co-production: now you see it, now you don’t

Co-production is currently a Big Idea in public services in the UK. The previous post summarised my attempts to track down the theory behind it. That search has prompted some further thoughts. I’d found out where the idea of co-production came from, but it’s presented quite differently by the NESTA papers and Parent Carer Forums (PCFs).   How did it get onto their agenda, and why are their models of it so different to the model originally developed by Elinor Ostrom and Edgar Cahn?

co-production and Parent Carer Forums

Co-production isn’t mentioned in the 2007 paper Aiming high for disabled children: better support for families, which proposed parent engagement via parent carer forums – and the funding for them. Nor does it appear in the 2011 Green Paper Support and aspiration: A new approach to special educational needs and disability that heralded the new SEND legislation.

The first appearance I could find was in the April 2013 report Co-production with parent carers: The SE7 experience.  In June 2013 it pops up, frequently, in a Pathfinder Information Pack Engagement and participation of children, young people parents and carers. The ‘strategic participation of parent carers’ is described as:

“The participation of co-production with representative parents carers in strategic planning, decision making, commissioning and service evaluation. Over the last five years, the Department for Education have supported and funded the development of parent carer forums in every area across England. It is essential that Parent Carer Forums are involved in co-producing plans and implementation of the reforms. Forums are also members of the National Network of Parent Carer Forums (NNPCF), provide the opportunity to feedback at regional and national levels. Representatives from the NNPCF work strategically with Department for Education (DfE) and Department of Health (DH).” (p.3)

The information pack cites the National Council for Voluntary Organisations (NCVO)’s March 2011 Participation: Trends, Facts and Figures. Page 36 of the NCVO almanac reviews participatory methods used to involve communities in local decision making. Interestingly, co-production isn’t mentioned.

Participation: Trends, Facts and Figures in turn cites a study by Involve, set up in 1996 and part of the National Institute for Health Research. I couldn’t find a publication date for their People & Participation: How to put citizens at the heart of decision-making, but it was based on research carried out in 2004/05 and has an introduction by Hazel Blears as Minister of State for Policing, Security and Community Safety, a post she held until May 2006. The Involve study does refer to co-production – in the context of Arnstein’s ladder of participation (p.18) – but doesn’t mention Ostrom’s or Cahn’s work.

putting the production back into co-production

The term co-production isn’t trademarked, so there’s nothing stopping people using it to refer only to one component of the Ostrom-Cahn model, such as a dynamic group process (PCFs), active participation (Involve), or volunteering to ‘give back’ (NESTA). But using it in such different ways is confusing. A single sentence could point readers to co-production’s origins and why an organisation was focusing on only one aspect of it.

Significantly, presenting only one aspect of co-production as co-production, also means that a key component of the Ostrom-Cahn model has repeatedly been overlooked. That missing component is the non-money-based, or ‘core’ economy; the things people make or do (‘produce’) that have value or benefit, but that they don’t get paid for. A key tenet of both Ostrom’s and Cahn’s model of co-production was that this unpaid production is effectively ignored by the market (money-based) economy. Making the invisible economy visible was fundamental to the original model of co-production.

now you see it, now you don’t

Obviously, a group of people drafting an Education Health & Care Plan (EHCP) or reconfiguring the local speech and language therapy service, won’t need to measure the economic efficiency of the project using Ostrom et al’s methods. Nor will they need to set up a Cahn-inspired time bank before they can get on with the task. But if the people doing the planning take into account the views, wishes and feelings of children, young people, parents and carers, but overlook the unpaid activities they all do that contribute to the development and well-being of the child or young person, what’s happening is co-design, not co-production.

Co-production PCF-style encourages parent carers to complete surveys, take part in consultations and conferences, and work with their local PCF in planning services at ‘strategic’ level. For most parent carers, this is on top of their already time-consuming caring responsibilities. A few get a nominal remuneration via the PCF. Most don’t.

