Co-Production of Public Services and Outcomes [1st ed.] 9783030555085, 9783030555092

Table of contents :
Front Matter ....Pages i-xvi
Why Co-producing Public Services and Public Outcomes with Citizens Is Timely (Elke Loeffler)....Pages 1-22
Distinguishing Types and Levels of Co-production: Concepts and Definitions (Elke Loeffler)....Pages 23-73
The Four Co’s: Co-commissioning, Co-design, Co-delivery and Co-assessment of Public Services and Outcomes Through Traditional and Digital Mechanisms (Elke Loeffler)....Pages 75-176
Co-production in Health, Social Care and Public Safety (Elke Loeffler)....Pages 177-246
Challenges to Effective Co-production of Public Services and Outcomes (Elke Loeffler)....Pages 247-333
Evaluating Co-production (Elke Loeffler)....Pages 335-393
The Future of Co-production: Policies, Strategies and Research Needs (Elke Loeffler)....Pages 395-427
Back Matter ....Pages 429-444

Citation preview

Co-Production of Public Services and Outcomes Elke Loeffler

Co-Production of Public Services and Outcomes “This wide-ranging book is based on a unique set of case studies, collected over a long period of time. It will be an invaluable resource to anyone who is keen to learn about the practice of co-production.” —Taco Brandsen, Professor, Radboud University Nijmegen, Netherlands “The co-production literature has, until now, been messy, featuring scholarship from different fields across many outlets. In Co-Production of Public Services and Outcomes, Elke Loeffler has ably synthesized this research and moved knowledge of co-production forward. Integrating voluminous academic literature and numerous case studies, Loeffler distils this knowledge seamlessly and effectively. Whether you are new to co-production, a seasoned researcher, or a practitioner seeking guidance, this book has much to offer you—and the field.” —Jeffrey L. Brudney, Professor, University of North Carolina, Wilmington, USA “Engaging citizens effectively in the work of government is an imperative as old as governance itself. But the concept of co-production is not easy to explain, nor is the role that citizen co-producers play easy to measure. This book is therefore timely in capturing both co-production’s design and its practical applications, focusing mainly on OECD country contexts, where the empirical work is richest. Of especial value is the coverage of co-production’s potential adverse outcomes.” —Beth Gazley, Professor, Indiana University-Bloomington, USA “This highly anticipated volume by Elke Loeffler provides an academically rigorous and evidence-based book that systematically builds on more than 70 international co-production case studies. It incorporates the experience from years of research and training programmes, with a focus on health, social care and community safety. It emphasizes different types and levels of co-production and explores the four Co’s of co-production, along with policies that can promote the future of co-production.” —Victor Pestoff, Professor, Ersta Sköndal Bräcke Univ. College, Sweden “Elke Loeffler has made an outstanding contribution to the understanding and application of co-production in Scotland. Her four Co’s framework has proved enormously influential in supporting the redesign of Scotland’s health and social care system and was adopted by the Scottish Government’s Joint Improvement Team as the model of choice in embedding co-production into the architecture of

service design; combining the assets of Scotland’s statutory, voluntary and private sectors, together with its communities and people.” —Gerry Power, Director of Integration, Health and Social Care Alliance, Scotland “Citizen co-production is an increasingly important topic in public administration, and here Elke Loeffler provides a comprehensive and accessible overview of research and theorising. She embraces the complex history of co-production theory, covering its treatment in different academic disciplines and synthesising useful insights from the wealth of theoretical and empirical work on coproduction. This book will be an important resource both for those new to the concept and those interested in staying abreast of developments in the field.” —Sophie Yates, Public Service Research Group, UNSW Canberra, Australia

Elke Loeffler

Co-Production of Public Services and Outcomes

Elke Loeffler Strathclyde Business School University of Strathclyde Glasgow, UK

ISBN 978-3-030-55508-5 ISBN 978-3-030-55509-2 (eBook) https://doi.org/10.1007/978-3-030-55509-2 © The Editor(s) (if applicable) and The Author(s) 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover illustration: Maram_shutterstock.com This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

For my dad, Kurt Löffler.

Preface

I started to write this book at a time when user and community coproduction was often considered as a ‘nice-to-have’ to improve public services and outcomes. However, with the emergence of the COVID-19 crisis in January 2020, there has come increasing awareness that this crisis cannot be solved by governments alone and that more effective citizen coproduction is a ‘must-have’ to achieve better quality of life outcomes and public governance. It is to be hoped that this crisis, for all of the sadnesses which come with it, will therefore bring a widespread recognition of how citizen co-production can make this world a safer and better place. A great deal of the material in this book was developed during my time as Chief Executive of Governance International, of which I remain a Director. I would therefore like to thank a number of people for their contributions to this monograph. First, I’m grateful to Tony Bovaird for his advice, comments and patience. I am really grateful for the imaginative graphic support provided by Rüdiger Kern and for the unflagging administrative support from Yvonne Harley. Furthermore, I’d like to thank my colleagues at the Department of Work, Employment and Organisation at the University of Strathclyde for the great collegial spirit with which they have welcomed me and for buying into the concept of co-production in teaching and learning. There is, of course, a long list of people—from academia, public services and local communities–who have inspired my own co-production journey, making it not only a key aspect of my work life but also a

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very important and fun part of my personal life. They include John Alford, Dick Atkinson, Taco Brandsen, Jeffrey L. Brudney, Paula Brown, Karen Cheney, Julie Christie, Davinia Edafioka, Penny Halliday, Dieter Lehmann, Vivien Lowndes, Jon Mansell, Mike Owen, Salvador Parrado, Gerry Power, Paul Slatter, Gregg Van Ryzin, Matthias Schulze-Böing and his devoted co-production teams in the Offenbach Employment Agency, Victor Pestoff, Robin Surgeoner, Lucie Stephens, Gareth Symonds and Jörgen Tholstrup. This book aims to inform current and future co-production research in the (post-COVID) world, so that richer evidence becomes available on how citizen voice and action can make a difference, as well as on the limitations and potential pitfalls of co-production. More than that, I hope this book also helps policymakers and practitioners in public services, by providing a wealth of case studies and revealing practice examples. Consequently, I will very much welcome contacts from researchers, policymakers and practitioners who have contributions to add to those highlighted in this book. So, my final message is to these groups of researchers, policy makers and practitioners, and indeed to all my readers—I hope you find this book interesting and helpful, both in your work and in your life. And, in the spirit of co-production, I’m looking forward to your feedback, so that the ideas in this book can be taken forward and improved upon by all of us. A final note of explanation: One of the penalties of having a name which is unusual in English is that spelling issues arise. In my academic work, I write my surname as ‘Loeffler’ (without an Umlaut) in the case of English publications but for publications in German I write it as ‘Löffler’. Birmingham, UK

Elke Loeffler

Contents

1

2

Why Co-producing Public Services and Public Outcomes with Citizens Is Timely 1.1 Introduction 1.2 Contextual Factors Promoting Co-production of Public Services and Outcomes 1.3 Academic Discourses Around User and Community Co-production 1.4 Conclusions References Distinguishing Types and Levels of Co-production: Concepts and Definitions 2.1 Introduction 2.2 Analytical Concepts of Co-production 2.3 Normative Concepts of Co-production 2.4 Co-production as a Form of Citizen Engagement 2.5 Strategic Pathways to Co-production 2.6 A Quality Assessment Framework for Co-production 2.7 Conclusions and Recommendations References

1 1 2 12 16 17

23 23 24 33 44 51 55 65 67

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CONTENTS

3

The Four Co’s: Co-commissioning, Co-design, Co-delivery and Co-assessment of Public Services and Outcomes Through Traditional and Digital Mechanisms 3.1 Introduction 3.2 A Framework for Co-producing Public Services and Outcomes with Service Users and Communities: The Four Co’s Model 3.3 Co-commissioning Priority Outcomes 3.4 Co-designing Public Services and Pathways to Outcomes 3.5 Co-delivering Public Services and Public Outcomes 3.6 Co-assessing Public Services and Public Outcomes 3.7 Digital Co-production 3.8 Conclusions References

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Co-production in Health, Social Care and Public Safety 4.1 Introduction 4.2 A Generic Public Intervention Model to Deliver Improved Outcomes 4.3 Co-production in Health 4.4 Co-production in Social Care 4.5 Co-production of Community Safety Outcomes 4.6 General Conclusions on Co-production in Health, Social Care and Community Safety References Challenges to Effective Co-production of Public Services and Outcomes 5.1 Introduction 5.2 Overcoming the Implementation Gap in Co-production 5.3 Risks and Uncertainties Arising from Co-production 5.4 Change Management to Implement Co-production 5.5 Leadership for Co-production 5.6 Negative Sides of Co-production and Ways of Addressing Them

75 75

76 85 98 114 127 135 159 160 177 177 178 179 194 216 231 233

247 247 248 261 278 297 304

CONTENTS

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7

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5.7 Conclusions References

321 323

Evaluating Co-production 6.1 Introduction 6.2 A Public Value Framework 6.3 Increased Quality of Life Outcomes Arising from Co-production 6.4 Increased Efficiency Arising from Co-production 6.5 Increased Service Quality Arising from Co-production 6.6 Improved Public Governance from Co-production Processes 6.7 Additive Versus Substitutive Citizen Co-production 6.8 Conclusions References

335 335 336

The Future of Co-production: Policies, Strategies and Research Needs 7.1 Introduction 7.2 The Future Role of Co-production 7.3 Policies for Mainstreaming Effective Co-production 7.4 Growing the Evidence-Base for Co-production: A Research Agenda 7.5 and Finally—The Future of Co-production Practice and Research Post-Covid-19 References

Index

344 356 363 370 379 384 387

395 395 395 399 408 421 423 429

List of Figures

Fig. 2.1 Fig. 3.1 Fig. 3.2 Fig. 3.3

Fig. 3.4 Fig. 4.1 Fig. 4.2 Fig. 4.3 Fig. 4.4

Fig. 5.1 Fig. 5.2 Fig. 5.3

A quality framework for user and community co-production (Source Author) The Four Co’s in the Co-Production Star (Copyright © Governance International 2013) The co-commissioning cycle (Source Adapted from Loeffler and Bovaird [2019, 246]) How digital technologies enable co-production: from e-government towards digital transformation (Source Author) How digital technologies can support moves towards and away from co-production (Source Author) A generic model of public service interventions (Source Adapted from Loeffler and Bovaird [2019a, 249]) The level of engagement of citizens with older people (Source Adapted from Löffler et al. [2015, 9]) The level of engagement of citizens with young people (Source Adapted from Löffler et al. [2015, 9]) The extent of co-production between citizens and local authorities to improve the quality of life of young or older people (Source Adapted from Löffler et al. [2015, 8]) Conceptual model of barriers to co-production (Source Author) A risk enablement co-production cycle (Source Author) The change management process of the co-production star (Copyright © Governance International 2013)

58 77 91

136 147 178 205 205

206 251 277 280

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LIST OF FIGURES

Fig. 6.1 Fig. 6.2 Fig. 6.3

The Governance International Public Value Model (Source Adapted from Loeffler and Bovaird 2019, 243) Dimensions of quality of life outcomes: Level, variability and change potential (Source Author) Perception by different groups of the quality of life and governance on Carrick Housing estates (Source Copyright © Governance International 2005)

341 350

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List of Tables

Table 1.1 Table Table Table Table Table

2.1 2.2 2.3 2.4 2.5

Table Table Table Table Table Table Table

3.1 3.2 3.3 3.4 3.5 3.6 3.7

Table 4.1 Table 4.2

Table 5.1 Table 5.2

PESTEL analysis of key drivers of co-production in services for young people, Surrey County Council Principles of co-production Co-production as a form of citizen engagement Who knows and who cares about a service? Pathways to user and community co-production Criteria for assessing the quality of user and community co-production A typology of co-production modes—the Four Co’s Types of user and community co-commissioning Types of user and community co-design Types of user and community co-delivery Types of user and community co-assessment Four modes of digital user and community co-production The potential impacts of the characteristics of digital technologies on the Four Co’s The potential role of co-production in social work theories Phases of social work treatment interventions and corresponding potential roles of user and community co-production Risks arising from user and community co-production Risk management strategies for different knowledge domains

7 39 45 49 52 63 81 86 100 115 133 139 151 195

204 263 272

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LIST OF TABLES

Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 7.1

Motivation factors and influence mechanisms for co-production Top-down and bottom-up versus inside-out and outside-in change management strategies Negative impacts of co-production and ways of addressing them: typology and examples Public governance pitfalls from co-production and ways of addressing them The relationship of public value to core administrative values in a co-production context: Hood revisited Young People’s Outcomes Framework of Surrey County Council Costs related to co-production Who knows about service quality? Modes of governance and key principles of democratic public governance Additive and substitutive forms of citizen co-production from a public sector perspective A research agenda for co-production from the chapters of this book

291 295 305 312 339 353 357 368 374 380 409

CHAPTER 1

Why Co-producing Public Services and Public Outcomes with Citizens Is Timely

1.1

Introduction

User and community co-production has experienced renewed interest internationally in both academia and practice since the early 2000s, after its original short burst of prominence in the US around the 1980s. In the words of John Alford (2009, 4), “co-production is (back) in fashion”. This has been accompanied by an exponential growth of publications on all aspects of co-production. Furthermore, the term co-production is increasingly used by a wide range of stakeholders in the policy community and public services—perhaps most obviously in countries such as the UK and Netherlands, but also in many other parts of the world (although rather less in Germany, France and the USA). Many governments have published reports on the potential of co-production, while the European Union has funded a considerable number of co-production research projects within its Horizon 2020 programme and other initiatives. European umbrella organisations such as the European Platform for Rehabilitation (2016) have also commissioned studies and briefing papers on co-production. This chapter will explore the contextual factors which help to explain the rise of interest in co-production. This analysis uses a PESTEL framework, which covers political, economic, social, technological, environmental and legislative drivers of co-production. This is necessarily quite a brief tour through each of the relevant factors—however, some

© The Author(s) 2021 E. Loeffler, Co-Production of Public Services and Outcomes, https://doi.org/10.1007/978-3-030-55509-2_1

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especially important co-production drivers such as leadership and digital technologies will be analysed further in later chapters of this book. Following this discussion of the factors driving co-production in policy and practice in OECD countries, this chapter then provides an overview of the evolution of the concept in public administration and policy.

1.2 Contextual Factors Promoting Co-production of Public Services and Outcomes 1.2.1

The Growing Interest in Co-production of Public Services and Outcomes

Not so long ago the term co-production was mainly used for the joint productions by media companies making films or television programmes together. More recently, this has changed dramatically—co-production has become one of the most widely used terms in the social sciences, but now in the sense of citizens as users of public services or members of the community working together with public service organisations. In particular, literature reviews show that in the field of public management and administration there has been an almost exponential increase in the number of articles making reference to co-production in the last ten years (Voorberg et al. 2015; Sicilia et al. 2019). Moreover, in the UK, the term has also become part of public sector policy and practice—for example, it has appeared in civil service reports (Horne and Shirley 2009) and even in government programmes (Christie 2011) and is now to be found in the strategic plans of an increasing number of local authorities and health and social care partnerships. Co-production, and in particular co-design, is also becoming a key element of digital transformation strategies in the public sector (Scottish Government 2018). Of course, this does not necessarily imply that there is now a shared understanding of co-production of public services and outcomes in the academic community or in public service organisations. Indeed, use of the term has become so widespread, and it has been applied to so many phenomena, that there is a risk that it is becoming the victim of its own success. If everything is described as ‘co-production’, then the concept ceases to add anything meaningful. Hence this monograph on the coproduction of public services and outcomes, which seeks to both clarify and to exemplify the role, the potential and the limitations of user and community co-production.

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Throughout this book, we will be exploring in detail how citizens, both as service users and as members of their communities, can contribute to improving public services and achieving publicly-desired outcomes. This means that we do not limit co-production to improving public services, since public services are only a means to an end—namely, to improve publicly-desired outcomes, including both quality of life outcomes for citizens and public governance principles. It is also important to note at the outset that this is not a book about ‘citizenship’ in the political science sense nor about ‘community development’—we use both the terms ‘citizen’ and ‘community’ in a very broad sense. Specifically, we take the term ‘citizen’ to include residents in a particular country, whether or not they have formal citizenship status. It therefore includes people such as migrants or children who are not allowed to vote. Again, we often contrast ‘user co-production’ with ‘community coproduction’. ‘User co-production’ focuses on the co-production relationship between public service organisations and those using a specific service. ‘Community co-production’, on the other hand, highlights how people in a specific community, including many who do not use a public service, may make a contribution to improve publicly desired outcomes through their co-production. Often the communities about which we are talking will be defined by geographic boundaries—but not always. In particular, in the digital age we need to recognise that communities may also be defined by their shared interests (Loeffler and Bovaird 2018, 405). Above, we have already used the term ‘public service organisations’, so it is also important to note right at the beginning that we include within this category all organisations, whether from public, private or third sectors, which make a significant contribution to public services— which also means, of course, that they are likely to have an interest in co-production of public services with citizens. 1.2.2

User and Community Co-production in a Context of Austerity

How can this increasing interest in co-production be explained? Academic interest in the concept of co-production originated with the Ostroms and their colleagues in the Workshop in Political Theory and Policy Analysis at Indiana University, Bloomington (known as the ‘Bloomington School’), who coined the term (see Parks et al. 1981 and Ostrom 1996). This

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was in the late 1970s and early 1980s, a period of economic uncertainty and even recession in the US. Similarly, the recent renaissance of co-production research around the world has occurred in the context of financial austerity, which has meant a reduction of government spending and lower living standards in many countries (Loeffler 2016, 325). It is therefore tempting to assume that interest in co-production is essentially an offspin from austerity and, in consequence, that it is being used as a strategy for cutting public spending. Indeed, it sometimes suggested that co-production is just a cover for ‘dumping government responsibilities on the public’ and that public sector interest in the potential benefits of co-production is actually just a pretence. From this perspective, co-production is simply a nice way of describing how responsibility for citizen wellbeing has been passed to those least able to cope—essentially it is the public sector saying ‘make better use of your own resources, because you can’t have ours’. As a community activist commented in 2012 on the launch of a major co-production initiative of the London Borough of Lambeth: “It was a top-down initiative. There had been no large-scale attempt to engage the community and voluntary sector in debating and shaping it [before it was announced]. Many affected treated it with a great deal of scepticism, as a cover for a Labour council to make massive budget cuts palatable” (Creighton 2012). Seven years later, another local resident blogged: “Lambeth Council is still officially a Co-operative Council. This may come as a surprise for some residents, especially those living on estates threatened with unwanted regeneration, or those fighting to keep their libraries open or people who don’t want to see their precious parkland handed over to private companies every year” (Cobb 2018). This perceived “deliberate rejection of responsibility” (Steen et al. 2018, 284) by the public sector points to an aspect of the ‘dark side’ of co-production. However, far from being the purpose of co-production, ‘hollowing out the state’ by transferring full responsibility for public services to citizens actually means the end of co-production. This book is about both public service organisations and citizens contributing to improvements in quality of life, not one side dumping all responsibility onto the other. However, perhaps surprisingly, there is actually little evidence that coproduction has been even considered by managers in local public services as a budget saving strategy, at least in the UK. While evidence from case study research in English local authorities shows the importance of a wide

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range of cost-cutting and efficiency measures, as in previous periods of austerity (Lowndes and McCaughie 2013), few of these have any connection to co-production. Moreover, front-line staff and middle managers who would like to promote the concept of co-production within their organisation or across partners often find it very challenging to get top managers, in particular those with financial and budget management responsibilities, to show any interest in the concept, let alone in the design and delivery of a savings plan which gives weight to co-production. It is telling that the major UK professional body for public finance, the Chartered Institute of Public Finance (CIPFA) has not really engaged much with the concept—at least, not in its policy documents nor in its training programmes for finance officers. We therefore suggest that the potential effects of user and community co-production, and the means by which it can be implemented, have to be understood in the context of austerity—but not simply as a reaction to austerity. So what might be the other reasons for this growing interest in co-production? In the following chapters there will be a close analysis of many case studies and quantitative research that suggest that co-production can be highly effective in improving public services and outcomes. So, as strong advocates of ‘evidence-based policy’, we might wish to attribute the growth of interest in co-production to the increasing data base of positive results. However, as we will see, it is too early to say ‘case proven’ in respect of co-production—the initiatives in these case studies are usually still too small-scale and the evidence base is still too thin to be conclusive. More generally, we now turn to look at a wider range of drivers of change in public services—first, through a PESTEL analysis of macroenvironment factors, then through a consideration of the academic discourse around how government and the public interact in a coproductive way. 1.2.3

A PESTEL Analysis of the Drivers of Co-production

Clearly, we need to consider a more comprehensive explanatory framework in order to understand the drivers of co-production. For this purpose, we shall start by using the PESTEL framework (Political, Economic/Financial, Social, Technological, Environmental and Legal/Legislative), which highlights key factors at the macro-level in the

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external environment that need to be taken into account in the context of each specific service or outcome. By way of illustration of how these macro-environment factors can result in a move to greater co-production, Table 1.1 shows a PESTEL analysis for a co-production initiative in Services for Young People of Surrey County Council. This initiative involved the recommissioning of all services for young people (from 14 to 19 years of age) characterised as NEET (Not in Education, Employment or Training) in order to improve their outcomes, especially their employment and educational outcomes. The Table draws mainly on information from Tisdall (2014) and Bovaird and Loeffler (2014). As far as political factors are concerned, there is a gap in the coproduction literature. While there is emerging research on leadership for co-production (Bussu and Galanti 2018; Schlappa and Imani 2018; Schlappa et al. 2020), little attention has been paid to the specific role of elected politicians, particularly at the local level. Hendriks and Tops (2005) suggest that facilitative leaders can only become ‘champions’ of a project if they have a ‘sponsor’ who gives political backing to their often unconventional practices. In the case of Surrey County Council, this was the Conservative Party Leader of the Council at the time, who did not necessarily embrace co-production but gave permission to the senior management team of the service to undertake a radical transformation of Services for Young People in order to work toward the highly ambitious political vision of ‘Zero NEETs’. The importance of support and strategic guidance from (at least some) top leaders in the organisation will be a pattern that we see often in this book (and will be discussed further in the section on leadership). Moving to the financial and economic factors in Table 1.1, these have clearly been a key concern for public service organisations around the world since the financial crash of 2008. In the case of Surrey County Council, a major budget cut to Services for Young People (which, unlike Children’s Services, are non-statutory in the UK) provided a window of opportunity for the Assistant Director of the service to start a major reform process. The budget cut was important enough to justify a systems transformation but not large enough to reduce slack completely. The existence of slack resources which can be put to new uses is important for innovation processes and, in this case, the transformation team in Surrey CC decided that co-production would be a key element of this process.

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Table 1.1 PESTEL analysis of key drivers of co-production in services for young people, Surrey County Council Dimensions

Factors driving co-production

Likelihood that the factor will occur (as seen in advance)

Impact on co-production (in hindsight)

Political

Leader of County Council promoted vision to reduce number of NEET young people Budget cut of 25% within 3 years Presence of wide range of specialist third sector providers in the market

High probability that a policy promoted by the Leader (with a stable majority) will be implemented Definite—clear decision of Council Medium probability—not possible to be sure in advance that claims to excellence of third sector organisations were justified

Social

Constant level of number of young people at risk of becoming NEET

High—had already remained almost constant over 10 years

Technological

Increasing use of social media by young people (e.g. Facebook)

High probability this trend will continue or even grow in pace

Environmental

NEET young people may be at risk of becoming homeless unless they have access to temporary accommodation

Medium—increasing housing prices mean that fewer young people will be able to afford to rent their own flat

Medium—co-production was not specifically promoted by the Leader but was an obvious option High—made options other than co-production within outcome-based commissioning more difficult High—but some providers were replaced quickly when they could not substantiate their claims and others needed substantial support from the local authority Medium—co-production became increasingly likely over time, as all other strategies to tackle NEETs over a decade appeared to have little effect Medium—made it easier for young people to interact with other young people but staff faced barriers in using social media at work High—Surrey County Council set up Volunteer Host Service to help to prevent young people aged 16–21 becoming homeless

Economic and financial

(continued)

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Table 1.1 (continued) Dimensions

Factors driving co-production

Likelihood that the factor will occur (as seen in advance)

Impact on co-production (in hindsight)

Legislative

Raising of participation age, which local authorities had a statutory duty to enforce

High—little leeway for councils to avoid enforcing this duty

High—gave strong mandate for bringing young people into council decision making and service delivery

Source Author

Looking at social factors, co-production also offers new collaborative service models and solutions to deal with social trends such as the ageing society, rising health service and social care demands, changing family relationships, educational needs and homelessness. In the Surrey example, a key factor was the constant number of young people in each generation who showed all the signs of becoming NEET, whatever policies had been tried to help them—this longstanding trend meant that the problem was unlikely to go away but also demonstrated that it was unlikely to be successfully tackled by previously tried interventions. More generally, looking beyond this example of the problems of young people, the social challenges facing public service organisations which have had most attention in OECD countries have been the increasing numbers of older people and of people living with chronic health conditions. Co-production not only offers new interventions to respond to these challenges but actually provides a quite new perspective on the ‘ageing society’, highlighting not simply the negative consequences of extra public spending associated with an ageing population but also the positive side, constituted by an increasing number of citizens, who now have the time to make valuable contributions to improving the wellbeing of local communities. Indeed, taking this positive perspective, and categorising people not by their age but by their “remaining life years”, we find that “the population may be getting younger” (Potter 2013, 7), over the past few decades, in the sense that on average, people at any given age (e.g. the statutory retirement age) now have much longer life expectancy than used to be the case, with the implication that many people now can be active co-producers for a much longer period.

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There are, of course, many other social factors which may impact on the level of co-production. Pandemics such as the recent Covid-19 crisis have led many governments to call on volunteers to meet a sudden rise in demand for help. In the UK, more than 750,000 citizens have responded to a call from the government for volunteers to support the NHS (Royal Voluntary Service 2020), mainly consisting of different types of co-delivery, including doing the shopping for or distributing food to ‘at risk’ groups, peer support to deal with mental health challenges, and co-influencing people to accept major behaviour change such as physical distancing (Loeffler 2020). Technological factors are also highlighted in the PESTEL as playing a key role in the evolving role of co-production. In particular, many digital technologies enable new forms of co-production or transform existing personal forms of co-production. However, as Lember (2018, 118) points out, in some cases, digital technologies such as remote health-monitoring devices, which automatically record and report their health data may mean there is less need for active contributions from citizens. The co-production literature (for example, Meijer 2012; Paletti 2016) has also highlighted the role of social media, which can enable local authorities to support community initiatives and also to invite citizen support for projects initiated by public service organisations. The Surrey County Council example in Table 1.1 highlights the potential of social media to connect young people with other young people, so that they are able to provide peer support to each other. However, the ability of public services staff to connect with young people through social media has been limited for a number of reasons, so that digitally enabled technology has had, at best, only medium impact as a driver of co-production. Nevertheless, as Meijer (2012, 196) points out, many of the ideas of social media champions are highly supportive of the concept of user and community co-production—actually, we would go further to suggest that many digital solutions in public services actually rely on citizen-professional collaborations. For example, according to research from Oxford University, for any digital contact tracing app to be effective it would need to be used by more than half the total population (Hern 2020). Environmental factors in the PESTEL framework cover both the natural environment and built environment. They also include both local environmental factors, such as urban pollution, and also macro-scale factors, such as global warming and the loss of wildlife habitats. Most

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such environmental challenges typically require public service organisations to bring about collective behaviour change and community action on a major scale. Environmental issues are one of the public policy areas in which there is a very high level of volunteering. Local initiatives such as the Street Ambassadors Network in Wales (Carnegie UK Trust et al. 2013) highlight how this can be achieved. However, increasing concern with the state of the global and local environments suggests that there will have to be a great deal more collective co-production if better environmental outcomes are to be achieved. In the case of Services for Young People in Surrey, lack of suitable accommodation was identified as an important environmental risk factor for NEET young people. In order to prevent homelessness Surrey County Council set up the Volunteer Host Service to provide successfully both short-term and longer-term accommodation for young people. The last category in the PESTEL framework is legal or legislative factors. An early example is given by the Economic Opportunity Act 1964 in the USA, which required the planning of national government poverty programmes to incorporate ‘maximum feasible participation’ of the poor (Cahn and Gray 2012, 132). There are now a number of legislative and regulatory frameworks encouraging co-production, although none of them make it obligatory. For example, the Framework on Integrated, People-Centred Health Services of the World Health Organisation (2016, 4) promotes a strategy for empowering and engaging people and communities which “aims to empower individuals to make effective decisions about their own health and to enable communities to become actively engaged in co-producing healthy environments, and to provide informal carers with the necessary education to optimize their performance and support in order to continue in their role”. Although most governments have signed up to it, this framework is, of course, only a guideline and therefore not mandatory. The Welsh Government (2015, 3) has gone further in its Well-being of Future Generations (Wales) Act 2015, which aims at “improving the social, economic, environmental and cultural wellbeing of Wales”. The Act requires all public bodies to publish an annual Well-being Statement which demonstrates that “they make sure that they involve people with an interest in achieving the [well-being] goals, and that those people reflect the diversity of their area” (Welsh Government 2015, 8). The Health Services in Ireland are even more specific by making co-production a key principle for recovery-promoting services in the new

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national framework for recovery in mental health (Mental Health Services 2017). In the case of Surrey County Council, Services for Young People, there was a key legislative driver in the raising of the participation age, which placed a duty on local authorities to ensure young people participate in education, training or employment (with training) up to age 19. This helped considerably by giving the service a mandate which local councillors and other local public services could not dispute. The overall governance system also determines how important the legal framework is for co-production. This is particularly apparent in the co-production of public safety and law and order. In administrative law countries, many activities to improve public safety are often considered to be ‘sovereign tasks’ of the state and unsuitable for co-production (Loeffler 2018, 213). This may be different in countries with a Westminister public value tradition such as the UK where the police actively promotes community support, e.g. through Neighbourhood Watch or Speedwatch groups. More research is needed to identify the extent to which different drivers (at macro- and micro-levels) are necessary and which drivers are sufficient to promote co-production. This will also involve research on obstacles to co-production in order to reveal what gets in the way. These contextual conditions are likely to differ from service to service and also between countries. This book will mainly explore co-production in OECD countries, with a particular emphasis on the UK. We recognise, of course, that developing countries offer many lessons in relation to co-production (as Elinor Ostrom highlighted in her work). However, their contextual conditions and challenges are often quite different, so we believe that a proper exploration of co-production in these countries will require a separate analysis. In many cases, it may turn out that the combination of factors is more important than any single factor. Indeed, it is likely that ‘wicked problems’ are caused by a combination of factors which may be related to social factors such as demographic change and environmental challenges such as climate change—and, as Head and Alford (2015) highlight, this means that they need to be tackled by strategies with multiple components, which go beyond simple collaboration and coordination strategies.

