motivation

Why co-production is an important topic for local government Elke Löffler, Governance International, elke.loeffler@govint.org Co-production has become an important reality in public services in the UK and internationally, as we witness greater involvement of service users and communities in the public service chain, both in extent and in intensity of engagement. Indeed, as a recent report by Governance International and pollster Tns-Sofres shows, service users in five European countries are already playing a much bigger role in public services than many professionals in those countries currently realise (French Ministry of Finance, 2008). And, as Figure 1 shows, citizens in the UK scored higher than those in the Czech Republic, Denmark, France and Germany in terms of co-production in health, community safety and crime prevention. * This paper has been commissioned by LARCI to provide an overview of the personal, community and efficiency aspects of co-production in public services and adds an international perspective to the debate on co-production in the UK. In particular, the paper brings together three LARCI contributions on specific aspects of user and community involvement in public services: • • • User involvement in public services by Catherine Needham (2009) Community involvement in public services by Simon Griffiths and Beth Foley (2009) Efficiency aspects of citizen collaborationby Elke Löffler and Peter Watt (2009) All of these papers can be found in the library section within the IDeA Community of Practice on CoProduction at www.idea.gov.uk Figure 1: Level of citizen co-production in Europe Level of User-Involvement in Europe (environment, health, community safety) UK 56 Germany 53 Czech Republic 52 France 51 Denmark 48 0 100 The index is a min-max (0-100) scale, with 0 representing minimum co-production (answering "never" to all the co-production questions) and 100 representing maximum (answering "often" to all the co-production questions). Note: Co-production was defined in this survey as the regular participation of citizens (as individuals or in groups) in order to improve outcomes, e.g. in community safety, the local environmental and their own health or health of other people. Source: www.5qualiconference.eu At the same time, in particular in the UK, there is now also a policy-level debate about the concept co-production among policy advisors and researchers. Most recently this debate has been given impetus by the Prime Minister’s Strategy Unit (Horne and Shirley, 2009), think tanks such as the New Economics Foundation (Nef, 2008: Harris and Boyle, 2009), the Social Market Foundation (Griffiths et al, 2009), practitioner associations such as Compass (Gannon and Lawson, 2008) and the Social Care Institute for Excellence (Needham and Carr, 2009) and by academics such as Prof. Tony Bovaird, Birmingham University and Marion Barnes, University of Brighton. At the European level, the issue of co-production was put firmly on the agenda of EU Ministries of Public Administration at the 4th European Quality Conference for Public Agencies in the EU in 2006 (Pollitt, Bouckaert and Löffler) and it was chosen as the core theme of the 5th European Quality Conference in 2008. Recently, the OECD has also started to focus on co-production within its agenda of promoting innovative public services. Clearly, co-production is not a new concept – indeed, it is inherent in most services. It has been long understood that a key characteristic of many services is that production and consumption are inseparable. Both require some contribution from the service user, as pointed out by Normann (1984) and by Zeithaml, Parasuraman and Berry (1990). 2 Or as Sharp (1980: 110) puts it, co-production is “the recognition that public services are the joint product of the activities of both citizens and government officials”. Catherine Needham (2009) observes that the original co-production literature came from American urban scholars in the late 1970s and early 1980s, responding to fiscal cutbacks in the United States at a time of rising public expectations of services (Parks et al, 1981; Brudney, 1984). Our current renewed preoccupation with different approaches to coproduction is again marked by a recession but there are also a number of other drivers as Box 1 points out. Box 1: Drivers of co-production in public services • • • • • Technological innovations, particularly in ICT, give citizens more control, choice and flexibility in their relations with service providers (in any sector). In the public sector, this applies quite obviously to transactional services, e.g. when citizens make use of e- government solutions. However, it also applies in social services and health, e.g. where new technologies allow patients to take responsibility for their own treatment. For example, patients with kidney problems can now run their dialysis at home so that they no longer need to go to the hospital several times a week. The latest development is health focused sensors in the home which allow remote monitoring of elderly patients for conditions including dementia so that they can stay in their own homes for longer while saving money. The rapid and far-reaching value change of modern societies has had a deep impact on attitudes and behaviours of citizens (see, for example, the empirical research by Hofstede, 2001 and Inglehard, 1997). This has also led to the rise of what Griffiths et al call ‘assertive citizens’, with service users seen as less deferential and more likely to want to have a say about the services they receive (2009: 72-3). Due to demographic changes taking place in most OECD countries, there will be more citizen involvement in public services in the future. As empirical evidence for five EU countries shows, the involvement of citizens in delivering public services clearly increases with age, so that the ‘ageing society’ not only means increased demand for social services but also increasing levels of ‘co-production’ (French Ministry of Finance, 2008). As fiscal constraints become more severe, public agencies are likely to seek to make best use of all the potential assets available to public services, including the resources which service users and communities can contribute to service outputs, quality and outcomes. While a number of co-production approaches such as egovernment solutions or the replacement of paid staff by volunteers are already widely used to achieve efficiency savings, other co-production approaches such as