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

What is co-production - Economics of co-production

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:

• Co-production may lead to some costs being reduced and others increased. [41]
• It may only be possible to know whether co-production is cost-effective by looking at things over a period of time. [12] If it is cost-effective it will have reduced the number of inefficient, ineffective and unwanted services.
• There will be costs of engaging with services, projects and so on. [42]
• It might be found during the co-production process that more spending is needed in some areas. [42]

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]

• Practice examplesOpen

  KeyRing

  This organisation has described co-production as a way of making the best use of resources. They give the example of people being supported to use public transport. This frees up resources that might be needed for specialised transport services.

  The Healthy Living Club

  The people with dementia, carers and volunteers who run the club kept the club running after funding ceased. The club’s coordinator worked unpaid for a time but the club secured a grant from a charitable trust. Volunteers still play a key role in the club, with their time being rewarded through a time bank.

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]

• instrumental benefits – the use of people’s experience and expertise, which can contribute to a more efficient use of resources
• intrinsic benefits – an increased sense of social responsibility and citizenship and benefits to the wider community (sometimes defined as social capital), particularly to improved health and wellbeing. [46, 47]

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]

• Practice examplesOpen

  The Healthy Living Club

  This club’s activities and events contribute to everyone’s sense of wellbeing. A warm environment has been created where everyone feels relaxed because it is viewed as normal to have dementia. The collaborative approach in which people with dementia, carers, volunteers and the coordinators all help each other also contributes to the running of the club.

  KeyRing

  KeyRing believes that its co-production approach in which members support each other helps people to gain independence in the sense of being in control of their lives.

  Action for Carers Surrey

  The new system set up for direct payments for respite breaks for carers is simple and avoids complex systems of referrals and form-filling. During the first 18 months of the service, it gave over 2,500 direct payments to carers so that they could have a break. It is believed to have improved the health and wellbeing of carers in the county and to have raised general practitioners’ awareness of carers’ issues.

  My Way

  This project supports young disabled people in the transition from school to adult life to take up opportunities that are in keeping with what they want to do in their lives. These opportunities have to be within the available budget but they are imaginative and flexible. The experience of co-production in the project has helped everyone involved to become experts and push the agenda of personalised care forward.

  All Together Now

  Using a co-production approach in a residential setting, this project has delivered an improved quality of life for the people living in the home. Support is focused on maintaining personal identity, meaning and purpose. This has meant that some people in the home now need less nursing care.

  Outcomes are assessed through the ‘senses framework’, which considers how supportive the environment is in terms of people’s sense of security, continuity, belonging, purpose, achievement and significance.