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1.3 Academic Discourses Around User and Community Co-production In the first section of this chapter, we discussed how a series of factors have produced a context in which there is lively practical and policy interest in co-production. In this section, we will briefly complement this analysis with a discussion of the discourses which have driven renewed academic interest in co-production. We shall begin with the ‘citizen-centric turn’ which can be identified in public policy from the 1960s and which was effectively captured by Sherry Arnstein (1968) in her ‘Ladder of Participation’, about which we shall say more later. The most visible policy manifestation of this turn in the UK was the statutory requirement from the 1960s onwards for public consultation in the preparation of development plans by local authorities. In exercising this right, however, citizens generally have to show that they have a material interest which will be affected by the proposals in the plan. This means that some citizens who might have potentially valuable contributions to make are limited in the roles they can play. At this time, academic research was particularly concerned with the rights of citizens to have their say around public policies which affected them. It therefore focused on ‘citizen voice’, rather than ‘citizen action’, on citizen rights rather than citizen capabilities, and on the opportunity of people to make known their individual concerns rather than wider social concerns. However, the ‘citizen-centric turn’ quickly gained a further dimension. Social movements became active from the 1960s. In the US they were initially identified closely with the civil rights movement but soon encompassed feminist, environmentalist and other causes. This quickly generated a literature which again had a major focus on rights rather than capabilities but now analysed collective goals and benefits and citizen actions, not just voice, although these collective goals were differently prioritised within each social movement. Barnes et al. (2007) map four different directions taken by this ‘citizencentric turn’: • ‘Empowered public’ discourse—which conceives of communities’ disadvantage as deriving from institutionalised discrimination/neglect and therefore supports interventions which will empower these communities to act on their own behalf.

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• ‘Consuming public’ discourse—which conceives of individuals as free agents, able to exercise choice in their use of available public services, acting as active consumers in the process of service selection and delivery, with rights and opportunities for redress. • ‘Stakeholder public’ discourse—which conceives of “the public (as individuals or groups) having a stake in the good governance of the public realm” (Barnes et al. 2007, 15), thereby acting to strengthen representative democracy or, in some cases, to provide a fundamental challenge to it by privileging citizen control and consensual decisionmaking in participatory democracy. • ‘Responsible public’ discourse—which emphasizes “the role of individuals and groups in owing a duty to others and to the state in their conduct” (Barnes et al. 2007, 19), acknowledging the vital role of the family and civil society, and highlighting the importance of selfgovernance, whether it be through self-discipline at individual level or communities governing themselves. The original academic exploration of co-production, by the Ostroms and colleagues in the Bloomington School, can be seen as a combination of several of these directions. They examined the contribution of citizens to policing in Chicago and highlighted how intense forms of police collaboration with the public increased policing effectiveness (Parks et al. 1981). Here, citizens were acting in their own interest as stakeholders to reduce crime in their community, but there was also a strong flavour of the ‘responsible public’ discourse, as communities were encouraged by the police to practice self-governance and use social pressure to dissuade those who might otherwise be tempted to commit crimes. Moreover, there was an element of ‘empowered public’ discourse, as police engaged particularly with disadvantaged communities in Chicago, where crime levels were high. Inspired by the empirical work of the Bloomington School, a number of academics undertook important conceptual work to clarify further the concept of co-production—for example, Sharp (1980) and Whitaker (1980). In particular, Brudney and England (1983) made the valuable distinction between individual, group and collective co-production. After this first outbreak of academic interest in co-production in the early 1980s, published research on co-production in the public domain rather languished until the mid-1990s, as New Public Management (NPM) captured academic attention and most researchers focussed on

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marketisation and managerialism as alternatives to direct government production of public services (Alford 2009, 4–5). John Alford (2009, 6) suggests that a major reason for the reduced interest in co-production at the time was that it was perceived to be about volunteering, which in the era of NPM was considered as too much dependent on altruistic behaviour. Since the early 2000s, the concept of co-production has taken on a new life in the academic public administration literature, demonstrating exponential growth in recent years. An early catalyst to this new interest was John Alford’s influential set of publications in (2002, 2009), which focussed on co-production by clients—which in this book we call user co-production. Later, the multiple roles of the public as citizen, customer and partner were highlighted by Thomas (2012). Widely cited and influential publications at this time on user and community co-production in the public sector include (for example, Bovaird 2007; Dunston et al. 2008; Loeffler et al. 2008; New Economics Foundation 2008; OECD 2009; Jakobsen 2012; Pestoff et al. 2012; Bovaird and Loeffler 2012; Osborne et al. 2013; Brandsen and Honingh 2016; Brandsen et al. 2018). Furthermore, interest grew in co-production through third sector organisations (Brandsen and Pestoff 2006; Pestoff 2012; McMullin 2019), particularly in their role of mobilising citizen involvement in co-production. Most of the recent empirical research has been based on a rather narrow range of qualitative methodologies, mainly involving single case studies, sometimes expanded to involve case comparisons (Voorberg et al. 2017). Qualitative research on co-production based on ethnographic methods or other methods is still rare. An increasing number of experimental studies have also been undertaken recently (Kang and van Ryzin 2020), sometimes showing positive results of co-production on outcomes (for example, Jakobsen 2012; Jakobsen and Andersen 2013), sometimes with negative results (for example, Thomsen and Jakobsen 2015). The absence of quantitative studies with a wider scope therefore constitutes a serious gap in the literature. In particular, comparative quantitative studies have been rare. A rare exception has been the quantitative comparison of co-production across five EU countries (Loeffler et al. 2008; Parrado et al. 2013; Bovaird et al. 2016), which has recently been expanded by inclusion of similar study of Australia (Alford and Yates 2016). In parallel to the public administration literature, the service management literature in the private sector highlighted that in service systems,

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the client appears twice, once as a customer and again as part of the service delivery system. Normann (1984) discusses how sometimes service professionals use a “relieving logic relieving logic,” in which they “do the service for the customer”, whereas in other services, the client actually performs at least some of the key tasks and the service professional plays mainly an enabling role. Early private sector examples, such as the self-service supermarket and bank ATMs were clearly meant to increase the efficiency (and profit levels) of their services. This customer service logic means that “When using resources provided by a firm together with other resources and applying skills held by them, customers create value for themselves in their everyday practices” (Gronroos ¨ 2008, 299). This approach has recently been explored further by Osborne et al. (2013) in a public service context. Normann (1984) predicted that as service users become increasingly competent, providers who could offer enabling relationships would become more prominent and pose tough competition for “relievers”. Until recently, this forecast appears to have been more prescient in the case of private services than in public services but what is perhaps most remarkable is that co-production in the public and private sectors has proceeded largely independently, with little interactive learning from each other’s experiences. The fast growth in academic publications on co-production is highlighted by Sicilia et al. (2019), who found in their electronic search of papers listed in the ISI Web of Knowledge and Scopus databases nearly 1500 papers using the terms “coproduction” or “co-production” in the title, abstract, and/or keywords sections (The search was restricted to English language papers published in peer-reviewed journals in the subject areas of management, business, public administration, economics, or sociology). Interestingly, of the 53 papers which presented empirical material which met their selection criteria, 62% were published since 2015. Important roles in promoting the academic study of co-production have been played by the annual meetings of the Study Group on Co-Production of the International Institute of Administrative Sciences (IIAS), the Permanent Study Group on ‘Civil Society, Citizens and Government’ of the European Group of Public Administration (EGPA) as well as many panels dedicated to co-production themes at the Annual Conference of the International Research Society for Public Management (Pestoff 2019, 5). Furthermore, Special Issues of the journal Voluntas (Vol. 23, No. 4, 2012), the International Review of Administrative Sciences (Vol. 82, No. 1, 2016), the International Journal of Public

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Administration (Vol. 39, No. 13, 2016), Public Management Review (Vol. 21, No. 11, 2019) and Public Money and Management (Vol. 39, No. 4, 2019) demonstrate how popular this topic has become in public management and governance academic research. While most of the published co-production research has focussed on OECD countries and, in particular, on English-speaking countries (with the partial exception of the USA, where interest has remained muted), there are now also more publications on co-production in African, Asian and Latin American countries. Unlike research into public participation, where most academic work has been based in political science, public administration and sociology, research into co-production has attracted scholars from across almost all social science disciplines. The theoretical and conceptual bases for co-production in political science, public administration, sociology, economics, psychology and critical theory have been set out in Bovaird and Loeffler (2012), and in this book we will call upon elements of analysis from each of these disciplines at various stages. Of course, this disciplinary focus raises the question as to whether co-production might be more productively studied from an interdisciplinary perspective— indeed, the Palgrave Handbook of Co-production of Public Services and Outcomes (Loeffler and Bovaird 2020) has been compiled to contribute to this purpose. One final academic discourse which deserves mention here is the ‘antiparticipation’ school. This approach is well represented in the book of readings Participation: The New Tyranny, edited by Cooke and Cothari (2001), who recount how the idea for the book arose from conference discussions with academic colleagues who told tales of “participatory processes undertaken ritualistically, which had turned out to be manipulative, or which had in fact harmed those who were supposed to be empowered” (p. 1). As we shall see, a number of academics have made similar criticisms of some practices of co-production.

1.4

Conclusions

Co-production has become a buzzword in public management and governance—both in practice and in academic research. Its growth in policy and practice has been encouraged by a wide range of factors (which we

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have categorised within the PESTEL framework). Simultaneously, coproduction has become a major theme in recent academic research into public administration. Nevertheless, there are grounds for doubting whether the commitment to co-production by public services is as full as public service organisations often maintain. In the rest of this book, we examine the different ways in which co-production operates and its potential benefits and costs—and also the factors which make it likely or unlikely that the public sector will choose this approach to transforming its services and improving the outcomes it achieves.

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Brandsen, T., & Honingh, M. (2016). Distinguishing different types of coproduction: A conceptual analysis based on the classical definitions. Public Administration Review, 76(3), 427–435. Brandsen, T., & Pestoff, V. (2006). Co-production, the third sector and the delivery of public services: An introduction. Public Management Review, 8, 493–501. Brandsen, T., Steen, T., & Verschuere, B. (Eds.). (2018). Co-production and co-creation: Engaging citizens in public services. New York and Abingdon: Routledge. Brudney, J. L., & England, R. E. (1983). Toward a definition of the coproduction concept. Public Administration Review, 43(1), 59–65. Bussu, S., & Galanti, M. T. (2018). Facilitating co-production: the role of leadership in coproduction initiatives in the UK. Policy and Society, 37 (4), 347–367. Cahn, E. S., & Gray, C. (2012). Co-production from a normative perspective. In V. Pestoff, T. Brandsen, & B. Verschuere (Eds.), New public governance, the third sector and co-production (pp. 129–144). New York and London: Routledge. Carnegie UK Trust, WCVA, Creation Development Trust and Time Banking Wales. (2013). Street Ambassadors (Llydsgenhadon y Stryd): A new approach to public services through co-production. https://www.carnegieuktrust.org.uk/ publications/street-ambassadors-a-new-approach-to-public-services-throughco-production/. Accessed 20 Feb 2019. Christie, C. (2011). Commission on the future delivery of public services. Edinburgh: Public Services Commission, Scottish Government. https://www2. gov.scot/Resource/Doc/352649/0118638.pdf. Accessed 18 Feb 2019. Cobb, J. (2018). Lambeth still officially a co-operative council despite resident requests to work with the Town Hall ignored. Brixton Buzz. http://www.bri xtonbuzz.com/2018/09/lambeth-council-still-officially-a-co-operative-cou ncil-despite-resident-requests-to-work-with-the-town-hall-ignored/. Accessed 18 Feb 2019. Cooke, B., & Cothari, U. (Eds.). (2001). Participation: The new tyranny. London: Zed Books. Creighton, S. (2012). “Never knowingly understood”? Realities of a co-op council. Inside Croydon. https://insidecroydon.com/2012/11/24/neverknowingly-understood-realities-of-a-co-op-council/. Accessed 18 Feb 2019. Dunston, R., Lee, A., Boud, D., Brodie, P., & Chiarella, M. (2008). Coproduction and health system reform—From re-imagining to re-making. The Australian Journal of Public Administration, 68(1), 39–52.

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European Platform for Rehabilitation. (2016). Briefing paper: Co-production of services. December 2016. Brussels: European Platform for Rehabilitation. https://www.epr.eu/wp-content/uploads/EPR_Paper_on_Co-pro duction_2016-1.pdf. Accessed 28 Feb 2019. Grönroos, C. (2008). Service logic revisited: Who creates value? And who cocreates? European Business Review, 20(4), 298–314. Head, B. W., & Alford, J. (2015). Wicked problems: Implications for public policy and management. Administration and Society, 47 (6), 711–739. https://doi.org/10.1177/0095399713481601. Hern, A. (2020). Digital contact tracing will fail unless privacy is respected, experts warn. 20 April 2020. The Guardian. https://www.theguardian.com/ world/2020/apr/20/coronavirus-digital-contact-tracing-will-fail-unless-pri vacy-is-respected-experts-warn. Accessed 27 Apr 2020. Hendriks, F., & Tops, P. (2005). Everyday fixers as local heroes: A case of vital interaction in urban governance. Local Government Studies, 31(4), 475–490. Horne, M., & Shirley, T. (2009). Co-production in public services: A new partnership with citizens (Discussion Paper). London: Strategy Unit of the Cabinet Office. Jakobsen, M. (2012). Can government initiatives increase citizen coproduction? Results of a randomized field experiment. Journal of Public Administration Research and Theory, 2012(23), 27–54. Jakobsen, M., & Andersen, S. C. (2013). Coproduction and equity in public services. Public Administration Review, 73(5), 704–713. Kang, S., & Van Ryzin, G. G. (2020). Experimental methods for investigating co-production. In E. Loeffler & T. Bovaird (Eds.), The Palgrave handbook of co-production of public services and outcomes. London: Palgrave Macmillan. Lember, V. (2018). The increasing role of digital technologies in co-production and co-creation. In T. Brandsen, T. Steen, & B. Verschuere (Eds.), Coproduction and co-creation: Engaging citizens in public services (pp. 115–127). New York and Abingdon: Routledge. Loeffler, E. (2016). Co-production of public services and outcomes. In T. Bovaird & E. Loeffler (Eds.), Public management and governance (pp. 319– 336). Abingdon and New York: Routledge. Loeffler, E. (2018). Providing public safety and public order through coproduction. In T. Brandsen, T. Steen, & B. Verschuere (Eds.), Co-production and co-creation: Engaging citizens in public services (pp. 211–222). New York and Abingdon: Routledge. Loeffler, E. (2020). Co-delivering public services and public outcomes. In E. Loeffler & T. Bovaird (Eds.), The Palgrave handbook of co-production of public services and outcomes. London: Palgrave Macmillan.

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Loeffler, E., & Bovaird, T. (2018). From participation to co-production: Widening and deepening the contributions of citizens to public services and outcomes. In E. Ongaro & S. van Thiel (Eds.), The palgrave handbook of public administration and management in Europe (pp. 403–423). London: Palgrave Macmillan. Loeffler, E., & Bovaird, T. (Eds.). (2020). The Palgrave handbook of coproduction of public services and outcomes. London: Palgrave Macmillan. Loeffler, E., Bovaird, T., Parrado, S., & van Ryzin, G. (2008). “If you want to go fast, walk alone: If you want to go far, walk together”: Citizens and the coproduction of public services. Report to the EU Presidency. Paris: Ministry of Finance, Budget and Public Services. Lowndes, V., & McCaughie, K. (2013). Weathering the perfect storm? Austerity and institutional resilience in local government. Policy & Politics, 41(4), 533– 549. McMullin, C. (2019). Coproduction and the third sector in France: Governmental traditions and the French conceptualization of participation. Social Policy & Administration, 53(2), 295–310. Mental Health Services. (2017). A national framework for recovery in mental health. A national framework for mental health service providers to support the delivery of a quality, person-centered services. https://www.hse.ie/eng/ services/list/4/mental-health-services/advancingrecoveryireland/national-fra mework-for-recovery-in-mental-health/recovery-framework.pdf. Accessed 17 Nov 2019. Meijer, A. (2012). Co-production in an information age. In V. Pestoff, T. Brandsen, & B. Verschuere (Eds.), New public governance, the third sector and co-production (pp. 192–208). New York and London: Routledge. New Economics Foundation. (2008). Co-production: A manifesto for growing the core economy. London: New Economics Foundation. Normann, R. (1984). Service management: Strategy and leadership in service businesses. Chichester, UK: Wiley. OECD. (2009). Rethinking e-government services: User-centred approaches. Paris: OECD. Osborne, S., Radnor, Z., & Nasi, G. (2013). A new theory for public service management? Towards a (public) service-dominant approach. American Review of Public Administration, 43, 135–158. Ostrom, E. (1996). Crossing the great divide: Coproduction, synergy and development. World Development, 24(6), 1073–1087. Paletti, A. (2016). Co-production through ICT in the public Sector: When citizens reframe the production of public services. In L. Caporelllo, E. Cesaroni, R. Giesecke, & M. Missikoff (Eds.), Digitally supported innovation (pp. 141–152). First edition. Switzerland: Springer International Publishing.

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Parks, R. B., Baker, P. C., Kiser, L., Oakerson, R., Ostrom, E., Ostrom, V., et al. (1981). Consumers as coproducers of public services: Some economic and institutional considerations. Policy Studies Journal, 9(7), 1001–1011. Parrado, S., van Ryzin, G., Bovaird, T., & Loeffler, E. (2013). Correlates of co-production: Evidence from a five-nation survey of citizens. International Public Management Journal, 16(1), 1–28. Pestoff, V. (2012). New public governance, co-production and third sector social services in Europe: Crowding in and crowding out. In V. Pestoff, T. Brandsen, & B. Verschuere (Eds.), New public governance, the third sector and coproduction (pp. 361–380). New York and London: Routledge. Pestoff, V. (2019). Co-production and public service management: Citizenship, governance and public service management. New York and Abingdon: Routledge. Pestoff, V., Brandsen, T., & Verschuere, B. (Eds.). (2012). New public governance, the third sector and co-production. New York and London: Routledge. Potter, R. (2013). Planning for an ageing population: Statistical and broad scope of issues. Cambridge: Analytics Cambridge. http://www.analyticscambridge. co.uk/AgeingAndPlanning.php. Accessed 19 Feb 2019. Royal Voluntary Service. (2020). NHS volunteer responders. https://www.goo dsamapp.org/NHS. Accessed 27 Apr 2020. Schlappa, H., & Imani, Y. (2018). Who is in the lead? New perspectives on leading service co-production. In T. Brandsen, T. Steen, & B. Verschuere (Eds.), Co-production and co-creation: Engaging citizens in public services (pp. 99–108). New York and Abingdon: Routledge. Schlappa, H., Yasmin, I., & Tatsuya, N. (2020). Relational leadership: An analytical lens for the exploration of co-production. In E. Loeffler & T. Bovaird (Eds.), The Palgrave handbook of co-production of public services and outcomes. London: Palgrave Macmillan. Scottish Government. (2018). Scotland’s digital health and care strategy: Enabling, connecting empowering. Edinburgh: The Scottish Government. Sharp, E. B. (1980). Toward a new understanding of urban services and citizen participation: The coproduction concept. Midwest Review of Public Administration, 14(2), 105–118. https://doi.org/10.1177/027507408001 400203. Sicilia, M., Sancino, A., Nabatchi, T., & Guarini, E. (2019). Facilitating coproduction in public services: Management implications from a systematic literature review. Public Money and Management, 39(4), 233–240. Steen, T., Brandsen, T., & Verschuere, B. (2018). The dark side of co-creation and co-production. In T. Brandsen, T. Steen, & B. Verschuere (Eds.), Coproduction and co-creation: Engaging citizens in public services (pp. 284–293). New York and Abingdon: Routledge.

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Thomas, J. C. (2012). Citizen, customer, partner: Engaging the public in public management. Abingdon and New York: Routledge. Thomsen, M. K., & Jakobsen, M. (2015). Influencing citizen coproduction by sending encouragement and advice: A field experiment. International Public Management Journal, 18(2), 286–303. https://doi.org/10.1080/109 67494.2014.996628. Tisdall, C. (2014). The transformation of services for young people in Surrey County Council: Governance International Case Study. Birmingham: Governance International. http://www.govint.org/good-practice/case-studies/ the-transformation-of-services-for-young-people-in-surrey-county-council/. Accessed 18 Feb 2019. Voorberg, W. H., Bekkers, V. J. J. M., & Tummers, L. G. (2015). A systematic review of co-creation and co-production: Embarking on the social innovation journey. Public Management Review, 17 (9), 1333–1357. Voorberg, W. H., Bekkers, V. J. J. M., Fleming, S., Timeus, K., Tonurist, P., & Tummers, L. G. (2017). Does co-creation impact public service delivery? The importance of state and governance traditions. Public Money and Management, 37 (5), 365–372. Welsh Government. (2015). Well-being of future generations (Wales) act 2015: The essentials. https://gov.wales/docs/dsjlg/publications/150623-guide-tothe-fg-act-en.pdf. Accessed 29 Aug 2018. Whitaker, G. P. (1980). Co-production: Citizen participation in service delivery. Public Administration Review, 40(May-June), 240–246. World Health Organisation. (2016). Framework on integrated, people-centred health services. Geneva: WHO. http://apps.who.int/gb/ebwha/pdf_files/ WHA69/A69_39-en.pdf?ua=1&ua=1. Accessed 20 Feb 2019.

CHAPTER 2

Distinguishing Types and Levels of Co-production: Concepts and Definitions

2.1

Introduction

There has been a lot of academic debate on what co-production is and isn’t. This chapter will contribute to the conceptualisation of coproduction by discussing both analytical and normative concepts of co-production. In particular, we point out differences and similarities between key definitions of co-production, which have become more widely adapted in academic research. A more detailed discussion of the strengths and weaknesses of key co-production definitions is available in Chapter 2 by Loeffler and Bovaird (2020). This chapter also locates co-production as a form of citizen engagement, which goes beyond public consultation and citizen participation. This does not mean, however, that co-production is superior to other forms of citizen engagement—the question is rather when each form of citizen engagement is appropriate, from the point of view of both public service organisations and also citizens. However, in contrast to public consultation and citizen participation, user and community coproduction includes both citizen voice and citizen action. This opens up opportunities for citizen contributions through co-delivery and not just co-commissioning, co-design and co-assessment. Further research is needed on the strengths and weaknesses of each form of citizen engagement but also how they may reinforce each other. This chapter also discusses two strategic pathways to user and community co-production: the ‘inside-out’ pathway, and the ‘outside-in’ © The Author(s) 2021 E. Loeffler, Co-Production of Public Services and Outcomes, https://doi.org/10.1007/978-3-030-55509-2_2

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pathway. In the ‘inside-out’ pathway, public service organisations bring citizen power into public services and invite service users and/or communities to add their resources and capabilities to those public services. The second, ‘outside-in’ pathway is much less common, where public service organisations map what service users and communities are doing already to improve their quality of life or public governance and build on this by adding their assets, resources and contributions to those citizen activities. Finally, this chapter will propose a quality assessment framework for co-production to enable all co-producers to assess both the process and the results of their co-production activities. The dynamic model which we present is based on collective learning, so that the results may not be achieved through a linear process but rather iteratively, as specific phases of the co-production process may have to be redesigned and repeated, improving system resilience in each cycle of learning (a theme which we pursue in more detail in Chapter 5).

2.2

Analytical Concepts of Co-production 2.2.1

Definitions of Co-production

The concept of co-production has already evolved through a range of meanings over several decades. The most famous early definition came from the Bloomington School of Political Economy in the early 1980s. It appeared in the most influential article on co-production at that time by Parks et al. (1981, 1002): Coproduction involves a mixing of the productive efforts of regular and consumer producers. This mixing may occur directly, involving coordinated efforts in the same production process, or indirectly through independent, yet related efforts of regular producers and consumer producers. (Parks et al. 1981, 1002)

In this definition, these ‘consumer producers’ are people who as “individual consumers or groups of consumers, acting outside of their regular production roles, may contribute to the production of some of the goods and services they consume” (p. 1002). This definition was clearly intended to focus specifically on public service delivery rather than service planning or design. The early literature identified that user and community co-production had long been widely practised, e.g. in citizen militias, jury systems, workers’ education associations and volunteer fire fighters.

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One of the key contributors in the Bloomington School, Elinor Ostrom, developed the concept in a range of further studies, and later adopted the definition: The process through which inputs used to produce a good or service are contributed by individuals who are not ‘in’ the same organization. (Ostrom 1996, 1073)

By 1996, Ostrom was explicitly including co-planning and co-design by citizens of low-cost neighbourhood sanitation systems in her concept of co-production and had located it within her concept of ‘polycentric’ decision making, involving multiple stakeholders. The case studies in Ostrom (1996) covered both collective co-production and individual co-production. However, her definition does not explicitly refer to citizens (either as service users or members of the community), although it is clear from her analysis that these are the ‘individuals’ to whom she is referring. Although the work of Ostrom and her colleagues focused very clearly on collaboration between citizens and service providers, some writers even in public administration have continued to use the term ‘co-production’ to refer to inter-organisational collaboration (along the lines of media collaborations in the private sector). However, we exclude this interorganisational meaning from our analysis in this book, on the grounds that the terms ‘collaboration’ and ‘partnership’ are more appropriate for these relationships. One of the important contributions from this early period which paved the way for later work came from Brudney and England (1983, 63– 64), who distinguished individual, group and collective co-production. Individual co-production can be either ‘captured co-production’, where service users have little choice but to participate in the service or active, voluntary behaviours that citizens undertake for their own consumption. Group co-production comprises voluntary, active participation by a number of citizens in groups, either formal or informal. Collective co-production occurs where co-productive activities result in collective goods whose benefits may be enjoyed by the entire community. All three forms of co-production may be service or outcome-oriented (Loeffler and Bovaird 2020). In later chapters we will highlight how these different forms of co-production have quite different drivers and impacts.

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Interest in co-production went into a temporary lull after the 1990s and it was nearly ten years before a new wave of interest emerged, interestingly just before the worldwide financial crisis of 2008 (which may have contributed to the continuing growth of interest, given the budgetary deficits it caused in public sectors around the world). Particularly Influential was the work of the new economics foundation, a UK think tank and NESTA, the UK Innovation Foundation. In a joint publication, they defined co-production as: Delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. (Boyle and Harris 2009, 11)

This definition became very popular in the UK, particularly in third sector organisations. It was very valuable that it spelt out very clearly the typical stakeholders involved in co-production, including those on the citizens’ side. It did, however, prove to be very difficult to operationalise—if relationships were not fully ‘equal’ or ‘reciprocal’, did that mean that co-production was not taking place, even though both citizens and public services staff were jointly making intensive contributions to the services? Moreover, this definition explicitly refers to ‘delivering’ services, even though it is very clear from the rest of the text that the authors include co-planning and co-design activities within their concept of co-production. As definitions of co-production multiplied in the literature, Bovaird and Loeffler (2012) tried to put some order into the ensuing jungle of concepts. After reviewing many of the previous influential definitions, they suggested a new definition to bring together all the key ideas of previous authors. They defined ‘user and community co-production of public services’ as being: The public sector and citizens making better use of each other’s assets and resources to achieve better outcomes or improved efficiency. (Bovaird and Loeffler 2012, 1121)

This definition recognises that co-production does not always involve a direct interaction between public services and citizens—this was already highlighted by Parks et al. (1981, 1002) when they stated that coproduction “may occur … indirectly through independent, yet related

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efforts of regular producers and consumer-producers”. Alford (2009, 20) later similarly stressed that the key point is not “whether there is interaction but where the citizen’s contribution is induced by the actions or behaviour of the government agency. …. If […] what is being produced is an outcome, then there is room for a broader understanding of what constitutes co-production…”. In this way, co-production can lead directly to the achievement of outcomes for citizens, without the direct intervention of public service organisations. Moreover, there has been increasing recognition that co-production not only takes place between public sector organisations and citizens but that third sector organisations are often funded by public sector organisations in order to support co-produced public services. While third sector organisations have always played an important role in the ‘welfare mix’ of social service provision (Pestoff 2018), in the UK this trend has been reinforced in the past decade by a shift within local authorities from being the lead service providers towards acting as a ‘commissioning council’. In this role they rely less and less on in-house service delivery, and instead plan and manage a wide range of service delivery models, which involve other providers from the public, non-profit and private sectors (Bovaird et al. 2014). In consequence, the Governance International definition of coproduction has been adapted as follows: User and community co-production of public services and outcomes is about public service organisations and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes or improve efficiency.

This definition has the advantage of including hybrid forms of service delivery, as the category ‘public service organisations’ covers not only public sector organisations but also third sector or private sector organisations which are funded by the public sector to deliver public services. Furthermore, under this definition, elected politicians as well as ‘professionals’ and ‘paid staff’ more generally are included as actors within ‘public service organisations’, which is important, given that their decisions often shape the conditions which determine the scope for and results of co-production.

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Within this definition of co-production is a clear specification of its domain—user and community co-production of public services or outcomes—and its purposes—to improve outcomes and/or efficiency. What is particularly important here is that user and community coproduction does not always have to involve public services—as we show in a later section, in the Governance International Public Value Model (Fig. 6.1), improved outcomes may also result directly from coproduction, not just from the direct outputs produced by public service organisations. As Alford (2009, 19) states: “… it may be that there are co-producer contributions which can also lead to that same outcome, and moreover that one or more of them does so more effectively than the output being produced”. This reminds us that not all the activities in which citizens and public service organisations are engaged can sensibly be described as ‘services’— the indirect effects of the public sector through its policies and practices can influence the behaviour and co-production activities of citizens, with consequent effects on outcomes. Furthermore, this definition highlights that user and community coproduction may, in the ideal situation, lead to both improved outcomes and efficiency but may, in other circumstances, bring about simply one or the other. We will discuss the inter-relationship between these two purposes in Sect. 6.7 (on additive and substitutive forms of coproduction). Last but not least, this definition deliberately speaks of ‘citizens’, leaving open whether this refers to individuals (e.g. service users or volunteers) or groups in civil society acting collectively. The term citizen is not to be interpreted in a legal sense to include only people with electoral rights but it resonates with the social sense of ‘citizenship’, which emphasises the engagement of individuals with the state and with each other to achieve social, political and economic purposes. In the seminal work “Engaging public sector clients ” Alford (2009) suggests a similar definition but limits co-production to ‘action’. According to his definition (Alford 2009, 23): “Co-production is any active behaviour by anyone outside the government agency which: • Is conjoint with agency production, or is independent of it but prompted by some action of the agency; • Is at least partly voluntary; • Either intentionally or unintentionally creates private and/or public value, in the form of either outputs or outcomes”.