participatory budgeting are rarely used as a strategy for getting “more for less” (Löffler and Watt, 2009). In particular, in the UK a greater outcome orientation of public agencies has increased awareness of public managers that outcomes “are very difficult to 3 achieve without some contribution from the service user” (Alford, 2009: 213). The key argument of co-production is that we can achieve an even higher level of outcome than by traditional service provision or self-help if we combine both the inputs of the public agency and the users and communities (Löffler and Watt, 2009). However, in many European countries there is still not a strong focus on outcomes, with the exception of health where it was always believed that “health is the result of a joint effort of patients and professionals (Austrian Department of Health, 1993). In particular, ICT technology has profoundly driven and enabled new forms of collaboration between professionals and citizens. It seems very likely that it will continue to change the relationship between service professionals, service users and their communities, making citizens less dependent, while, at the same time, giving them more responsibility. Although there is substantial evidence that co-production is already happening and that there is likely to be more of it in the future, there is also some research which indicates that this reality is still not well appreciated or understood by local authority professionals, managers and councillors – and that, when they do become more aware of it, they sometimes resist it strongly. The first challenge for the research community, think tanks and local government umbrella organizations is to find mechanisms and a language to make professionals more aware of this concept and to help them understand why it is becoming more prevalent in practice. The second challenge is to understand better the sources of resistance to the concept. What co-production is about Whereas there is now an increasing body of academic research on co-production in the English-speaking world, the term is largely unknown (and, where it is known, even sometimes disliked) in local government. As the interviews with ‘co-production champions’ conducted by Catherine Needham (2009) confirm, the term ‘co-production’ may be an unhelpful one, if local government is to deal with and exploit the issue fully. This applies even more strongly in other countries, where the debate on co-production is rather more likely to take place under the topic heading of ‘co-responsibility’. Just to make things more complicated, even academics cannot agree what to include and what to exclude under the bracket of co-production. However, when analyzing the myriad of definitions of co-production, there are a number of ‘common denominators’ as Box 2 shows. 4 Box 2: Distinctive principles of co-production • • • • Co-production conceives of service users as active asset-holders rather than passive consumers. Co-production promotes collaborative rather than paternalistic relationships between staff and service users. Co-production puts the focus on delivery of outcomes rather than just ‘services’. Co-production may be substitutive (replacing local government inputs by inputs from users/communities) or additive (adding more user/community inputs to professional inputs or introducing professional support to previous individual self-help or community self-organising). There is also a normative element to co-production. One normative perspective is that coproduction is based on the principle of reciprocity – in return for greater control over resources and decision-making in public services, citizens are expected to bear more responsibility and risk. While this idea has underlain some participatory budgeting exercises such as in the London Borough in Tower Hamlets, UK councillors have not shown much appetite so far for translating this idea into practice. However, the new community plan in the London Borough of Barnet may turn this idea into reality: it suggests that people may get a bigger say on the priorities given to different services in their neighbourhood but, in return, will have to take care of green spaces, etc. themselves. A second normative perspective on co-production is that it entails giving more power to users and their communities and means that they no longer have to accept passively the services decided for them by politicians and managers and provided for them by professionals. However, both these normative perspectives are contested – in particular, some have argued that it is unfair that vulnerable and disadvantaged service users should have to put their resources into the co-production effort, while others have argued that, in practice, it is unlikely that those stakeholders who currently possess power will allow it to be shared. Of particular interest is the question as to which services are most likely to be appropriate for co-production. Some authors argue that co-production is necessarily relational rather than transactional (Horne and Shirley, 2009), i.e. it requires active involvement and decision making by the person using the service, in collaboration with others (Parker and Heapy 2006; Boyle 2008 Needham, 2009). However, Alford (2009) does not consider personal interactions between public officials and citizens to be necessary, if the focus of co-production is on improving outcomes through the ‘collaborative behaviours of service users’ in transactional services, e.g. in filling out tax self-assessments. This latter argument could clearly be extrapolated more generally to all ICT-enabled forms of increased citizen involvement in delivering services and outcomes. 