Co-production in Scotland -
a policy overview

Mark McGeachie and Gerry Power, Joint Improvement Team
www.jitscotland.org.uk

JIT LogoThe purpose of the resource: ‘Co-production – how we make a difference together is to support practitioners and public service leaders to better understand:

  • what is co-production and how co-production can help deliver outcomes which matter to people;
  • the importance of co-production within the Scottish policy landscape; and
  • the support available to embed this way of working across our public services.

In this section of the resource, we will take an overview of the policy landscape in Scotland and how co-production is a component of achieving the aims of a wide range of policies.

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There have been a number of policy developments which have further embedded co-production in Scotland’s policy landscape since Power’s (2013) review in the second edition of ‘Co-production of Health and Wellbeing in Scotland’. Given the continuing socio-economic challenges facing Scotland, it is encouraging that the value of co-production – of working with, rather than doing to, people and communities to achieve better outcomes – is increasingly recognised. The astonishing 84.6% turnout (Scottish Government, 2014a) at Scotland’s Independence Referendum was a further indicator of people’s desire to engage in the debate about the type of country Scotland is and our public services.

Why co-production?

The Commission on the Future Delivery of Public Services stated that “… unless Scotland embraces a radical new collaborative culture throughout our public services, both budgets and provision will buckle under the strain …” (Christie, 2011: viii). Christie asserts that it is essential we recognise “that effective services must be designed with and for people and communities – not delivered ‘top down’ for administrative convenience” (2011: ix). Our public services need to be reformed and “built around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience...” (2011: 23).

The Scottish Government (2011a) embraced the Commission’s recommendations and articulated the need for public service reform based on four pillars:

  • Prevention – “ …directly aimed at improving outcomes and reducing the demand for a range of acute services over time … (by) … better utilis(ing) the talents, capacities and potential of our people and communities…” (Scottish Government, 2011: 6&8)
  • Partnership – which will be “…comprehensive and participative, harnessing the full spectrum of talents and capacities of public bodies, citizens, third sector organisations and local businesses… (and)… where appropriate … place greater responsibility and control in the hands of citizens and communities …” (Scottish Government, 2011: 10)
  • Workforce development – building on Christie’s recommendation that frontline staff working with people and communities are best placed to plan and deliver services, Scottish Government priority is that “… management and frontline staff in public services need to be encouraged and supported to prepare for change, promote innovation, embrace new approaches, improve performance and involve communities and services users in the design of public services …” (Scottish Government, 2011: 14)
  • Performance improvement – Christie emphasises the importance of outcomes in improving and measuring performance. In response ‘Renewing Scotland’s Public Services’ calls for “… greater clarity around the objectives of public organisations which offer transparent measurement of progress and benchmarking …” (Scottish Government, 2011: 16).

Christie (2011) highlighted that both the financial need to reform our public services and the need to focus on delivering better outcomes. Building on the financial imperative, Audit Scotland highlights that the available public spending budget has fallen in real terms by nine percentage points between 2009/10 and 2014/15 (2014: 5). The report also indicates that this budget is likely to be further reduced over the coming years, awaiting spending decisions by the UK Government, and advocates for “rigorous options appraisal based on sound information, including information from service users, helps ensure good budget-related decisions and helps make clear why decisions are made” (2014: 12).

This emphasis on the importance of information from people who use services as part of the process for identifying how to make the best use of our resources is consistent with Governance International’s definition of co-production. This states co-production is “professionals and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes or improved efficiency” (Loeffler & Bovaird, 2013: 23). It is also consistent with the values and principles of co-production outlined by the New Economics Foundation which recognises people as assets and highlights the importance of blurring distinctions between organisations and administrative structures (Stephens, Ryan-Collins, & Boyle, 2008).

The policy context for co-production

Power describes a “‘golden thread’ of co-production and community capacity” (2013: 37) running through a wide range of Scottish Government policies and legislation, both existing and forthcoming. Some of the most significant legislation includes:

  • The Public Bodies (Joint Working) (Scotland) Act 2014 which requires the integration of adult health and social care services and places a statutory obligation on the new Integration Authorities or Lead Agency to create and deliver a strategic plan for the delivery of health and social care services. There is also a legal requirement for people who use services, carers, organisations which provide services – including the third sector – and professionals to be involved in the strategic planning and commissioning process. Locality arrangements in each partnership area will contribute to this process and “ensure that people get the right care, in the right place, at the right time” (Scottish Government, 2014b) through removing the barriers and divisions within health services and between health and social care services. In doing so, the legislation seeks to create the conditions for shifting the balance of care “from institutional care to services provided in the community” and improve the health and wellbeing of people using services across Scotland (Scottish Government, 2013: 4).

