidence to work with the local authority.

Resources

Commissioners in health and social care - co-production (PDF, 646kB)