5 As Table 1 demonstrates, the specific approach which is taken to co-production may have important implications for the costs and staffing involved of public services. Where coproduction is substitutive, it may result in cost savings to the public sector and lower staffing. It is likely that belief that this will happen has coloured the reaction of many stakeholders in local government to the prospect of co-production (both positively and negatively). However, there are many stakeholders in local government (particularly front-line staff) who are not yet aware that additive co-production might also mean providing more professional support to activities which are currently largely characterized by self-help. For example, traditionally public sector care of the elderly has focused mainly on cases of high need - but the million of people (mainly women) looking after their elderly partners on a voluntary basis, and thereby avoiding huge costs to the public sector, have not benefited from much professional support or financial rewards for their unpaid work. It may be important in future to consider the potential for highly costeffective improvements to the quality of co-produced care from some extension of public sector support to these unpaid carers. Table 1: Types of co-production Types of coproduction Nature of interaction Relational Transactional Resources brought by professionals and users/communities Additive Substitutive peer support Professionals and networks of users doing joint expert patients assessment of user needs and care plans Participatory Doing initial illness budgeting done on- diagnosis from line (“e-PB”) with professionally´citizens submitting supported web-site proposals for community projects/public services As Table 1 shows, additive forms of co-production typically add more resources (either personal or ICT-based) in order to achieve better citizen outcomes. So if both users and professionals undertake a joint assessment of needs (rather than the needs assessment being done by several professionals), this co-production approach is both relational and additive, in allowing for more inputs by service users. Sometimes, however, the additional resources available in the community may best be harnessed through more arms-length ICT-enabled forms, rather than personal service relationships. This is typically the case in those on-line suggestion and voting schemes referred to as ‘participatory budgeting’. As the case of the City of Cologne demonstrates (see also Cabinet Office, 2009) the number of citizens taking part in the on-line debate and voting 6 has outnumbered the typically low turn-out in face-to-face PB events. However, transactional forms of co-production are often substitutive - for example, when citizens use NHS-supported web-services to undertake a diagnosis of diseases such as swine flu, they undertake work previously done by medical staff. The same effect can be seen when trained expert patients provide advice to peers which replaces work being done by a nurse or other medical professionals – in this case co-production is relational but with substitutive resource implications. There is also not much agreement as to whether compliance should be considered as a form of co-production. According to Griffiths and Foley (2009), “a citizen may be said to be ‘cooperating’ with the state by refraining from vandalism or littering, but this does not fulfill the criteria of active engagement necessary for genuine co-production”. Clearly, there are different degrees and intensities of ‘active engagement’ of service users and communities. It is obvious that the outcome ‘public safety’ requires more than the voluntary compliance of citizens not to rob a bank – to use the example used by Griffiths and Foley (2009). However, if even a minority of young people considers knife crimes socially acceptable, many other young people and elderly people will not feel safe in their neighbourhood anymore. From a local government perspective, lack of voluntary compliance costs local councils (and the taxpayer) millions of pounds – for example, Solihull Metropolitan Borough Council spends £1.2m. a year to remove graffiti, chewing gum and litter in its area. One key objective of its Environmental Champions scheme is to induce communities to ‘co-produce desired forms of behaviour’, with citizens acting as environmental champions in the neighbourhood. More widely, there is now a growing movement in government to promote behaviour change (COI, 2009). Another debate relates to different types of co-production. One important distinction made in the literature is between collective and individualistic forms of coproduction – LARCI refers to it as personal and community co-production. Personal co-production is closely linked to personalization, as illustrated by the trend towards individual budgets in adult social care in the UK and other OECD countries. Collective co-production is closely linked to volunteering, but many of the people involved in it, e.g. people who attend participatory budgeting events, would not normally see themselves as ‘volunteers’ in the normal sense of the word. At the same time, a lot of volunteering happens in non-organised forms, for example, most social care is delivered by millions of women looking after their elderly parents, other family members or friends. One important reason for seeking to make this distinction relates to the kind of values produced through individual and community co-production: • According to the definition adopted by Needham (2009) which is based on Alford (2009), personal co-production encompasses services that generate private value for the individual, as well as public value for the community. • According to the definition adopted by Griffiths and Foley (2009), community co-production produces instrumental benefits such as improving outcomes but also opens the way to achieving many intrinsic values. In particular, “the collective approach not only builds trust and improves relationships between service users and service providers, but also contributes to more cohesive 7 communities and offers new channels for the creation of social capital” (Griffiths and Foley, 2009: 5). However, Löffler and Watt (2009) suggest that both personal and collective coproduction can produce either private value alone or public value alone – or, of course, both. However, community-led forms of co-production can be expected more often to create social values such as enhanced community leadership and increased public confidence. Clearly, as governments across the OECD become more interested in measuring social progress, we can expect to have more hard evidence on the values generated through different forms of co-production. This is another important area for research to explore. Yet another approach to distinguishing personal and community co-production is based on who organises co-production: • • • Personal co-production often occurs in services where the co-production activity can be done alone by the individual (usually the service user, as in the case of a patient agreeing to self-apply dialysis at home, but sometimes a volunteer, e.g. a citizen who agrees to collate and report regularly on the complaints or compliments forms returned to a public service by its users); Collective co-production generally encompasses services