Gerry Power sets out why, when it comes co-production, there might be merit in looking back to 1942 to help guide our future.
This November will mark the 75th anniversary of the publication of Sir William Beveridge’s landmark 1942 report “Social Insurance and Allied Services” (1) which prepared the groundwork for the introduction of the NHS and welfare state some six years later.
Beveridge’s second guiding principle calling for an onslaught on the giant evils of Want, Disease, Ignorance, Squalor and Idleness is often quoted and confers a sense of how enormously ambitious the proposed changes were at the time of publication.
I would suggest however that this historic focus on tacking the five giants has somewhat overshadowed Beveridge’s third founding principle that welfare and the provision of a comprehensive health service can only be achieved by co-operation between the State and the individual; in essence the concept that we now recognise as co-production.
Co-production as a concept was first articulated in the late 1970s by Nobel laureate Elinor Ostom and her colleagues at Indiana University (2). Many definitions have since followed but co-production is essentially about “the public sector (state) and citizens making better use of each other’s assets and resources to achieve better outcomes and improved efficiency”(3).
The fact that the Christie Commission on the Future Delivery of Public Services (4) recognised as recently as 2011 that increasing financial and demographic pressures demand much greater involvement of Scotland’s people and communities in designing and delivering public services perhaps demonstrates that Beveridge’s 3rd principle had been neglected for too long.
Beveridge’s contention that the restoration of a sick person to health is a duty of both the State and the individual and that the national provision of health and social services should not stifle personal incentive, opportunity and responsibility but should instead encourage voluntary action by each person to win for themselves and their families something more than the minimum service echoes the principles of reciprocity and the asset-based approaches enshrined in co-production as well as being consistent with the shift towards greater self-directed support and self management.
As the new U.K. health and social care system emerged and grew after World War 2 these principles seem to have been side-lined as a professional hierarchal model of public administration initially developed with citizens primarily being viewed as passive recipients dependent on the state and local government for the provision of services. This was replaced in the 1980s with the appearance of New Public Management which introduced market orientation into the public sector via quasi–markets which valued competition, performance management systems and customer focused quality improvement systems. Whilst the influence of this model continues today there has been a shift in the last decade towards a more pluralist approach to governance within our public services where the concept of co-production has come more to the fore.
To many the recognition of the need to make use of all of our citizen, community, cross sector and state assets in co-producing effective health and social care seems a relatively new concept. As we approach the 75th anniversary of Beveridge however we should reflect that this was always the intention and that perhaps we should look back to 1942 as a guide to our direction of travel in the future.
(1) Beveridge, W. H. B. (1942). Social insurance and allied services. Report by Sir William Beveridge. London, H.M. Stationery Off.
(2) Parks, R. B., P. Baker, L. Kiser, R. Oakerson, E. Ostrom, V. Ostrom, S. Percy, M. Vandivort, G. Whitaker, and R. Wilson. 1981. Consumers as co-producers of public services: Some economic and institutional considerations. Policy Studies Journal 9 (7): 1001–1011.
(3) Loeffler, E. & Bovaird, T. (2013). ‘The role of co-production for better health and wellbeing: why we need to change’. In Loeffler, E., Power, G., Bovaird, T. & Hine-Hughes, F. (eds.) Co-production of Health and Wellbeing in Scotland, Governance International.
(4) Report on the Future Delivery of Public Services by the Commission chaired by Dr Campbell Christie, 2011