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This definition appears to rule out co-production through contributions by citizens using their voice, rather than their direct actions, which we think is too restrictive. However, it is interesting that it shares with the definition of Parks et al. (1981) that co-operation between the “regular and consumer producers” does not have to be ‘direct’ or ‘intentional’— it is the results which count, which is consistent with the Governance International definition. More recently, Brandsen and Honingh (2016) have also surveyed the range of definitions of co-production and come up with somewhat narrower definition: Coproduction is a relationship between a paid employee of an organization and (groups of) individual citizens that requires a direct and active contribution from these citizens to the work of the organization. (Brandsen and Honingh 2016, 431)

This definition is also now becoming widely cited and usefully reiterates that what is being discussed is a citizen’s relationship with formal members of an organisation. However, it is also leaves a number of key questions unanswered: which ‘organisations’ are included (does it only apply to public sector organisations or would it still be ‘co-production’ if it only involved the third sector, with no public sector connection?) Moreover, it rules out ‘indirect’ citizen contributions to public services and outcomes, even if they are induced by the actions or behaviour of public service organisations, e.g. a move to healthy eating after a health promotion campaign. Finally, it does not allow consideration of the role of politicians in co-production, as opposed to ‘paid employees’, which may be important in a public sector context. Obviously, any academic definition of co-production has to be ‘fit for purpose’ for the analysis to be conducted. Therefore, we consider it entirely legitimate that different authors should choose to use different definitions of co-production. The same applies to local stakeholders putting co-production into practice. They need to find a common understanding and language for co-production which has to be context-specific. Most importantly, we suggest that a definition of co-production should be co-produced by the stakeholders who wish to undertake a co-production initiative.

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In the rest of this book, we will use the Governance International definition of user and community co-production of public services and outcomes which is given above. 2.2.2

Disciplinary Roots of Co-production

The approach to co-production which was pioneered by the Bloomington Workshop on Political Economy was most strongly influenced by micro-economic production theory and political science. Since then, the development of co-production has been informed by the other social sciences. Here we provide a short summary of the conceptualisations of co-production in the literature from these different disciplines. (A longer discussion of the disciplinary roots of co-production can be found in Bovaird and Loeffler [2016a], of which this is a resume.) • Economics: while economic theories of jointness in production have usually been framed in terms of joint inputs and joint processes shared by producing firms, they have sometimes also included joint producer-consumer inputs (Garn et al. 1976) or inputs from ‘regular producers’ and ‘consumer producers’ (Parks et al. 1981). Earlier the treatment of joint inputs in the ‘characteristics’ approach to goods and services (Lancaster 1966) foreshadowed the ‘service dominant logics’ approach (see below). Furthermore, as Jackson (2020) has pointed out, service users can sometimes decide whether or not to add extra inputs to public goods which are non-excludable and/or non-rival in consumption. Welfare economics also recognises the concept of externalities in consumption, whereby improved outcomes for one service user can, in addition, bring a series of benefits for others, e.g. benefits to those who are close to and care about welfare of the user (care-givers, friends, volunteers, etc.), or benefits to other users who can learn how to make better use of the service from the example set by the service co-producer (e.g. from the ‘expert patient’ who has learnt to cope with chronic diabetes or self-administered dialysis). • Political science: this conceptualisation of co-production clearly builds upon the literature on citizen participation in government, an approach identified by Frederickson (1982) as an early formulation of public administration in the nineteenth century. In more recent times, this perspective has taken on many different facets.

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Lipsky (1980) highlighted the frequently interdependent relationship between ‘street-level bureaucrats’ and citizens. Some research on social movements (see Chapter 1), particularly the literature on the urban poor in the ‘South’, has focused on the use of co-production strategies, usually through place-based struggle for improved livelihoods within neighbourhoods and for political inclusion at the city-wide level. In OECD countries a parallel social movement based on the disability rights agenda has insisted that people should be active participants in decisions about their own lives (Oliver 1990). • Sociology: the literature on social capital highlights how a service user or citizen who is co-producing may be doing it in large part because of a desire to participate socially in a collective endeavour with others—and this social capital, as it accumulates, may be the source of pressure on other members of a community (either placebased or theme-based) also to join in (Putnam 2000). The sociology of philanthropy also highlights how co-production may arise from a desire to help others, rather than simply to produce benefits for oneself, so that its collective benefits may be underestimated through over-emphasis on selfish motivations. • Services management: Normann (1984) distinguishes the ‘enabling logic’ in services (which depends critically on mobilising those contributions that users can uniquely provide to enable service outcomes) from the ‘relieving logic’, in which providers do the service to the user. A parallel to this approach is the ‘service dominant logic’ approach (Grönroos 2000; Lusch and Vargo 2006), recently taken further as the ‘public services dominant logic’ by Osborne et al. (2013). More recently still, Osborne (2018, 228– 229) argues for a ‘public service logic’, in which value can only ever be created by the service user and which “shifts the locus of public service delivery from linear production processes instigated by the [public service organisation] and which ideally should involve the service user (co-production), … to the way that service users create value by their interactions with the [public service organisation] and within the wider service system (co-creation).” • Public choice: Aligica and Tarko (2013, 740) distinguish two schools of public choice. The traditional approach applies the logic of individual decision making to collective deliberations and choices

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in respect of both public goods and social dilemmas—here, coproduction is simply one available mechanism for collective problemsolving. In the second, public choice is about how individual preferences, values, and decisions intertwine and co-evolve with the institutionally constructed environment and governance system—the “public” is not a ‘given’ but rather emerges as a result of an ongoing, collective process of interaction, so co-production is intrinsic to all public action. In this approach, as in most governance perspectives, publicly-desired outcomes are achieved by multiple organisations working with multiple stakeholders through a variety of mechanisms, including not only ‘services’ but also behaviour change, where co-production is essential. • Consumer psychology: this approach explores how user involvement in service design or operation may bring both a better ‘fit’ of services to users’ needs and also commitment to enter fully into the service process. Etgar (2008, 98) links co-production to customisation, arguing that co-production helps to fragment (and therefore ‘personalise’) overall market offers, assists one-to-one marketing and therefore expands the choices facing consumers. • Governance: Elinor Ostrom (1998, 153) states that “It is ordinary persons and citizens who craft and sustain the workability of the institutions of everyday life”. Consequently, citizens can be seen as also co-producing the governance system by shaping these everyday institutions, as well as the services, which emerge from these institutions. Many varieties of the governance perspective stress that the government and public sector institutions are not simply about ‘services’, and that publicly-desired outcomes are achieved by a wide variety of influence mechanisms (Stoker 2006; Dickinson and Sullivan 2014). A key message from these different disciplinary roots of co-production is that there may be major collective or ‘indirect’ outcomes from coproduction, going well beyond the benefits experienced by the individuals who are directly involved, which can be missed by focusing simply on the motivations of citizen co-producers. Consequently, user and community co-production may well give rise to major positive synergies, i.e. non-linear benefits, which are not captured in the measurement of ‘individualised’ co-production. They are also likely to be missed by public service planners and managers, leading to an underestimation of the

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importance of user and community co-production in contributing to quality of life outcomes and achievement of public governance principles. We will consider further how to assess these wider benefits of co-production in Chapter 6. The potential from these indirect benefits is a key reason for avoiding definitions of co-production which insist on only ‘direct’ contributions from citizens to a specific organisation. While the definitions of co-production and identifying its analytical social science roots are very important, there is no doubt that the concept of co-production owes much of its popularity to its normative resonance with many people who are involved with public policy and public services. We now consider these normative perspectives on co-production.

2.3

Normative Concepts of Co-production

2.3.1

Roots of Normative Concepts of Co-production

For advocates of normative concepts of co-production, it is key that coproduction is not just a means to an end but that it embeds specific public governance principles or social values in order to improve outcomes. As Cahn and Gray (2012, 131) state: “co-production is not only a method of production; it is both a means and an end, method and purpose, process and outcome”. Typically, normative concepts of co-production promote the implementation of co-production principles as a vehicle for achieving greater social justice and social equality. From this perspective, co-production strengthens citizenship, not just the achievement of quality-of-life outcomes. This section will highlight the contribution of the civil rights and disability movements to the development of co-production principles. Historically, the US civil rights movement in the 1950s and 1960s and government programmes resulting from the Economic Opportunity Act 1964 during the Johnson Administration reinforced each other to shape the emergence of a wide range of co-production initiatives. As Cahn and Gray (2012, 132) state, the Economic Opportunity Act 1964 introduced a new level of engagement with citizens through what was later coined ‘co-production’ by Ostrom, by requiring related government funded initiatives to incorporate ‘maximum feasible participation’ of the poor—a positive example of how co-production can be driven through legislation, one of the macro-factors in the PESTEL framework that we considered in Chapter 1. This government driven pathway to

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co-production was supplemented by the influential publication The War on Poverty: A Civilian Perspective by the civil rights lawyers Edgar Cahn and J.C. Cahn (1964). This combination of legislation and civil society pressure resulted in a wide range of new government programmes from education to community policing which involved citizens as co-producers. For example, the preschool Head Start Programme was launched with an explicit requirement to engage parents as essential ‘co-producers’ of preschool child development (Head Start Act 2007, cited in Cahn and Gray 2012, 133). From the 1980s, Edgar Cahn, who had earlier been a speech writer for President John F. Kennedy, built on these earlier government initiatives by popularising the concept of time banking. He saw this as a “lineal descendant of ‘maximum feasible participation’ and the struggle of the civil rights movement for equal citizenship and enfranchisement” (Cahn and Gray 2012, 134). For Cahn and Gray (2012, 135), one mechanism for implementation of co-production stood out—time banking is THE social technology to generate co-production. While there is now a wide range of different time banking models, one common characteristic is that all contributions of time bank members are equally rewarded on the basis of time and not on market prices (Cahn and Gray 2015). There is some empirical evidence that time banks do indeed enhance social capital and improve health. The evaluation of a US hospital-related time bank by Lasker et al. (2011) showed that time banking may be particularly valuable in promoting mental and physical health and a sense of belonging among older and lower-income individuals and those who live alone. In the UK, the charity Spice supports community-building by using time credits as an alternative currency that uses time as the unit of exchange. Its 2018 Time-Credit-Spending Report (Spice 2018, 2) assesses the private and social value which members receive from spending their time credits: Of the 1100 people surveyed, 54% indicated as benefits ‘being able to treat my friends and family’, 38% stated ‘meeting new people and making new friends’ and another 38% highlighted ‘being part of my community’. As Spice recognises, the breadth and diversity of its network facilitates exchange among members and makes membership attractive. However, other time banks have sometimes had a less diversified membership, which have made it more difficult to encourage exchange, where many members provide very similar offers

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(a classic example is a surfeit of jam making). Clearly, time banking remains a co-production model which still has a lot of potential but is only one approach and does not work for everybody. However, its founding principle of ‘equal citizenship’ remains influential in many other co-production initiatives. Another important root of the normative perspective on co-production is the disability rights movement, in particular, the learning disability movement. The ‘social model of disability’ from the 1980s insisted that people should not be treated as passive recipients of care but should rather be seen as active participants in decisions about their lives, with power to influence the support they receive (Oliver 1990). In this way, people with disabilities have become co-designers and co-deliverers of services. Furthermore, the personalisation agenda in social care, which originally focussed particularly on people with disabilities before widening out to other service user groups, has promoted the concept of co-production, which is considered essential to making public services more personalised (Carr 2012). In 2006, the United Nations Convention on the Rights of Persons with Disabilities places a duty on signatory governments (and their local authorities) to promote the rights and equality of people with disabilities and to “recognize the valued existing and potential contributions made by persons with disabilities to the overall well-being and diversity of their communities…” (United Nations 2006). Most political parties have been reluctant to endorse co-production as a concept to transform the relationship between public services and citizens. One exception in the UK is the Cooperative Party, which is a centreleft political party supporting co-operative values and principles. It has an electoral pact with the Labour Party which means party candidates do not compete with each other. Its 2017 policy platform for public services includes co-production as part of its ‘police, crime and justice’ agenda, although, surprisingly, it does not mention co-production in the context of social care (Cooperative Party 2019). In Wales, a Labour Government White Paper on improving public services stated: “Public services in the future need to be a shared endeavour between the user and the service based on the principles of co-production” (Welsh Government 2014, 23), echoing a briefing note on co-production which it had earlier commissioned from Bovaird and Loeffler (2014).

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Furthermore, a centrist government coalition in the Netherlands initiated a reform process of social care in 2012, which among other objectives, aimed to strengthen the role of informal care through coproduction. Nederhand and van Meerkerk’s (2018) analysis of government documents shows that the new narrative of citizens as active service co-producers has become more common than the traditional narrative of citizens as passive clients of care services delivered by professionals. In summary, normative approaches to co-production approaches, particularly in the form of personalisation, have been endorsed by a wide range of social movements and political parties around the world. Indeed, co-production approaches have sometimes become the object of political competition, as was the case with participatory budgeting in Porto Alegre (Fox 2008). In spite of the strength of passion with which many supporters adhere to a normative concept of co-production, an agreed underpinning from political theory is still missing. In the next section, we explore the range of views on principles of co-production. 2.3.2

Principles of Co-production

Many advocates of normative concepts of co-production have committed to or suggested some core principles or values which reflect their normative stance. For Cahn and Gray (2012, 136), for example, these comprise an asset-perspective, honouring real work, reciprocity, community and respect. Edgar Cahn’s conceptualisation of co-production also influenced the new economics foundation which stressed the principles of equality and reciprocity: “Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours” (Boyle and Harris 2009, 11). This emphasis on equality has led some commentators to suggest that in co-production both citizens and professionals need to make an equal contribution. We consider this to be a misinterpretation—depending on the context, and the willingness and ability of citizens, the contributions of both parties can be quite different but be equally important. While more equality is strongly desirable in most cases, to insist that coproduction only occurs in fully equal relationships between professionals and citizens with their networks would reduce drastically the number of

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cases which could be described as co-production. Rephrasing the nef definition to say ‘in a more equal relationship’ might capture rather better what is desired here, and would be more operational. The principle of reciprocity is inherent in most definitions of user and community co-production. Interpreted in the widest sense, it implies that both ‘experts by profession’ and ‘experts by experience’ need to make a contribution. This distinguishes ‘co-production’ from self-organisation of civil society or self-help of service users—it requires joint contributions, not simply inputs from citizens. A narrower interpretation of reciprocity suggests that the benefits resulting from co-production should be mutual. Such a narrow understanding, however, risks overlooking positive externalities created through co-production, which may not directly benefit those who made a contribution but may nevertheless bring substantial social benefits. It also overlooks that citizen co-producers may be driven by intrinsic motivations rather than simply seeking private value. For example, many citizen co-producers who are active in timebanks supported by public service organisations choose not to make use of their time credits (which may seem generous of them but risks bringing the time bank to a halt, as it depends on time credits circulating to others) (Goan 2014). And of course, even when time bankers exchange activities and support each other, this may not be directly reciprocal in the sense that time bank members benefiting from support from other time bank members may not themselves be able to offer something wanted by the beneficiary, which is why it is important that time banks have a wide and diversified membership, so that the needs of timebank members are likely to be met by at least one other member. The Social Care Institute for Excellence in the UK is committed to the following core co-production principles (SCIE 2013): “equality (everyone has assets), diversity, accessibility and reciprocity”. This usefully adds to the nef principles but the inclusion of ‘equality’ and ‘reciprocity’ similarly needs to be carefully interpreted. However, all of these sets of normative principles appear to neglect the major literature which has grown up around good governance (Loeffler 2016a). Based on categorisations of key governance principles by academics and international organisations we suggest the following principles of ‘good governance’ to be relevant in co-production contexts:

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• • • • • • • • • • •

Citizen engagement Transparency Accountability Human rights The equalities agenda (gender, ethnicity, age, religion, etc.) Equity (fair procedures and due process) Social inclusion Ethical and honest behaviour Respect for the rule of law Sustainability of results Maintenance of privacy and confidentiality.

In particular, in the context of digital co-production, the maintenance of privacy and confidentiality are highly important. Clearly, all co-production approaches, just like any other public service interventions, must be expected to conform to these principles, although in any given context some of these principles may be seen as more important than others. These principles are therefore not, in themselves, distinctive to co-production. However, there are some principles specific to co-production which complement these principles of good governance. In particular, Governance International considers the following principles to be distinctive to co-production: Asset-based approaches imply that public service organisations need to ask citizens a new question—not just: ‘What do you need?’ but also: ‘What can you do to improve the quality of life in your neighbourhood?’ and ‘What are you doing already to help others?’ Although a number of local authorities and other public service organisations in the UK have undertaken asset-mapping, this has been far from wide-spread, even in social care (Rippon and Hopkins 2015, 3). Moreover, it has largely been confined to mapping of community assets, such as local community organisations, the services they offer, community buildings and community transport—there have been few systematic approaches to mapping the capabilities of service users or even of informal volunteers, never mind of wider community members. ‘Enabling ’ is also a key co-production principle, closely linked to assetbased approaches. While everybody has strengths, not all people are aware of them, nor are they able to use them effectively to improve personal or public outcomes. For example, experimentation with five co-production

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initiatives between job seekers and the Employment Agency in Offenbach showed that vulnerable service users may not be able to make contributions at times when they face crises, such as homelessness or financial debts (Loeffler and Schulze-Böing 2020). However, when such crises have passed, or where job seekers are beginning to cope more successfully, it often becomes possible to identify their capabilities and find ways to put them to good use—and the results can be dramatic. For example, one co-production initiative of the Offenbach Employment Agency, which involved the development of a one-to-one peer support approach, showed that the empathy and ‘knowledge by experience’ of confident service users who acted as peers also motivated other service users with little self-confidence to act as peers. As a result, at the end of the 120 days experimentation phase, all the job seekers involved in the three peer support teams had either found an apprenticeship or an internship with an employment option (Neseli and Herpich 2020). Tuurnas (2015) considers ‘enabling skills’ as core competencies of professionals to support service users and communities to make effective contributions. However, the co-production principle ‘enabling’ in Table 2.1 highlights that citizens, too, need to be active in encouraging contributions from public service organisations. In particular, citizen co-producers need to be persistent in keeping co-production initiatives moving, as the agendas of public service organisations may well be overtaken by issues apparently more urgent than co-production. Table 2.1 Principles of co-production Principle

What it means

Assets-based

Co-production sees people as active contributors and asset-holders Co-production requires co-producers to encourage and value each other’s contributions Co-production promotes collaborative rather than paternalistic relationships between public service organisations and citizens Co-production puts the focus on the achievement of outcomes rather than just services In a representative democracy, co-production needs to be in line with the policies of elected politicians, which in turn need to pay attention to the needs and capabilities of citizens

Enabling Collaborative Outcome-oriented Democratic

Source Copyright © Governance International 2019

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‘Collaborative’ relationships between stakeholders of public service organisations and citizens (either as service users or community members) and their networks are an obvious principle of co-production (Loeffler 2016b, 323). However, it is quite challenging to put this into practice in organisational (sub-)cultures, which are more strongly characterised by hierarchical or market-oriented modes of governance. As Lindsay et al. (2018) demonstrate, however, collaborative approaches may be more effective to promote innovation in public service workplaces than New Public Management-oriented practices. ‘Outcome-oriented’ co-production does not always have to involve public services. As discussed in Sect. 2.1, this co-production principle stresses community co-production may directly impact on quality of life outcomes and governance principles. ‘Democratic’ as a co-production principle implies that elected politicians need to play an active role in co-production. First, they may have an operational role as mobilisers of local communities, as they are typically closer and more in touch with local communities than public managers, who often lack opportunities and time to meet with their service users and local communities. Secondly, and more fundamentally, elected politicians also have a vital normative role in balancing the interests of different stakeholders, and setting priorities between governance principles and the outcomes to be achieved through co-production. This role is particularly important in co-commissioning processes, which will be discussed in more detail in Sects. 2.3 and 3.2. In a democratic society, the prioritisation involved in this balancing act must be at least rubber-stamped by politicians to be legitimate. 2.3.3

Prioritising Co-production Principles

Principles are fundamentally important—but only if they can be operationalised. Here we meet a challenge which is not often understood—or tackled. The principles and processes of public governance are not absolute—they are likely to vary in importance between contexts and over time. Moreover, different stakeholders will often have differing views on what they mean and how important they are. In practice, this suggests a ‘governance impossibility theorem’—it is unlikely that all of these principles can simultaneously be implemented—at least, not to their full extent (Bovaird and Loeffler 2016c). Consequently, there is a need to prioritise both those wider good governance principles which should also apply

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to co-production but also the specific principles which are distinctive to co-production. This need for prioritisation naturally produces some thorny choices for public decision makers—and, in the context of co-production, for the citizens who become involved in this prioritisation process. For example, if we take the principle of the new economics foundation (nef) that coproduction should embody an ‘equal and reciprocal relationship between professionals, people using services, their families and their neighbours’, what does ‘equal relationship’ mean in practice? For some, it might imply that public service boards should have an equal number of professionals and community representatives and that all decisions should be taken unanimously. However, where many of the decisions of the board are on relatively technical issues, this could make decision-making processes inefficient. In such circumstances, there might be a need to negotiate an agreed set of rules, which clearly set out the ways in which citizens and public service providers intend to make decisions. This could, for example, be interpreted as ‘equal power in decisions where both have equally relevant inputs’, while allowing more weight to one side in relation to decisions where it has more relevant inputs. In other words, ‘equality’ has to be interpreted in context. In our example, relevance of expertise is being given a high priority, and formal equality is being given a lower priority. In other situations, especially where one side distrusts the other, an insistence on formal equality might be more appropriate. Coming to an agreement on how to deal with these thorny issues of prioritisation will never be easy—it is the very essence of political activity. It could, for example, take the form of a co-production charter, which sets out what both parties are going to contribute to improve public services and public outcomes, how they are going to help each other to make effective contributions and how they are going to work with each other. In order to be effective, such a charter would normally need to be backed up by an independent advocacy organisation, including an effective complaints management and monitoring system, so that alleged abuses of the agreed procedures can be dealt with in a way satisfactory to all stakeholders. So far so good—but what if some co-producers are more experienced, or articulate, or have more time than others? Should extra resources be devoted to helping those participants who are disadvantaged in coproduction activities? In some contexts, the obvious answer is ‘yes’—the priority in some cases is that everyone should have an equal opportunity to

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take part fully in the co-production activity. This might apply, for example, when co-commissioning a new community centre for the neighbourhood. The extra resources needed to ensure that this co-commissioning approach is clearly fair may well be seen as a very good way to spend public money. However, there may be other cases where such a concern with ‘equality’ may seem a low priority—e.g. when a group of ‘guerilla gardeners’ want to decide whether to focus on growing flowers in the traffic roundabout at the end of their street or on the grass verges outside the local school—here, those who want to contribute should be free to do so, while most people will be happy not to bother. The basic point is that priorities matter and that it is not possible to have everything we want—just as desirable quality of life outcomes have to be traded off against each other, so also do desirable governance principles. Moreover, desirable quality of life outcomes may have to be traded off against desirable governance principles. We shall consider later in this book (in Chapter 6, in the context of our public value model), some of the ways in which these priorities might be set in a co-productive way. Normative concepts of co-production are also key to decisions involving some aspects of the ‘dark side of co-production’ (Steen et al. 2018), namely when the implementation of governance principles is weak. In such cases, even time banks, which Edgar Cahn considers as a key social technology for addressing the absence of core social values, can be considered as exploitative. For example, in a German co-production study focus group, participants from East Germany criticised time banks for replacing paid work through unpaid volunteering, which is particularly an issue in deprived areas where paid jobs have been declining (Löffler et al. 2015, 23). Awareness of such negative consequences is important in political decisions about the role of co-production in service commissioning and delivery. Of course, this is not new—there are likely to be negative consequences for specific stakeholders arising from whatever intervention mechanisms are chosen, not just co-production approaches—that is why elected politicians must be involved in the final decision making. The implications of these normative concepts of co-production are quite different from the implications of positivist concepts of coproduction: Whereas the latter emphasise that co-production is not a purpose in itself but needs to increase effectiveness and/or improve

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efficiency in order to justify the use of public and citizen resources, advocates of normative concepts promote co-production per se because they believe that it promotes specific values in the public domain (Cahn and Gray 2012, 136). This difference between the descriptive and normative aspects of co-production can give rise to tension when a co-production strategy is adopted. It has become common place for public service practitioners to be told, on the one hand, to invest public sector resources only if there is significant evidence that co-production is likely to improve outcomes, while they are urged, on the other hand, to embed coproduction principles into all their decision-making and service delivery processes, as part of a citizen-centric and service-user-led philosophy. This seeming contradiction can be resolved, in some circumstances, by taking a public value perspective. From a public value point of view, co-production can only be said to have unambiguously brought about a social welfare improvement if the achievement of both quality of life outcomes and public governance principles has increased. If, however, the move to greater co-production has involved a trade-off between the achievement of outcomes and public governance principles, then policymakers should make clear what their normative priorities are, so that the appropriate trade-off judgements can be made. What can increase the tension in practice is that frontline staff may be more committed to the normative concept of co-production, emphasising the governance principles with which it is associated, while top management may not see beyond the descriptive concept, with its focus on cost-benefit analysis of the quality of life outcomes achieved per £ spent, in comparison with other intervention approaches. These differing perspectives may lead to frustration on the part of enthusiastic frontline staff who are convinced that their small-scale co-production practice works. However, without any hard evidence of improved outcomes they may not convince commissioners to scale this co-production practice. Such conflicts will be discussed further in Sect. 5.3 on change management to implement co-production.

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2.4

Co-production as a Form of Citizen Engagement

2.4.1

Intensity of Citizen Engagement

As the concept co-production has become increasingly widespread, particularly in personal social services (Needham and Carr 2009) and neighbourhood management (Thijssen and van Dooren 2016; van Eijk et al. 2018), the meaning of the term has become more fuzzy, since it is now sometimes used to describe more traditional forms of citizen engagement, such as consultation and public participation. So, what is the difference between co-production and these other forms of citizen involvement with the public sector and public services? As we shall see, the distinction is not hard and fast—in particular, some forms of public participation do indeed qualify as co-production—which naturally makes for confusion. However, there are important differences which mean that it is valuable to maintain the distinction between these concepts. One of the most widely quoted typologies of citizen engagement is the ‘ladder of participation’ of Sherry Arnstein (1969). This typology suggests a hierarchy of forms of engagement, with high-level engagement such as citizen control at the top of the ladder. This typology is often taken to imply that such high-intensity forms of citizen engagement are inherently superior to less intense forms of engagement. However, in practice, what matters most is that the form of citizen engagement is fit for purpose (Tritter and McCallum 2006). The Arnstein ladder does not explicitly include the concept co-production. Alternative ladders which place co-production as the top (see for example, National Co-Production Advisory Group 2016) suffer from the same normative bias in suggesting superiority of co-production when the real challenge is to identify the appropriate mix of ways of engaging the public. In Table 2.2 we compare key characteristics of consultation, participation in public decisions and co-production of public services and outcomes. Table 2.2 demonstrates that there are different intensities of citizen engagement between the approaches of consultation, participation and co-production:

Consultation

Low Voice

Listening and feedback

Public space

Inputs of citizens Contributions of citizens

Activity of public service organisations

Space

Public space

Dialogue

Medium Voice

Participation in public decisions

Co-production as a form of citizen engagement

Forms of citizen engagement

Table 2.2

(continued)

High Voice Behaviour change Commitment Actions Joint decisions and action: • Co-commissioning • Co-design • Co-delivery • Co-assessment Public and non-public space

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Bus passengers and/or residents are asked to fill out surveys to provide their views about plans to change bus routes

Example

Source Adapted from Loeffler and Martin (2016, 303)

Consultation

(continued)

Forms of citizen engagement

Table 2.2 Co-production of public services and outcomes A group of bus passengers works with local public transport officers and private bus providers to determine which bus routes need to be kept and which ones can be cut (co-commissioning) Another group of passengers works with social transport provider contracted by local authority to find new alternative transport provision to deleted bus routes (co-design) A group of residents sets up a social mini bus scheme, run by volunteer drivers, with the support of the local authority (co-delivery) A group of passengers evaluates accessibility, public safety and cleanliness of buses and bus stops, after training by their local authority (co-assessment)

Participation in public decisions

Bus passengers are invited by their local authority to a public debate on new solutions to local transport in order to make bus services and other local transport more efficient

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• Consultation is a two-way flow of information between public organisations and citizens, whereby citizens are given a voice on an issue. Their contribution will typically be low—for example, it covers activities such as citizens filling out a questionnaire (perhaps online) or attending an event to give their views on issues raised by public services. Ideally, the public service organisation should provide feedback to the citizens taking part in the consultation on what they said and which decision the public sector organisation has taken and why. The formula “you said – we did” summarises the two-way interaction in the case of a good consultation. However, there is no guarantee that citizens will be listened to or that decision-makers will implement the views of the majority (Loeffler and Martin 2016, 303)—and citizens often get the impression that these are low payoff activities, so are consequently reluctant to put much effort into them. • Participation in public decision-making involves a dialogue between public service organisations and citizens, in which each party has a role in decision-making (which is ideally laid out and guaranteed in a public participation charter) and an influence upon the final decision. As with consultation, public participation is a top-down form of citizen engagement, with the public sector organisation deciding (and in some cases, negotiating with citizen representatives) when and to what extent public participation is appropriate. Nevertheless, it goes further than consultation, as it typically challenges public managers and elected politicians to engage in a genuine deliberation with citizens. Generally, forms of participatory democracy at the local level also imply that the local councillors have the last word. • Co-production of public services and outcomes is the most intense form of engagement. The ‘high’ levels of input may involve citizen ‘voice’, as with consultation and participation, but also citizen behaviour change, commitment and actions, with the mix of citizen voice and action depending on specific circumstances—the context shapes whether the emphasis is on citizens’ co-commissioning, codesigning, co-delivering or co-assessing the relevant public services or outcomes. For public service organisations this means going beyond dialogue towards an enabling role in which they help users to help themselves or help communities to organise themselves. In contrast to consultation and public participation, co-production may also be initiated from service users and local communities and

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it may take place in private spaces—for example, when care-givers who have received training from social services, look after a family member who needs care. However, it is only co-production of public services and outcomes if there are meaningful contributions from both citizens and the public service organisations, as in the example provided in Table 2.2. There is a recursive side to this discussion, of course. Moving to a co-productive approach may itself help to improve the effectiveness of communication, even where that communication is intended to be purely consultative or a relatively perfunctory form of public participation. For example, using a co-production approach to get citizens’ views on how to phrase a consultation without using jargon or how to run a participation approach with more suitable contents, media and language, tailored to the target group, may help to make these exercises cheaper or more meaningful, even if they do not themselves use a co-productive approach. There is also an important difference between co-production and standard approaches to consultation and public participation, namely that those citizens who get involved are likely to be quite different. This has the corollary that the way co-production is implemented should also be quite different. 2.4.2

Participants in User and Community Co-production

Where consultation and public participation are part of the democratic process, representativeness of the engagement process with citizens is of fundamental importance—to the point where a non-representative process is likely to make the process illegitimate. Of course, ‘representativeness’ is not an absolute category—it must be understood in its context. For example, in an in-depth public participation exercise, such as a ‘citizen’s jury’, we may want only a sample of those who are affected to participate. Nevertheless, we are likely to be anxious that they are genuinely representative of the whole population of those affected. In a consultation about a specific proposal which we intend to implement and which has important and widespread consequences, however, we may want ALL those affected by a public policy to be consulted and ‘representativeness’ is irrelevant.