where the coproduction can only be generated by two or more people, working together as a group such as members of a time bank (Griffiths and Foley, 2009). Of course, some co-produced services involve both personal and collective co-production, e.g. recycling, where many individuals can take their recyclable waste to recycling centres, while others may agree to do a ‘collection rota’ in their neighourhood. This means that collective co-production will typically involve some kind of volunteering. So is co-production simply a new label for volunteering? While Griffiths and Foley leave this question unanswered, their definition of community co-production suggests that volunteering is simply of “instrumental” value, i.e. it is a means to an end. Some collective action for co-production, e.g. voting on potential community projects in PB initiatives, does not constitute volunteering in the normal sense of the word. Moreover, volunteering is often imbued with strong normative implications in the typical political rhetoric, stemming from the “intrinsic” values which it is believed to represent and to promote. It is interesting to note that in all UK participatory budgeting events the debate about “resources” has been restricted to the pot of money provided by the local authority but not about the resources brought in by volunteers and the values created by volunteers. As Löffler and Watt (2009) stress, local government has to become better at measuring the contributions made by users and members of the community, including volunteers. So it seems that collective co-production goes beyond the normal concept of volunteering and does not always have the normative connotations attaching to volunteering. 8 Finally, empirical research shows, only a few citizens wish to get engaged in some form of organised activity on a regular basis (Ministry of Finance, 2008). As Figure 2 shows, the level of regular participation of citizens in groups and organisations is highest in health (9.7%), followed by environment (7.9%) and then safety (5.9%). This is an interesting finding since the index of overall co-production activities of citizens is highest in local environment, not in health. The fact that more citizens ‘co-produce’ in health by getting organised may indicate a lack of availability of individual forms of co-production. Figure 2: Levels of community co-production across five European countries How often do you participate in a group or organisation that works to improve ... 16 14 Percent "Often" 12 10 Safety 8 Environment 6 Health 4 2 0 Total France Germany UK Czech Denmark Note: Community co-production is defined in this survey as the regular participation of citizens in groups in order to improve outcomes, e.g. in community safety, the local environmental and their own health or health of other people. Source: www.5qualiconference.eu These findings are also supported by preliminary evaluations of participatory budgeting which show that typically the numbers of residents attending neighbourhood meetings or other so-called ‘PB events’ are very low, whereas the number who get embodied in ‘nonsocial’ or ‘disembodied’ PB through e-participatory mechanisms can be rather large as the city-wide and multi-channel e-PB approach of the City of Cologne shows (see the interview at www.govint.org). From a cost-benefit perspective, a key concern likely to become more important to local government in the recession is the question of whether the added benefits of such forms of community co-production justify the relatively high investment costs to develop a collective or community approach? Clearly, the most effective and efficient forms of community co-production tap into existing social networks, meaning that the costs associated with creating infrastructure and 9 recruiting participants may in fact be lower than for more personalized schemes. The problem is that many disadvantaged citizens who need most help from the public sector are no longer part of social networks but first need to gain some self-confidence to perceive themselves as a member of A community. As Griffiths and Foley (2009) show, time banking may be one way to ‘empower’ such individuals and make them part of a community. Obviously, this process does not happen overnight and may require financial resources and professional inputs by local government. However, keeping disadvantaged citizens passive and dependent may be even more expensive to the public sector. Another way to perceive co-production is to explore forms and levels of citizen involvement at various points in the service chain, including co-designing, cocommissioning, co-delivery, co-managing and co-evaluating (Pollitt, Bouckaert and Löffler, 2007; Bovaird, 2007). Clearly, real world behavior does not always proceed in neat rational cycles, based on a theoretical notion of the order in which the different elements of decision making are made. So, we know that experience in service delivery can lead back to changes in service design, while evaluation findings can lead to a recasting of a more realistic set of objectives in the service chain. Nevertheless, for public officials and councillors this seems to a much more accessible way of relating to coproduction. What do we know - and what do we NOT know - about personal, community and efficiency aspects of coproduction? The State of the Art There is a now an emerging body of literature from academia, think tanks and policy advisors which has mainly an agenda-setting function and explicitly uses the term coproduction to raise awareness of the benefits of this new approach. This includes, for example, discussion papers by the Prime Minister’s Strategy Unit (Horne and Shirley, 2009), the New Economics Foundation (Nef, 2008), the Social Market Foundation (Griffiths et al, 2009), Compass (Gannon and Lawson, 2008), the Social Care Institute for Excellence (Needham and Carr, 2009) and Dunston et al (2009). Most empirical research, however, looks at specific forms of co-production such as co-commissioning (individual budgets, participatory budgeting), co-design of public services (Bradwell and Marr, 2008) co-managing (e.g. the Quirk Review of community ownership and management of public assets (Quirk, 2007), co-delivery and co-evaluation. Evaluations of co-production approaches are rare. Clearly, one of the most well researched co-production initiatives is the expert patients programme (DH, 2006) 10 and self-directed care in general (DH, 2007). Extensive evaluations have also been done