Involve’s ‘active participation’ and NESTA’s ‘giving back’ also expect people to engage with public sector services in addition to whatever unpaid activities they do already. Sometimes, that participation can result in a power-shift leading to increased ‘citizen control’. It can also result in citizens having even less free time (and thus fewer resources) than previously. If expenses aren’t paid, they can be out of pocket as well.

In all the new co-production models, the unpaid contribution of carers to the well-being of the people they care for is almost invisible. There are nods to it, in the shape of Carer’s Allowance and ‘celebrating’ it during Carers’ Week. Parent Carer Forums are well aware of unpaid production on the part of parent carers and frequently refer to it, but it’s not an integral part of their model of co-production, and one has to wonder why not. I’ll come back to that point later.

culture change

The Involve participation report devotes an entire section (2.4 p.22ff) to issues and tensions. It includes several paragraphs on culture change. Culture change is frequently cited as the reason new legislation hasn’t been properly implemented in public services.  Involve describes an organisation’s management culture as “a reflection of the values that underpin how they do their work” (p.26). PCFs frequently cite culture change as a key challenge, and see co-production as an important route to changing the values of public services, thus changing their culture.

Organisational culture is a reflection of values, obviously, but that’s not all there is to it.   Culture is an emergent feature of an organisation – an outcome of the interaction between a wide range of factors. I can’t better the Wikipedia list, attributed to David Needle’s book Business in Context: An Introduction to Business and Its Environment. The factors include “history, product, market, technology, strategy, type of employees, management style, and national culture”. Culture manifests itself as “vision, values, norms, systems, symbols, language, assumptions, environment, location, beliefs and habits.”

It is difficult to change people’s values, and one way to do it, in the case of implementing new legislation relating to people with disabilities (e.g. Mental Capacity Act, Children and Families Act, Care Act) is to ensure public services are aware of, and comply with, statutory requirements.

The current system explicitly expects people with disabilities and their carers – who together form one of the most vulnerable and resource-poor demographic groups – to enforce compliance, using their knowledge of the law, and via complaints and litigation. This is inequitable. And blaming culture change for the system not working, to me looks like an excuse.

I’ve lost count of the number of times I’ve heard organisational culture cited as the reason public services don’t carry out their statutory duties, or why new legislation isn’t being properly implemented. Culture change, apparently, takes years to effect and there’s not a damn thing anyone can do about that. Which provides a convenient excuse for poorly drafted legislation, non-compliance, and any failure of participation, engagement or co-production initiatives.

co-production has been framed

Earlier, I wondered why the invisible activities of children, young people, parents and carers have remained invisible in the co-production model adopted by Parent Carer Forums. After all, the forums are acutely aware of those activities.

The most likely explanation is that the idea of co-production has passed from one organisation to another, becoming transformed on the way by a process of conceptual Chinese whispers, and that few people have read Ostrom or Cahn. And so have missed their key point about activities in the non-money economy.  Parent carers are sometimes paid for participation, but that just makes participation part of the very money-based economy that co-production is supposed to help reform.

The NESTA authors clearly have read Ostrom and Cahn, and understand the informal non-money economy and the contribution it can make to communities. But they’ve framed tapping into that economy as “patients, pupils, parents or service users are being asked to do something, to give back and to help deliver the service.” (Challenge of co-production p.14)

To me this comes across as somewhat paternalistic. It frames co-production in terms of the state being in charge, service users being obliged to it for the services it provides, and being expected to ‘give back’. An alternative perspective, and the one taken by Ostrom and Cahn, is that the state exists for the protection of the people, that public services exist for their benefit, that people informally exchange activities, and that informal system of exchange can interact with public sector services so that everybody benefits.

Ironically, given the number of times Sherry Arnstein’s analysis of power structures has been cited alongside models of co-production, it’s not just unpaid activities that have remained invisible. Power structures have too.

references

Arnstein, S. (1969).  A Ladder of Citizen Participation, Journal of the American Planning Association, 35, (4), 216-224.

