Co-production and community mobilisation are not new concepts to the NHS, or indeed commissioning – recent years have seen examples such as the King’s Fund Experience Based Co-Design toolkit and NESTA’s People Powered Health programme. However, this new report suggests that in the NHS we haven’t entirely grasped the more radical aspects of the concept. Increasing numbers of commissioners in the NHS are looking to work closely with their communities, through community mobilisation and place-based commissioning initiatives. So this think-tank report is a timely one.
Co-production is an approach already in use in the health sector and other aspects of the public sector. Examples given show how a co-production approach, mobilising volunteers in a systematic way, can help support self management, peer support, integration, outcomes-based commissioning, prevention and helping patients navigate their way around the system. Essentially, volunteers can bring to a service something the service itself can’t offer and there are opportunities to build networks of volunteers around services. David Boyle strongly emphasises that co-production is not consultation – this is much more than engagement – it’s about collaboration, involvement and openness.
What might co-production involve?
Boyle describes service users as “assets” who should be involved in services as “equal partners in delivery”. This requires a significant shift in mindset, in particular, how patients and the public may be perceived by some professional groups. There are different models in use, including time banks (where people donate their time); health champions (trained volunteers); navigators; and participatory service planning, to list a few examples. Boyle suggests such schemes are cost effective suggesting savings of around £1 to £3 for every pound invested; there is little detail but some reference to published studies. Boyle suggests that the following factors need to be in place to support a co-production approach:
- infrastructure, through a network of local teams which can be mobilised to tackle challenges
- contractual levers and incentives, mandating contractors to build or work with existing networks
- commissioning which is open to different models and options for meeting needs
- joint investment and merged budgets
- a national network to coordinate volunteers and support their development.
Key messages for commissioners
- A key message from the report is to work with existing networks – mapping out these networks and relationships already in place would be a useful early step.
- Locality-based commissioning is at variable stages of development across commissioners -there is a potential role for locality-based commissioners to facilitate networks and to mobilise them to help tackle some priority problems.
- It will be important to maintain as well as build momentum – Boyle suggests sustainability can be improved through mechanisms such as: local funding; involving existing networks; aligning with existing projects; and avoiding the silo mentality which may be present in the public sector.
- There may be some very practical ways commissioners can help local networks thrive, including the use of meeting rooms; publicity campaigns; flexible working for staff involved in volunteering; and joint applications for grant funding.
The report serves well as a readable introduction to the concept of co-production and commissioners will find it helpful to read up on the learning shared from programmes such as People Powered Health. The report doesn’t read as entirely balanced as there is good coverage of the potential benefits but very little on the challenges and barriers.
Boyle D (2014) Turbo charging volunteering: co-production and public service reform, Centre Forum, Available at: http://www.centreforum.org/index.php/mainpublications/628-turbo-charging-volunteering.
Partnerships between trusts and voluntary sector can deliver efficient, high-quality, patient-centred care, according to report – http://www.thecommissioningelf.net/partnerships-between-trusts-and-voluntary-sector-can-deliver-efficient-high-quality-patient-centred-care-according-to-report/