Opinions

Co-production of Public Services and Outcomes – Book review

Written by: Gerry Power, Associate Director, the ALLIANCE

Published: 02/02/2021

This review shares fundamental principles of co-production through to the latest developments in the field.

Dr Elke Loeffler is a Senior Lecturer at the University of Strathclyde, and Director of Governance International. Elke has been a long-time collaborator with the ALLIANCE in promoting and developing co-production in Scotland. Elke’s latest book ‘Co-production of Public Services and Outcomes’, published during the current COVID-19 pandemic is a timely reminder of the importance of citizen involvement in addressing the immediate challenges facing all of us during this crisis, as well its potential in supporting longer term recovery.

Thoroughly researched and richly illustrated with practical examples the book provides the reader with a first-rate academic and practical reference guide to the evolving concept of co-production.

Whether you are new to co-production or an experienced practitioner this book takes the reader from the fundamental principles of co-production through to the latest developments in the field. A great book for those interested in co-production to read from cover to cover or to delve into as a practical reference guide.

Synopsis

Chapter 1 ‘Why co-producing Public Services and Public Outcomes with citizens is timely’ provides the reader with a concise overview of the political, economic, social, technological, environmental, and legislative factors driving the development of co-production, followed by discussion on the growth and development of the concept through academic thinking.

The Chapter concludes by asking us to consider ‘whether commitment to co-production by Public Services is as full as Public Service organisations often maintain’(p17). This issue is addressed in greater detail later in the book, particularly in Chapter 4.

Chapter 2 ‘Distinguishing types and levels of co-production concepts and definitions’ discusses the similarities and differences in definitions of co-production ranging from those defined by pioneers such as Elinor Ostrom in late 1970s (p25) through to those more familiar to us in Scotland such as Bovaird and Loeffler (p27). This chapter reminds one of the unproductive debates around the precise meaning of co-production during the early days of its introduction into health and social care policy in Scotland.  The rational conclusion expressed by the author is that any definition of co-production needs to be fit for purpose and that all stakeholders in a co-production enterprise need to find a common understanding and language which is context specific.

The chapter goes on to provide a commentary on the origins of co-production from the perspective of different academic disciplines, including political science, public choice, and consumer psychology. Principles derived from these sources are many and the author argues, quite rightly, that it is unlikely all of these can be applied simultaneously in every enterprise i.e., ‘governance impossibility theorem’. Principles, the author argues, are only important if they can be operationalised and prioritised to support the specific business at hand.

Chapter 2 ends with a discussion of quality assessment frameworks which help organisations determine how well they have implemented co-production. The author proposes a new quality framework and offers a practical set of tools for assessment which will prove valuable for practitioners.

Chapter 3 ‘The Four Co’s: Co-commissioning, Co-design, Co-delivery and Co-assessment of public services and outcomes through traditional and digital mechanisms’ introduces the systematic categorisation of co-production activities known as the ‘Four Co’s’, which many practitioners in Scotland and beyond will be familiar with as part of Governance International’s ‘Co-production Star model’. This chapter examines each of the ‘Co’s’ in detail, using a number of international case studies to illustrate their place in the co-production process. Building on the concept of ‘governance impossibility theorem’ the author again stresses that it is unrealistic to expect all modes of co-production to be implemented simultaneously – as the focus on each ‘Co’ will be more applicable at specific times and contexts. Nevertheless, the ‘Four Co’ model serves to remind us of the wide range of co-production activities that can be undertaken as and when required.

A discussion on digital co-production follows which considers its evolution driven by enablers such as increases in the availability of social media and mobile interactivity.  Early examples cited include public services agencies shifting tasks previously performed by staff, such the transfer of form filling to service users through to the use of on-line applications, the reciprocal benefit to users being they no longer needed to visit the public agency in person. Whilst several excellent examples of digital co-production are cited in the text, the author quotes Lember (2018, p117) to the effect that some digital technologies ‘just add a digital layer on top of human centred processes’ and simply provide one-way information in the same way as a traditional information outlet, rather than providing a means of interaction between the service provider and user. Other potential pitfalls of digital co-production are examined including the lack of security and importantly the social exclusion of those service users who lack access or the capability to use digital technologies. The author concludes by suggesting two paradoxes exist as far as digital co-production is concerned. Firstly, in spite of the speed of technological change, the take-up of digital technologies by the public sector in the UK has been slow, resulting in a ‘digital divide’ between public sector agencies and the public at large; secondly in spite of the importance public sector agencies claim they place on development of digital technologies there seems little in the way of evaluation of effectiveness of public sector digital ‘co-production’ initiatives. This reflects back to the authors’ challenge in Chapter 1 regarding the commitment of Public Sector agencies to Co-production.

Chapter 4 ‘Co-production in Health, Social care and Public Safety’, exploring as it does the effectiveness of co-production within in the public sector, this chapter will be of specific interest to those involved in the operational and strategic integration of health and social care in Scotland.

Each of the three sectors, health, social care, and public safety is considered in turn against the ‘Four Co’s’ described in the previous chapter.

The section on co-production in health, particularly that focusing on co-delivery, has echoes of ‘Gaun Yersel’ Scotland’s Self Management Strategy for Long Term Conditions, which was jointly developed by the ALLIANCE and Scottish Government. Commissioning, participatory budgeting and Self-Directed Support as well as various forms of citizen review and assessment are also considered. The section concludes by quoting Musekiwa and Needham (2021, p194) emphasizing there is ‘strong evidence that the culture of health services still privileges the technical knowledge of ‘expert staff’ over the everyday knowledge of ‘experts by experience’ and that this cultural barrier only recedes slowly even where co-production in health is being promoted.