on individual budgets (Glendinning et al, 2008) and budget-holding lead professionals in children's services (OPM, 2008). Smaller scale evaluations have been carried out on co-production approaches in mental health services (Gannon and Lawson, 2008; Boyle et al, 2006) and family intervention projects (White et al, 2008). There is now also an on-going evaluation of participatory budgeting approaches in the UK, commissioned by CLG. Interestingly, the focus of these evaluations is more on effectiveness than efficiency. Last but not least, there is hardly any quantitative research on co-production in public services. So far, most literature is qualitative, drawing on case studies – the most prominent being Alford’s comparative analysis of co-production in postal services, employment and tax services (2009). The only international example of a detailed quantitative study is the 2008 citizen survey undertaken by Governance International in co-operation with Tns-Sofres in five European countries, including the UK, which shed some light on the scale or potential of co-production in three public services – local environment, health and public safety. As Matthew Horne, Head of the Innovation Unit, has suggested, these statistically representative data cannot be simply dismissed and provide some hard data that we are already well under-way in the path to co-production of public services. So what can government learn from the existing research? In 2008, the government used the research in the Bovaird and Downe (2008: p. 39) policy paper for CLG, to illustrate a number of themes in its White Paper on citizen empowerment. First, it cited the argument in the policy paper that, in relation to user participation in service delivery, it may be unrealistic and inappropriate to expect a very large proportion of the population to be involved in ‘deep’ engagement activities. Clearly, this is a major issue in citizen engagement – but still under-researched. Again, the empowerment White Paper cited evidence from the policy paper (p. 57) that many active citizens are driven by strong positive motivations, such as a wish to ‘get something done’. But it noted that such motivations can be couched in less positive terms – for example, a wish to fight against something, or counter the interests of others (Grimsley et al., 2005). We also need to take into account that some cases of coproduction involve coercion as for example, parenting contracts. So co-production may also be motivated by negative incentives. Clearly, there is still very little convincing research on the motivations and incentives behind either individual or community co-production. Finally, the empowerment White Paper highlighted the findings of the survey of local authority officers in 2006 (part of the Meta-Evaluation of the Local Government Modernisation Agenda) which found that the great majority of them believed that public engagement in their authority or service had led to better services. Bovaird and Downe (2008) reported from this survey that engagement had led to: • services that were more responsive to the needs of users (89%) • more informed decisions (86%) 11 • • • • more accessible services (81%) higher quality services (79%) more ‘joined up’ services (76%) better value for council tax payers (59%) However, the findings of the EU survey, based on the responses of citizens rather than local authority officers, were much less positive on this score – they were consistent with the possibility that co-production of public services (possibly because it gives users and citizens such a vivid insight to the internal processes of service design, management and delivery) may lead them to be less satisfied with public services (see also, Löffler and Watt, 2009. Research gaps from the perspective of different stakeholders However, this commentary from government on work done on co-production gives only an indirect indication of what government wants to know about co-production – and it is a central government rather than a local government perspective. What are the gaps from a local government point of view? In order to answer this question properly some market research would be needed which is missing at present. Indeed, there has been very little research focusing on the perceptions and needs of professionals working in a coproduction context. As a National Consumer Council/Unison project found out there may be high levels of distrust between professionals and users, at least initially (Needham, 2008). This was also a major finding of research related to time banks (Seyfang, 2004; Boyle et al, 2006a: 53). The attitudes and behaviours towards coproduction by different stakeholders in local government must be a key area for research. It would be especially valuable if it could highlight the kinds of circumstances in which these attitudes and behaviors are most likely to be changed, whether by forces external to local government (e.g. government policies, new service delivery partnerships) or internal (e.g. local authority policies, budget shortages or the dissemination of ‘revealing practices’ and emergent co-production strategies within an authority). Clearly, the needs of different stakeholders working in local government will be different. The table below attempts to match the challenges identified for personal, community and efficiency with the perspectives of different professional groups in local government. 12 Table 2: Interests of key local government stakeholders in co-production issues Professional groups Front-line staff Interest in co-production • • • Research gap How to harness the expertise, • resources and voluntary compliance of users/communities How to manage risks when things go wrong or users/communities are no longer committed? • How to ensure that professional status and rewards are not undermined by a move to user- and citizen-centric services? • • Middle managers • • • HR managers • • How does co-production help to improve outputs, service quality and outcomes? What new information and communication systems are needed? How will user- and citizencentric services necessitate different skills in different managerial groups, e.g. balancing self-directed services by users against risk management What are the implications of co-production for staff recruitment and training? How to bring about cultural change of the organisation and its partners? • • • • Use of social marketing, viral marketing and other influence strategies to generate greater involvement by users and communities in coproduction Positive and negative incentives needed to mobilize and make sustainable a greater level of co-production Barriers to co-production from the side of users and communites Potential losses to professional status and rewards How to integrate coproduction into standard customer service and quality tools? How to assess the potential gains and risks from user and community coproduction in ways which will be understandable to users, active citizens, managers and politicians What are the implications of co-production for professional culture change? How will frameworks for planning and managing staff competencies be altered by a greater focus on coproduction? 