    The Act clearly identifies a set of National Health and Wellbeing Outcomes that apply equally across health and social care services in Scotland. These outcomes focus on improving the experiences and quality of services for people using services, carers and their families (Scottish Government, 2015). Section 31 (1) of the Act also identifies a set of integration delivery principles which “are intended to be the driving force behind the changes in culture and services required over the coming years to deliver these reforms successfully and improve outcomes” (Scottish Government, 2014c: 2). These are also consistent with the values and principles of co-production and will help “encourage the utilisation of the talents, capacities and potential of all of Scotland‘s people and communities in designing and delivering health and social services” (Scottish Government, 2013a: 5).
  • The Children and Young People (Scotland) Act 2014 covers a broad range of areas but has the primary goal of supporting the Scottish Government’s ambition “for Scotland to be the best place to grow up in” and for children and young people to be “at the heart of planning and delivery of services and ensuring their rights are respected” (Scottish Government, 2013b: 1). The Act places the UN Convention of the Rights of the Child on a statutory footing in Scotland and in doing so seeks to create the conditions for children and young people to know about and exercise their right to have a say in decisions which affect them. With a strong focus on person-centred care and designing and delivering services to meet the needs of children and young people, rather than services which they need to fit into, there is a strong emphasis on co-production principles within this legislation.
  • The purpose of the Social Care (Self-directed Support) (Scotland) Act 2013 is to shift the balance of power and enable people to have greater choice and control in the way they are supported. People can have control over their individual budget if they wish and can make decisions on how resources are spent to meet their own personal health and social care outcomes. This is further evidence of the Scottish Government’s commitment to answering the challenge laid out by Christie (2011) to develop systems around people rather than people having to ‘fit’ into administrative systems (Scottish Government, 2012). Shifting the balance of control and power to create an equal and reciprocal relationship between people who need support services and those who provide the services are central values of co-production. This legislation builds upon the movement to support self-management in Scotland and ‘Gaun Yersel’, The Self Management Strategy for Long Term Conditions in Scotland (Scottish Government / Long-Term Conditions Alliance Scotland, 2008).
  • “The Scottish Government believes that Scotland’s people are its greatest asset: they are best placed to make decisions about our future, and to know what is needed to deliver sustainable and resilient communities.” (Scottish Government, 2014d: 1). The objective of the Community Empowerment Bill is to remove the barriers and increase the opportunities for people and communities to use the skills and strengths to make a positive difference in their community. It aims to “ensure that people can meaningfully participate in decisions that affect their lives” (Scottish Government, 2014d: 2).

    As part of the Government’s response to Christie, this Bill aims to support the reform of public services. It will shift the balance of power towards equal and reciprocal relationships between people, communities and the public sector – clear principles of a co-production approach. As well as embedding our national outcomes approach in legislation, it will also strengthen community planning, where co-production and joint working particularly between the public and third sector to take a prevention approach is a strong focus of The National Community Planning Group (2014).

    From a co-production perspective, the Bill proposes to enable constituted community groups to take part in a process to improve the outcomes of a service delivered by a public body. This is based on evidence that involving people who use services in decision making results in better outcomes and makes “the most of the knowledge and talent that lies in communities”. (Scottish Government, 2014d: 10). It will also make it easier for community groups to own land and buildings in their area, and make the best use of local resources.

As well as legislation, there is a wide range of strategies and policies which reference the importance of co-production approaches and working with people and communities.

Scotland’s Regeneration strategy: ‘Achieving a sustainable future’, highlights the importance of community-led regeneration and emphasises that people need to be at the “heart of delivery” (Scottish Government, 2011b) in order for sustainable change to be achieved. While our 2020 Vision for Health and Social Care and the supporting Route Map to the 2020 Vision highlights the importance of identifying and working with the strengths and assets which people and communities have, and of “shift[ing] the balance of power” (Scottish Government, 2013c).

Scotland’s first National Dementia Strategy (Scottish Government, 2010) from 2010-2013, highlighted the importance of people with dementia and those who care for them to be full participants in planning the care which they need to live full lives. As we have moved forward into our second National Dementia Strategy (Scottish Government, 2013d), the active participation of people with lived experience of dementia has been important in developing our understanding of what works and is making a difference. Co-production principles are essential to meeting the challenge, highlighted in the plan, of improving services and support for people from the point of diagnosis and beyond along with their carer. The plan calls for mutual respect and equality in the relationship between the person living with dementia and their carer by ensuring that care is planned “from their perspective, not the perspective of service managers or clinicians” (Scottish Government, 2013d: 3).

Another vital factor in creating the conditions for co-production to become embedded in the way our public services are delivered is the implementation of Scotland’s National Action Plan on Human Rights 2013 to 2017 (Scottish Human Rights Commission, 2013). This plan is the first of its kind in Scotland and advocates for a the human rights based approach based on “participation, accountability, non-discrimination, empowerment and legality (PANEL)” (ibid, 2013: 9). These principles are aligned with those of co-production and the actions which will be taken forward to support the objectives of this plan can contribute to creating a co-production culture.

Reshaping Care for Older People (Scottish Government, 2011c) is Scotland’s ten year change programme to address the challenges we face from changing population demographics. This strategy is clear that we need to recognise the strengths and assets of older people in our communities and work with them to develop and deliver services which enable older people to maintain their independence. Age, Home and Community : Scottish Government’s Housing Strategy for Older People (Scottish Government, 2011d) also recognised the vital role which housing and housing-related services have in providing cost effective ways of enabling older people to live as independently as possible at home rather than in hospital or care homes. This can only be delivered through working in partnership with older people, local communities and service providers.