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However, strengthening democracy is not always the priority outcome of co-production. Where it is, then the above arguments apply and representativeness is indeed important—and may even be essential. (We will discuss this in more detail in the next chapter under the headings of ‘cocommissioning’ and ‘co-assessment’.) However, co-production may be attractive in some situations, not because it offers a more democratic way of improving high level public value but because of its instrumental value in allowing democratic decisions to be implemented in a cost-effective way—this is likely to be particularly true of co-delivery of public services. Here citizens are involved mainly because of their roles as users of the service or as people who experience important indirect effects from it. The main question is then whether the contributions of citizens are likely to improve the achievement of quality-of-life outcomes and public governance principles, both as seen by the citizens concerned and the respective public service organisations. There are two fundamental questions we must ask in this situation. First, who has knowledge about the service— the needs for it, the way it operates, the effects it has? Second, who cares about the service sufficiently to be prepared to get involved? In Table 2.3 we consider the four different groups who emerge from this analysis. In Box A of Table 2.3, we have citizens who are knowledgeable about the issue concerned and care about it. These ‘people who know and care’ are the core recruitment targets for many co-production activities. They may not, of course, be very numerous—this is likely to vary greatly from issue to issue. However, it seems likely that the higher the number of Table 2.3 Who knows and who cares about a service? Level of caring about the issue

Level of knowledge about the issue

Don’t know

Know

Don’t Care D Lower priority participants in co-production C Potentially valuable but unenthusiastic co-producers

Source Adapted from Loeffler and Bovaird (2017)

Care B Co-producing enthusiasts but may not have the right expertise or skills A Core co-producers (‘people who know and care’)

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people in this group, the greater the chances of co-production being a successful intervention. In Box B we have enthusiasts for co-production, who care about the issue and are therefore likely to be prepared (or even keen) to make contributions. The difficulty, of course, is that they are not very knowledgeable about the issue, so it would be unwise to allow them to have a strong say or an important delivery role on aspects of the service outside their experience. However, there are likely to be some aspects of the issue about which they do have relevant personal knowledge (and there are always many ‘backroom’ activities which are needed in any co-production initiative), so there will usually be valuable tasks for them to perform. Nevertheless, this group can be difficult to manage in co-production, as their enthusiasm may drive them to seek a greater role than their knowledge and experience warrants. There is also another group of citizen co-producers who may believe they are in this box, caring about the issue but lacking self-confidence to believe that they have anything to contribute. Here professionals with enabling skills are needed in order to strengthen their self-confidence. For example, service users with mental health issues may have valuable knowledge as ‘experts by experience’ but in order to engage with professionals in a meaningful way they require support to develop their strengths and build their self-confidence. In Box C, we have people knowledgeable about the issue but not particularly concerned about it, so that they may not be interested in making the contribution which their knowledge would equip them to provide. Retired professionals in the field may sometimes come into this category. Here there may be more room for extrinsic motivations to be offered to tempt them to become co-producers. In Box D we are likely to find a large group (perhaps even a majority) of the population in relation to a specific issue—they are not knowledgeable about the issue, nor do they care much about it. While it is both expedient to inform them about the issue (otherwise they may feel something is being hidden from them) and also a good governance principle (so that those people are alerted who may have been unaware of the existence of issue rather than genuinely unknowledgeable), this group will generally not be a priority in recruiting co-producers. In Chapter 3 we will refine this analysis by exploring how it needs to be interpreted within the different modes of co-production (cocommissioning, co-design, co-delivery and co-assessment).

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Clearly, deciding who should be involved in co-production can be critically important in improving quality of life outcomes from public interventions. On the one hand, involving people who have no knowledge or interest in an issue will waste their time and public money, while, on the other hand, not involving people who do know and care about an issue is potentially a waste of valuable resource. With such important political implications, these decisions should therefore be made, or at least overseen, by elected politicians. Moreover, the distributional aspects of co-production, in cases where it favours some groups more than others, have to be taken into account in government strategies to tackle inequality. For these reasons there has been growing interest recently in ‘democratic co-production’ (Verschuere et al. 2018) and on the role of elected politicians. We will return to the role of politicians in co-production in Chapter 5.

2.5

Strategic Pathways to Co-production

Most of the co-production literature has focussed on how public service organisations can more effectively bring citizens into public services and get them to contribute to public service pathways to outcomes. Clearly, this is a natural approach from the perspective of someone who is working in public services on a daily basis and is grappling with all the problems which this entails. It is a naturally ‘inside-out’ rather than ‘outside-in’ vision of what it means to move towards co-production. Moreover, it is an even more natural perspective for those who are at a strategic level within organisations, whether commissioning or providing public services. Whereas frontline staff often have frequent meetings with and close knowledge of service users, care-givers, neighbours and the wider community, the experience of senior managers is more framed by their tasks and contacts within their own organisations and those of their partners. However, there is a very different way of moving towards a more coproductive approach—not the ‘inside-out’ vision but rather the ‘outsidein’ vision. This is shown in Table 2.4, which explores the different combinations of active and passive behaviours by both citizens and service professionals. Where professionals are active but citizens are not, we have the traditional public service model. Often, the main contribution of such passive users is simply compliance with the service regime—e.g. doing what they are told and not challenging how they are treated by staff.

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Table 2.4 Pathways to user and community co-production Engagement of public services (provided by public sector organisations, the third sector or private sector)

Engagement of service users and communities Active Passive Active C Co-production A Traditional provision

Passive

B Self-help or selforganising

D Service and community failure

Source Adapted from Loeffler (2016b, 323)‘

Where citizens are active, but professionals are not, we have the normal self-organising activities of civil society—indeed, this category is covers much of human life. For most citizens, their daily activities do not generally involve public services but are about family, friends, work, leisure, etc. For example, most care is provided by unpaid care-givers, not by social care services. Only if the care-givers or volunteers are supported by public services would this be a form of co-production. Some forms of volunteering fit into this cell, rather than being co-production, since they do not relate at all to public services and are simply community self-organising. Where neither citizens nor members of public services are active, we have a ‘black hole’ where nothing much is happening. If the issue has any public salience, any action is likely to be purely symbolic. The fourth cell in the matrix is, of course, the co-production cell, in which both citizens and professionals are active. These contributions are not always of equal intensity, as these players have different assets, capabilities and skills (although they may be seen as equally important, in that both sets of inputs are required to achieve the desired improvements in outcomes or service efficiency). Here public service organisations are ‘doing with’ citizens, not ‘doing to’ or ‘doing for’ citizens. Consequently, we can see from Table 2.4 that there are actually two strategic pathways towards a co-production approach. First, public service organisations could invite or attract users and communities to contribute to existing public sector activities—this is an example of publicly-initiated and ‘inside-out’ co-production. Alternatively, they might build on the existing and independent activities of service users and their communities, adding public service inputs in order to improve public outcomes (‘outside-in’ co-production).

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We can also see another strategic direction in which public service organisations might move—they might cut public services and simply delegate all responsibility to local communities. Here, of course, the term ‘co-production’ is not at all justified, as there is no public services contribution (even though some politicians and public service organisation top managers may still wish to refer to such retrenchment strategies as ‘co-production’). The ‘inside-out’ strategy to move towards co-production (from Cell A to Cell C in Table 2.4) has characterised the approach of many public service providers. This has meant enabling service users to make a more important contribution, e.g. transforming personal social services by providing personal budgets. Many public service providers have also launched campaigns to mobilise more local people to work alongside public services. An example is the environment initiative of the Department of Environment in Serbia which worked with about 20 volunteers to co-design a national clean-up day (Rabrenovic 2011). In 2010 “Spring Cleaning of Serbia” mobilised about 209,000 volunteers which rose to 289,000 in 2011—4% of Serbia’s total population. Indeed, in 18 out of 168 municipalities which participated in 2011 over 10% of the local population turned out. The alternative, ‘outside-in’ pathway into co-production (from Cell B to Cell C in Table 2.4) entails public service resources being added to already existing self-help or self-organising activities in civil society. Here public services identify how they can supplement the capabilities of service users and local communities, providing help for self-help. This has always been the practice of some social workers, neighbourhood managers and many third sector organisations. An example of how effective this ‘outside-in’ strategy can be comes from Rimini, where a local resident in 2011 was dissatisfied with the state of a park outside the window of his house and decided to take action by cleaning it up and cutting the grass in his spare time (Artuso and Montini 2016). After a few months, he was joined by some neighbours, who helped him to maintain the park. These activities triggered a number of meetings between the engaged citizens and district and municipal authorities to discuss how to sustain and scale out the initiative. This resulted in the local authority of Rimini supporting the co-production initiative CI.VI.VO. By December 2016, the number of CI.VI.VO. volunteer groups had grown to 68.

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However, public service organisations are often reluctant to grow coproduction systematically from ‘grassroots’ initiatives. One immediate barrier is that this pathway requires public service organisations to ‘buy into’ the offer of local communities, rather than the other way round, which is a significant change of mindset. This would also require strategic commissioning to take a more systematic approach to asset-mapping, rather than focusing on needs analysis (Loeffler and Bovaird 2019). Moreover, and currently even more deterring for many public service organisations, this pathway requires them to invest extra resources in the activities of other people and communities, at least in the shortterm, so that the activities of service users and communities can become more effective. In a cash-starved public service organisation, such ‘additive forms of co-production’ (see Sect. 6.7) have been less popular, as this probably means diverting resources from other activities. Valuable as the ‘outside-in’ pathway to co-production may be, Brandsen et al. (2017, 676) highlight that it can have a downside, in that it may bring the risk that the state takes over such initiatives, “leading to a manufactured civil society that has little to do with spontaneous citizen initiatives”. In other cases, it depends on the point of time as to whether to categorise the pathway to co-production as ‘inside-out’ or ‘outside-in’. We have already mentioned the Rimini CI.VI.VO. project. Here, the project was initiated from civil society. The activities of volunteers continued to be complementary to the services regularly managed and delivered by the local authority and local contractors. This means that there are no savings for the local authority, as the local areas taken care of by the volunteers had previously been neglected by local public services. However, the local authority of Rimini has now mainstreamed this project, so it has become an ‘inside-out’ co-production activity. The Council now covers insurance costs for volunteers, provides materials required by them, and also runs other marketing activities to increase the number and diversity of volunteers taking part in CI.VI.VO. groups. Of course, not all civil society initiatives increase publicly desired outcomes or efficiency, or improve the implementation of good governance principles. Indeed, as Brandsen et al. (2017, 686) suggest, “the dynamics between top-down and bottom-up initiatives can … be complex”. As their examples show, civil society initiatives may often be narrow in terms of the interests and stakeholders involved. Co-production may then require corrective actions by the public sector and its partner

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organisations to improve equalities and social inclusion. Of course, there is the risk that such interference by the public sector to correct for or prevent poor outcomes or bad public governance may put an end to user and community self-help and discourage local people from doing more in the future to help others—but in co-production both citizens and public service organisations need to feel that they are furthering the agendas which matter to them. Clearly, a move towards co-production could also emerge from a situation in which both service users and professionals are passive (i.e. from Cell D to Cell C) but this is relatively unlikely, being high-risk and resource-intensive for both parties. Indeed, we have no examples of this pathway in the extensive Governance International data base of co-production case studies. Given the limited progress which has typically been made with ‘insideout’ co-production in many public service organisations, it seems likely that in future it will be important to give more weight to the ‘outsidein’ strategic pathways towards co-production. This may well be made easier by digitalisation, which is already helping public service organisations to identify potential user and community contributions and to support engaged users and communities to find a match for the contributions they can offer amongst their communities (whether geographical or virtual). This will be discussed in more detail in Chapter 3.

2.6 A Quality Assessment Framework for Co-production For public sector organisations which commit to co-production and initiate new co-production initiatives—typically using the ‘inside-out’ pathway—there is often the desire to assess progress made and how well the organisation has ‘implemented co-production’. This raises the question of which quality assessment systems exist for user and community co-production and what their strengths and weaknesses are. Based on this meta-assessment we will develop a new quality assessment framework for co-production processes and critically discuss its potential and limitations. A review of quality assurance systems such as the ISO 9001 series of norms (ISO 2019) and international quality systems used in the public sector, such as the Common Assessment Framework (CAF), which is disseminated by the CAF Resource Centre at the European Institute

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of Public Administration (EIPA) and its network of CAF correspondants (EIPA 2019), shows that the focus has usually been on assuring or enhancing the quality of organisational processes and results of public service providers (Bovaird and Loeffler 2016b). Co-production is in many ways the other side of the coin of traditional quality management, where quality is often seen as how well internal organisational processes bring results which satisfy citizens (the assessment of which we cover in Chapter 6). In this new form of quality management, not only staff but also citizens need to get engaged in the value creation process. Now service providers need to ask citizens a new question: not just ‘How satisfied are you with the quality of public services?’ but also “How satisfied are you with the way in which we enabled you to make a contribution towards improving outcomes that matter to you?” The organisational perspective inherent in these conventional quality tools implies that the contributions made by users and communities to public services and outcomes are mainly considered as an ‘add-on’ to the ‘production process’ of the organisation. For example, the 2013 version of the CAF model recognises citizens as part of organisational partnerships in the ‘enablers’ section of the model. Sub-criterion 4.2. of the CAF says: “The role of the citizens/customers in general can be approached from four angles: as co-designers, co-decision makers, co-producers and co-evaluators” (European CAF Resource Centre 2013, 35). They go on to suggest that, as co-designers, citizens/customers have an impact on what services public organisations want to deliver, and how to deliver them; as co-decision makers, they will have greater involvement in and ownership of the decisions affecting them; as co-producers, they themselves will partly deliver some aspects of services and their quality; and finally, as co-evaluators they will judge the quality of public policies and the services they receive. This organisational perspective focusses on how citizens as part of organisational partnerships add value to the services provided by the organisation, which reflects the ‘inside-out’ pathway toward co-production. However, it does not capture well how the specific organisation enables citizens (and other stakeholders) to achieve private or public value based on an ‘outside-in’ pathway towards co-production. Nevertheless, such organisational quality models are attractive to public managers since they provide a systematic framework with categories to which public managers can relate, and, in the case of the CAF, reduce complexity to nine ‘boxes’ of core assessment criteria.

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The co-production assessment framework which has been developed by nef in co-operation with Edgar Cahn (Stephens et al. n.d.) invites practitioners to reflect on the extent to which a number of core co-production principles have been put into practice. For example, as far as the principle ‘assets’ is concerned, the nef assessment framework asks staff to assess the extent of the transformation of “the perception of people from passive recipients of services and burdens on the system into one where they are equal partners in designing and delivering services” (Stephens et al. n.d., 2). Typically, the framework provides four scales (‘not there yet’, ‘basic’, ‘making progress’, ‘excellent’) with a brief description of the specific principle and invites practitioners to think of examples to support their assessment. The nef assessment framework has the strength that it is very compact and user-friendly. However, it focusses mainly on procedural quality, while neglecting the efficiency and effectiveness of co-production. In the event, this framework has not been developed further. Consequently, we believe that a new quality assessment framework for coproduction is needed. Here we develop the core elements of a quality framework for co-production, aiming to build on the strengths of both the CAF and the nef co-production assessment framework. The model is illustrated in Fig. 2.1. It takes into account the quality of the contributions made both by public service organisations and also by users or communities, the quality of their co-production process and its effects on public service outputs, public service quality, social capital and on individual, community and public outcomes. As Fig. 2.1 shows, coproduction by users and communities will be shaped by formal and informal rules, regulations and manuals, depending on the service and co-production initiative concerned. As Fig. 2.1 highlights, quality management of co-production needs to ensure that both the public service organisation and citizens are able to make effective contributions. The quantity, quality and sustainability of their contributions is likely to be influenced by the willingness and ability of professionals and citizens to co-produce—and this may depend partly on their level of trust in each other’s ability and in how effectively they mobilise each other’s contributions—co-producers have to be expert at working together, not just doing their own tasks well. Furthermore, rules and regulations may facilitate the co-production process or provide barriers to it. This may also include the guidance contained within quality manuals. While some rules and regulations cannot be changed by the stakeholders involved, depending on the

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Resilience

User inputs

Community inputs

Public service organisation inputs

User co-production activities

Rules, regulations and quality manuals

Community co-production activities

Coproduced activities

Public service outputs

Trust

Public service quality

Public governance principles

Social capital

Individual outcomes

Collective outcomes

Public sector outcomes

Collective learning

Fig. 2.1 A quality framework for user and community co-production (Source Author)

context, the co-producing stakeholders may agree on a number of rules which shape their behaviour towards each other, such as the sharing of risks. The extent to which quality manuals facilitate or hinder co-production processes depends on the scale of user and community co-production. Is co-production limited to small-scale projects or even co-production champions doing it ‘on their own’ or does co-production cut across services and even organisations? Here, there are two contesting scale and quality effects: it may be that for citizens and professionals to make the most of each other’s resources and improve public service quality and outcomes, they need to be very familiar with each other at a personal level—this argues for small-scale, usually locally-based co-production initiatives, which are bespoke to the individuals involved in the co-production relationship. In this case, there may be no need to codify mutual expectations as a written set of rules or quality manuals. This would reduce flexibility and may also be interpreted as a lack of trust.

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However, if co-production initiatives are to be scaled more widely, it is essential that the co-producers involved agree on a set of rules and quality manuals, so that new co-producers understand what they can expect from others and what is expected of them. One example is the Values Based Standard® of the UK charity Macmillan Cancer Support, which provides a quality framework for improving both patient and staff experience, which also involves co-production with people being diagnosed with cancer (Dhanda and Wells 2013). It has been co-designed during an 18-month process with over 300 healthcare staff and people living with cancer across the country, based on the insight that relational aspects of care are more important than transactional aspects such as waiting times and the décor of waiting rooms. In particular, the standard identifies eight forms of behaviours which are expected of staff. In a nutshell, the Standard suggests that ‘difference’ is the norm and that care must respond to the needs of each individual patient. The implementation of the Standard in some test sites also triggered some new co-production initiatives such as the induction of patients on the ward through other patients or patient buddies. This tension between the requirements of small-scale, locally-based co-production initiatives and more widely-scaled initiatives can never be entirely resolved. The correct approach to providing appropriate quality depends on the priorities of the key stakeholders involved—the citizen co-producers and the service providers. The balance which they agree between these competing requirements is context-specific and should not be laid down in advance. However, there is another quality management argument that needs to be considered, namely that avoidable differences in service design and delivery should be recognised well in advance, so that they can be taken into account in the negotiation of agreed service standards. This is important both for fairness reasons and also to allow standardisation (and therefore lower costs) in the administration of services. The issue here is whether differences in service design will improve service effectiveness in the eyes of co-producing service users or communities. Resolving this issue requires understanding the trade-off between personalisation (which potentially improves personal outcomes but may increase public sector costs) and standardisation (which may reduce costs to the public sector but also potentially reduces the personal outcomes experienced by citizens and may also increase costs to citizens). We will explore this issue further when we look at evaluation of co-production in Chapter 6.

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The co-production activities such as meetings of co-production groups or trained volunteers providing support to service users will generate coproduction outputs, and in most cases, impact on public governance. There is a two-way relationship between co-production and public governance. In one direction, the way user and community co-production operates is influenced by externally defined public governance principles (such as data protection rules to ensure privacy). In the other direction, the co-producers who are involved may also give special weight to improved achievement of those public governance principles which are particularly important to them. Similarly, there is a two-way relationship between co-production and trust. In one direction, user and community co-production is likely to be made much easier if a basic level of trust exists between the stakeholders who are co-producing. In the other direction, successful co-production activities of users, communities and public service organisations are likely to increase the level of mutual trust—and this applies to all kinds of trust, including cognitive trust (based on knowledge of each other), affective trust (based on emotional identification with each other) and conative trust (based on a belief that values and objectives are shared) (Bovaird and Loeffler 2005). The outputs resulting from user or community co-production may increase the quantity and/or range of public services provided and improve service quality. Moreover, community co-production is likely to increase levels of social capital. The dynamic element of quality management, which is often ignored in the co-production literature, enters in Fig. 2.1 through collective learning. In particular, if user and community co-production deals with complex problems rather than transactional services, co-production is unlikely to be a linear process where we know about and disseminate best practice. This means that, if co-production takes place in complicated or complex knowledge domains where the effects of co-production on service quality and outcomes cannot be predicted, action learning through iterative processes is needed (Snowden and Boone 2007). As Fig. 2.1 shows, the collective learning processes may involve a constant process of redesigning the inputs of users, communities and public service organisation and their co-production process, as lessons are learnt about the interdependencies in the service system.

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Here, a key quality issue is to what degree the learning taking place involves single-loop, double-loop or triple-loop learning (Argyris and Schön 1978). Do failures during the co-production process result in ‘patching up’ the problems, rather than tackling the root causes? An example of single loop learning would be replacing a volunteer social transport driver who has been unable to help a passenger having an epileptic fit with another driver who is able to do this (single-loop learning), rather than ensuring that all drivers were able to cope with the emergencies which they were likely to encounter in the job (double-loop learning). Triple loop learning would involve making sure that that this failure triggered an improvement in the learning processes of the organisation, so that potential failures such as this could in future be spotted much earlier. In some cases, co-production may help to improve outcomes directly, rather than acting indirectly through a public service, e.g. where volunteers who have been recruited by a public service organisation help to coordinate informal service user meetings which enable service users to make new connections and sometimes even develop friendships, raising their self-esteem and reducing their feelings of inadequacy. This is naturally more likely in the strategy of ‘outside-in’ co-production, where public professionals are using their capabilities to improve the outcomes of activities in civil society, rather than in the ‘inside-out’ strategy based on existing public services. Another dynamic element of quality management, which is often ignored in the co-production literature, enters in Fig. 2.1 through user, community, organisational and market resilience. Here ‘resilience’ means adaptation that supports successful achievement of goals and objectives, as well as learning for future planning and preparation (Edson 2012). Resilience can be based on the characteristics of service users, of the communities in which they live, of the organisations which provide services to them or the market wide group of organisations from which these providers are chosen by service commissioners. For resilience to be fully effective, all of these sources of resilience must be in place and interacting in synergy with each other—i.e. there has to be a fully functioning ‘whole system’ resilience chain in place (Bovaird and Quirk 2017). As shown in Fig. 2.1, resilience supports co-production activities, contributes to the level and quality of outputs achieved, the achievement of public governance principles, and the formation of social capital; and has an impact on the outcomes achieved. At the same time, the successful

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achievement of each of these elements of the quality model in Fig. 2.1 reinforces at least some elements of the whole system resilience chain. The mutual reinforcement of resilience and co-production is key to how sustainable are the outcomes brought about by co-production. How can we operationalise this quality framework for co-production? Table 2.5 shows how the quality of user and community co-production can be assessed on the basis of objective and subjective quality criteria, covering all of the aspects incorporated in the model in Fig. 2.1. In the spirit of co-production, both professionals and citizens involved should discuss the quantitative and qualitative evidence in order to co-assess the quality of co-production improvements to service quality and outcomes. In Chapter 6 we consider key elements of this framework in more detail and setting out some of the evidence so far available in relation to these criteria. This quality framework for co-production is much more comprehensive than existing co-production self-assessment schemes, which mainly put the focus on the degree to which co-production principles have been put into practice. While this latter is important, the quality of the contributions of both citizens and public service organisations need to be assessed as well, as well as their effect on the other variables in Fig. 2.1. Finally, in quality management we need to assess to what degree all the variables considered in Table 2.5 have been improved through the coproduction activities, rather than simply because of other factors which have occurred at the same time as the move to greater co-production. (This is known as the ‘attribution problem’ in evaluation.) Such a quality framework for co-production may be helpful to support the change management process, which will be discussed further in Sect. 5.4. In particular, in quality management it is important to ensure that moving to co-production results in some outputs and outcomes within a reasonable timeframe, rather than getting bogged down in endless talk shops between professionals and service users, which can be a real danger where changes are being proposed which have the potential to be threatening to one or both parties.

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Table 2.5 Criteria for assessing the quality of user and community coproduction Quality criteria

Objective quality criteria

Subjective quality criteria

Contributions of users/communities

Time contributed Financial resources contributed

Contributions of professionals

Staff time contributed Financial resources contributed (set-up costs and recurrent costs) Other resources contributed

Rules and regulations

Existence of risk management framework Conformance to health and safety regulations Agreement of mutual expectations (e.g. through co-production charter) Agreed conflict management process (for example, through independent advocacy) Number of services/organisations involved (extent of co-production) Number of vertical organisational levels or levels of government involved (depth of co-production) Embedded in organisational or government strategy? Number of services/organisations involved (extent of co-production) Number of vertical levels involved (depth of co-production) Embedded in organisational or government strategy? Embedded in neighbourhood management strategy?

Level of effort contributed, including psychological costs experienced Call-off of interpersonal relationships Level of effort contributed, including psychological costs experienced Call-off of interpersonal relationships Call-off of interorganisational relationships Perception of right balance of risks for both professionals and service users Perceived meeting of mutual expectations Perceived level of conflicts experienced during co-production process

User co-production activities

Community co-production activities

Mutual recognition and appreciation of each other’s contribution Perception of how often the process operated as agreed

Mutual recognition and appreciation of each other’s contribution Perception of how often the process operated as agreed

(continued)

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Table 2.5 (continued) Quality criteria

Objective quality criteria

Subjective quality criteria

Governance principles

Existence of document which sets out mutually agreed governance principles (e.g. Co-Production Charter) Evidence of conformance (or non-conformance) to governance principles Agreed delegation of critical tasks to the other side (by professionals to citizens, by citizens to professionals)

Perception that agreed governance principles were implemented (e.g. through focus group assessments) Satisfaction that agreed governance principles are adequate Public services’ belief that service users and communities will contribute appropriately to the joint activity Citizens’ belief that professionals will contribute appropriately to the joint activity Perception that trust between citizens and staff has increased Satisfaction with co-produced solutions and/or services Satisfaction with timeliness

Trust

Co-produced outputs

Public service outputs

Public service quality

Joint framing of problems (mapping document) Identified solutions (number of proposed solutions, prioritised solutions) Co-produced solutions put into practice (Toolkit for prototypes) Services delivered through co-production process (days of service delivered, number of service users supported) Savings from reduction of statutory services (e.g. A&E services) (while still meeting agreed standards) Increase of (preventative) non-statutory services Access to service (e.g. opening times) Number of service failures (and number of service users affected) Proportion of service days where quality fell below minimum agreed standards

Satisfaction with (now reduced) levels of statutory services Satisfaction with new service options Service user satisfaction level Staff satisfaction level Inspection/audit ratings Emotional reactions of users to service

(continued)

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Table 2.5 (continued) Quality criteria

Objective quality criteria

Subjective quality criteria

Social capital

New relationships and networks created (number of new contacts made, new friendships and new memberships in associations) Diversity of personal networks/local networks (range of skills and capabilities represented in a network) Improvements of quantitative outcome indicators (e.g. reduced number of days of ill health, reduction of unemployed young people) Time available for reflection and discussion Number of documented mistakes Number of services changed after experience of co-production initiative Number of times co-production plans have been significantly changed (as illustrated, for example, by budget changes) in the light of learning from crises and service failures Volume of co-produced services which have disappeared as result of crises or service failure

Satisfaction with the quality of networks (e.g. perception to have somebody to talk to about personal issues) Satisfaction with the quality of networks (perception that other network members have set of skills and capabilities which are complementary) Satisfaction with improved outcomes (quantitative and qualitative)

Outcomes

Collective learning

User, community, organisational and market resilience

Satisfaction with learning opportunities Perceptions of staff/citizen co-producers that they are allowed to make mistakes Satisfaction with changes resulting from learning Perception of users/communities that they are better able to cope with crisis and service failure Perception of public service organisations that they are better able to cope with crisis and service failure Perception that lessons learnt from previous crises and service failures have been acted upon by all stakeholders involved in co-production

Source Author

2.7

Conclusions and Recommendations

In this book we will define user and community co-production of public services and outcomes as being about public service organisations and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes or improve efficiency. For many advocates of co-production, co-production is seen not just as a means to an end but as a way of achieving important aspects

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of public governance. Typically, normative concepts of co-production promote the implementation of co-production principles as a vehicle for achieving greater social justice and equality. From this perspective, coproduction strengthens citizenship, not just the achievement of qualityof-life outcomes. Normative approaches to co-production approaches have been endorsed by a wide range of social movements around the world. Clearly, all types of co-production, just like any other public service interventions, must be expected to conform to the principles of good governance, which are not, in themselves, unique to co-production. However, there are some distinctive principles of co-production, which complement these good governance principles—co-production should be asset-based, enabling, collaborative, outcome-oriented and democratic. The principles and processes of public governance are not absolute— they are likely to vary in importance between contexts and over time, and will be valued differently by different stakeholders. The ‘governance impossibility theorem’ suggests that it is unlikely that all of these principles can simultaneously be implemented—at least, not to their full extent. Consequently, there is a need to prioritise both those wider good governance principles which should also apply to co-production but also the specific principles which are distinctive to co-production. Co-production of public services and outcomes is the most intense form of citizen engagement. It involves higher levels of input, whether in the form of citizen ‘voice’ or citizen behaviour change, commitment and actions. For public service organisations this means going beyond dialogue towards an enabling role in which they help users to help themselves or help communities to organise themselves. In contrast to consultation and public participation, co-production may also be initiated by service users and local communities. Those ‘people who know and care’ are the core recruitment targets for many co-production activities. Moreover, it seems likely that the higher the number of people in this group, the greater the chances of co-production being a successful intervention. Clearly, deciding who should be involved in co-production can be critically important—on the one hand, involving people who have no knowledge or interest in an issue will waste their time and public money, while, on the other hand, not involving people who do know and care about an issue is potentially a waste of valuable resource. These decisions should therefore be made, or at least overseen, by elected politicians. Moreover, the

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distributional aspects of co-production, in cases where it favours some groups more than others, have to be taken into account in government strategies to tackle inequality. In Chapter 3, this analysis will be further refined by exploring how it needs to be interpreted within the different modes of co-production (co-commissioning, co-design, co-delivery and co-assessment). Given the limited progress which has typically been made with ‘insideout’ co-production in many public sector organisations, it seems likely that in future more weight will be given to the ‘outside-in’ strategic pathways towards co-production. There is a need to focus on the quality management of coproduction—a framework is proposed in this chapter to take into account the quality of the contributions made both by public service organisations and also by users or communities, the quality of their co-production process and its effects on public service outputs, public service quality, social capital and finally on individual and collective outcomes. Quality management will involve finding a balance between the two arguments that, on the one hand, personalisation may improve outcomes but increase public sector costs, and, on the other hand, standardisation may reduce costs to the public sector but also potentially reduce the personal outcomes experienced by citizens (and may also increase their costs). This quality assessment framework for co-production is intended as a useful tool for the process of change management to promote coproduction, which will be discussed in more detail in Sect. 5.4, and for evaluation of the effects and public governance of co-production, discussed in Chapter 6.