13 Professional groups Finance managers Interest in co-production Research gap • • • • Performance managers • • • Chief executive • • • Efficiency issues, in particular whether community/user input comes at a higher opportunity cost than the professional input it is replacing How can ICT investment increase the scope for service improvement and for cost reduction? Can co-production reduce future investment needs in public services? How to assess outcomes of co-produced services? How to assess the direct and indirect benefits from coproduction Where does co-production fit into CAAs? In particular, how does co-production contribute to NI1-7 How to use co-production as an efficiency strategy? How to adapt organisational structures to make coproduction effective? How to decide the scale of co-production in the organisation? • • • • • • • What are the potential effects of individual and community co-production on cashable and noncashable savings in local authorities? Is there a predictable trajectory in the effects of ICT for co-produced services upon service costs and service quality How much difference does co-production make? And how does this differ between services? How robust are these differences when some allowance is made for the value of time contributed by co-producing users and community members? How is the costeffectiveness of different strategies for ‘getting more for less’ affected by coproduction? How does co-production contribute to different approaches for ‘getting more for less’ and how could the efficiency increased from these strategies be measured? How ‘much’ co-production can a local council deliver and what kind of partnership working is needed to scale up co-production? 14 Professional groups Councillors Interest in co-production Research gap • • • • How does co-production influence accountability? How can councillors play a role in mobilizing coproduction in the community? How can the limitations and potential downsides of coproduction be taken into account in council decision making? • • • How does increased coproduction affect the public’s perception of the quality of local government services? How does increased coproduction affect the public’s level of trust and confidence in local government? What are the resource costs imposed upon service users and other citizens during a move to greater coproduction To what extent is coproduction being imposed on users and citizens, who are unwilling or unable to make the most of it, so that they end up disadvantaged by this model of service design and delivery? 15 Better dissemination of existing and in-pipeline research –suggestions towards an action plan Clearly, some of the research gaps identified above will require new research. However, in the current fiscal climate one key issue is how to make better use of existing research and that research which is already in the pipeline but which still can be influenced. Obviously, this not only concerns the research community but also intermediary bodies, such as think tanks, training institutions, professional and representative bodies. Box 3 outlines some key elements of such an action plan. Box 3: How key research co-producers can make better use of existing research Research community • Draw better on research from private sector (e.g. on co-design, co-creation) • Look at cross-sector co-production issues • Undertake more international comparisons • Look at co-production issues from the point of view of key stakeholders Think tanks • Avoid term co-production • Provide more case studies, killer facts, killer stories, headlines (‘the best health service is a mother’) and hard evidence • Write stakeholder specific strategies for achieving their objectives through some aspects of co-production Local government umbrella bodies (LGA, IDeA, National Consumer Council, Audit Commission, etc.) • Develop toolkits and ‘how to’ guides for their members • Bring in users and community members to make sure that these instruments are user-friendly • Ensure that all policy and managerial seminars have inputs from users and community members – a clear commitment to user and community coproduction of policy and of key outputs from the organisation So what kind of actions could be suggested to key stakeholders involved in the ‘research production and marketing’ chain for co-production in public services? Clearly, as the research community is likely to argue, more research is needed. While there are certainly many research gaps – the most important of which we have tried to identify above, it may be beneficial also to set up a new database which allows the collation of existing research from the public and private sectors, different policy sectors and international studies. For 16 example, it is striking that the public sector co-production literature makes little reference to co-creation approaches and experiences in the private sector (see, e.g. the 2000 Harvard Business Review article, “Co-Opting Customer Competence” by C K Prahalad and Venkat Ramaswamy). Furthermore, it is striking that there is little co-operation and exchange of knowledge between researchers working on co-production issues in social services, environmental sciences and technology – e.g. how to design more enabling environments and technologies for everyday living. Moreover, the climate change agenda is an obvious candidate for closer co-operation and comparisons. Last but not least, there is a rich database of international co-production innovations which is waiting to be exploited for policy transfers – for example, the recent European Public Sector Award (www.epsa2009.eu/ ) shows many interesting cases which could be fitted under a coproduction label. One very obvious bracket which could bring all these streams of research together is looking at co-production from the point of view of