Boyle, D. & Harris, M. (2009).  The Challenge of Co-production: How equal partnerships between professionals and the public are crucial to improving public services, NESTA.

Britton, C. & Taylor, J. (2013).  Co-production with parent carers: the SE7 experience, Mott Macdonald & South-East 7.

Cahn, E. S. (2004) No More Throw-Away People: The Co-production Imperative (2nd edition).  Essential Books, Washington DC.

Department for Education (2011).  Support and aspiration: A new approach to special educational needs and disability: a consultation.

HM Treasury & Department for Education and Skills (2007). Aiming high for disabled children: better support for families.

Involve (2005/6). People & Participation:  How to put citizens at the heart of decision-making.

National Council for Voluntary Organisations (2011).  Participation: Trends, facts and figures. 

Parks, R.B., Baker, P.C., Kiser, L., Oakerson, R., Ostrom E., Ostrom V., Percy, S.L., Vandivort, M.B., Whitaker, G.P. & Wilson, R. (1981).  Consumers as Coproducers of Public Services:  Some Economic and Institutional Considerations, Policy Studies Journal, 9 (7), 1001-1011.

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in search of co-production

Co-production. The only time I’d seen the word was in film credits, so when it appeared in a Parent Carer Forum (PCF) newsletter in 2013, I asked what it meant. I was directed to one of the Pathfinder area information booklets.  It defines co-production as:

“…when all team members together agree outcomes, coproduce recommendations, plans, actions and materials as a collective. It is an approach which builds upon meaningful participation and assumes effective consultation and information sharing. In its essence, co-production is a dynamic group process and happens in the room when there is equal value for each participant’s contribution and when there is a meaningful proportion of participants who are service users (in this case parent carers) present.” (p.10)

scaling up

Co-production turned out to be a buzzword in public services. That prompted another question. I could see how co-production could be used to develop a personalized programme of medical treatment, or an individual Education Health and Care Plan, but how could it be scaled up? A handful of patients wanting unusual therapeutic interventions, or half-a-dozen EHCPs specifying provision that has to be imported from out-of-county, is one thing. Tens, or hundreds of treatment plans or EHCPs along those lines is quite another and would require some major changes in commissioning.

I asked around. I joined several online groups and met many well-informed people. They all said ‘that’s a good question’, but no one could answer it, and no one had any examples of co-production happening at scale. This was significant. If co-production didn’t work at scale, there wasn’t much point to it.

I asked around some more. An organization called NESTA has done a good deal of work on co-production, so I read their research papers. NESTA (National Endowment for Science, Technology and the Arts) describes itself as an innovation foundation. It was founded as a non-departmental public body in 1998 with a grant from the National Lottery, and in 2010 became a charity.

Their co-production discussion papers The Challenge of Co-production, Public Services Inside Out and Right Here, Right Now, (more have been published since) were fascinating. But I couldn’t find an answer to my question about scaling up. The papers were packed with inspiring examples of co-production, but unless I missed something, all the examples looked like one-off local projects, some of which had been quite short-lived. Would co-production at scale consist of a bunch of local projects? If so, at what point would you need to do some joined-up thinking?

engagement

The NESTA papers indicated there was considerably more to co-production than producing “recommendations, plans, actions and materials as a collective”. The NESTA authors saw it as the active participation of citizens in delivering public services, a model that had significant potential to halt spiraling and unsustainable costs. The citizens’ engagement was framed in terms of ‘giving back’. There were obvious parallels with David Cameron’s ‘Big Society’.