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Ostrom, E. (1998). A behavioural approach to the rational choice theory of collective action. In E. Ostrom & V. Ostrom, Choice, rules and collective action: The Ostroms on the study of institutions and governance (F. Sabetti & P. D. Aligica, Ed.). Colchester: ECPR Press. Parks, R. B., Baker, P., Kiser, L., Oakerson, R., Ostrom, E., Ostrom, V., et al. (1981). Consumers as co-producers of public services: Some economic and institutional considerations. Policy Studies Journal, 9(7), 1001–1011. Pestoff, V. (2018). Co-production and public service management: Citizenship, governance and public service management. New York and Abingdon: Routledge. Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York: Simon & Schuster. Rabrenovic, A. (2011). Cleaning-up Serbia: Designing and Delivering a Public Campaign with over 200,000 volunteers. Governance International Case Study. Birmingham: Governance International. http://www.govint.org/good-pra ctice/case-studies/cleaning-up-serbia-designing-and-delivering-a-public-cam paign-with-over-200000-volunteers/. Accessed 2 Apr 2019. Rippon, S., & Hopkins, T. (2015). Head, hands and heart: Asset-based approaches in health care: A review of the conceptual evidence and case studies of asset-based approaches in health, care and wellbeing. London: The Health Foundation. https://www.health.org.uk/sites/health/files/Hea dHandsAndHeartAssetBasedApproachesInHealthCare.pdf. Accessed 15 Nov 2018. SCIE. (2013). Co-production in social care: What it is and how to do it (Guide). London: Social Care Institute for Excellence. https://www.scie.org.uk/ publications/guides/guide51/what-is-coproduction/principles-of-coproduct ion.asp. Accessed 29 Mar 2019. Snowden, D., & Boone, M. E. (2007). A leader’s framework for decision making. Harvard Business Review, 85(11), 68–76. Spice. (2018). Spending time credits 2018. http://www.justaddspice.org/wpcontent/uploads/2018/06/Spending-Time-Credits-Report.pdf. Accessed 15 Sept 2018. Steen, T., Brandsen, T., & Verschuere, B. (2018). The dark side of co-creation and co-production. In T. Brandsen, T. Steen & B. Verschuere (Eds.), Coproduction and Co-creation: Engaging citizens in public services (pp. 284– 293). New York and Abingdon: Routledge. Stephens, L. Slay, J. & Penny, J. (n.d.). Coproduction self-assessment framework: A working reflection tool for practitioners. London: New Economics Foundation. Stoker, G. (2006). Public value management a new narrative for networked governance? American Review of Public Administration, 36(1), 41–57.

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Thijssen, P., & Van Dooren, W. (2016). Who you are/where you live: Do neighbourhood characteristics explain co-production? International Review of Administrative Sciences, 82(1), 88–109. Tritter, J. Q., & McCallum, A. (2006). The snakes and ladders of user involvement: Moving beyond Arnstein. Health Policy, 76, 156–168. Tuurnas, S. (2015). Learning to co-produce? The perspective of public service professionals. International Journal of Public Sector Management, 28(7), 583– 598. https://doi.org/10.1108/IJPSM-04-2015-0073. United Nations. (2006). Preamble of the Convention on the Rights of Persons with Disabilities (CRPD). https://www.un.org/development/desa/disabi lities/convention-on-the-rights-of-persons-with-disabilities/preamble.html. Accessed 28 Mar 2019. van Eijk, S., Steen, T., & Verschuere, B. (2018). Case study—Dutch and Belgian citizens’ motivations to engage in neighbourhood watch schemes. In T. Brandsen, T. Steen, & B. Verschuere (Eds.), Co-production and co-creation: Engaging citizens in public services (pp. 226–228). New York and Abingdon: Routledge. Verschuere, B., Vanleene, D., Steen, T., & Brandsen, T. (2018). Democratic co-production: Concepts and determinants. In T. Brandsen, T. Steen & B. Verschuere (Eds.), Co-production and co-creation: Engaging citizens in public services (pp. 243–251). New York and Abingdon: Routledge. Welsh Government. (2014). Improving public services for people in Wales. Cardiff: Welsh Government, https://gweddill.gov.wales/docs/dpsp/publicati ons/140708-response-to-commission-en.pdf. Accessed 28 Mar 2019.

CHAPTER 3

The Four Co’s: Co-commissioning, Co-design, Co-delivery and Co-assessment of Public Services and Outcomes Through Traditional and Digital Mechanisms

3.1

Introduction

As discussed in Chapter 2, there are different conceptualisations in the coproduction literature as to what co-production is and what it isn’t. A key part of this debate is around the scope of co-production and, in particular, the balance in co-production between citizen voice and citizen action. This chapter will focus on unpacking the key issues in this discussion. Section 3.2 will introduce the Four Co’s Model, which distinguishes between the different modes of co-production—co-commissioning, codesign, co-delivery and co-assessment of public services and outcomes. Sections 3.3–3.6 then discuss each of the four co-production modes in more detail, illustrating them through examples, providing evidence of improved public value but also critically discussing the limitations and risks attached to each co-production mode. These examples will mainly focus on non-digital cases. Given the ever-increasing importance of digitally enabled coproduction, we will devote Sect. 3.7 of this book to a discussion of potential impacts, risks and pitfalls of digital forms of co-production. This includes illustrative case studies of digital co-production in each of the Four Co’s. Consequently, there will only be passing reference to digital approaches to the Four Co’s in the earlier part of this chapter.

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3.2 A Framework for Co-producing Public Services and Outcomes with Service Users and Communities: The Four Co’s Model In the early work of the Ostroms and their colleagues in the Bloomington School, co-production was essentially seen as co-delivery (Parks et al. 1981), focusing on the potential of citizen action to improve public services. In a widely cited typology of user and professional roles in coproduction, Bovaird (2007, 848) compared the intensity of involvement in a service by professionals and citizens in the service planning and service delivery stages of a service. He suggested that only where there was high involvement of professionals and citizens in both planning and delivery could there be said to be ‘full co-production’. This is, of course, a very demanding test to apply to co-production but it remains a key way of distinguishing between co-production and public participation, where the intensity of citizen contributions is typically much lower. This typology was developed further in Bovaird and Loeffler (2013, 5) to provide a systematic categorisation of co-production activities throughout the public service cycle, distinguishing four key coproduction modes, namely co-commissioning, co-design, co-delivery and co-assessment (the Four Co’s)—a conceptualisation which was later adopted by other scholars, for example, Nabatchi et al. (2017). The Four Co’s form the inner ring of the Governance International Co-production Star model, which constitutes a systematic framework for public service commissioners, providers and citizens to map how much co-production is already taking place, focus on how to make it work better and identify ways to develop it further (Loeffler and Bovaird 2018, 409). The outer ring of the Co-Production Star visualises a five step change management process for implementing the Four Co’s to improve outcomes or efficiency. This will be analysed in more detail in Sect. 5.4. As Fig. 3.1 shows, the Four Co’s provide an integrated cycle of cocommissioning, co-designing, co-delivery and co-assessing co-production for public service organisations and citizens. They offer citizens, staff and elected politicians a range of quite different roles for making use of their strengths and capabilities. Consequently, having the Four Co’s as a template serves to remind stakeholders that a much wider range of coproduction activities may be possible than is currently being undertaken (Bovaird and Loeffler 2016a, 263). We will examine each of the Four Co’s in detail throughout this chapter.

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Fig. 3.1 The Four Co’s in the Co-Production Star (Copyright © Governance International 2013)

From the definitions we discussed in Sect. 2.2, it is clear that other scholars sometimes accept only some of the Four Co’s as co-production. For example, Brandsen and Honingh (2018, 14), see co-production as involving the design and implementation of a service or just the implementation of a service—co-design or co-delivery in terms of the Four Co’s. They refer to the strategic co-planning of a service (‘cocommissioning’ in the Four Co’s) as ‘co-creation’, rather than part of co-production. However, each of the Four Co’s represents citizen involvement in the different phases of the ‘rational management cycle’ and, moreover, each has strong advocates in the co-production literature, so we believe that it is appropriate to include each of them as modes of co-production. While each of the Four Co’s represents an important mode of coproduction, it makes sense, when we are considering just one of the Four Co’s in a specific context, to label it directly (co-commissioning, co-design, co-delivery or co-assessment), rather than swallowing it up in the more generic term ‘co-production’ and we will do this throughout this book. It is also important to stress that each of the Four Co’s may represent a serious and sufficient co-production approach on its own. It would therefore be wrong to suggest that co-production is only happening when all Four Co’s are being practiced—that is not only unrealistic, it smacks of a lack of strategic focus, since it is unlikely that all Four Co’s are going to be equally important in a specific context at a particular time.

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Similarly, while a public service organisation or a local area may well decide to put all Four Co’s into practice over a period of time, it would be unrealistic to expect that this will happen in a neatly sequenced order. Change management often does not follow a linear process but rather behaves as a complex adaptive system (Koliba and Koppenjan 2016, 263– 264). For example, co-assessment may be triggered ‘out of the blue’ by a wave of similar citizen complaints, rather than coming as the result of the implementation of a new service delivery initiative. A common response would then be to redesign the service, with the public service organisation concerned working alongside some of the more constructive ‘complainers’ who are motivated to help the public service organisation to get it right. An example of this approach comes from the City of Offenbach, close to Frankfurt, which launched the initiative Better Living in Offenbach to improve the built environment in disadvantaged neighbourhoods, together with the local arms-length public service company and residents in the area. Two citizens who were ‘street champions’ in the initiative recalled: “Recruitment took place at street parties but also when people complained, as they were then asked whether they could not help to make things better” (Birk and Süßmann 2013). In this way, one ‘Co’ may lead to another ‘Co’, as windows of opportunity for change open up and a critical mass of co-producers becomes available. However, there will be times when a focus on just one or two of the Four Co’s is entirely appropriate. As suggested above, the Four Co’s provide a range of different roles for citizens to get involved in co-production. According to Bovaird and Loeffler (2013), they include: 1. Co-commissioning of priority outcomes: Citizens know best what matters to them (citizens as strategic thinkers and funders). 2. Co-design of improved pathways to outcomes: Citizens know things which professionals don’t know (citizens as innovators). 3. Co-delivery of pathways to outcomes: Citizens have capabilities, skills, time and resources to improve public services and public outcomes (citizens as asset-holders) and can promote the value of public services they engage with (citizens as legitimators’ and ‘testimonial providers’), so that other citizens are more likely to work closely with those services and agree to their (co-)funding (citizens as ‘co-workers’ and ‘financiers’).

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4. Co-assessment of public services, quality-of-life outcomes and governance principles: Citizens often know better than professionals whether a new pathway works for them (citizens as evaluators). Three of the Four Co’s—namely, co-commissioning, co-design and coassessment—mainly involve citizen voice. Co-delivery, of course, is mainly about citizen action to improve public services and/or outcomes, rather than citizen voice. This distinction is important, as not all citizens who make significant hands-on contributions to improve public services and outcomes like to attend public meetings or engage in ‘talk-shops’ (Loeffler and Bovaird 2019). This distinction between citizen voice and action constitutes a reworking of the Hirschman (1970) ‘exit, voice and loyalty’ framework. It highlights that in public services, where service users consider that their voice for change is not achieving the results they desire, they have more choices than simply ‘exit’ (which often incurs major transfer costs) or ‘loyalty’ to an unsatisfactory service (Loeffler and Timm-Arnold 2020, 3). Indeed, exit is often not an option, as alternative providers are rarely available and, even if they are, service users are often not eligible to register with them. Loyalty is always available but, for dissatisfied service users, can represent a highly undesirable strategy. The new category of ‘citizen action’ through co-delivery presents the possibility of a much more positive strategy, in which citizens get actively involved in the delivery of a service or outcome, so that it conforms more closely to their wishes. In other words, when we take account of coproduction, the choices facing citizens in failing services are ‘Exit, Voice, Loyalty and Co-delivery’, an expanded version of Hirschman’s taxonomy. While stressing that the Four Co’s can be independently valuable as modes of co-production, it is also important to recognise that they also provide a systematic framework for linking citizen voice and action. Evers (2015, 7) makes the point that public services need to establish a dialogue between the ‘doers’ and ‘talkers’ in order to overcome the separation between traditional volunteering and citizen participation. He argues that the old demand for more citizen influence through deliberation needs to be refocused, paying more attention to valuing and mainstreaming social innovation which provide citizens with more influence on public decisions through citizen action. When volunteers co-delivering services are later included in commissioning processes, public services then benefit from the tacit knowledge of citizens with hands-on experience. At the same time, volunteers and their organisations widen their horizons and do not simply concentrate on making demands for more public funding.

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Similarly, there is often an opportunity to turn successful citizen voice into citizen action. For example, when university researchers undertake a co-produced evaluation with citizens and volunteers, this co-assessment approach usually involves some interaction with the community—e.g. carrying out a community survey, holding service reviews with service users, and even beyond-text techniques, such as dramatic performance, art and photography (Durose et al. 2011). This interaction constitutes in itself a set of opportunities to mobilise community members to take action to put right the deficiencies which they identify in the evaluation, so that citizen voice can lead to citizen action. Citizen action has the advantage of giving citizens the opportunity directly to influence outcomes. However, it may do more—in particular, Pestoff (2009) has highlighted the potential of citizen action to indirectly enhance democracy. Citizens who engage in co-production through action learn more about the public sector, what it might do more of, and what it is less capable of doing. This creates a better informed citizenry, one more capable of making appropriate democratic choices. While political scientists have typically paid more attention to, and given more weight to, the exercise of citizen voice, citizen action may be a more effective learning space for participative democracy. Of course, not all citizens will be comfortable about taking on both citizen voice and action roles—and this is fine, as the whole point of co-production is to make use of the capabilities and assets of those concerned, not try to push them into inappropriate and uncongenial activities. However, it is likely that some co-producers will become interested in playing more roles in co-production over time, as they see the opportunities being taken by others and are building up their own capabilities. Again, their circumstances may change, meaning that a different coproduction role becomes more valuable for them. For example, parents of young children are likely to be interested in helping them with homework in their early years at school (a co-delivery role) but later may not need to do this. At this later stage, however, they can contribute to the development of the school as members of the school governance board (a citizen voice role). Table 3.1 provides an overview of the four modes of co-production and types of user and community co-production activities which can occur within each of the Four Co’s.

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Table 3.1 A typology of co-production modes—the Four Co’s Co-Production Modes

Types of user and community co-production

Mechanism

Co-commissioning of priority outcomes (i.e. WHAT is to be achieved together)

• Co-planning of strategies • Co-prioritising personal outcomes, public outcomes, public budgets • Co-selecting public service providers on basis of tenders in procurement process • Co-financing and resourcing of projects and services (e.g. crowdfunding) • Co-development of public spaces, projects, communication and services • Co-development of improvement processes (micro-level) • Co-development of radical new ideas for social innovation • Co-development of experiments and disruptive prototypes • Co-implementation of projects • Co-management of projects and public facilities • Co-performing peer support • Co-performing of services by volunteers • Co-influencing behaviour change (e.g. through mentoring) • Joint actions to make public services more effective • Joint actions for improving public outcomes • Giving feedback to public service organisations (e.g. making complaints or completing surveys as a respondent) • Asking questions to public service organisations (e.g. as a member of a service user panel or ‘citizen inspector’) • Undertaking joint research (e.g. through community research or community inquiries)

Voice

Co-design of improved pathways to outcomes (i.e. HOW to innovate together to achieve priority outcomes for priority groups)

Co-delivery of pathways to outcomes (i.e. HOW to implement together actions to achieve improved outcomes)

Co-assessment of public services, and public outcomes (i.e. WHAT works and WHY)

Voice

Action

Voice

Source Adapted from Bovaird and Loeffler (2013, 5)

As the Four Co’s indicate, all four modes of co-production require contributions from both public service organisations and citizens, although these contributions may differ greatly between (and even within) each co-production mode. Without an input from a public service organisation, we are dealing with user self-help or community self-organisation, not modes of co-production, as illustrated in Table 3.1.

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So if peer support is purely provided by service users for each other, without any support from public sector organisations or service providers commissioned by a public sector organisation, this is not co-delivery. At the same time, co-production in the public domain does not always involve the co-production of public services. For example, when professionals informally help to connect users with other users or volunteers in order to reduce their social isolation, this may directly improve personal and public outcomes. Of course, it is possible (and sometimes done in the UK!) to call this a ‘befriending service’, but where it is informal or even serendipitous, such a label is rather overblown. (Indeed, the idea of developing a service which will ‘find a friend’ for someone is rather far-fetched—a service can indeed put people in contact with each other, with the hope that they hit it off together, but whether or not they then become ‘friends’ is way beyond the power of the service). Co-commissioning is about public sector organisations working with citizens to prioritise, plan and resource public outcomes. As Table 3.1 shows, co-commissioning can include a wide range of activities, such as co-prioritisation of outcomes or budgets, co-planning of strategies, and co-financing of projects. In the case of users co-prioritising outcomes— as part of care planning, for example—the focus is likely to be on personal outcomes, rather than on wider outcomes experienced by society as a whole. However, when community members are brought into the process, the opposite is true—they are likely to be able to advise on community priorities, rather than priorities between personal outcomes. Co-design is about public service providers and citizens co-developing new pathways to improved outcomes. In many cases, this will involve gradual improvements of existing services and community-based practices but there is now increasing focus on how the potential of major (disruptive) innovation (even ‘transformation’) in existing services can be explored through experimentation, which spreads the risk over a range of interventions. Co-design by users or communities may be related to public spaces, public projects or public services. Urban regeneration, for instance, has long recruited residents to make suggestions on how local parks and squares, children’s play areas and pedestrian areas can be laid out to make them more attractive. Co-delivery is about citizens and public service providers taking action to achieve improved public outcomes. This seeks to enlist citizens in ensuring that pathways to public outcomes are successfully implemented, including activities such as co-implementing projects and co-managing

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public facilities like sports facilities or local parks being run by their users. There are many types of public services which can be and sometimes are delivered by their users or relevant communities. Indeed, as discussed in Sect. 2.2, it is a characteristic of services that there is often a minimum contribution which service users have to make for the service to take place at all. However, the definition of co-production used in this monograph requires user co-production of public services to involve some intensity of effort and a significant contribution by service users, in order for it to be non-trivial. A particularly important type of co-delivery, which can be very intense in the effort it requires, involves peer support by service users who are trained or supported by public services in order that they can help other users of public services to improve their quality of life. Other types of co-delivery involve co-influencing behaviour change—for example, through mentoring by volunteers. We shall explore some highly effective cases of these types of co-delivery of public services or outcomes later in this chapter. Co-assessment is about citizens and public sector providers working together to monitor and evaluate public services, public governance principles and quality-of-life outcomes and the impact of co-production on public services, public governance and public outcomes. Co-assessment approaches can vary greatly in their intensity of input from citizens. Filling out of a survey or making a complaint generally qualify as a type of co-assessment, although they typically involve a relatively low but still significant contribution from citizens (depending on the userfriendliness of the complaints system). Actually, the contribution may be rated as rather higher by citizens than by those running the survey or the complaints system—many researchers have experienced with some pain how reluctant potential respondents are to spend time participating in such co-assessments. Other types of co-assessment such as service reviews by users or citizen inspections of public services entail very significant contributions by users or communities. Probably the most intense form of co-assessment involves service users and their communities actually participating in generating and interpreting evidence, for example, the development and running of a door-to-door community survey or evaluation of a neighbourhood regeneration plan based on a locally developed evaluation framework with local people. For the public sector (or, more specifically, for the politicians determining public policy), there may sometimes be a conflict between making effective use of these modes of co-production and the key governance

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principles to which they subscribe. In many cases, public service organisations may wish to issue a call to ‘all’ stakeholders to get involved in a citizen voice or citizen action initiative. Yet, it may be quite clear that this might attract citizens with little to contribute to the specific activity, potentially holding back the initiative and wasting both citizen time and public service staff time. Even worse, this vague ‘shotgun’ form of advertising to recruit co-producers brings the risk that those with relevant ‘expert experience’ do not hear about the initiative, since they are not directly targeted, or they do not get the point that it is relevant to them. As we will see in Sect. 5.3, getting the right people involved in coproduction is fundamental to its success. In relation to the Four Co’s, digital technologies can now enable public service organisations to target specific user groups or communities as potential co-producers much more accurately and easily than ever before. For example, in the Netherlands the police developed Citizens Net, which is a digital system for contacting signed-up citizens when they need information from them after a crime has been reported in their area (Meijer 2012, 199). It will also be important to analyse how the Four Co’s vary across public services and, ultimately, across administrative traditions. For example, a German case study has shown that the range of self-reported co-production by professionals working in public services is far wider in social services for young and older people than in public safety at the local level (Loeffler and Timm-Arnold 2020). This raises the question of the extent to which different models of governance influence implementation of the Four Co’s. Further research is also needed on the influence of administrative traditions on modes of co-production (Parrado et al. 2013). We will now discuss each of the Four Co’s in more detail, identifying the range of approaches within each Co and illustrating them through international case studies. In each section, we will discuss key issues around co-commissioning, co-design, co-delivery and coassessment processes, the evidence of improved public value arising, and the challenges posed by each of the Four Co’s.

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Co-commissioning Priority Outcomes Types of User and Community Co-commissioning

There is no agreed definition in UK public services of what commissioning includes—and outside the UK there is often a complete lack of understanding of the concept. Indeed, it is often considered to be just another term for ‘service planning’ or even ‘externalisation’ (the letting of contracts for public services to private sector firms or to other public sector organisations, third sector organisations or cross-sector partnerships). However, these are misconceptions—commissioning generally involves more than just service planning, and it actually may not involve externalisation at all. So in this section, we look at what commissioning involves in practice and what citizens can contribute to it. Commissioning, as currently conceived in the UK, covers all the planning, prioritisation and resource mobilisation activities that are strategically important for achieving the results desired by a public sector organisation. When the commissioning approach started, which was as early as the 1980s in UK local government services, the results desired were generally expressed in terms of output and activity targets (but also sometimes even in input targets). Over the ensuing period the emphasis has changed significantly, so that it is now common for a commissioning organisation or partnership to aim at improving the outcomes achieved. In this way the focus in commissioning has changed from improving services to improving outcomes (Bovaird and Davies 2011). Moreover, since not all desired outcomes are likely to be achievable, commissioning has to make it clear what are the priority outcomes which are being sought and which priority groups are to benefit from them. The focus on outcomes opens up the perspective for improved outcomes achieved through contributions from service users and local communities—the coproduction option—not just professionally provided interventions. This will be highlighted further in our Public Value Model in Chapter 6. There are two ways in which co-production can be embedded in public sector commissioning: one is to involve citizens in the co-commissioning process, which ensures that service users or communities are able to contribute to all the key phases of the commissioning cycle; the other involves public sector organisations using commissioning to support and embed co-production, through citizen voice and action, in all of their prevention, treatment and rehabilitation strategies (Loeffler and Bovaird 2019, 242).

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This section will focus on the first of these approaches, namely identifying key forms of co-commissioning, which is about public sector organisations working with citizens and people who use services to identify, prioritise and resource public outcomes. It will also illustrate how co-commissioning with service users and communities has been put into practice in services for young people in Surrey County Council (the case study we introduced in Chapter 1), and discuss evidence of improved public value through co-commissioning. Then in Chapter 4 we will discuss the second of these approaches, namely how to embed co-production, through citizen voice and action, in the prevention, treatment and rehabilitation strategies of a public service organisation or partnership. Table 3.2 provides an overview of key types of user and community cocommissioning. Co-planning of strategies may make use of the capabilities of either service users or communities, or both, depending on the context. A number of public services involve service users in commissioning boards or procurement panels. In Surrey County Council, for example, Services for Young People involved young people in the procurement process for a set of new preventative services in local areas. The 11 Youth Task Groups which were set up included County Councillors, District and Borough Table 3.2 Types of user and community co-commissioning Types of co-commissioning

Examples of user co-commissioning

Co-planning of strategies • Service users shaping strategic planning as members of commissioning boards and procurement panels Co-prioritisation of • Individual budgets outcomes or budgets (micro-commissioning) • Service users shaping outcomes frameworks or co-prioritising grant applications

Co-financing of projects and services Source Author

• Fundraising by user groups

Examples of community co-commissioning Community neighbourhood planning

• Participatory budgeting to prioritise community projects or public services • Citizen Inquiries to identify priority issues and priority actions at local level • Crowdfunding at local level

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officers, young people and other stakeholders, who worked together to prioritise the needs of their local area. Moreover, they supported Local Committees in the process of selecting providers—shortlisted providers were asked to pitch their proposal to the Youth Task Group, which scored their proposals (Bovaird and Loeffler 2014, 22). According to a public manager taking part in this innovative project, the contributions of the young people changed the conversation with the service providers, since the questions they asked were more focussed on outcomes and less on service specifications. Community neighbourhood planning is a traditional form of coplanning at community-level. In the UK, the neighbourhood Balsall Heath in Birmingham has long been considered to be a ‘neighbourhood frontrunner’. Balsall Heath Neighbourhood Forum, a third sector organisation with staff and volunteers, was selected as one of the national pilots to test neighbourhood budgets (Bovaird et al. 2013) and, together with Birmingham City Council, developed a neighbourhood development plan in 2015, with contributions from the elected board members of the Neighbourhood Forum and more than 300 residents, who provided inputs during a series of communal meals and street group meetings (Balsall Heath Neighbourhood Forum 2015, 3). The co-prioritisation of outcomes or budgets may be done at the level of individual citizens, organisations or the local area. In recent years, there have been increasing moves towards individual budgets for service users, as a key mechanism for delivering personalisation within social care, in order to increase service users’ choice and control (Needham 2013; Musekiwa and Needham 2020). “They bring money closer to the individual service user (either as a direct payment to be spent by the individual, or as a ‘notional’ budget to be managed by others), and by-pass the commissioning organisations that have historically spent the funds on agency-directed care” (Gadsby et al. 2013, 16). The extent to which users actually exert choice depends on a number of factors such as the existence of alternative service providers in the care market. This leads Boyle and Harris (2009, 17) to suggest that individual budgets are not a form of co-production as “they can encourage users to ‘buy solutions’ or consume passively, rather than have an active stake in devising and delivering their own solutions”. However, this overlooks that many service users with individual budgets do make use of them to choose alternative forms of care and alternative providers to devise their own care package, which involves a significant effort. Increased

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choice, control and self-confidence may motivate them to make even bigger contributions to improve individual and public outcomes. Nor is this just ‘self-help’—in ‘planned’ forms of individual budgets, where users get the support of public service providers to identify and prioritise personal outcomes and select appropriate support mechanisms, we have a genuinely joint form of ‘micro-commissioning’. In practice, as the comparison of personal budgets in 11 OECD countries by Gadsby et al. (2013) shows, personal budget programmes differ internationally, with varying degrees of user choice and control and support of service providers. In particular, personal budget programmes in England, the Netherlands, the US, Canada and Germany, demonstrated not only increased opportunities for service users to have more choice and influence on their care programmes but also a considerable input from commissioners/providers with the aim of ensuring informed user choice (Gadsby et al. 2013, 18). Moreover, the experience of making good use of individual budgets can lead service users to engage in other modes of co-production, such as the co-design and co-delivery of care interventions and co-assessment of care plans. At an organisational level, co-prioritisation may involve groups of service users in shaping outcomes frameworks. In Wales, an increasing number of local authorities collaborate in the Children’s Commissioning Consortium Cymru to improve the way that children’s services commission placement services for looked-after children. The consortium works with young people who have care experience as co-commissioners: “Young people have defined the outcomes which are critical to their achieving well-being in care, and developed a 360 degree outcomes survey, capturing a range of perspectives, including those of young people in placements” (Public Health Wales and Co-Production Wales 2015, 86). Furthermore, the consortium has provided training to young people in care to become accredited ‘Young Commissioners’, which has enabled these young people to contribute to regional and national commissioning activities. In the California Institute for Regenerative Medicine, which funds research to produce therapies from stem cells, patient advocates coprioritise funding applications (Sheehy 2018). Of the 29 board members, 12 posts are designated for patient advocates, including the chair and vicechair. Board members participate in peer review of all grants, including clinical-stage grant applications, which involve intense discussions with

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expert scientific reviewers, lasting days. After completing the formal review, the board members vote on the final approval of all grants. At community level, participatory budgeting is a co-commissioning approach which enables local residents to co-prioritise community projects and public services at neighbourhood or city-wide level (Escobar 2020). Participatory budgeting was first developed in South America, particularly in Brazil, during the 1980s and became a global movement by 2010 (Sintomer et al. 2012, 3–4). Participatory budgeting has been implemented in many different ways but in most cases, coprioritisation means that local communities either propose their own projects and vote on the allocation of public funds between these projects or suggest improvements to local services and vote on the priorities between these citizen suggestions. In representative democracies the elected local council typically has the final say on the prioritisation resulting from the participatory budgeting process. In a case study of participatory budgeting in Recife, all choices made by citizens in respect of project priorities over a ten year period had been respected, which built credibility with citizens (Bovaird 2012). Interestingly, over time it became recognised that the choices made by citizens were often similar to (and sometimes even better than) those made by ‘technical experts’ of Recife City Council. An example of the ‘common wisdom’ exhibited by citizens of the ‘morros’ (hills) was that city engineers could not come to a technical agreement on the best way of building a paved road system linking the communities in the hills, so this became a project in the participatory process. Local people gave their views (and votes) and the approach chosen was later seen to have been a very effective way of working out the best solution (Bovaird 2012). Citizen Inquiries are another approach to co-commissioning at community level. They bring together groups within a community who are interested in specific issues, identify challenges, and produce recommendations (Buck and Wenzel 2018). For example, in Blackpool, the public health department commissioned the non-profit organisation Shared Future to run a Citizen Inquiry on the theme of health and wellbeing to identify what local people thought were the main things that affected people’s health and well-being and what could be done about them. The nine inquiry events resulted in 33 prioritised recommendations which local people presented to local commissioners and other stakeholders at a listening event in 2017 (Shared Future 2017).