key stakeholders such as the elderly, disadvantaged citizens, etc. Such a citizen-centered research perspective would not only help researchers to understand better how different approaches of co-production within the service and outcome delivery chain fit together but also be appealing to key decision-makers in local and central government. As think tanks play a key role in transferring findings from research to local government and other stakeholders with an interest in local government, it will be key to market the ‘co-production idea’ more effectively. In particular, there is a lot of evidence which suggests that the term ‘co-production’ should be substituted by terms which are already being used in local government and which local government finds it more natural to use. There is no harm in showing the links between various ‘co-production approaches’ but such conclusions should rather come at the end than being introduced up-front. Another issue is how to ‘package’ co-production approaches. We have already referred to the need to provide more vivid showcasing of research findings (‘killer facts’, ‘killer stories’, headlines etc) to a local government audience. The innovative social marketing campaign of “five ways to well-being” of NEF show a possible way forward to raise the awareness of local government. Research into how research findings can be packaged to have greater impacts upon their intended audiences would be valuable here, following on from the recent interest in this filed in many other research fields. Finally, local government umbrella bodies are likely to have an important role to play in making ‘co-production’ approaches ‘fit for purpose’ by developing toolkits and ‘how to’ guides for their members. These instruments will not just require inputs from professionals but also from users and community members to make sure that they help local government to harness the expertise and resources of citizens better. Furthermore, it would be an interesting – and consistent - principle to suggest that all policy and managerial seminars related to co-production issues should have inputs from users and community members, which would mark quite a change from typical seminars which are delivered by professionals only. Some research on how the source of the ‘co-production’ message influences the recipient would be valuable (and, after all, this is one of the 17 rationales for using ‘expert patients’ to recruit new ‘expert patients’ for co-production of care for those with long-term conditions). The availability of new social media may help to spread messages more effectively and quickly to different audiences and to co-ordinate existing research better as there is now more transparency as to ‘who’ does ‘what’. Again, valuable research might be done into how the different social media can be packaged and promoted to different stakeholders (service users, their ‘significant others’, professional staff, managers, etc.) in order to explore the relative effectiveness of different approaches – but also to map the limitations of e-co-production. Short-term and longer-term research needs Role of the Research Councils Clearly, these research issues potentially span the whole range of UK Research Councils. While there has been particular interest in user and community co-production on the part of social scientists in recent years, the research issues highlighted here suggest that a fully successful approach to co-production may need an understanding of its potential and its implications from much wider perspectives. For example, research through EPSRC might counteract the over-focus in UK public services on person-to-person service mechanisms, partly born out of three decades of low capital investment, which has led to serious under-estimation of the value of technology (apart from ICT) in improving user quality of life. Such research, might for example, demonstrate how modern design and technology for everday living might allow users a much greater degree of autonomy and independence in their lifestyles, with less need for intervention from carers. Again, research through MRC and NERC might explore how behavioural change (of individuals or groups) towards greater co-production might best be encouraged by public services, in such a way as to improve outcomes in health or environment. Research through AHRC might explore how the arts could be used to trigger greater self-confidence of users so that they are more prepared to contribute to the public services from which they benefit and how they might trigger more greater social interaction between service users, their communities and public agencies, so that self-organising activities in the community can be made more productive in terms of public value. General research challenges in co-production Summing-up the issues outlined in this paper, there are a number of short-term and longer-term research needs which emerge from the papers focusing on personal, community and efficiency aspects of co-production. 18 As stressed above, the first challenge for the research community, think tanks and local government umbrella organizations is to find mechanisms and a language to make professionals more aware of this concept and to help them understand why it is becoming more prevalent in practice. This may mean that co-production has to be relabelled and better explained in ways which will be clearer to these stakeholders, especially councillors. In particular, it is important that both professionals and councillors understand more clearly how different public services are already supported by coproduction and where and why co-production breaks down. Secondly, this involves more qualitative and quantitative research on the perceptions, expectations and risks associated with personal and community coproduction of different professional groups in local government. In particular, we need to learn more about: • • what different stakeholders, especially councillors, understand by the concepts around ‘co-production’, ‘co-design’, ‘co-commissioning’, ‘co-delivery’, etc? what are the sources of resistance to the concept? Specific research issues with potential for future research A range of new research issues have been explored in this paper which it would be valuable for the Research Councils to address in the medium to longer term. From the point of view of personal co-production these include: • What skills do service users need in order to be able to co-produce effectively? • What incentives are