Co-production - a step in the right direction

A reflection by Elspeth Gracey, CHEX

The World Health Organisation tell us that redistribution of power is needed to change health inequalities. 


Here at CHEX tackling health inequalities is core business for us and the community led health organisations wesupport. In my opinion co-production is one way of ensuring that redistribution of power can be put into action and lead to positive change.

Fundamental to the concept of co-production is working with others in a trusting relationship to build something better than might have been possible if either party had worked alone.

From my perspective working with others for a better future is what community-led health organisations do daily. However, while the NHS espouses phrases like ‘shifting the balance of care’ and finds itself within new structures around health and social care integration, we still hear from community-led health organisations that the NHS, in particular, can be hard to get to know.

For me as a former ‘insider’ within the NHS this is not hard to understand. The NHS is literally in the business of life or death decisions. They are charged with looking after us when we are at the most vulnerable times in our lives and they are held accountable for the decisions they make. They deal with us as individuals and so working with groups of people let alone whole communities is, not surprisingly, perceived to be something of a challenge.

Yet, we in the community and voluntary sector would dearly like them to work more co-operatively with us, shifting resources into our keeping and investing in organisations that lie outwith their direct sphere of influence and governed by mechanisms that they know not of.

Since the days of working on Healthy Communities: Meeting the Shared Challenge, we who are committed to the benefits of community development and community-led health are still struggling to make a case that will stand up to scrutiny by those who are trained in ‘evidence based approaches’, ‘double blind trials’ and who can be sent to the professional wilderness for a single lapse in judgement.

So, while we beat the drum of greater empowerment for individuals and communities how can we best work with professionals hidebound by statute and encourage them to take the plunge and engage in the co-production of new and innovative services?

Within this mix are questions of power and empowerment, recognition of diverse voices and needs, and so we have a heady mixture of things to overcome. 

Our previous CHEX conference examined the role of power in relation to health inequalities, and our key note speaker on that topic was Elinor Dickie who has produced, with colleagues in NHS Health Scotland and the Glasgow Centre for Population Health (GCPH), a useful animation about power and how the lack of power contributes to health inequalities. 


Our most recent conference, only a week ago, explored how people might influence policy and practice in terms of tackling health inequalities. And on Tuesday of this week I was a participant at an event run by GCPH where Elinor Dickie presented on further developments of her work on Power and where Oliver Escobar, of What Works Scotland and Edinburgh University, provided some very useful information about how the existing status quo continues to resist the shift in power required to do things differently. 



This is where I think co-production and its first cousin participatory budgeting can play a critical role. Both processes allow statutory services to put a toe in the water of a more participatory process in delivering the services that they are legally bound to deliver. From what we know of where co-production and participatory budgeting work well, those involved find themselves encouraged and are inclined to do more and gain in confidence about how these processes can be used.

So, I look forward to hearing more about co-production and participatory budgeting and by extension increasing transfer of power which will hopefully mean that through persistent positive change we might see health inequalities and social injustice diminish and fade.

It’s about listening to people, building trusting relationships and relinquishing power: and its good for all of us.

Which leads me to reflect on what I first knew of the World Health Organisation which was that via their Alma Ata declaration they put before us the aspiration to Health for All as a human right and the business of all of us. I sincerely hope that this is something to which we can all still aspire.

Elspeth Gracey, Community Health Exchange, CHEX