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Finally, co-commissioning may also involve co-financing by service user groups or local communities. This can be initiated by users or communities, who want to enhance public budgets (e.g. for school equipment) or by public service organisations who need to make savings. In the UK, the London Boroughs of Greenwich and Lewisham had for years run a highly popular public fireworks display on Guy Fawkes Night, based on funding from the two local authorities and private sponsorship. In 2010, Greenwich Council decided to pull out its funding, putting the event at risk. Lewisham Council was still committed but could not afford to fund the shortfall all by itself. It launched a public appeal for donations (Hilton and Blake 2011), using both traditional and social media. The campaign raised £25,000 which went towards the shortfall of £36,000, with the rest being raised through sponsors, whose response was partly stimulated by the wide public support through co-financing (Hilton and Blake 2011). 3.3.2

Co-commissioning Processes

The types of co-commissioning described above enable commissioners to bring the expertise of users and communities into the commissioning cycle. In many UK local government and health services, the commissioning cycle is based on the ‘Analyse, Plan, Do, Review’ (APDR) sequence, which is an adaptation of the original Deming ‘Plan, Do, Check (or Study), Act’ cycle (Löffler 2018). In Fig. 3.2 we show how co-commissioning activities can be embedded within each of the Analyse, Plan, Do and Review phases of the commissioning cycle. Phase ‘Analyse’: The involvement of citizens in commissioning has traditionally focused on needs assessment. This is where most public consultations begin and end. However, from a co-production perspective, it is no longer sufficient to ask citizens about their needs—commissioners also have to identify the assets of service users and local communities. Asset mapping requires professionals to find out what citizens are doing already and what they might be willing to do in the future to improve public services and outcomes. These questions imply a completely new conversation with service users and local communities, a conversation based upon their strengths, not upon their deficiencies. The asset-based approach ABCD provides a methodology for community-asset mapping (Russell 2020)

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Joint asset mapping Joint needs analysis Joint risk analysis Joint resilience analysis Joint mapping of co-production

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Joint decision-making on – Priorities – user groups, outcomes and services – Criteria for service providers – Service pricing and – Volunteering – levels and types

– Co-assessment of provider performance – Co-assessment of quality of life outcomes – Co-assessment of conformance with public governance principles – Joint revision of commissioning strategy

– Joint monitoring of service quality – Joint development of wider provider market – Building co-production capacity - in citizens - in providers

Fig. 3.2 The co-commissioning cycle (Source Adapted from Loeffler and Bovaird [2019, 246])

whereas the ‘Three-Conversations’ Model is strongly personalisationbased and provides an asset-based approach for social care staff working with service users (Department of Health 2017, 30). Furthermore, risk assessments in the public sector have typically focussed on the risks involved for the commissioning organisation and have therefore aimed at minimising such risks (Bovaird and Quirk 2017, 259). From a co-production perspective, it is important that commissioners also explore the risks for service users and communities, particularly the extent to which those at risk are actually willing to accept some risks as a trade-off for achieving the higher outcomes which those risks make potentially available. This means that a co-produced risk analysis involves co-assessment of ‘whose risks’ are involved, what might be the benefits as well as the potential negatives from taking those risks, and which mechanisms can enable appropriate risks to be taken. This is discussed in more detail in Sect. 5.3.

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Last but not least, the ‘analyse’-phase may also include the mapping of new co-production opportunities to make better use of existing user and community assets and to respond to identified needs. Phase ‘Plan’: Commissioners may involve users or communities in different planning tasks, depending on the context. Co-planning can include such tasks as co-deciding on priority outcomes, co-determining a new vision for a service or even co-developing a new overall commissioning strategy. Other co-planning activities are the joint specification of criteria for providers, definition of service specifications, agreement of pricing policies on how much public services should cost the users. If volunteers are part of the new service offer, commissioners and citizens also need to co-plan volunteering strategies. A key part of most planning activities will be resource planning. Traditional public sector-led planning typically focusses on the public sector budgetary aspects and regards the contributions of citizens, whether service users or volunteers, as a ‘free resource’. Co-planning should provide a more holistic view of the resources to be invested by the public sector, citizens and third sector organisations, so that a better informed decision can be made about the appropriate mix between staff time and citizens’ time and effort. This needs to recognise that using up citizens’ time is also a cost to society, even when it is ‘free’ to a public service organisation, as discussed in Sect. 6.4. Furthermore, the planning phase should explore whether citizens may also be willing to raise extra resources through donations or crowdfinancing to complement public budgets. Phase ‘Do’: In this phase, service users and the wider local community have an important role to play in helping commissioners to ensure that the service provision arrangements, which have been co-planned, are implemented in an appropriate way. This can include monitoring contracts with external providers or monitoring the quality of public services delivered through in-house provision. In particular, service users are often the most relevant stakeholders to determine if providers are complying with the specifications agreed for the service. These roles can be achieved by ensuring that citizens are represented at the regular service or contract monitoring meetings between commissioners and providers. Service users may

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also help commissioners to develop markets by bringing in their ‘service experience’—for example, people living with onset dementia may contribute to the training of social and health care providers to develop a better service offer, as is done, for example, by Early Dementia Users Cooperative Aiming to Educate (EDUCATE), a co-production initiative supported by Pennine Care NHS Foundation Trust and the local authority of Stockport, which works with health and social care providers to raise awareness of dementia (EDUCATE 2019). Finally, citizen coproducers may also help to develop the co-production capacity of other citizens. (Note that the ‘do’-phase of commissioning is about ‘doing’ co-commissioning, not about citizens co-delivering public services or outcomes.) Phase ‘Review’: In this last phase of the co-commissioning cycle, commissioners undertake with citizens a summative evaluation of their commissioning strategy, to inform the next iteration of the commissioning cycle (‘recommissioning’). This may also be strongly driven by the need of commissioners to demonstrate external accountability. In this phase, citizens have a twofold role to play as co-producers: on the one hand, they will play an important role in co-assessing to what extent the commissioning strategy and the way it has been put into practice has improved their quality of life. On the other hand, building on these evaluations, they are well placed to suggest incremental or radically new improvements to existing commissioning practices. This may involve relatively ‘arms-length’ forms of co-assessment (e.g. through citizen online or paper-based satisfaction surveys) or more personally involving mechanisms, such as acting as service user inspectors or ‘experts by experience’ in peer reviews of public services or public facilities. An even more intense co-assessment approach may be citizen coproduction in research (Durose et al. 2011), in which citizens are enabled to contribute to the development of evaluation and learning frameworks, collection of data and interpretation of evidence gathered.

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3.3.3

Evidence of Improved Public Value Through User and Community Co-commissioning

It is evident that putting such a co-commissioning cycle into practice takes more time and resources than traditional commissioning approaches. The case study of the transformation of young people services in Surrey County Council (Tisdall 2014) shows the potential of embedding some of the co-commissioning approaches from Table 3.2 into the four phases of the commissioning cycle. The design of the new commissioning cycle started in April 2009 with the most comprehensive needs assessment of young people ever undertaken in Surrey, drawing together data and intelligence from a wide range of sources and partners. During the ‘analyse’-phase a qualitative needs assessment based on story telling by young people categorised as Not in Education, Employment or Training (NEET) was carried out as well. However, what was largely missing was asset-mapping of the capabilities of the target group. During the ‘plan’-phase, the project team worked intensely with young people, partners and stakeholders to prioritise outcomes. The new outcomes framework and the new portfolio of public services that emerged focused clearly upon developing young people’s economic wellbeing. The key performance measure became young people’s participation in education, training and employment (PETE) from the ages of 16 to 19. This gave rise to a very clear strategy (‘From NEET to PETE’). The new commissioning model was put into place from 2012 to 2014. The ‘do’-phase included market development through co-production training of providers. While not all service providers turned out to be effective in using co-production in practice, young people played an active part in encouraging the new services to continue to explore the scope for co-production. For example, several innovative service providers supported a number of NEET young people who wanted to set up a carpentry enterprise, which became quickly successful and won a local business award (Bovaird and Loeffler 2014, 18). The ‘review’-phase included story telling by front-line staff and service users about the transformation of the service and their improved quality of life. The performance assessment showed that between 2012 and 2014 the number of young people who were NEET in Surrey fell by 60%. These radical improvements were achieved whilst reducing the budget by £4.5m or 25% between 2009 and 2013 (Tisdall 2014). These results show the potential of outcome-based co-commissioning, even though the Surrey

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case study did not make use of all potentially useful co-commissioning methods and tools. The empirical evidence shows that comprehensive co-commissioning cycles are still rare in practice, even in the UK, where they have been most strongly promoted. Even in health care, where a duty is placed on UK primary care practitioners to involve the public in commissioning decisions and strategies, there is little evidence of effective patient and public involvement in primary care-led commissioning (Petsoulas et al. 2015). Nevertheless, in those contexts where co-commissioning is practiced there is some evidence of improvements. In particular, research on individual budgets has shown evidence of improved outcomes for individuals, along with extended choice and control for service users, partly due to greater financial literacy by service users and their carers and also to system-level improvements in the market management process (Needham 2013). 3.3.4

Challenges in User and Community Co-commissioning

Bringing citizens into the commissioning cycle involves costs, of course— it usually involves set-up costs for the commissioning organisation or partnership, and usually there are also recurrent costs later. Therefore, it is unrealistic to expect that all service commissioning will shift to become co-commissioning—at least in the short-term. In deciding how best to bring citizens into the commissioning process, it is important that public sector organisations focus on those public services and outcomes where co-commissioning is most likely to bring about improvements for both citizens and the public sector. This is a key challenge for change management, which we will explore further in Sect. 5.4. Co-commissioning is the most value-laden aspect of co-production. It typically involves shaping or reshaping the high-level strategic decisions of the public service organisation or partnership, and this has major political implications. Deciding who participates in the co-commissioning process and how ‘representative’ stakeholders are a key public governance issue (Bovaird and Loeffler 2016a, 267). Many people typically want (and even expect) to be involved in such prioritisation decisions, regardless of whether they know much about the issue concerned. Others may be invited to get involved for purely symbolic reasons, even though they do not care about the issues—the greatest danger here is that they will agree to participate and then inject rather irrelevant views into the

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commissioning process. Neither of these approaches constitute effective co-commissioning. Moreover, it is likely that a sizeable group of those ‘who care but don’t know’ will be keen to be involved in co-commissioning but their views may be out of line with the evidence, so decision makers cannot allow them to dictate which solutions are chosen. A very different dilemma arises from the group of those ‘who know but don’t care’—e.g. retired employees of the service. Such people may have really valuable views but be reluctant to get involved. Clearly, some rather delicate decisions have to be made in recruiting the citizens who will be centrally involved in co-commissioning activities. Therefore, “it is essential that democratically elected politicians either have a final say in the commissioning process or else should put sufficient safeguards in place to ensure that those most intensely involved are those whose views are most relevant to the commissioning decisions” (Bovaird and Loeffler 2016a, 268). In exercising this responsibility, politicians need to balance the effectiveness of co-production, which implies giving a privileged role to those ‘who know and care’, against the good governance principles of general citizen engagement, particularly the equalities agenda. In seeking to get this balance right, the nature of the decisions concerned is an important factor. When co-commissioning involves more technical decisions such as selecting service providers, only a small number of citizens will typically wish to contribute. The key citizens for commissioners to involve will be those ‘experts by experience’ who already know and care about the specific service concerned. In such cases, it is not unreasonable for the commissioning organisation or partnership to distinguish the roles of those ‘experts by experience’ who are knowledgeable about this specific service from those who are not, and to ensure that the technical aspect of decisions is most influenced by those with an appropriate background. However, this should not give carte blanche to professionals, even in this kind of technically complex decision. It is usually the case that the technical aspects of a public service commissioning decision are not the only important aspects—e.g. in deciding which drug regimes a GP’s surgery should recommend for different conditions, a key issue is whether the prescribed drugs will be taken by the patients at the prescribed frequency and in the appropriate way—not all drug treatments are equally convenient. This is a role where the patients have more knowledge than

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the doctors and nurses. Even where the technical aspects are highly important, professional knowledge may be inadequate and may benefit from being supplemented by the knowledge of service users—e.g. where a cocktail of drugs is prescribed by a doctor, the effect of the interaction of the drugs concerned can generally not be accurately predicted Indeed, it has been estimated that ‘poisonous drug cocktails’ are responsible for up to 28% of US hospital admissions and may be the fifth leading cause of death in the USA (Dr. Michael Stern, reported in Brody 2007). Here, only careful and informed patient management of their own drug cocktail, in constant communication with their nurses and doctors, can reduce the potential dangers (Woodruff 2010). In all cases, commissioners must seek to ensure that those involved in co-commissioning are not simply the ‘usual suspects’, whose views are already known and whose attitudes are sometimes strongly shaped by and attached to the ‘status quo’, since they are often ‘captured’ by the service and reluctant to engage in a genuinely innovative commissioning process. While not every service user or community member is necessarily keen to become an intensive co-producer, commissioners should assume that many more people have a potentially valuable role to play in commissioning than is currently the case. More research is needed on the interactions between politicians and citizens in co-commissioning processes and their impact on public value. In particular, the question arises of why some elected politicians are willing to share power with citizen co-producers and have even gained a reputation as citizen engagement champions, while others are reluctant to let citizens influence commissioning. One factor highlighted by empirical research on the extent of co-production in social services for young and older people and public safety at the local level in Germany is that co-commissioning may be viewed as a threat to the budgetary role of local councillors (Löffler et al. 2015, 28). Such issues touch on the fuzzy relationship between representative and participatory democracy, which remains problematic both in theory and practice.

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3.4 3.4.1

Co-designing Public Services and Pathways to Outcomes Types of User and Community Co-design

Co-design is a co-production mode, which has its roots in modern design thinking (Leifer et al. 2014). Following the conception of the ‘four orders of design’ (Buchanan 2001), the first and second orders emerged in the first half of the twentieth century as graphic design with a focus on the nature, shape, and meaning of symbols, followed by industrial design which was concerned with tangible products. As Torfing (2016, 93) points out, industrial design was a downstream process in product development to improve the look of a product but since the mid-1990s design thinking has become more of an upstream process, with designers working with service users to develop new services to meet customer needs. Buchanan (2001) refers to the expansion of design methods into human interactions as design of the third and fourth order: Whereas in third order interaction design the focus is on actions, fourth order environmental design is concerned with “[t]he idea or thought that organizes a system or environment” (Buchanan 2001, 12). In other words, co-design has become a method not just of improving service quality but also of harnessing the creativity of communities to find new solutions for complex problems. Transferring Buchanan’s design model into the context of co-production, we can conceive of third order design as concerned with co-design of public services, whereas fourth order design focusses on co-design of public outcomes, which goes beyond public services. Co-design is already widely used in the private sector to improve service quality and customer experience. A famous example is the reinvention of the LEGO company, which nearly went bankrupt in 2003 but achieved a come-back with a new portfolio of innovations. One of the key success factors was collaboration with the LEGO community, who helped to test new products and explore new markets (Kastelle 2013). Recently, co-design approaches have been introduced into the public domain, in particular, in health, adult social care, young people services and education, in order to identify new solutions to complex problems. However, the use of design thinking still remains rather rare in some service sectors, such as community safety (Loeffler 2018).

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While many types of user and community co-design involve face-toface collaboration with professionals working in public services and design companies, digital technologies have enabled a new range of co-design methods such as crowdsourcing. This chapter will focus on non-digital types of co-design with users and communities as illustrated in Table 3.3 (Digital types of co-design are discussed in Sect. 3.7). Co-design often involves the use of creativity and social innovation techniques such as brainstorming, story-telling, prototyping of models and experimental approaches in an iterative process (NESTA and IDEO 2017). In the public sector, such techniques have been used to codesign public spaces, projects, communication, services and improvement plans. While co-design processes involving the co-development of public spaces, projects, communication and services tend to be quite shortterm, co-developing improvement plans is often a rather longer-term process. Therefore, we are going to distinguish between these shorter and longer-term types of co-design. Furthermore, the scope of co-design may be essentially incremental, as is often the case with joint improvement processes for existing public services and community-based practices; however, sometimes co-design in the public domain may be more radical and aim at the joint development of new services as well as the codevelopment of experiments and disruptive prototypes. This gives us four types of co-design: short-term and incremental, short-term and radical, long-term and incremental, long-term and radical. We will now illustrate the use of these four types of co-design in the public domain through international case studies. In the context of the ageing society, the design of the built environment is becoming of increasing concern to public services. As the Dementia Services Development Centre at the University of Stirling (2018) points out, “age-related changes and impairments can make it more difficult to understand and navigate the built environment. These can be sensory, mobility or cognitive impairments, and sometimes a combination, which can affect functioning, behaviour, independence, and ultimately, quality of life”. Therefore, public commissioners need to ensure that public facilities such as care homes are tailored to the needs of service users to improve their wellbeing. An example which illustrates how co-design can come up with a highly user-friendly environment is given by a co-housing scheme in London (details from Fernández Arrigoitia and Scanlon 2015, 2016). When an old house, which had been a drug rehabilitation centre, closed at the depth of the financial crisis, a local couple

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Table 3.3 Types of user and community co-design Types of co-design

Examples of user co-design approaches

Co-development of public • Adaptation of the built spaces, projects, environment with people communication and services living with disabilities (short-term and (e.g. ‘Co-House’ project incremental) in London) • Co-development of projects with specific user groups (e.g. ‘Kids Tell the Pros What To Do in City of Umea, Sweden • Co-development of newsletters with user groups (e.g. the local dementia network in East Dunbartonshire, Scotland) • Redesign of existing services or design of new personal services with users (e.g. the ‘Esther’ network in the County of Jönköping, Sweden) Co-development of • Co-development of improvement processes personal improvement (long-term and processes with service incremental) users (e.g.Therapy Focus in Australia)

Co-development of radical new ideas and small-scale experiments for social innovation (short-term and radical)

• Ideas competitions (e.g. local schools) • Innovation Labs open to service users and other stakeholders (e.g. Offenbach Employment Agency)

Examples of community co-design approaches • Neighbourhood forums, regeneration forums (e.g. the regeneration Square Austerlitz, Strasbourg) • Co-development of local projects with volunteers • Co-development of neighbourhood newsletters with volunteers (e.g. the local authority of Nuertingen, Germany) • Redesign of existing services or design of new services with communities (e.g. redesign of community services in Canterbury District Health Board in New Zealand) • Co-development of neighbourhood improvement processes with communities (e.g. Balsall Heath Neighbourhood Forum in the UK) • Citizen Assemblies on Climate Change (e.g. in Bristol, UK) • Innovation Labs with communities and other stakeholders (e.g. Innovation Hub Ulm, Germany)

(continued)

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Table 3.3 (continued) Types of co-design

Examples of user co-design approaches

Examples of community co-design approaches

Co-development of wider experiments and disruptive prototypes (long-term and radical)

• Scaling social innovation with service users and other stakeholders (e.g. Offenbach Employment Agency) • Standing Innovation Labs open to service users and other stakeholders (e.g. Social Innovation Lab Kent, UK)

• Standing Innovation Labs open to communities and other stakeholders (e.g. Social Innovation Lab Kent, UK)

Source Author

interested in co-housing approached Hanover, a not-for-profit retirement housing provider, who agreed to buy the site and develop one of the UK’s first senior co-housing communities, as long as the couple could recruit a group of residents. In 2011, a core group of interested participants began the design process, working with Pollard Thomas Edwards Architects. About 30 homes were agreed, some in the existing house and some new build, on a site with dramatic views, a beautiful garden, and an impressive existing house but with a steeply sloping site which was challenging for older people with mobility problems. The group met often over several months to talk about the design, including the configuration of individual flats, movement through the site (including a common main door) and social and communal spaces, including the large garden. This common house (‘co-house’) is key to co-housing, typically providing enough space for residents to share a kitchen and dining area, and often even craft studios, workshops, music rooms, etc. The remit that the flats had to be ‘affordable’ affected the size of dwellings, construction materials and methods, and the approach to sustainable technology. Since Hanover Housing Association wanted to ensure the scheme could be sold as traditional market housing if the co-housing group were to fail, the final designs were not particularly radical, although beautiful and suited to community living. However, there is warning attached to this case study— many specific ‘elder-friendly’ features were rejected, often vehemently, by members of the group, who found them unnecessary, ugly or depressing (Fernández Arrigoitia and Scanlon 2016, 121).

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While such user co-design initiatives are still relatively rare, community co-design of public spaces is more widely used in urban planning. This applies in particular at neighbourhood level, where local authorities often work with neighbourhood forums to redesign public spaces. Remesar (2020) highlights how a team of urban change agents from the University of Barcelona has facilitated a series of projects in the Besós River area of Barcelona since 1997, using co-design approaches, working with ‘organized neighbours’ in neighbourhood associations, who act as gobetweens between the people in the area and the local administration and organise the participation of neighbours in activities such as workshops, civic forums, exhibitions, talks, demonstrations, walks, etc. to tackle problems that residents themselves consider relevant for the improvement of the neighbourhood. Another example is provided by the regeneration of Austerlitz Square in Strasbourg (Scheek et al. 2017), a public space with a high symbolic value which had fallen into disarray. Strasbourg City Council decided to launch a major regeneration project in 2008, whose key objectives including creating a space for enabling ‘soft’ forms of mobility as an alternative to cars and social space for people to meet others and relax. Over several months, a neighbourhood forum helped co-design the regeneration plan with a local project manager, followed by consultation with the wider public. As a result, the final terms of reference given to the landscape architect in charge of implementing the project put a strong emphasis on biodiversity with a majority of indigenous plants. In a city-wide citizen survey of 2015 the new square was considered to be one of the most three popular green spaces in Strasbourg (Scheek et al. 2017). In Germany, the City of Mannheim even launched a much bigger urban co-design initiative in 2011 when the directly elected Mayor invited citizens to contribute ideas on how to convert 500 hectares of military barracks into new residential and business areas (Lawlor 2017). Citizens submitted more than 1000 ideas, which were aggregated into five priority issues, including green space, engineering, culture, housing and energy. Within each of these topics, citizens were invited to shape these issues further during citizen assemblies and within networks. The results of the co-design process were documented in four subsequent White Books, which were approved by the local council. This ensured that the proposals included in the White Books were put into practice by the Council. The fourth White Book was published in 2016 and concluded the regeneration process after five years (MWS Projektentwicklungsgesellschaft mbH 2018).

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User design of projects is increasingly being used in young people’s services. The City of Umea in Sweden has developed a particularly innovative co-design approach by involving school pupils of different ages in the design of arts and culture projects in order to improve learning outcomes. The City set up a new department for culture in 2005, which employs a wide variety of artists who work with children and young people in schools. Most projects with pupils are based on the approach “Kids Tell the Pros What to Do” (Hammar and Berggren 2015) so that the children’s ideas, thoughts and creative work are developed together with older pupils, students and ‘the professionals’ (practising artists and cultural organisations). The children and young people are the creators, and play an active role at professional exhibitions, shows and concerts but it is adults with their experience, knowledge and resources that actually make it happen by implementing the ideas. The children and young people tell the pro’s what to do! When parents get involved as well, user co-design evolves towards community co-design. As research on barriers to co-production shows, inadequate language often makes effective co-production with citizens difficult (Governance International 2012). User co-design can help to adapt public information outlets to the needs of their target groups. In the local authority of East Dunbartonshire, the local dementia network has had a newsletter for some time. However, with increasing awareness of the concept of coproduction, the idea emerged to change the way in which the newsletter was produced—people living with dementia decided on the frequency of the newsletters and what stories would go into the newsletter, told the stories in their own words, approved the newsletter once it had been written up and decided where it should be distributed to (Brown et al. 2016, 20). The local advocacy organisation supported this process and the local dementia network helped to promote the newsletter to people living with dementia and the wider public. In South-West Germany, the citizen engagement unit of the local authority of Nürtingen (about 40,000 inhabitants) and two local media companies have teamed up to publish the volunteer newspaper BINGO, which is distributed as a supplement to the local newspaper Nürtinger Zeitung three times a year (Governance International 2008). BINGO is co-written by members of the local community reporting on their volunteering activities and marketing new volunteering opportunities to the wider public.

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User co-design may involve redesigning existing services or designing new services by harnessing the knowledge of service users as ‘experts by experience’ and front-line staff as professional experts with the insights available to ‘street bureaucrats’. An example of a comprehensive service redesign process is the development of the Esther Coaching Network, which is a transformational model of person-centred health and social care in the County of Jönköping in Sweden (Vackerberg 2013). Analysis of patients’ care journeys to identify duplication and gaps in the current system resulted in the creation of a much more cost-effective system focussed on ‘patient value’. This process consisted of over 60 interviews and several workshops with patients, staff, and government officials, which revealed that patients felt that healthcare personnel didn’t have enough time to listen; and that too many people were involved in their care. It also became obvious that individual work processes of staff in the care chain didn’t fit together with the work of other colleagues, before or after their patient contact. As a result of the system-wide redesign and new patient-focussed culture, the number of unnecessary days in hospital decreased from 1113 in 1999 to 62 in 2011 (Vackerberg 2013). Furthermore, a network of staff championing more holistic ways of patient care was set up, acting as coaches for other members of staff in order to disseminate the new working practices. In the UK, the King’s Fund makes the case for reforming community services in public health in the light of austerity and changing demographics (Charles et al. 2018). Even though there have been reform attempts and NHS Policy Papers since the 1960s arguing for an increased allocation of resources for community services, the King’s Fund notes a growing gap between the rhetoric and the realities of community-based care. In order to change this situation traditional organisational changes are unlikely to be sufficient. “This means drawing on the energies and ideas of staff providing care and on the experience of people and communities needing care” (Charles et al. 2018, 9). In particular, Charles et al. (2018, 58–85) propose to apply ten design principles to redesign community services such as better needs analysis and community asset mapping, empowering people to take control of their own health and care and involving families, carers and communities in planning and delivering care. Charles et al. (2018, 83) highlight the Canterbury District Health Board in New Zealand as an international good practice example of an effective redesign of community services with local communities which has

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integrated care across public services, increased investment in community services and strengthened primary care. In social care, user co-design can bring into play the assets and skills of service users so that they can contribute to their own improvement journey. The case study of Therapy Focus in Western Australia shows the transformation of a public service provider from ‘doing to’ towards ‘working with’ people with a disability and their social network. Following a policy change in 2015 of the Commonwealth Government, Therapy Focus has redefined its purpose as “enabling people living with a disability to optimise their quality of life” (Barrows 2017). Two people with lived experience of disabilities were appointed to the Board of Governance in order that the voice of ‘people with lived experience’ could be heard where it had the greatest impact. Furthermore, to support the CEO, a Parent Reference Group was established, which consists of about 10 parents of children with disabilities who advise top managers on policy reform and clinical practice. Most importantly, in the therapy planning process the therapy team engages in a conversation with service users to find out what they can do and what they need help with. In particular, advice on peer-to-peer service options is now a key element of the Therapy Focus Strategic Plan to co-design services that people need and want (Barrows 2017). Such longer-term oriented co-design of improvement processes are still exceptional at neighbourhood level. An example is the residentled renewal process of the neighbourhood Balsall Heath in Birmingham which experienced increased levels of crime, drug dealing and prostitution in the 1980s (Atkinson 2010). This situation was changed by a number of community activists who encouraged local people to have a voice and eventually founded the Balsall Heath Neigbourhood Forum in 1994, when local residents were given a piece of land by the City of Birmingham that used to be a drugs den. This place was turned into a welcoming site, with an office and allotments where residents grew vegetables and plants. The non-profit organisation facilitated a neighbourhood improvement process working with residents as volunteer board members and other resident groups over many years with the objective “to change the way the neighbourhood was managed, disentangling services from remote head offices and devolving as much as possible to the neighbourhood itself” (Atkinson 2010).

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An increasing number of public sector organisations have set up Innovation Labs (or similar workshops) to enable the co-development of radical new ideas with service users and communities as well as experiments and disruptive prototypes in a real-life setting. By 2016, there was already a wide range of Innovation Labs at different levels of government within most EU Countries, in particular, in the UK and France (but interestingly none in Germany) (Fuller and Lochard 2016, 4–5). While there is no agreed definition of Innovation Labs, they are typically time-limited collaborations between stakeholders from different sectors, with the objective of co-designing radical new solutions for social issues, based on evidence-based approaches. Traditional Innovation Labs mainly involve private and public sector organisations as well as universities, such as the Innovation Lab HibriturSelva in Catalonia which aims at improving the innovation capacity of local companies in the tourism sector in rural areas (Gesti and Remesar 2015). Urban Living Labs are more based on the quadruple helix approach and involve collaboration among public authorities, business, research organisations and communities (Nesti 2018). While the specificities of Innovation Labs vary from place to place, experimental settings give public sector staff ‘permission to make mistakes’, as long as the learning from the mistakes is shared within and beyond the Lab. While various Innovation use slightly different co-design methodologies the co-design phases typically consist of a short-term ideation phase and a longer-term experimentation and prototyping phase. The ‘Double Diamond’ model which was originally developed by the Design Council in the UK provides a user-friendly illustration of the key phases of participatory design processes (Robert et al. 2020). In order to foster the creative potential of local communities to codevelop radical new ideas for complex social problems an increasing number of local authorities have created innovation hubs or launched other initiatives such as citizen assemblies. For example, in 2019 the City of Ulm opened an innovation space in a prominent historical building to invite citizens, in particular, young people, to find new solutions for education, mobility and ageing issues, ideally based on digital technologies (Bertelsmann Stiftung 2020). The City of Bristol set up the first citizen assembly on climate change issues in the UK (Bristol One City 2020)—this practice is now followed by an increasing number of other local authorities. The involved citizens will meet four times during week-ends and be supported by an advisory and an academic panel.

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These new co-design initiatives complement more traditional ways of harnessing creative ideas of communities or service users through ideas competitions run by local authorities or schools, which nowadays often involve the use of online-platforms. Nevertheless, it is still rare that public service providers encourage their service users and staff to co-develop radical new ideas. One exception is the Employment Agency in Offenbach, which started a systematic co-production process with the participation of senior managers and front-line staff, representatives of their sector organisations and service users in 2019 based on the Governance International Co-Production Star toolkit (Loeffler and Schulze-Böing 2020). This consisted of a series of co-production workshops to make the professionals familiar with key concepts and tools. The core of the training included a ‘learning by doing’ process involving the co-development of radical new ideas for social innovation as well as experiments and radical prototypes. In the first ideation phase, the staff participating in the Labs engaged with service users (on a voluntary basis) to brainstorm together how to co-commission, co-design, co-deliver and co-assessment employment services more effectively. Two of the five Labs focussed on co-design: one Co-Design Lab focussed on working with service users to co-design a public event to inform unemployed people close to retirement age about steps to be taken to prepare for their retirement. This Lab demonstrated to the Offenbach Employment Agency that this target group needed not only more accessible information on how to get a supplementary income but also on volunteering and social networking opportunities. Another Co-Design Lab involved collaboration with vulnerable service users who were interested in a whole range of activities, including the codesign of a digital training workshop. The Labs also experimented with small scale actions to test their ideas within 120 days (the usual 100 days were extended as the experimentation started during the summer holiday period). The Co-Design Lab focussing on the public event on retirement issues managed to launch a first event with a service user speaking about his (often negative) experience in approaching public services and lessons for other service users. Following an evaluation of the learning and results achieved (and a celebratory event), the team involved in the Lab has moved on to prototyping the co-design of public events and considering testing the prototype with other groups of service users. The other CoDesign Lab had several meetings to co-develop the training session but did not manage to test the training during the 120 days due to health

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issues of the service users involved. However, this group learnt valuable lessons which involved a redesign of some of the initial parameters and is determined to continue the experimentation. While the initial CoProduction Labs had provided the momentum and energy to co-develop radical ideas and experiments for social innovation, the prototyping and scaling of the innovations will be a long-term process which will require a degree of ‘institutionalisation’ of the emerging prototypes—but without formalising co-production, which would stifle creativity. In order to provide a permanent space for co-developing radical new ideas but also to allow for longer-term experimentation Kent County Council (2020) set up Social Innovation Lab Kent (SILK) within the local authority in 2007. In the early years, the small innovation team co-developed a methodology and toolkit—the SILK approach—working with service users, communities, staff and other stakeholders. Over the years SILK has been working across a number of public services. In a context of austerity, with frequent organisational restructuring and staff turnover, there is often a plethora of short-term projects which briefly involve local communities in the design phase. While these may have positive effects, they are often too short-term to test different pathways to outcomes at neighbourhood level. This highlights a paradox— some public service innovations are often abandoned too slowly, even though it has quickly become clear that they are not likely to work. Others are abandoned too quickly, without giving them time to work. It seems likely that this paradox can only be resolved by a two-stage process of design—all innovations should come in several variants and these variants should be quickly rejigged (and some of them even abandoned) as it becomes clear that some variants are more cost-effective than others. However, it is important to persist with at least some variants for long enough to test their effectiveness when they have bedded down and been appropriately tailored to their context. 3.4.2

Co-design Processes

The co-design of public services and pathways to outcomes typically consists of a step-by-step approach. While design toolkits vary in their approach and terminology, there are usually five key processes in codesign.