most effective and appropriate at encouraging co-productive behaviours? • What are the advantages and disadvantages of co-production taking a compliance route, such that people are penalised for non-involvement? • How can the workforce challenges of co-production be effectively mapped? What sorts of professional development resources are required to support staff in their roles as co-production facilitators? • What are the distinctive challenges of trying to embed co-production in services where staff act as gatekeepers to scarce resources? • How can traditional asymmetries of information between professionals and service users be overcome so as to draw in user expertise most effectively? • How far can the budget-holding model be applied to other services? • How can multiple budget streams be integrated to facilitate budget-management by service users? • What sorts of technologies (pre-payment cards, online brokerage and support services) are required to support co-productive approaches? • What new actuarial models will be required to support service users and organisations in balancing safeguarding with risk enablement? 19 • What can be learned from co-production case studies in the UK and internationally about how to mitigate any inequities which co-production may foster? From the point of view of community co-production these include: • • • • • An investigation into the ways in which various forms of co-production, and collective co-production in particular, build trust and solidarity through developing the relationships between citizens and between citizens and government. An examination of the ways in which co-productive approaches, and the involvement of active citizens, can be used to challenge anti-social norms and boost community outcomes. An investigation into the extent to which collective approaches to co-production can escape the equity challenges of individualistic approaches, where more assertive users tend to benefit most from their relationship with the state. An examination of the institutional barriers to rolling out more radical forms of collective co-production such as PB. How can resistance within traditional local government structures be overcome? Further study of the ways of encouraging involvement in collective coproduction: in particular, given financial constraints on local government, there is room for further examination of how the internet can be used as a means of reaching a wider group, especially in rolling out PB programmes. From an efficiency perspective these include: • • • • • Understanding more clearly the resources which users and communities can bring to services. Understanding better how to measure the value of these resources. How can we assess the value of outcomes directly, rather than trying to put values on outputs? Does use of co-production in public service provision increase the reliability of evaluations of outcomes inferred from users’ behaviours or attitudes? How can broader benefits from co-production be measured in such a way that they can be incorporated into the efficiency analysis – in particular, what are impact is co-production likely to have on: o benefits experienced by citizens other than those directly benefiting from co-produced services (e.g. reassurance of neighbours and friends that services are working for the user, demonstration of the availability and effectiveness of services which citizens may expect to use in the future, etc.); and 20 o social value-added (or subtracted) from co-produced services (e.g. because co-producers are more alert to the possiblity of achieving social inclusion outcomes from their activities). • • • • • • • • • Clearer understanding of the costs of co-production to all stakeholders involved and how these costs might be measured. Better understanding how to measure the inputs of volunteers in a community coproduction context. How is the cost-effectiveness of different strategies for ‘getting more for less’ in local government affected by user and community co-production? How can citizens be involved in the de-commissioning of services in meaningful ways? How will e-government, particularly the new, more interactive web 2.0 technologies (such as Twitter and Facebook) increase the ability of service users to increase co-production of public services and affect council service costs? How can the use of technological solutions (e.g. assistive technology) affect the ability of service users to increase their co-production of public services (or avoid relying upon public services)? How can the use of behavioural change approaches encourage a greater contribution by citizens and service users to their own health and ‘wellness’, thus reducing the need for health and social care services? How can the use of behavioural change approaches encourage a greater contribution of citizens and service users to improving the environment, both at local level and more widely? How can the efficiency implications of co-production be more clearly set out and illustrated for councillors. How can the balance between short-term costs and longer-term benefits of ‘preventative co-production’ be illustrated more clearly to stakeholders, especially councillors? Maximising the value of a research programme into user and community co-production The above suggestions for research should not be taken as exhaustive – they tend to reflect in particular the interests of those researchers who have so far been active in the area, rather than map the whole of the potential research field. In order that a much fuller mapping be available before final commitments are made to a research programme, we suggest that a very general call for Expressions of Interest from all of the Research Councils would be of great value, allowing imaginative proposals from researchers in all 21 research fields to consider how they might contribute to research into user and community co-production of public services. In addition, we suggest that new research being commissioned in the UK would benefit from comparative international research, especially given that some of the most active researchers into user and community co-production have been working in the US and Australia, while important parallel work has long been done in the international development studies field. 22 Literature Austrian Department of Health (1993), Koproduktion durch Empowerment. Mehr Qualität durch verbesserte Kommunikation mit Patient/innen in der Chirurgie. Wien. 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