This shift from ‘doing to’ to ‘doing with’, of co-producing with older people points towards a fundamental shift in approach to seeing the opportunities of the changing demographics of our population. The supporting Change Fund for Reshaping Care also heralded a shift towards enabling better partnership working between health, social care, the third and independent sectors in Scotland in working together to achieve better outcomes with and for older people.

Conclusion

Public services need to be designed, commissioned, delivered and assessed in ways which value the contributions, the experience, skills and knowledge of the people who use and need the service. There are a great deal of examples of co-production already in Scotland, and increasing evidence of its positive impact. However, there remains untapped potential within all our communities. This potential will only be realised through people who deliver services working with the people who use services, making the most of their combined assets and shared desire to achieve better outcomes for people and communities.

In her inaugural address setting out Scotland’s Programme for Government, the First Minister Nicola Sturgeon MSP, was clear that, following the massive engagement in democracy across Scotland for the Independence Referendum:

“We need to find new ways of harnessing that democratic energy – not just in the great constitutional questions of our time, but also in the day to day decisions made by and for our communities… But fostering a sense of participation is about more than consulting – it’s also about handing decision-making powers back to communities. I want to ensure that more of the money we spend is directed by communities themselves - by the individuals and organisations who know best how to harness the energy of local people.”  First Minister, Nicola Sturgeon MSP, Scottish Parliament Address 26 November 2014

Throughout the address, it is clear the principles and values of co-production are essential components for the Scottish Government in its vision of public services moving forward. The Permanent Secretary to the Scottish Government, Sir Peter Housden, in his interview with the Scottish Co-production Network for this resource in January 2015, shares his views on co-production and its role within the Scottish approach to Government along with his vision for our public services. Co-production is not just ‘nice to have’; it is a key driver of reforming public services and our move towards prevention and reducing inequalities. It is clear from the range of policies outlined – which is by no means an exhaustive list – that co-production needs to become essential to the way Scotland works if we are to achieve the public services which Christie envisioned and achieve better outcomes for people and communities.

References

Audit Scotland (2014). ‘Scotland’s public finances - A follow-up audit: Progress in meeting the challenges’. Audit Scotland, Edinburgh. http://www.audit-scotland.gov.uk/docs/central/2014/nr_140605_public_finances.pdf accessed 8 January 2015
Christie, C. (2011). ‘Commission on the Future Delivery of Public Services’. Scottish Government. http://www.gov.scot/Publications/2011/06/27154527/18, accessed 8 January 2015

First Minister, Nicola Sturgeon MSP. (2014). ‘Programme for Government – address to the Scottish Parliament.’
http://news.scotland.gov.uk/Speeches-Briefings/First-Minister-Programme-for-Government-12b1.aspx, accessed 8 January 2015

Power, G. (2013). ‘Co-production in Scotland – a policy update’. In Loeffler, E., Power, G., Bovaird, T. & Hine-Hughes, F. (eds.) Co-production of Health and Wellbeing in Scotland, Governance International. http://www.jitscotland.org.uk/action-areas/co-production-community-capacity-building/ , accessed 8 January 2015

Loeffler, E. & Bovaird, T. (2013). ‘The role of co-production for better health and wellbeing: why we need to change’. In Loeffler, E., Power, G., Bovaird, T. & Hine-Hughes, F. (eds.) Co-production of Health and Wellbeing in Scotland, Governance International. http://www.jitscotland.org.uk/action-areas/co-production-community-capacity-building/ , accessed 8 January 2015

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Stephens, L., Ryan-Collins, J., & Boyle, D. (2008). ‘Co-production: A Manifesto for growing the core economy’. New Economics Foundation http://b.3cdn.net/nefoundation/5abec531b2a775dc8d_qjm6bqzpt.pdf, accessed 8 January 2015

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Scottish Government (2014b). ‘Health and Social Care Integration, Public Bodies (Joint Working) (Scotland) Act 2014 – Strategic Commissioning Plans Guidance’ http://www.gov.scot/Topics/Health/Policy/Adult-Health-SocialCare-Integration/Implementation/ImplementationGuidance/SCPlans, accessed 8 January 2015

Scottish Government (2014c). ‘Health and Social Care Integration, Public Bodies (Joint Working) (Scotland) Act 2014 – Guidance on the Principles for Planning and Delivering Integrated Health and Social Care’ http://www.gov.scot/Topics/Health/Policy/Adult-Health-SocialCare-Integration/Implementation/ImplementationGuidance, accessed 8 January 2015

Scottish Government (2014d). ‘Community Empowerment (Scotland) Bill – Policy Memorandum’. http://www.scottish.parliament.uk/S4_Bills/Community%20Empowerment%20(Scotland)%20Bill/b52s4-introd-pm.pdf, accessed 13 January 2015

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Scottish Government (2011d). ‘Age, Home and Community : Scottish Government’s Housing Strategy for Older People’. http://www.gov.scot/Resource/Doc/365373/0124256.pdf, accessed 17 February 2015

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