From debate to ‘doing’ – Co-production and Feeley

Co production is a much used (and misused) term.  It sat at the heart of the Feeley Review and will be the focus for the next ‘Our World Reimagined – Social Care’ series session on 24th August.

In this blog, PhD student Riley Livingstone explores the idea and implementation of co-production and will be presenting as part of the session book here.

 

The recent independent review of adult social care in Scotland (Feeley, 2021) provides us with some excellent examples of innovative work that involves user and community co-production of social care.

Riley in a black jacket with green top smiling at camera

Riley Livingstone

Co-production is not a new approach or debate in Scotland – however, implementation has been slow and patchy.  As the Feeley report states:

“The problem is not that we do not have good ideas; it is that we have not acted on them at scale and with genuine commitment” (chapter 8).    

In the webinar Our World Reimagined on 24 August 2021 we would like to discuss with you why this implementation gap has persisted for so long and which strategies could be used in social care to scale effective co-production approaches.

My own research centres around collaborative innovation, a sister concept to user and community co-production of public services and outcomes. While the academic literature (Torfing and Sørensen, 2019; Loeffler, 2021) provides evidence of increased public outcomes and service quality when professionals engage with citizens effectively,  it appears that systematic co-commissioning, co-design, co-delivery and co-assessment of social care is still the exception. This applies not only to Scotland but also to my home country of Canada.  

The Feeley report (2021) reviewed the state of adult social care in Scotland and made important recommendations.  The work of the review group leading up to the report benefitted from extensive engagement events and discussions with a range of stakeholders involved in social care across Scotland. Feeley Review Report cover

The three recommendations for major change in the report were: (1) Shift the paradigm (2) Strengthen the foundations and (3) Redesign the system.

With regard to shifting paradigms, in many ways the struggle for social care to be seen as valuable to all and not just to those at the margins of society is the struggle to replace the dominant medical model of care by a holistic, person-centred and preventative social model of health (Russell, 2014). 

It is not simply about shifting from one model to another; the new model brings with it unknown levels of risk, which is uncomfortable for public servants who have been influenced by the risk-averse legacies of what’s known in the public service literature as New Public Management (NPM) – a paradigm which sought to ape approaches in the private sector (McCourt, 2013).

That processes of commissioning and procurement still largely centre around market-based competition shows how NPM continues to have an influence, and Feeley (2021) is right to promote instead ethical commissioning based on fair work, and a focus on collaboration rather than competition in procurement processes.

The strengthening of foundations recommended in the Feeley (2021) report centres on health and social care integration, something that turned out to be more of a struggle than anticipated after it was embedded in legislation – Feeley refers to this as the ‘implementation gap’.

This may well stem from the lack of a national strategy for social care, as identified by Feeley. Another issue, that however receives minimal reference in the report, is the contrast of experience between urban and rural service users in respect of both health and social care.  This is particularly tricky for the social care strategy of increasing the capability for people to live independently at home, because in my research, participants have highlighted that packages of care are much more difficult to generate and thus suffer from longer waiting times in rural areas. This is partly because the care workforce is much smaller in rural areas and everywhere has a high rate of turnover.  Wait times for packages of care in rural areas can be quite poor, which is even more disturbing when one reflects that often older adults retire to rural communities (Stockdale, 2006).

Feeley also advocates redesign of the system, and makes some recommendations, one of which is that support plans for adult social care should be co-produced with the person receiving the services as well as with others in their support circles e.g. family/unpaid care-givers.  While some components of this approach have been established in attempts to provide personalisation in social care, it is unclear what a system of co-produced adult social care, at national and local levels, would look like and whether it would lay most stress on increased co-commissioning, co-design, co-delivery or co-assessment, the typification of co-production approaches in public services highlighted by Loeffler (2016).

In general, co-production is about letting go of the assumption that experienced public managers and policy makers know more about what users need and want than they do themselves, instead welcoming users as active-contributors and as an asset in the process, rather than simply people who have to check the boxes in a consultation exercise.  The difficulty, of course, is that then public managers and policy makers would have to surrender some of their power and control and share it with users through the process of co-production, which presents them with an unknown level of risk (Torfing, 2016).

All of these issues – and more – will be explored on August 24th at the upcoming GCVS webinar run in partnership with the University of Strathclyde – Feeley and Opportunities for Co-Production led by Dr. Elke Loeffler from the University of Strathclyde.

Elke will be using the lens of her research on what works in co-production to analyse and debate the insights and recommendations from the Feeley report. Her presentation will be complemented by presentations on ‘hands-on’ co-production experiences from Jenny Miller, Chief Executive of PAMIS, a charity which works and campaigns alongside people with profound and multiple disabilities, their families, carers and health and care professionals. My research will also be highlighted, so I hope to see you there!

(For detail of the references and research mentioned by Riley, contact us at healthandcare@gcvs.org.uk)

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