Co-production in social care: What it is and how to do it

What is co-production - Economics of co-production

Economics is the science of looking at the costs and benefits of goods and services. This section looks at this important issue in relation to co-production.

Organisations, programmes and projects that use co-production have a complex and dynamic nature, which makes it difficult to assess their costs and benefits.

Evaluations of co-production have tended to focus on how people have participated and on their experiences, rather than on costs and benefits. [38, 39]

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The costs of co-production

Issues around the costs of co-production are particularly complicated. While there is some evidence that it can reduce costs, the available evidence is inconclusive. This may be something that varies between different organisations and different projects.

None of the studies included in the review of the evidence for this guide produced reliable information on costs. Most ignored the issue altogether. In several cases, the evaluations looked at peer support mechanisms – where people who use services take on peer support roles on a voluntary basis – suggesting that delivery costs are minimal. However, even in some of these cases there were costs that were significant, such as for training. There are also costs for professionals in taking time to work more effectively with peer support workers. However, such activities may reduce costs in the long term if services are better fitted for purpose and more effective.

Co-production will probably lead to short-term increases in the use of services and other costs as it increases people’s knowledge of and access to services. It may also lead to services that are ‘more appropriate’.

Potential savings

One of the key arguments about the economic benefits of co-production is the potential returns from a perspective that focuses on prevention, and on early intervention when people’s needs arise rather than letting them get worse. So if there is investment in community services, this means that people are less likely to need more expensive services (such as crisis and emergency services) later on. This will reduce the cost of acute services.

Some of the clearest evidence of the potential savings that can be achieved in prevention using co-production in health services has come from Nesta’s People Powered Health programme. [40] This programme focuses on ways to improve practice in health services, including peer support and co-design/co-delivery with people who use services. Nesta’s analysis of the programme shows that where these approaches are used with people with long-term conditions, they deliver savings of approximately seven per cent through things like reduced and shorter hospital admissions and fewer visits to casualty departments. They also argue that these savings would grow to 20 per cent as the different parts of the programme support each other.

A few other points to note about co-production and costs are:

One of the key studies of the economics of co-production looked at three co-production/community capacity projects. [43] It analysed them using a method called ‘decision modelling’. This compared what happened with the projects in place with what might have happened if they had not existed. The projects were a time bank, a befriending scheme and a community navigator scheme (volunteers who support people to obtain support services). The authors looked at all of the costs and gave a monetary value to all of the benefits. They recognised that there were limitations in their analysis. However, they made conservative estimates that the projects produced net benefits for their communities in a short time.

Economic evaluations of direct payments, individual budgets and—more recently—personal health budgets have shown that they are cost-effective. Giving people who use services and carers more control over those services can increase their health and wellbeing. [44, 45] But it is important to give them more support in the form of information, advice and advocacy. [44, 45] This will mean that more people will take up budgets. However, not everyone will benefit from personalised approaches. [44, 45]

The benefits of co-production

Co-production approaches can bring a range of benefits and improvements for all concerned. Ensuring that everyone involved has a shared understanding of what benefits are expected from co-production is important to the success of the initiative. [42]

Potential benefits from co-production can be divided into two types: [36]

Professionals working with communities and people who use services are likely to have a stronger focus on the outcomes of the support provided when they are co-producing, and potentially a greater focus on prevention. So there are improved outcomes for people who use services as a result. [36, 48]

The contribution that co-production makes to developing social networks and communities is another benefit. [48] Some have argued that this only happens where there is collective co-production with groups and communities and not where there are individuals involved in the co-production of the services they receive. [36]

Why does co-production lead to improved outcomes?

One study looked at how effective co-production in services that support people looking for employment is. It found that trust and personalised communication between professionals and clients positively influenced whether a person found employment. They were also linked to a higher level of self-confidence and motivation. [49]

Evidence from the health field shows that incorporating co-production principles into programmes for people with long-term conditions can help them to gain knowledge, learn skills and adopt behaviours that are thought to be important in achieving better health and wellbeing. [50, 51, 52, 53]

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