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The first phase involves framing the innovation challenge or defining the problem to be solved. In the Governance International (2017) CoDesign Toolkit, this phase is called ‘Experiencing’ as professionals are provided with user or community perspectives on their experiences to enable them to see issues through the eyes of service users or communities. NESTA and IDEO (2017) suggest that in this research phase a wide range of qualitative research methods may be used, starting from interviews to focus groups, ethnographic observation, card sorting and role plays. The second phase typically aims at developing insights and ideas through brainstorming and other creativity techniques—this is called ‘Exploring’ in the Governance International co-design toolkit. It involves prioritising the ideas gathered in order to decide which ideas are going to be developed further and tested. In the third phase, priority ideas are tested in an iterative process and turned into prototypes based on experimentation, which is the third ‘E’ in the Governance International toolkit. This is different from running a pilot project for a predefined time period as “a prototype is measured by how much you learned and what it informed” (NESTA and IDEO 2017, 53) whereas “ultimately a pilot is measured by success or failure” (ibid.). In the fourth phase of the Governance International co-design toolkit, ‘Evaluation’ is required to formalise the learning from the experimentation phase. This may involve both quantitative and qualitative approaches. Depending on the (intermediate) results achieved, the co-producers may decide to move to the next step and undertake more testing with different groups, with a view of scaling the new co-production initiative, or a decision may be taken to go back to the ‘drawing board’ and to change the co-production approach and test the modified approach again. This helps to shape the further implementation of the innovation, which is the fifth ‘Evolve’ phase. Here, the focus is on scaling the prototype, which implies the need to change both the ‘hardware’ of public service organisations, such as performance frameworks, but also the ‘software’ by fostering collaborative organisational cultures and relational leadership within the organisations and communities involved. As the Design Council (2018) points out “in all creative processes a number of possible ideas are created (‘divergent thinking’) before refining and narrowing down to the best idea (‘convergent thinking’).” This happens twice—once to agree on the problem definition and once to identify the solution through an iterative experimentation process.

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According to the Design Council (2018), one of the greatest mistakes is to omit the first phase, on problem definition, which risks focusing on solving the wrong problem. 3.4.3

Evidence of Improved Public Value Through User and Community Co-design

It appears from the proliferation of Innovation Labs that design thinking and co-design approaches are becoming increasingly popular in the public sector across the world (even though not all so-called Labs actually undertake experiments). This raises the question of the benefits arising from user and community co-design and the challenges it poses in a public service context. The evaluation of the benefits of different types of user and community co-design will depend on the expectations which are held for a specific type of co-design: Do co-design projects have to deliver social innovation? Or is it sufficient that the co-design process generates higher legitimacy for improvement processes? A study of the involvement of patients in quality improvement in five Dutch hospitals showed that the improvement issues identified by the involved patients were quite similar across hospitals and, importantly, were mostly not new or surprising for the project team (Vennik et al. 2016, 162). Interestingly, however, the authors suggested that “it was not so much what patients say is important; it is the process and the way they are given the opportunity to have their say” (Vennik et al. 2016, 162). This was because patients’ inputs through their stories not only got staff engaged but also helped to gain legitimacy for improvement actions, many of which were already recognised by staff to be desirable, and, importantly, to encourage top management commitment to the extra budget required to fund the required changes. Robert et al. (2020) highlight the evidence gathered by the CREATE study of four stroke units in England from 2016 to 2018, which evaluated the feasibility and impact of the co-design approach Experienced-based Co-design (EBCD) on patients, carers and staff. The results show positive benefits for patients and carers—moreover, the staff involved considered EBCD to be a positive experience but had difficulties in changing their behaviours and shifting from a ‘task-based culture’ towards more enabling ways of relating with patients and carers (Jones et al. 2020). Furthermore, in a context of austerity, with frequent restructuring and staff changes, institutional memory is often short-lived. There is

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therefore a risk of testing very similar sets of ideas every few years, without ever drawing the appropriate lessons and moving on to implementation. This again brings us to the need for a coherent strategy of experimentation, with rapid learning and cessation of obviously unsuitable initiatives but moving to longer-term trials for the more promising experiments. The Cynefin framework by Snowden and Boone (2007) is helpful in this context: When we are concerned with an issue in the simple knowledge domain, where best practice is known, there is no need to experiment. However, in complicated and, particularly, in complex knowledge domains, experimentation is a must in order to learn what works and what doesn’t, so avoiding the potential waste of large amounts of taxpayers’ money resulting from ineffective public services or public policies. Finally, co-design processes require resources—not just from public sector organisations but also from the citizens, non-profit organisations and private sector organisations involved, so it is important to consider the costs and benefits of co-design projects and processes. This means that we need to establish when co-design is justified and when it may not be required. When considering ‘what works’, the benefits of user and community co-design also need to be evaluated in relation to the achievement of governance principles. While co-design in itself appears to promote the good governance principle of citizen engagement, it is important that the other principles are also considered. For example, when dealing with vulnerable groups, co-design projects and processes require high ethical standards. Again, Innovation Labs involving citizens testing prototypes as volunteers in services from private sector providers need to address critical questions on the extent to which it is legitimate to impose the costs of co-design on citizens, while the profits go to private sector companies. 3.4.4

Challenges of User and Community Co-design

The effective use of co-design in public services faces a number of challenges. One is to enable both staff working in public services and also citizens to think ‘outside the box’. While many creativity techniques are available, they are still rarely used in the public domain. This is not simply a feature of public services—it starts in school education and continues in university programmes. Moreover, creative thinking requires practice, just like exercise in a fitness studio, and also time for reflection. This is,

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of course, particularly difficult in a context of austerity, where there is insufficient slack and restricted opportunities to use creative techniques regularly. Another co-design challenge is overcoming barriers to implementation (Nesta and IDEO 2017, 79–84; Evers and Ewert 2020). Innovation Labs try to address this in two ways: A number of Labs are specifically set up ‘outside the public sector’ for a limited time to encourage co-productive behaviours. As Pestoff (2012, 378) concludes from his in-depth empirical study on the co-production of childcare services in Sweden, co-production is likely to be hampered in contexts characterised by mainly hierarchical modes of governance or market-oriented forms of governance. However, while external Innovation Labs may facilitate the identification of radical new ideas and experimentation with innovative solutions, they have the disadvantage that they often fail to get the buyin of key stakeholders in public service organisations, when trying to scale the innovation in the institutional context where it is supposed to change practice. On the other hand, where Innovation Labs are undertaken (and institutionalised) in a public service organisation, there is the risk of their becoming “technocratic instruments that act as ‘filters’ for people’s responses to political initiatives. The unwanted consequence often is that Innovation Labs become ‘delivery agencies’ without sufficient mandate to challenge or influence problem definitions or hypotheses for creating change. In other words, the overall (political) intent and/or framing of problems remains unchallenged by the work of the Lab” (Christiansen 2016). However, the biggest barrier may be unrealistic expectations regarding the degree and pace of change resulting from co-design. In spite of the desire of social innovators to bring about radical changes quickly, codesign initiatives may often only result in small-scale changes. However, they may also change the values of staff, which makes them potentially more impactful than other more traditional staff-led or externallyfacilitated quality improvement approaches. In this context, there is interesting evidence on the impact of Experienced-based Co-design (EBCD) to improve local healthcare services via improving the experience of patients, carers, and professionals within them (Robert et al. 2020). EBCD was originally developed as a specific co-design method through which to improve not only specific ‘touchpoints’ at which service users come into contact with healthcare but also to help transform the values

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of staff. It aims to do so by explicitly providing opportunities to rethink the fundamental basis on which services are provided and experienced. However, as Robert et al. (2020, X) comment critically: “contemporary projects are often reported solely in terms of small-scale and heterogeneous changes to existing service processes and interactions which are relatively easy to observe; the impact of these are typically measured - if at all - through narrow metrics …. Any broader - potentially transformative - impacts on the mindsets and behaviours of service providers over time remain relatively unstudied. Radical changes to forms of service delivery are, nonetheless, rare”. Last but not least, it may also be challenging to identify the ‘right’ co-producers, in particular, people who know and who care. This means that representativeness of the general population is not appropriate, but rather representatives of the different types of service users (Bovaird and Loeffler 2016a, 269). The role of politicians is likely to be smaller in codesign processes. However, politicians need to make sure that the choices made by the engaged service users are not biased by poor information or narrow self-interest—and they also need to consider the knock-on effects on other citizens. This can be achieved by building wider consultation into the co-design process, as was done in the case of the regeneration of Square Austerlitz in Strasbourg, where, in a step-by-step process, the design inputs of neighbourhood associations were subjected to a wider consultation of local people through a survey (Scheek et al. 2017). As Robert et al. (2020) point out, more rigorous research into the implementation and impact of design thinking in the public sector is needed. Torfing (2016, 94) too, suggests that “design thinking has yet to establish itself as an academic field of research with a clear set of research questions, theoretical underpinning, and a methodological toolbox that facilitates empirical studies of design processes”. Norman (2010) goes a step further and suggests that design education itself should be reformed, so that designers are provided with knowledge of the social and behavioural sciences and statistics.

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3.5 Co-delivering Public Services and Public Outcomes 3.5.1

Types of User and Community Co-delivery

Co-delivery is the mode of user and community co-production which involves citizen action. While the citizen participation literature has focussed on voice, it has often underestimated the importance of the co-delivery role of citizens in improving public services and outcomes, perhaps because action on the ground is less visible to managers in any public service. Actually, focus groups on co-production at the local level in Germany have shown that in community safety almost all co-production initiatives identified by professionals working in this sector can be characterised as co-delivery, and even in social services for young and older people this was still the most common form of co-production reported by professionals working in these two sectors (Loeffler and Timm-Arnold 2020). In co-delivery co-production partly overlaps with volunteering. However, not all forms of volunteering qualify as co-delivery—when there is no public sector input, such as training or co-ordination of volunteers, volunteering is a pure form of self-help or self-organising. However, when volunteers get support from the public sector, volunteering initiatives turn into co-production. User and community co-delivery may involve a wide range of citizen actions as Table 3.4 shows. Types of co-delivery include the co-implementation of projects, co-management of public facilities, coperforming peer support, co-influencing behaviour change and taking joint action to improve public services and outcomes. These types of codelivery may overlap to some degree. For example, a specific peer support initiative may also facilitate behaviour change, which improves public outcomes. However, each type of co-delivery puts a different emphasis on what is co-delivered and which co-delivery mechanisms are used as the following case studies will show. Co-implementation of projects with contributions from public sector organisations and users or communities is a quite common type of codelivery. An example comes from ‘Stepping Forward Together’, a falls prevention programme taken forward in a Governance International CoProduction Lab supported by the Aberdeen City Health and Social Care Partnership (Thompson and McConnachie 2019). Here, users of adult

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Table 3.4 Types of user and community co-delivery Types of co-delivery

Examples of types of user co-delivery

Co-implementation of projects or programmes

Community members working with public services to implement projects (e.g. ‘Clean Serbia’) Community asset transfer and management (e.g. community members running social projects on the estate of Witton Lodge Community Association, UK) Service users, supported by Support groups, public service organisations, comprising community providing peer education members, supported by (e.g. for learner drivers in public service organisations Austria) (e.g. Mosaic Clubhouse London) Peer support by service users Community volunteers with specific lived experience providing coaching for users of public services (e.g. in mental health) Employment of users with a (e.g. Manchester Community Health specific lived experience in Trainers) public service organisations to facilitate behaviour change Mentoring by trained volunteers (e.g. mentoring of service users and staff scheme in two Swiss (e.g. User Voice, UK) Cantons to support job seekers) Community volunteers Tenants doing minor repair working with public work in social housing (e.g. services (e.g. volunteers Shelter England) driving mini-buses in rural areas) Service users undertaking Volunteers working with self-care with support of the police to achieve better public service organisations outcomes through (e.g. ‘Healthy Kinzig Valley’, behaviour change (e.g. Germany) Speedwatch Groups in the UK)

Users working with public services to implement projects (e.g. the falls prevention programme in Aberdeen, Scotland) Co-management of Tenants contributing to projects and public facilities housing association management (e.g. Resident Directors of Witton Lodge Community Association, UK) Co-performing (peer) support groups

Co-influencing behaviour change

Taking joint action to improve public services

Taking joint action to improve public outcomes

Source Author

Examples of types of community co-delivery

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social services have been encouraged to take classes on falls prevention in order to improve their stability. This has already given a number of participants increased confidence, not only helping them around the house but also encouraging them to be more mobile in their community. Some of the participants have now become active in marketing this programme to widen its reach to other people at risk of falls. A Serbian environmental initiative provides an example of project co-implementation with local communities. In Serbia, the Department for the Environment launched a national ‘Clean Serbia’ activity which was co-delivered by volunteers in two stages. First, the Department recruited 25 young people as volunteers to help prepare the public campaign and the actual clean-up day during a two-month period. Secondly, the Department launched a big national campaign to mobilise volunteers and succeeded in getting 289,000 citizens (4% of Serbia’s total population) engaged during the ‘Spring Cleaning of Serbia Day’ in 2011 (Rabrenovic 2011). Furthermore, the ‘Clean Serbia’ initiative resulted in a 12% increase in organised waste collection from 60 to 72% in 2011 (Rabrenovic 2011). However, there is no evidence of the degree to which this initiative created higher level outcomes, such as increased social capital. Another type of co-delivery involves the co-management of public facilities. In Birmingham, the Witton Lodge Community Association, which also acts as a Community Landlord with its own housing association, provides an example both of a co-delivery initiative involving the service users (as tenants of the housing association), and initiatives managed at community level (Jones 2012). It emerged from a rundown social housing estate in the 1990s, where many houses faced demolition, since no government grants were available for urgently needed repairs. As many residents faced dislocation, the four resident associations decided to merge and to set up Witton Lodge Community Association in 1994. This new community-owned housing association was based on a model in which the government gifted land to the community association, against which capital could be raised to commission the building of new homes. The new Community Association meant that residents could strongly influence the redevelopment of the estate. By 2000 Witton Lodge Community Association was able to negotiate housing allocations with the City of Birmingham, which enabled it to exercise more influence and pursue a policy of ‘social integration via housing allocation’ (Jones 2012). Witton Lodge Community Association has eight Resident Directors, who play a major role in the management of the Association. It also

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puts a strong focus on promoting volunteering—the volunteers include all age groups and both run and participate in a wide range of activities, such as improving employability, the local environment and social wellbeing. While the Witton Lodge Community Association has been an early champion of co-management of housing services there are now more policy drivers promoting community asset transfer. In Scotland, for example, the introduction of the Community Empowerment (Scotland) Act in 2015 has given community organisations a right to ask to take over control of land or buildings. If the community organisation’s plan is considered to be better for people, they will be allowed to buy, rent or have the use of it (Scottish Government 2015, 1). Another type of co-delivery is co-performing peer support, for example, through peer education or peer training. The case study of an Austrian peer training scheme involving young offenders who caused an accident (often under the influence of alcohol) shows the benefits for both trainees and peer trainers. The objective of this Austrian peer training initiative is to deter risky driving by young people. “Young offenders add to the theoretical training given in driving schools by telling their peers in a very direct and authentic way how they caused an accident and by using their own cases to point out the implications of risky driving. The fact that the offenders are of the same age and meet with their peers face-toface during the driving tuition creates an emotional closeness between the offender and the driving school pupils. The principle of peer education means that young learners are directly confronted with the experiences of young offenders” (Pawelke 2011). An extensive evaluation showed that this peer support approach had a significant impact on the behaviour of learner drivers, with 89% of learner drivers in the survey saying they will drive more carefully in the future. While some types of user peer support are primarily co-delivered oneto-one, peer support can also provide collective benefits when it is codelivered in groups (Slay and Stephens 2013, 8). As well as helping people with their immediate problems, peer support groups of people dealing with chronic conditions often put a strong emphasis on empathy exchange and relationship development (Nicholas and Broadbent 2015, 21). Mosaic Clubhouse in the London Borough of Lambeth works with people with mental health issues to improve their wellbeing and employability. It strongly focusses on encouraging Clubhouse members to provide mutual support in their journeys towards recovery. The charity also works with volunteers who are trained to provide specific support

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services. Mosaic’s approach is built on the internationally-recognised Clubhouse model, which embeds co-production between staff and members throughout all activities. The staff enable Clubhouse members to provide mutual support in their journeys towards recovery and assist them to regain self-confidence, self-belief, and self-esteem (Ness 2014). In particular, the members are provided with opportunities to co-deliver the services provided by the Clubhouse. Indeed, there is no separate space for staff or members but all activities of the Clubhouse are delivered jointly. An important type of co-delivery involves co-influencing behaviour change. This may occur when service users with a specific lived experience are supported by public service organisations to facilitate behaviour change of citizens and/or staff working in public services. This may occur through peer support. For example, one of the long-standing members of the Midlands Co-Production Network in the UK is an ‘expert by experience’ in mental health issues, who has been running an influential blog on mental health (Jon aka exboozehound 2013) and eventually used his specific expertise to set up a new support group for men in Dudley after receiving volunteer training by his local authority (Dudley Metropolitan Borough Council 2015, 26). While such behaviour change can be purely triggered through self-help as in this blog by ‘exboozehound’, it qualifies as co-production where there are important contributions by public services, such as expert advice or training which complements the tacit knowledge of service users or communities. Increasingly, service users with a specific lived experience are recruited by public service organisations to be trained and employed as staff in order to enable their former ‘peers’ to change behaviours. An example is the UK charity User Voice (2018) which is majority staffed and led by people who have experienced the criminal justice system. Co-influencing behaviour change can occur in other ways, often with the help of volunteers. In Manchester, the NHS, local authority and the voluntary sector have been working together since 2006 to enable behaviour change of vulnerable groups in deprived neighbourhoods towards a more healthy lifestyle through Community Health Trainers (Lawson et al. 2014). This involves the recruitment and training of people from a range of backgrounds, in particular from disadvantaged groups to enable them to provide personalised support to those most at risk of illhealth, so that they can change towards a healthier way of life. The role of Health Trainers is not to give advice but to empower local people participating in the programme to develop and use their own skills to

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change their behaviour. Interventions are generally brief, with the aim being to assist participants to achieve self-defined goals. A national evaluation showed that 28% of clients were signed off after completing their full personal health plans (Royal Society for Public Health 2013). Co-influencing behaviour change may also involve communities mentoring and coaching service users who need support. For example, in Switzerland, the two Cantons of Basel-Stadt and Basel-Landschaft have developed an effective mentoring scheme to reduce youth unemployment. Instead of staff providing advice to young people to improve their employability, experienced business leaders provide personalised support through mentoring, with impressive results: “About 70% of mentees find an apprenticeship or placement each year, and while the length of time spent on the programme can vary from three months to two years, it is often the case that mentees find appropriate training after eight months. Around 10% drop out of the programme altogether, although in some cases mentees have returned to the programme, experiencing later success” (Cooper 2011). When users or communities undertake joint actions with public service organisations to improve public services, the contribution of citizens often goes beyond the minimal inputs required from a passive service recipient, as discussed in Chapter 2. So, in public housing organisations, tenants are often encouraged to undertake minor forms of repair, which is a type of user co-delivery. In particular, the right to undertake repairs themselves enables tenants in social housing to get small repair jobs done quickly, compared to waiting for their landlord to arrange for it to be done (Shelter England 2017). In times of austerity, many public service organisations intensify efforts to recruit more volunteers to co-deliver public services. Volunteers already play an important role in co-delivering social care but increasingly volunteers also work as co-deliverers of library services and in some rural areas even as co-deliverers of local public transport such as in Brieselang (with about 11,000 inhabitants) in the Land (state) of Brandenburg, close to Berlin. This rural local authority suffered from poor public transport, so some local residents decided to set up a non-profit organisation to run a mini-bus service which complements the public transport offer (Lüder and Werth 2010). The first mini-bus was funded through a grant from the state government lottery, while the local and district authorities agreed to share the operating costs of the bus. The association now has 26 drivers and serves two routes from Monday to Friday.

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An innovative example of user co-delivery of public outcomes is illustrated by the health prevention programme ‘Healthy Kinzig Valley’ (Gesundes Kinzigtal ) in the Black Forest in Germany, which has grown from 875 patients in 2006 to 10,190 patients in 2014, most of whom are actively engaged in fitness programmes in order to improve their health. The sports activities are closely coordinated by a network of GPs and health specialists and tailored to each patient. The average age of patients participating in this programme is 48 years and about 16% are actually above 65 (Höhl 2016). As the testimonials of active patients show, the self-care of patients reduces the need for more expensive alternative therapies. Co-delivery of public outcomes, separately from public services, can also occur through volunteers. For example, the UK police has launched Speedwatch schemes in both urban and rural areas to promote behaviour change of speeding drivers. In Wiltshire County Council a Community Speedwatch scheme was co-designed and co-delivered in 2009 with the local authority, police and volunteers (Milton 2016). Its objectives were both ‘building resilient communities’ (the volunteering element) and ‘safer communities’ (tackling dangerous driving). The areas for Speedwatch activities are identified through ‘Metrocount’ data, a system for electronic traffic data collection and analysis. Once an area is agreed to be suitable for Community Speedwatch, the parish council recruits community volunteers. The Community Speedwatch co-ordinator trains the volunteers to carry out roadside checks on the speed of vehicles. The volunteers are also supported by neighbourhood police teams. Community volunteers record the speed and registration numbers of offending vehicles with laser speedgun cameras and the owners of speeding vehicles get letters from the police drawing attention to the offence and warning the driver of the consequences of excessive speeding. By December 2015 there were 140 Volunteer Teams active across Wiltshire and Swindon Counties, with 765 volunteers carrying out regular speed checks (Milton 2016). These examples illustrate that the different types of co-delivery highlighted in Table 3.4 can be found in a wide range of public services and that service user co-delivery can be quite different from community codelivery. The balance between them is clearly a matter to be decided in each case, dependent on the context.

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Co-delivery Processes

Whereas it is generally recognised that co-commissioning, co-design and co-assessment processes are limited in time, there is often the expectation that co-delivery initiatives should be sustainable and not just be shortterm. However, both from the point of view of citizens and public service organisations, user and community co-delivery has a life cycle. First, people’s interests and interactions with public services are likely to change over time. When people have children they will be in contact with a nursery and pre-school, later with school and perhaps with university education. Later in their lives, they may interact with adult social care services. Pestoff (2019, 87) calls these public services ‘enduring’, as service users are locked into them for a significant time period, related to their own life cycle (as long as there are no alternative providers). So when children change from pre-school to school, parents are more likely to transfer any co-production contribution they make to the new school (although a few parents may be so committed to a nursery that they many continue volunteering there, even though their child has moved on). From the perspective of public service organisations, there is an initiation phase with ‘recruitment’ and ‘incentivisation’ of users or communities to bring co-deliverers on board, if the pathway to co-delivery is ‘insideout’. In the ‘outside-in’ case, where public service organisations start to support user or community self-help, the initiation phase involves identifying those who are likely to benefit most from public sector support. The subsequent developmental phase of co-delivery may require implementation of a safeguarding policy, and in some cases, training or other capacity-building activities. So there are likely to be set-up costs for both citizens and public service organisations to put this phase of co-delivery into practice. Furthermore, what and how citizens and public service organisations co-deliver may change over time, depending on changing needs. At the same time, citizens and staff may wish to develop new capabilities, as their expectations rise in terms of what they can contribute. But there may also be cases where citizens may be satisfied with their contributions and move on to do other things in their spare time. In particular, new digital technologies may impact on specific types of co-delivery and, in some cases, make them obsolete as discussed in Sect. 3.7.

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Given the varied potential time-paths of co-delivery approaches, sustainability of the results may be a more important (and realistic) objective for all co-producers concerned than sustainability of the co-delivery initiative itself. 3.5.3

Evidence of Improved Public Value Through User and Community Co-delivery

While there is a myriad of examples of user and community co-delivery, the evidence base on how this mode of co-production improves public value is still quite thin and therefore has often not been accepted by policymakers. In many cases, the success of co-delivery is judged on relatively weak criteria, e.g. the number of volunteers involved, rather than the improved outcomes achieved. In other cases, the evidence is simply not seen by politicians as convincing or is disregarded. An example is the Lambeth peer education programme (Tatam 2011). It involved training groups of young people aged 14–19 as peer educators who were tasked to raise awareness about sexuality and relationship issues and to positively influence other young people in Lambeth. The co-delivery initiative received very positive feedback from students in formal evaluations after the workshops. There is also evidence of positive self-development of the peer trainers, as some young people from disadvantaged families progressed to undertake a university education. Furthermore, between 1998 and 2009 Lambeth’s under 18 teenage pregnancy rate reduced by 30.2%—a faster rate of reduction than elsewhere in London. However, the initiative was discontinued after eight years, as the local council was unwilling to fund this programme any longer, refusing to give weight to this evidence of valuable results. There is also evidence that some types of co-delivery are indeed more effective in improving public safety outcomes than traditional forms of service delivery. For example, an evaluation of the effects of the Wiltshire Speedwatch Scheme (mentioned earlier) on public safety showed that, where the scheme was operating, fatal and serious injuries associated with road traffic accidents had reduced by 35% over a four year period, whereas the average decline for Great Britain as a whole during the same period was only 22% (Milton 2016). Another evaluation of the impacts of co-delivery was provided by the gastroenterology unit in Highland Hospital, Eksjoe, Sweden (Bovaird and Tholstrup 2010). To cope with its increasing waiting lists, this unit

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has, since 2001, involved patients more intensively in and given them more responsibility for their own care, through self-monitoring and selfreporting. Subsequently, the number of unscheduled visits of patients with symptom flare-ups fell from two a day in 2001 to two a week in 2005. Patients who needed in-patient care decreased 48% in the period from 1998 to 2005, compared to a 4% decrease nationwide. In-patients of the clinic per 100,000 residents fell to almost half the national average during this period. Even though many co-delivery initiatives involving volunteering aim at providing savings there are not many cost–benefit evaluations of this type of co-delivery. One exception has been the external evaluations which have been commissioned by the UK charity KeyRing to provide evidence on the cost effectiveness of ‘Living Support Networks’ as an alternative social care delivery model. The results of multiple evaluations show that KeyRing Networks are effective in significantly reducing the level of paid professional support that service users (called Network Members) receive and reducing future demand for expensive specialist services and hospital services while improving their wellbeing (Parker et al. 2019). At the same time, the results of some of these evaluations suggest that there is ‘time decay’ of the benefits brought about by the Networks—it appears that the savings to be achieved within a local area may decrease, as the number of people in inappropriate residential care who can be relocated into ‘Living Support Networks’ decreases over time. While this means that the savings generated may no longer cover the full costs of local networks (Alder 2013), they may nevertheless continue to be cost-effective in terms of the quality of life outcomes achieved. There are even fewer evaluations of the effects of co-delivery on the achievement of governance principles. One exception is the evidence on the effects of the Danish Early Child Programme in Aarhus (Jacobson and Hjortskov 2015) on educational inequalities. This co-production experiment aims to help parents of pre-school children to improve their child’s reading ability. In particular, it focusses on reducing the gap between poor and skilled readers by supplying parents with a low socio-economic (SES) background a suitcase containing children’s books, games, and a tutorial DVD about language development techniques after informing parents of bilingual children at pre-school about why it is important to read with their children and how best to read with their children. The results of an external evaluation show “increased language comprehension among children with low-SES parents, as measured in a municipal language

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comprehension test. In particular, the reading ability of low-SES children participating in the Early Child Programme increased significantly …. Furthermore, the Early Child Programme substantially lowered the share of children attending reception classes when they started in school, down from 6.7% in the control group to just 0.7% in the Early Child Programme group” (Jacobson and Hjortskov 2015). Given the highly positive effects on language proficiency among pre-school children the local authority of Aarhus developed the co-production initiative READ targeted at older children as a follow-up to the Early Childhood Programme. However, there is often a concern that user and community co-delivery may be exploitative and increase inequalities instead of reducing them (Steen et al. 2018, 287–288). This possibility is considered in more detail in Chapter 5 but is important to note that such impacts from co-delivery have so far been recorded relatively rarely. Another concern is that co-delivery may not be sustainable. While this overlooks that many public services are also not sustainable, the growing importance of this criterion in public policy means that there is an urgent need to evaluate the sustainability of user and community co-delivery. Considering the time pattern of health and social care, Pestoff (2019, 107) argues that small self-help groups of people with chronic conditions are likely to turn their members “into sustainable co-producers of their own care”. However, as their condition may get worse over time, he points out that they may become less able to contribute, so that more contributions from professionals may be needed to coordinate and facilitate the self-help group. This suggests that adaptability may be a better governance principle for evaluating co-delivery initiatives than sustainability. 3.5.4

Challenges to User and Community Co-delivery

While there is some evidence of the benefits of user and community co-delivery, the literature also identifies a number of challenges, in particular with regard to volunteering in public sector and third sector organisations. As Nesbit et al. (2018, 503) point out “important volunteer-related challenges arise when volunteers’ and host organizations’ decisions operate at cross-purposes”. This may relate to the intensity and kinds of contributions that volunteers make to the public service organisation concerned or to the quality of the co-production between staff and volunteers.