I felt uneasy.   Big Society emphasized the importance of volunteering, but blithely overlooked limitations familiar to volunteers. I vividly remember eyebrows being raised at a local meeting where it was suggested volunteers could support elderly people discharged from hospital. One former nurse asked what training the volunteers would get. Another asked about insurance – she’d once been falsely accused, by a patient with dementia, of stealing money. It would be more cost-effective to employ a few more district nurses.

power

The Pathfinder description of co-production had a footnote to Sherry Arnstein’s 1969 paper ‘A Ladder of Citizen Participation’. Variations on the ladder of participation are widely cited.  Here’s Arnstein’s version:

arnstein

Arnstein’s paper is about the role of power structures in planning decisions in the USA, and cites numerous examples of citizen participation. In some cases, the citizens had to engage in quite robust action before getting to the point where they were actually participating.

The NESTA papers referred to power shifts, but not quite as explicitly as Arnstein does.  Parent Carer Forums often refer to the ‘empowerment’ of parents, but generally in terms of parents sharing experiences and familiarising themselves with the law.  It’s assumed that in and of itself, this will make things happen. I can’t recall seeing any references to power structures.

Parent Carer Forums do, however, report co-production taking place at a ‘strategic’ level. As far as I can ascertain, this means PCF representatives working with commissioners and providers on the design of local services. Public sector services do appear to have shifted from a ‘doing to’ to a ‘doing for’ approach, and are now en route to ‘doing with’.

How far ‘doing with’ is likely to extend is debatable.   Even if the contributions of the people ‘in the room’ are given equal weight, what about the ones who aren’t in the room? The non-verbal children? The ‘hard to reach’ parent carers who’ve never even heard of parent carer forums? And at the other end of the scale, what about the Treasury, the DfE and the Education & Skills Funding Agency?

Most PCFs are funded indirectly by the DfE and/or directly by their local authority (see p.10), so who’s in the room and what power they have over the dynamic group process are key questions.

missing pieces

Although I could see the potential for co-production, as a model it still didn’t make sense. Pieces of the jigsaw were missing.  I found frequent references to Edgar Cahn, who worked on co-production in the 1980s. The NESTA papers presented his role in terms of ‘transforming public services’ (Challenge of Co-production p.13), which didn’t quite square with his being a civil rights lawyer. Then there was Elinor Ostrom, the Nobel prize-winning economist who coined the term ‘coproduction’ in her studies of the Chicago police force in the 1970s. You don’t get a Nobel Prize for studying a police force. Something didn’t add up.

So, I read Cahn’s book No More Throw-Away People, and the 1981 paper ‘Consumers as coproducers of public services: Some economic and institutional considerations’, co-authored by Ostrom.  And had an epiphany.  Cahn and Ostrom use ‘production’ in the economic sense: an activity that creates a good or service that people value and that contributes to their well-being.  This might have been obvious to policy makers, but I’d been completely unaware of it in my reading until then.  I suspect I’m not alone.

markets and time banks

Ostrom’s analysis straddles the divide between a formal market economy that uses money as the unit of exchange, and an informal economy based on exchanges that don’t involve money. (Cahn calls them the market economy and core economy.)

Exchanges that don’t involve money are generally marginalised by the market economy even though it’s utterly dependent on them. The profits of plantation owners in the 18th century, mill owners in the 19th century, and multinationals in the 20th and 21st, have depended variously on the labour of slaves or low-paid employees, and the market economy would grind to a halt without the unpaid, invisible, behind-the-scenes labour of what Gordon Brown called ‘ordinary people’.  It’s a point Cahn makes explicitly, right after he compares the core economy to a computer operating system.  Interestingly, NESTA cites Cahn’s operating system analogy several times in The Challenge of Co-production, but omits his reference to “the subordination of women and the exploitation of minorities, immigrants and children” in his next paragraph (Cahn, p.54).

Ostrom was interested in the interface between the activity of public services and the activity of private citizens. Coproduction referred to their joint activity in producing services. Co-production can make services more efficient, but Ostrom and her colleagues identified a number of issues around the incentives for citizens to get involved.

