Does co-production provide hope in a world of austerity?
In Sheffield alone, council funding from central government has been cut by over £350 million since 2010. This has had an adverse effect across the city and a clear impact on the city’s social care landscape. On a national level a similar picture can be seen, with local governments expecting to experience a funding gap of £5.8 billion by 2020. The situation in the NHS is no different. Although the local picture is harder to discern, nationally our hospitals had a record deficit of £2.45billion in the 2015-2016 period.
Austerity is biting our health and social care provisions hard. These cuts are delivered in light of major policy reforms. The Health and Social Care Act of 2012 disbanded primary care trusts in favour of Clinical Commissioning Groups so that commissioning in the NHS could take place under competitive tendering and services could be opened up to the voluntary and private sector. The Sustainability and Transformation Plans (STPs) – part of the NHS’s Five Year Forward View - pose a new challenge for commissioners in the NHS and for social care under local authorities. The main issue being that implementing them has soaked up £325million of investment. The BMA claim this is unlikely to be enough to implement the plans properly. To get the plans rolled out correctly they estimate £9.25billion will be needed. One therefore wonders whether this £325million could have been utilised to a greater extent elsewhere. While the numbers are alarming, what many of us do not however witness is the ground floor effects on people, who rely on these services in their day to day lives.
One thing I witnessed as a front line worker in the social care sector was that people’s voices are so often left out of major decisions which have such a severe impact on their lives. This can be seen in individual care packages, where customers I have encountered have had little input into the design of their care; all the way through to national decisions such as the introduction of STPs, where there has been little to no consultation with those who they will affect.
Benedict Wauters, The European Social Fund’s Transnational Platform’s Expert, said that when designing policy, “…the question is: are we trying to make the wrong things more efficient or are we trying to do the right thing in the first place? And the answer is: we figure that one out by looking at what is going on in the field from the perspective of the citizens”. What Wauters is touching on here is that the use of co-design and co-production could be the answer to ensuring that we get the designing of national policy and services right from the outset.
A criticism which is often used to rebut suggestions of implementing greater degrees of co-production and co-design in services is that doing so costs money. This is an understandable notion when you consider the figures I mentioned at the start of this blog. What this does not take into account though, are the long term economic benefits of getting services designed right from the start.
Recent evidence emerging from the fully co-produced Gellinud Recovery Centre, in Wales, highlights the financial benefits of co-producing our services. Gellinud is a fully co-designed, co-produced and co-delivered mental health service. Its aim is to help its guests – people that stay at the centre are not called patients – to have an experience where everything, from the design of the building to the implementation of their care, is based around their voice. With an investment of £1.5million from the Big Lottery Fund and the Welsh Government, Hafal, the charity which runs the centre, estimates that Gellinud could potentially save the NHS £300,000 year on year. This means that over the timespan of the NHS’s Five Year Forward View we could be looking at a co-produced service which will have paid for itself. After this point, the Gellinud Recovery Centre will be incrementally taking the NHS back towards the black.
There is clear evidence that involving patient voices in the design, production and implementation of services has tangible financial benefits for the health and social care sector. Coupled with this is the fact that shared decision making and the co-production of services greatly improves outcomes and the speeds at which patients recover. One must therefore ask, when the ramifications of austerity are having such a detrimental effect on the pockets of services: why more is not being done to implement co-design and co-production into all aspects of service design and implementation. Through co-production and co-design we can achieve better patient experience and, potentially, work towards filling the gaps left over by austerity.
Brendan Warner-Southwell - Co:Create Programme Coordinator