Chapter 5 ‘Challenges to Effective Co-production of Public Services and Outcomes’ carries on with the theme of barriers to co-production, providing the reader with a conceptual framework for understanding these and distinguishing between contextual and organisational barriers as well as those arising out of the behaviours and characteristics of services users and communities. Some of the facets considered include the risk aversion of politicians and public service managers to co-production, citizen perceptions of their ability and agency to contribute, levels of trust between users and staff as well as past experience of co-production.

The risks and uncertainties arising from co-production are examined in more detail later in the chapter and the author lays out a typology of risks, from the perspective of politicians through to service users and communities, which helpfully illustrates these; management strategies to overcome these uncertainties are then discussed.

Section 5.4 re-examines Governance International’s ‘Co-production Star model’ discussed in Chapter 3, this time from the perspective of its five ‘outer steps’ which describe a pattern for initiating and implementing effective citizen co-production activities.

Many readers will be familiar with the five steps in this model i.e., ‘Map It’, is about identifying existing co-production initiatives in an organisation. ’Focus It’ prioritizes co-production initiatives likely to bring significant improvements. ‘People it’ involves a structured process of experimentation with the prioritized initiatives undertaken by people who are able and willing to contribute. ‘Market It’ involves marketing the improved services and outcomes to existing and potential co-producers. Finally, ‘Grow It’, by embedding co-production at both strategic and operational levels through outcome-based commissioning and culture change. The author points out that whilst the ‘Co-production Star Model’ suggests a sequential planned process, in practice some co-production successes simply emerge and grow because they work within a specific set of local circumstances. Given these successes are context specific they do not tend to ‘travel’ well, and the author cautions that pure ‘mimicry’ of successful initiatives transplanted elsewhere can result in crude and unsuccessful imitations. Nevertheless, strict sequential adherence to each step in the model would not appear to be a prerequisite for success.

The importance and challenge in achieving the distributed leadership required to promote co-production is then considered. The barriers to how this is achieved within institutions which experience other demands, such as performance targets is recognised. The author concludes, however, that more research is needed into the effect of leadership on achieving successful co-production at all levels within organisations, as well as from citizen leaders.

Chapter 5 concludes by considering potential negative consequences of co-production and provides a typology for recognising some of these and ways of addressing them. Examples include loss of professional jobs through citizen co-producers delivering services in, say, libraries or the creation of new dependencies through volunteers solving issues for people instead of helping them to help themselves. As the author says co-production is not a panacea, and unless the cost-benefit ratio is positive for all of those involved it is unlikely co-production will be successful.

Chapter 6 ‘Evaluating Co-production’ begins by asking’… do we actually know how successful co-production is likely to be in any given context?’ In exploring the answer to this question, the author considers the creation of public value as a measurement of success from the perspectives of two key academics, before proposing a Public Value Model which includes co-production as a key choice in improving the effectiveness of services and increasing public value.

An important factor in using the model as an evaluation tool is the impact co-production has on quality-of-life outcomes, including individual, community and business outcomes and how these interact with each other. This aspect is explored in greater detail, illustrated with an in-depth case study, in section 6.3.

Whilst the impact of co-production on quality of service is considered, the author concludes that more research is needed as most of the current analysis remains subjective.

Chapter 6 goes on to consider the extent to which user and community co-production promotes good governance in public services. By way of illustration the author provides a classification of the key principles of democratic public governance against each of the ‘Four Co’s’ discussed in previous chapters.

The chapter ends with a section discussing the relative benefits/challenges of the additive and substitutive forms of citizen co-production. Whilst substitution of public services through co-production may well be attractive for service commissioners seeking economies in an age of austerity, it will not necessarily result in the longer-term behaviour changes necessary to maximise the wider societal benefits from co-production.

Chapter 7 ‘The Future of Co-production: Policies, Strategies and Research Needs’ asks what might be the role of co-production over the next decade and longer?

In this concluding chapter the author argues that going forward co-production needs to be mainstreamed into public service planning and provision instead of continuing with the current ‘piecemeal’, project-based approach. This doesn’t mean to suggest that every public service decision needs to be co-produced, however the author invites the reader to consider three implications of this approach; firstly, citizen co-production should be the assumed starting point for all future social and digital innovation in the public domain; secondly, co-production needs to be implemented as a holistic transformation approach instead of being an add-on project to existing services; and thirdly, rather than organisations simply seeking to bring citizen contributors into the organisation they should look outwards to learn what they can do to improve people’s everyday lives.

The author the considers a number of policies that need to be put in place to facilitate mainstreaming and this is followed by proposals for a research agenda to grow the evidence base for co-production.

The chapter ends with a timely reflection on the implications for co-production in the wake of COVID-19, citing two interesting and contradictory trends. On the one hand, the enormous response to the government’s call for volunteers during the crisis as well as the countless examples of community self-help, all of which may, it is hoped, give way to a more collaborative state in the longer term. On the other hand, we have seen evidence of a more coercive state, requiring compliance of citizen in following strict guidelines. This, the author suggests, raises the question of whether citizen co-production can always be a voluntary activity or part of enforcement. Food for thought.

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