Cahn’s contribution to the concept of co-production came about because of his pioneering work with time banks. A time bank is a system that allows people to earn credits for any activity they engage in that’s of benefit to others. The credits are based on the time spent, and can be exchanged for goods or services produced by other people. So you might earn credits by collecting library books for housebound elderly neighbours, and use the credits to pay someone to cut your lawn.

incentives

Cahn realised that time banking addressed some of the problems with incentives highlighted by Ostrom and her colleagues. Time banking:

  • Explicitly recognises, via credits, the value of activities that contribute to the wellbeing of others
  • Provides incentives for people to engage in and continue with such activities
  • Prompts people to identify and develop their skills and knowledge
  • Enables those on low incomes to participate in economic exchanges
  • Reduces economic and social inequality
  • Creates and sustains social support networks
  • Increases community stability and reduces crime
  • Facilitates the development of local businesses.

Parent carer forums and the NESTA papers also address incentives, but very differently.

The National Network of Parent Carer Forums (NNPCF) has a reward, recognition and remuneration policy. There are good reasons for parents not being out-of-pocket as a result of their participation, but the policy has had some unexpected and unwanted outcomes. Most PCFs have relatively small budgets. If, as a matter of principle, volunteers have to be rewarded financially, the budget limits the involvement of volunteers, so it’s hardly surprising PCFs report limited capacity (see p.27).

NESTA’s Public Services Inside Out goes into some detail about rewards (p.11ff), but they appear to be treated as an added extra rather than an integral feature, as incentives are in time banks. The underlying incentives of the NESTA model look more like moral indebtedness – there are frequent references to ‘giving something back’ and being ‘rewarded’ for one’s efforts.

The beauty of time banking is that it isn’t framed in terms of contributions and rewards. It’s framed in terms of exchange. People decide what activities they can offer and what activities they’d like in exchange. The exchange system is very flexible and can be modified to accommodate people’s resources and needs as they change; young children can be credited for learning and the elderly for mentoring.

Time banking also offers a way of integrating the market (money) and the core (non-money) economies. Taking family carers as an example, it would be impossible for all carers to be paid a living wage for the number of hours they work, but they could be paid in credits that could be exchanged for other services of real value, such as cleaning, child-minding or transport.

conclusion

The model of co-production adopted by Parent Carer Forums is different to the NESTA model in several respects, and both differ from the model developed by Ostrom and Cahn. There’s nothing stopping someone taking some features of the Ostrom-Cahn model and badging it ‘co-production’, but it’s unlikely to result in the significant changes in economic activity, power and well-being that Ostrom and Cahn envisaged.

Co-production, in the sense that Ostrom and Cahn used the term, offers the opportunity for everyone to be ‘in the room’, and allows the dynamic group processes to be scaled up to local and national level. It has the potential to transform economies, reduce inequality, increase the resources within communities and kick-start businesses. That’s the one I’m going for.

More thoughts in the next post.

references

Arnstein, S. (1969).  A Ladder of Citizen Participation, Journal of the American Planning Association, 35, (4), 216-224.

Boyle, D. & Harris, M. (2009).  The Challenge of Co-production: How equal partnerships between professionals and the public are crucial to improving public services, NESTA.

Boyle, D., Coote, A., Sherwood, C., & Slay, J. (2010) Right Here, Right Now: Taking co-production into the mainstream, NESTA.

Boyle, D., Slay, J. & Stephens, L. (2010).  Public Services Inside Out: Putting co-production into practice, NESTA.

Britton, C. & Taylor, J. (2013).  Co-production with parent carers: the SE7 experience, Mott Macdonald & South-East 7.

Cahn, E. S. (2004) No More Throw-Away People: The Co-production Imperative (2nd edition).  Essential Books, Washington DC.

Contact (2017).  Parent Carer Forums in 2017, Contact.

Parks, R.B., Baker, P.C., Kiser, L., Oakerson, R., Ostrom E., Ostrom V., Percy, S.L., Vandivort, M.B., Whitaker, G.P. & Wilson, R. (1981).  Consumers as Coproducers of Public Services:  Some Economic and Institutional Considerations, Policy Studies Journal, 9 (7), 1001-1011.