Moving beyond ‘one size fits all’ models of public service design

• Written by: Hannah Ormston — Carnegie UK Trust — Policy and Development Officer
• Published: 12th September 2019

Hannah takes a look at the policy shifts that are needed to make co-production a reality.

To achieve meaningful, transformational change, public bodies and services need to address a gap in their design and delivery: they need to engage with, listen to, and – most importantly – involve the people who use the services, or might need to use them in the future. But taking a co-produced approach to public service design and delivery questions the status quo. It requires decision makers to go against the tide, challenging a current of structural and cultural barriers that inhibit real transformation.

When the Carnegie UK Trust (this link will take you away from our website) commissioned Ipsos MORI to undertake jurisdiction polling in 2018, we found that 51% of respondents in Scotland felt they have too little control of the services they use. This was a surprising statistic, particularly because there are many initiatives and organisations that champion co-production in Scotland, such as the ALLIANCE, Scottish Co-production Network and NDTi Scotland. There appears to be a strong desire for the direct involvement of users in the production of their own services.

This is a story that reaches beyond Scottish waters and is distinctively evident within the health and social care sector across Wales and England. The Social Care (Self Directed Support) (Scotland) Act 2013, the Social Services and Well-being (Wales) Act 2014 and the Care Act 2014 have all contributed to the introduction of legislative frameworks for personalised care, with an underpinning vision to move away from traditional individual deficit based models, towards approaches that recognise individuals and their families as valuable assets, with resources and insights to share.

Yet despite clear evidence that public service users would like more control, found that the language of co-production is creating barriers to change. With multiple meanings and definitions, there’s confusion about what exactly it entails. Added to this, the structures that are currently in place for the funding and evaluation of services are not conductive to co-production methodologies. They are seen as approaches that involve a great deal of risk, with potential moral and ethical implications for those who use the services.

The complexity of these structures and relationships, and the need to shift away from individuals and communities being regarded as recipients of services, to co-producers of services, is one of the seven key principles of an Enabling State. For over eight years, the Carnegie UK Trust has undertaken research and development to examine the shift away from a welfare state and believes that, to effectively improve wellbeing, policy and practice should be grounded and informed by good quality, appropriate evidence (this link will take you away from our website).

The Enabling State is an approach to governance that takes a holistic approach. It recognises the value that people and communities have, and their capacity to create transformational change. Made up of seven key principles – or policy shifts – it champions the strength of individual and collective autonomy and aims to empower individuals and communities, in turn addressing stubborn inequalities in our wellbeing, and improving outcomes for people.

The seven interdependent policy shifts of the Enabling State are:

• From target setting to outcomes
• Top down to bottom up
• From representation to participation
• From silos to working together/integration
• From crisis intervention to prevention
• From doing-to to doing-with
• From the state to community ownership and management.

Our findings might provide an explanation as to why, despite there being many good examples and case studies of co-production (this link will take you away from our website) out there, these have mostly been at a local level. There is a struggle to get co-production off the ground in mainstream settings. By its very nature, real, meaningful co-production should be reactive, responsive, reflective and tailored to the needs of individuals and communities of a particular setting or circumstance. It could be detrimental and inappropriate not to do so.

Co-production is not a ‘one size fits all’ but takes time, understanding, capacity and leadership – our review found that the scale of budgetary and demand pressures facing public services are significant and in many cases the evidence shows that it’s these very issues that are hampering and undermining transformation.

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