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Furthermore, both public service organisations and citizens may consider certain types of co-delivery as risky. In particular, when volunteers work with vulnerable groups or take on highly responsible tasks such as driving social mini-busses, they need to have appropriate training and insurance. Insurance schemes covering citizen co-producers are relatively easy (although not always cheap) to arrange. There are various ways to do this. In the case of the social mini-bus in the rural local council of Brieselang, the volunteer bus drivers are insured through the volunteer insurance policy of the state of Brandenburg (Lüder and Werth 2010). In the case of the Streetwatch scheme of the local authority of Weyhe, close to Bremen, the citizens trained as ‘Streetwatchers’ are considered as ‘volunteer employees’ of the local authority in order to extend the insurance benefitting the staff employed by the local authority to the volunteers (Meyer and Grosser 2014). Furthermore, ‘Streetwatchers’ always work in teams of three—at least one male, at least one female and at least one elderly person—which is another strategy to reduce risk for the involved volunteers, as well as assuring that each team has members who have a similar profile to the people they try to help. For many types of co-delivery, volunteers need to be trained, which may be perceived as a burden and therefore may increase the reluctance of citizens to contribute as volunteers. This may be particularly the case in activities such as social mentoring—for this reason, after the first year of its new social mentoring scheme, the local authority of Augsburg in Germany reduced the training for social mentors from five days (comprising 40 hours) to four days (comprising 24 hours) (Klopf et al. 2016). Furthermore, it decided that participation in the free training programme would not oblige the trainees to become engaged as a social mentor afterwards. Not only the length but also the form and content of the training needs to meet the needs and interests of volunteers and, most importantly, must build on their assets and tacit knowledge, rather than trying to professionalise them by providing them with the same skills and expertise as paid staff. For example, filling out forms (e.g. funding applications or performance monitoring) is rarely of interest to volunteers. Instead of training up volunteers to do this task (reluctantly), resources are often better spent on effective support by highly trained clerical staff in public service organisations, while using the inputs from volunteers to undertake the activities with which they are more qualified to help.

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Regulations, more generally, may also be perceived as another challenge to putting user and community co-delivery into practice. For example, UK public service organisations which work with volunteers need to ensure they have in place a robust approach to safeguarding. This may involve the need to undertake ‘Disclosure and Barring Service’ (DBS) checks, particularly when volunteers work with vulnerable groups. Compliance with such regulations imposes costs on both volunteers and public service organisations. However, the burdens can be reduced through partnership working with third sector organisations, as the latter typically have more flexibility. However, the biggest challenge for citizen action is its invisibility—by definition, it often takes place in the homes, streets and neighbourhoods where citizens live, rather than the offices and facilities in which public service staff work. Consequently, commissioners and public managers are often unaware of what citizens are already doing, never mind how they could do more to improve public outcomes or improve efficiency. This invisibility of citizen action suggests that the potential of user and community co-delivery remains underused, even during austerity when there is a lack of public resources. It is mainly during crises, such as the Covid19 pandemic, that public policy-makers become aware of the potential of (and need for) citizen co-delivery (Loeffler 2020). It remains to be seen to what extent such high levels of co-delivery can be sustained after the crisis. In general, the academic literature on co-delivery is woefully thin. Further research is needed on the benefits and costs of co-delivery, including its impact on governance principles. At the same time, we need more empirical research on drivers of and obstacles to co-delivery. This needs to take into account demographic factors such as the role of gender but also organisational and contextual factors. While there is some empirical evidence on the motivations of citizens to co-deliver (for example, in Dutch neighbourhood watch schemes [Van Eijk and Steen 2016]), we still do not have much knowledge about staff motivations for taking joint action with citizens. As Wenene et al. (2016) demonstrate in their study of staff perspectives on the actual and potential role of citizens in service delivery in Uganda, context is important. For example, the challenges to co-delivery are likely to be very different in political systems where a large part of the population lacks access to public services, compared to highly

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developed welfare states where many service users have become dependent on receiving state support. As we have emphasised throughout this book, context matters.

3.6 Co-assessing Public Services and Public Outcomes 3.6.1

Types of User and Community Co-assessment

In contrast to the recent academic interest in service co-design, there has been less focus on the co-assessment of public services, outcomes and governance. Co-assessment involves citizens working alongside professional staff, managers and local councillors to give feedback to public service organisations on their perceptions and expectations and on how well these have been met. Co-assessment does not undermine the political role in governmental decision making—at the end of the day, elected politicians have to make the final decisions. It simply gives them much better evidence on what works and does not work, from the citizens’ point of view, and therefore a clearer understanding of the implications of their decisions. A great illustration of how important it is to get the citizen’s point of view has often been provided by the discrepancy between declining crime statistics, which the police tend to see as proving that crime rates in an area have reduced, and the fear of crime by local residents, which often continues to increase in spite of the reported statistics. Only through co-assessment can we find out why this is happening, and act to bridge the gap between objective performance indicators and the perceptions and feelings of citizens. “It therefore offers the ‘insider view’ that is often lacking in formal assessment” (Governance International 2019). For some scholars, it is not evident whether co-assessment should be considered as part of co-production (Brandsen and Honingh 2018, 12). We argue that evaluation is a key part of the public service production cycle and that therefore, co-assessment needs to be the fourth ‘Co’ of co-production, as defined in Sect. 3.2. It can both strengthen and challenge traditional formal mechanisms of assessment, such as scrutiny and audit (Mckenna 2020), since citizen inputs provide new perspectives on the extent to which extent public outcomes have been achieved and governance principles have been respected.

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Furthermore, the results from the other three Co’s of co-production also require co-assessment—have they improved public services and outcomes and, if so, have these improvements been implemented with due attention to the principles of public governance? The importance of a citizen perspective in evaluation is well exemplified by an evaluation of day services provided by charities working with people with visual impairment and people with cerebral palsy (Willis et al. 2003). The researchers, using an outcome-based approach rather than a servicefocused methodology, elicited users’ own definitions of the outcomes that were important to them in their daily lives. The rankings by the two groups of people with serious disabilities were contrasted with the rankings of the staff, displaying marked differences (Willis and Bovaird 2012, 154). For example, the user groups ranked ‘meeting people and friendship’ as their most important outcome-enabler, whereas staff placed this fifth. Staff ranked ‘getting information and advice about other services for people with a visual impairment’ first, whereas service users only ranked this third. This section will identify key types of co-assessment with service users and communities, illustrated with international case studies. Furthermore, we discuss available evidence on the extent to which co-assessment improves public outcomes and efficiency of public services. There is a wide variety of ways in which public service organisations enable users or communities to provide feedback. They may ask them to provide ratings of the service received (nowadays most often online) or invite them to respond to wider surveys—either online, in writing or through face-to-face interviews. Citizen surveys are generally informative and have become a standard and regular part of many services. For example, NHS England undertakes a range of different surveys directly with patients and other service users as a source of feedback on the care that they receive. This includes the GP Patient Survey, which assesses patients’ experience of primary healthcare services provided by GP surgeries. Patient surveys in secondary care are undertaken by the Quality Care Commission; the Cancer Patient Experience Survey is conducted by Quality Health, and other patient surveys are also undertaken (NHS England 2019). Complaints can be considered as a form of user feedback as well— indeed, complaints have traditionally been one of the most important points of contact between public services and citizens. While many complaints may be just casual, more often they involve careful thought

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by service users and some considered reply by service providers. However, the interpretation of complaints has raised some interesting issues in the performance management literature. Often, a low level of complaints is (unsurprisingly) interpreted by organisations as indicative of high customer satisfaction. However, this may well not be the case. Dissatisfied citizens may have decided that making a complaint is not worth the effort, as they consider it unlikely that their voice will be taken seriously or will be acted upon. In fact, complaints constitute valuable feedback from service users and communities. For this reason, the former Leader of the local authority of Arnsberg introduced ‘active complaints management’ in 1994 by encouraging local people to complain in order to obtain information of the perceptions of citizens of the quality of life and the quality of public services in the local area (Bogumil and Vogel 2002, 32). Barriers to making complaints, even where they would be fully justified, are especially likely to be experienced by vulnerable groups. Therefore, independent advocacy organisations play an important role in helping disadvantaged groups to have a stronger voice. In the UK, the national organisation Healthwatch and local Healthwatch organisations have the role of identifying the needs and concerns of people who use health and social care services and speaking out on their behalf. Community co-assessment also involves rating of public services and, in many cases, public infrastructure. City planning decision-makers often find this information useful for shaping their decisions about which services are likely to be important in the future. In the context of the recent focus on wellbeing (Bache and Reardon 2016), an increasing number of cities participate in the Urban Audit of the European Union which started in 2009. This EU-wide benchmarking initiative compares objective performance information but also since 2015 includes community perception surveys on the quality of life at city level (European Commission 2019). Finally, getting feedback from citizens has been made more instantaneous and considerably easier by the increasing availability of digital forms of feedback, such as online rating schemes, at least for those citizens who are digitally literate. Moreover, many public service organisations now provide service users with feedback kiosks which only request citizens to press a ‘smiley’ button to express their level of satisfaction with a service. For example, many hospitals in the UK now enable patients to provide instant and easy feedback on the quality of their hospital visit by selecting a ‘smiley button’ of kiosks at reception desks or exits. At

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community level, environmental services have benefited from ‘Fix My Street’ (https://www.fixmystreet.com/), a widely used interactive app to enable citizens to report litter, potholes and other issues in their neighbourhood to their local public service providers. Interactive websites of local authorities also allow local communities to provide online feedback on the quality of public spaces in a neighbourhood. Such digital user rating schemes are a low intensity co-assessment approach but still provide valuable feedback to service providers and commissioners. Digital types of co-assessment are discussed further in Sect. 3.7. A more intensive type of co-assessment involves citizens in asking questions to service providers by taking part in inspections and service reviews. This occurs, for example, in so-called peer reviews, where service users are trained to carry out formal reviews of the public services which they access. For example, the Customer Engagement Team of Warwickshire County Council established a group of 23 trained peer reviewers in 2011 to co-assess the quality of commissioned care services. Five of the peer reviewers had learning disabilities and focussed specifically on services used by people with learning disabilities (Hawthorne 2013). The initial reviews were conducted over a period of three days. Reviewers were seeking to assess if services met the needs of individuals and the outcomes established in the standards laid down in the local commissioning strategy for adults with a learning disability. After the review visits, Customer Engagement Officers and Reviewers went through the notes that had been written up during the three days and ensured that the review reports accurately captured what was discussed. While none of the reviews highlighted safeguarding or other serious issues, one peer reviewer noted that one lady was given children’s toys to hold, as she had expressed pleasure in the tactile sensation of carrying things. He suggested that, as an adult, she should be supported to have and carry appropriate adult objects and not be treated as a child (Hawthorne 2013). Service reviews may also be carried out by trained members of local communities. The local authority of West Lothian close to Edinburgh with about 170,000 inhabitants, initiated citizen-led service inspections as a co-assessment approach (Kelly 2012). The local project team developed a comprehensive toolkit in order to train ‘citizen inspectors’, including the creation of an evaluation framework, adapted from the Excellence model of the European Foundation for Quality Management, based on a 5-point rating system of public services. Citizen-led inspections took place

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over six days (not including training), a time period chosen to allow sufficient depth, without making them too inconvenient for the citizens who had volunteered, or too burdensome for service delivery organisations. The first inspections were started in 2011 with eight trained citizens who evaluated winter maintenance and pupil placement services in the council area. Afterwards, citizen inspections were rolled out to other services and modified in 2015 to perform lighter ‘Look See’ inspections. For example, in 2018 a ‘Look See’ inspection by citizens was launched to look at the council’s web, print and social media communications, including how accessible, effective and reliable they are as tools for providing information to citizens (West Lothian Council 2018). A report is generated at the end of each inspection and the lay inspectors meet with the service(s) involved in the inspection to feedback their findings. Based on the results of the citizen inspection, an improvement plan is developed and planned improvements fed back to the inspectors in order to close the feedback loop. The most intensive type of co-assessment, however, is generally that which enables citizens to undertake joint research with professionals. For example, the Macmillan Listening Study, a UK-wide study exploring research views and priorities of people living with cancer, adopted a collaborative research approach (Wright et al. 2012), in which patients and care-givers, including two participants receiving palliative care services, collaborated on all aspects of the study as co-researchers. The ‘Jam and Justice’ project is an example of a more place-based approach to co-research which involves an ‘Action Research Cooperative’ (ARC) in Greater Manchester, bringing together academics, practitioners, citizens and political leaders to shape research on emerging urban governance challenges (Urban Transformations 2019). The Children and Young People Service in the Berlin Borough of Marzahn-Hellersdorf initiated a highly innovative co-research project by encouraging 8–14 year-olds to sign up as ‘district detectives’ to research what is going on in the district during school holidays (Bovaird and Loeffler 2016b, 171). This involved the use of photos and video clips. The positive results were submitted to the ‘Treasure Box’ on the website, whereas negative results landed in the ‘Rubbish Bin’. The findings were prioritised by the young people themselves and presented to the political Leader and local officers at a meeting of the Young People’s Council. In 2012 and 2014, this coassessment approach was used in a different context—young people were trained as ‘climate detectives’ and encouraged to seek out and publicise examples of energy wastage in their schools.

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3.6.2

Evidence of Improved Public Value Through User and Community Co-assessment

There have been few meta-evaluations of the improved public value resulting from user and community co-assessment. Although the Quality Care Commission highly recommends the practice of conducting reviews of social services through service users acting as ‘experts by experience’, there is a lack of qualitative or quantitative evaluations of such ‘peer reviews’. Indeed, a number of local authorities in the UK have discontinued their ‘peer review’ programmes, partly because of the impact of financial austerity since 2010. While the responsible project managers are often able to provide anecdotal evidence of benefits for the involved peer reviewers, they often find it challenging to identify the degree to which user co-assessments have influenced service improvements. Moreover, as a literature review undertaken by the Joseph Rowntree Trust states, there is still very little research on the assessment of risk by service users, in particular, from different groups of service users, such as those from Black and Minority Ethnic communities (Mitchell et al. 2012), although this would seem an area particularly likely to benefit from user insights. In various part of this chapter, we have referred to co-production as requiring intense contributions from both citizens and public service provider—for example, the types of co-assessment in Table 3.5 have been listed in ascending order of likely intensity of inputs. It is important to stress that the intensity of co-assessment is only partly a reflection of the amount of time users or communities spend in assessing public services or outcomes. For example, let us compare the relative intensity of contribution between filling out a written survey (or answering a phone survey), which typically might require about 20 minutes, as opposed to pressing the feedback button in a digital kiosk in a public hospital, which requires only a matter of seconds. However, this analysis may well be too superficial. The assessment of which ‘smiley’ to press may have been made as the result of considerable thought during a long waiting period in the hospital, and, sometimes, after a passionate discussion with a care-giver or even a member of staff about the level of ‘customer care’ experienced while in the hospital. So, even feedback by ‘kiosk smileys’ may qualify as co-production, if we have reason to believe that it represents intensive consideration on the part of the citizen.

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Table 3.5 Types of user and community co-assessment Types of co-assessment

Examples of user co-assessment

Examples of community co-assessment

Giving feedback to public service organisations

User rating of public services Users responding to surveys or relaying their user experiences (e.g. patient surveys) Users making complaints (e.g. Active Complaints Management in Arnsberg, Germany) Peer review of services by trained users (e.g. tenant inspectors in social housing) Users as researchers shaping and carrying out evaluations (e.g. patients co-researching public health issues with professionals)

Community rating of public services and public infrastructure Communities responding to surveys (e.g. quality of life at neighbourhood or city-level)

Reviewing public services and outcomes

Undertaking joint research with public service organisations

Citizen inspections of public services and/or public infrastructure (e.g. in West Lothian, Scotland) Citizen researchers shaping and carrying out joint public evaluations (e.g. ‘Children Detectives’ evaluating the child-friendliness of their neighbourhood in a Berlin borough)

Source Author

Moreover, we need to be aware that the intensity of co-production by citizens is likely to affect positively the motivation, and therefore the intensity of contributions, by staff in public service organisations. (It is sobering to realise that, up to now, the opposite dynamic may often have been important, whereby low contributions by service users and communities have allowed staff to feel justified in not ‘going the extra mile’ to make their service work.) Understanding this interaction also needs to take into account to what extent citizens know and care about the service or outcome they assess. Many citizens who know and care about a service may be ready to dedicate significant time to co-assessment by providing more detailed feedback (e.g. by participating in a focus group). In such circumstances, public services staff are likely to take citizens’ views more seriously, because of their knowledge and commitment— consequently, such an approach would potentially increase the intensity of co-production contributions from the public services side as well.

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Challenges in Relation to User and Community Co-assessment

Effective user and community co-assessment faces multiple challenges. First of all, there is the issue of who is the ‘right’ person to co-assess? In the case of user or community co-assessment based on surveys, commissioners or service providers will typically prefer a statistically representative sample. However, in the case of more qualitative feedback, public services may engage in purposeful sampling. For example, in the case of the quality improvement project in five Dutch hospitals, the project team tried to ensure that appropriate numbers of ‘complainers’, ‘satisfied people’ and ‘troublesome people’ (e.g. ‘no show’ patients) were all part of the patient focus group (Vennik et al. 2016, 160–161). Secondly, more intense forms of co-assessment such as peer reviews undertaken by service users or community appraisals are likely to require substantial set-up costs and ongoing support by public service organisations. In the case of the peer reviews by people with learning difficulties in Warwickshire County Council, the third sector organisation Changing Our Lives was commissioned to provide a one day training programme for the service users and support them during the review (Hawthorne 2013). Furthermore, the peer review programme was supported by two customer engagement officers in the local authority. However, the effects and the benefit-cost ratio of such peer review programmes upon strategic decisions are often unclear—this is an area where there has been little research. Thirdly, a key challenge for co-assessment (which also applies to academic evaluations in a public sector context) is the extent to which key recommendations resulting from it are put into practice. Indeed, studies of evaluation utilisation have frequently expressed concern about the apparent under-use of evidence-based research (Weiss 1998). In the case of co-assessment, there is the potentially embarrassing extra factor that citizens have to spend their own (unpaid) time to provide feedback to public service organisations. If their feedback is not seen to be acted upon, this can undermine confidence in the public sector. A typical case is provided by a co-assessment project in Southern Italy, where citizens volunteered to assess the quality of the built environment in their local area. The time required for training and carrying out the assessment, including the preparation of the feedback report, was more than four days (Massoli 2012). As one involved citizen stated: “…Now I am waiting for the local council to tell me what they are going to do about the evaluation

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which we have done” (Massoli 2012). In many cases, they wait in vain— and therefore do not respond the next time they are asked. It is key that the public service organisations specify the obligations of all stakeholders involved in co-assessment and also commit to taking their work seriously, including giving them proper feedback on what actions have been taken as a result of their activities. One way in which this could be done would be through developing and agreeing a co-production charter. For example, in Hackney and the City of London, the local Healthwatch groups developed a Co-Production Charter for health and social care services with residents and partner organisations (Healthwatch Hackney and Healthwatch City of London 2018). Such a co-production charter could set out the responsibilities and the reasonable expectations of each side—both citizens and the public service organisations involved. It could make clear that not every area for improvement identified by citizens may be acted upon by the public sector organisations, but that feedback would be provided on which decisions and actions the public sector organisation had taken, based on the co-assessment.

3.7 3.7.1

Digital Co-production The Evolution of Digital Co-production

Digital co-production is not a new phenomenon. Indeed, we can trace its evolution back to the development of e-government in the late 1990s, even though at this time, conceptualisation of e-government, mainly as a form of co-delivery, was in its infancy (Bovaird and Loeffler 2010). The interest in the links between co-production and digital technologies increased greatly with availability of “social media, ubiquitous mobile connectivity, and web 2.0 interactivity” … “which enable coproduction on an unprecedented scale” (Linders 2012, 446). Subsequently, digital technologies have evolved, as we shall discuss, from simple efficiency applications (‘web 1.0’) and citizen voice applications (‘web 2.0’) to digital technologies based on more ambitious web 3.0, 4.0 and 5.0 applications). As this section will show, technological change has been underpinned by a paradigm change, or rather a paradigm extension— from e-government to e-democracy and finally to digital transformation.

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Each of these phases have had implications for the role and scope of coproduction—and indeed rather different implications for each of the Four Co’s. Right from the early days, the implementation of e-government solutions meant that governments shifted tasks to service users which had previously been performed by staff working in public services, such as filling out forms. At the same time, citizens were provided with more flexibility—for example, they could fill out these forms when it was convenient to them and no longer had to visit a public agency in person. As a result, digitalisation became an important driver of user co-production. Over time, digitalisation went beyond transactional services, reaching even personal services such as health, where the introduction of new technologies allowed patients to take on wider responsibility for their own treatment—for example patients with kidney problems could run their dialysis at home, so they no longer needed to visit hospital several times a week. And of course, the world of education has changed as well, with schools and universities investing in e-learning, which gives students more flexibility on how to access learning materials and when to do their coursework. As Fig. 3.3 shows, this first generation of e-government

Fig. 3.3 How digital technologies enable co-production: from e-government towards digital transformation (Source Author)

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projects tended to enable more co-delivery of public services with a focus on increased efficiency. Whereas e-government focussed on more efficient public services by providing citizens with fast and convenient 7/24 access to government information and services online, the concept of ‘web 2.0’ meant that “the citizens’ voices could be heard and reflected back to transform existing government policies” (Chun et al. 2010, 2). The use of new forms of digital communication with citizens, including the use of social media, not only potentially reduced the transaction costs of communication for public service organisations (Meijer 2014) but also implied a stronger focus on strengthening democracy and achieving public governance principles associated with the concept of ‘open government’ such as transparency, public participation and accountability. As a result, many OECD countries launched initiatives to promote e-democracy (Bellamy and Campbell 2016), which enabled new forms of co-commissioning (e.g. online participatory budgeting), co-design (e.g. crowdsourcing of ideas on e-platforms) and co-assessment of public policies, services and outcomes through citizen reporting (e.g. online complaints platforms such as ‘FixMyStreet’). However, from a co-production perspective, a limitation of ‘open government’ was that it mainly aimed to encourage and support citizen voice but only to a much lesser degree citizen action. The concepts ‘web 3.0’ (‘internet of data’) and ‘web 4.0’ (‘internet of things’ and ‘internet of services’) (see the Häfler stage model of the development of the World Wide Web and internet in von Lucke 2016, 175) imply a further shift from a narrow focus on improved efficiency within government towards more holistic changes of public service systems. In particular, the concept of digital transformation is seen as a paradigm change which goes beyond public service efficiency: “The use of digital tools allows for changes in the way public administrations deliver their work, communicate, and provide services, but can also have much more extensive impact such as changing the structure and culture of an organization, or engaging and integrating citizens and other partners into the co-design and co-delivery of public services” (Mergel et al. 2019, 3). Consequently, digital transformation may enable all four Co’s (cocommissioning, co-design, co-delivery and co-assessment) in order to improve public value.

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Can we then make the converse proposition, that digital transformation will only fulfil its potential to improve public value if citizens play an active part in the transformation process as co-producers? In practice, as Mergel et al. (2019, 12) comment critically, “a change in relationships (and a focus on citizens) has only been mentioned by a few experts” interviewed in the empirical study on digital transformation. Consequently, further research on the link between co-production and digital transformation is needed. Similarly, it is too early to be clear about the relationship between co-production and future ‘web 5.0’ applications, based on the tactile internet, which, on the one hand, may further dehumanise personal services such as healthcare by enabling remote diagnosis, treatment and surgeries but, on the other hand, may also enable much more intense real-time interaction between distant people as if they were close. 3.7.2

Digital Modes of Co-production

Table 3.6 shows the range of digital co-production approaches based on the Four Co’s with examples from OECD countries. This table builds on the typology by Linders (2012) who distinguished between digital coproduction in the design, day-to-day execution and monitoring of public services. However, in contrast to Linders (2012, 449), this table does not include those forms of ‘Do It Yourself Government’ where citizens govern themselves with no interference from government at all, since we do not consider these as co-production. Furthermore, we also consider digital forms of co-commissioning in this table. Digital technologies have enabled a range of new forms of cocommissioning . In particular, digital technologies can now make user and community involvement in urban planning much more meaningful through open notification and comment systems regarding new developments, the visualisation of different scenarios in 3D, and more effective data management (Parvin 2016). Furthermore, participatory budgeting has gone digital in many countries. In particular, in Germany early adopters of participatory budgeting such as the Berlin Borough of Lichtenberg have quickly added a digital platform to complement the prioritisation of citizen proposals at neighbourhood meetings (Loeffler and Martin 2016, 312). This has increased the numbers of involved citizens dramatically and also made voting on proposals made by citizens

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Table 3.6 Four modes of digital user and community co-production Key co-production modes

Examples of digital user co-production

Examples of digital community co-production

Co-commissioning of priority outcomes

• Digital development planning for individual citizens • Personal budgets with digital marketplaces

Co-design of improved pathways to outcomes

• Users co-designing new digital apps and websites • Users designing new services based on open government data

Co-delivery of pathways to outcomes

• Users making use of e-government services • Online user peer support groups (supported by public services) • E-health and e-care technologies enabling self-care

Co-assessment of public services, public governance and public outcomes

• Citizen reporting of complaints and user satisfaction online (e.g. ‘FixMyStreet’, ‘Carer Opinion’) • User-monitoring of individual health conditions based on electronic sensors (in collaboration with public service organisations)

• Digital development planning at neighbourhood level • Online participatory budgeting • Crowdfunding through government online platforms • Crowdsourcing of ideas through government online platforms • Designing new services or solutions based on government open data (e.g. Hackathons) • Smart City Labs and other digital Innovation (Living) Labs • Digital volunteer networks supporting public services (e.g. in emergency and disaster management, such as implementing new solutions to the Covid-19 crisis, like GlobalHack) • ‘Open book government’ with citizens holding their government to account (e.g. based on online information about budgets) • Neighbourhood monitoring and audit apps (in collaboration with public service organisations)

Source Author

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more transparent, as all subscribed platform users can see in real time to which degree various proposals are backed by votes. An increasing number of local authorities provide online crowdfunding platforms to enable local communities to raise financial resources from other community members. For example, the City of Ghent in Belgium set up the online platform ‘Crowdfunding.gent’ in 2015 to help citizens raise funds for projects which aim to improve local public outcomes (Monstrey 2016). In its first year of operation, the platform raised e70,000 in contributions from civic society. In addition to financing the set-up and running costs of the platform, the City of Ghent provided e55,000 extra funding for community projects which achieved their funding goal through the crowdfunding platform. Most importantly, the local authority is aware that not every citizen initiative is likely to succeed and considers the platform successful if 1 out of 3 projects reach their predefined funding goal. However, in 2015, 80% of projects raised enough funding to be implemented (Monstrey 2016). Civic crowdfunding has also been employed by the University ‘Tor Vergata’ in Rome to extend the opening hours of a departmental library to Saturdays. Not only was the funding target achieved before the 40-day deadline but the success of the campaign convinced the university administration of the need to reallocate budgets, so that all faculty libraries could extend their opening hours without having to undertake crowdfunding (Colasanti et al. 2018, 286). However, the most impressive crowdfunding initiative to date has clearly been undertaken by the UK citizen Captain Tom Moore, a 99 year-old who has to use a walking frame to get about, who set himself the target of walking 100 laps around his garden before his 100th birthday to raise £1000 by crowdfuning as a donation to the NHS during the Covid19 crisis in May 2020 but, in the event raised over £30m (and became the oldest person ever to top the UK hit parade) (BBC 2020). Co-design is also increasingly focussed on the design of new digital services with potential service users, and at the same time, is used to undertake research on how to make digital services more user-oriented. For example, HMRC commissioned a qualitative research and co-design project to understand how individual customers who complete selfassessment tax returns respond to the use of new digital technologies and what design features would support their engagement with HMRC through new and existing digital channels (Cordes et al. 2017). In Stockport, the Department of Adult Social Care rebuilt its website by working together with service users (Wells 2011). Website specialists

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and ethnographers were commissioned to recruit about 30 service users and to work with them intensely to understand how they navigate the website and what information is important to them. This revealed the need to develop an online charging calculator that gave social care users an idea how much the likely cost would be, if they were eligible for social services from their local authority. The Departmemt also completed a mystery shopping exercise with a group of customers on the old website and then used the learning from this in the redesign of the new site. The website redesign also involved staff from voluntary sector organisations and social care staff of the local authority to ensure ownership of the operational teams. The new website was so effective that contacts, enquires and observations at the contact centre went down by 29%, freeing up staff resources to deal with more complex issues which required personal interaction. Furthermore, the number of enquiries and observations received by the Contact Centre that lead to a referral to the ‘back office’ (i.e. social work teams) has been reduced by 36%. Co-designing the website with users has also made staff more ambitious to deliver greater functionality—for example, building a citizen portal where someone can complete a self-assessment, develop their support plan and shop for services and choices in an online market place. Interactive platforms such as ‘Changify’ (http://www.changify.org/) provide local authorities with technologies to crowdsource new ideas from local communities. At the same time, they can also be used by local communities to share their ideas and seek support from each other in order to experiment with new solutions at neighbourhood level. The latter may lead to co-production through an ‘outside-in’ pathway (see Sect. 2.5), if local communities manage to get the buy-in of public sector organisations to their offer. Urban Living Labs and related innovation lab concepts often focus on digital innovation. “The aim is to develop, try out and test innovative urban solutions in a real-life context” (Steen and Van Bueren 2017, 5). The methodology typically engages stakeholders from public sector organisations, communities, business and research institutions in iterative learning processes based on experimentation through social innovation which is designed, prototyped, tested and validated in real life contexts. Nesti (2018) compares three major Urban Living Lab projects in Boston, Amsterdam and Turin. In particular, the Amsterdam smart citizen project involved the co-design of local networks of quality air

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measurement stations and co-assessment of digital sensors of air quality with 73 volunteers. Another example of digital co-design is hackathons, which are competitive events where developers and people interested in a specific issue meet together and try to create new solutions within a short time period. The City of San Francisco launched the Hackathon ‘Digitize’, targeted at high school students “to promote social good through technology and computer science” (ChallengeRocket 2018). While a number of small-scale awards were created to incentivise the students to undertake projects that address social injustices or global issues, the initiative also aimed at improving the students’ education in computer sciences and programming. Digital co-delivery may take many forms such as the use of egovernment solutions or online peer support groups with contributions from public service organisations. Furthermore, digital technologies may help people who are at risk of social isolation to connect to other people and improve their self-management. For example, the charity Age UK (2018) has launched the multiple award-winning co-production initiative ‘Time to Call’, which is a free telephone ‘befriending’ service for matching volunteers with older people. This involves a weekly, 30-minute chat with a volunteer with similar interests to reduce social isolation. While most e-health solutions focus on individual co-production, online platforms can also enable user groups and local communities to generate, share and disseminate collective experiential knowledge between themselves and public services. In particular, patient groups are at the forefront of the development of collective intelligence (Nicholas and Broadbent 2015). Their knowledge exchange not only improves the wellbeing of members but also has the potential to improve clinical knowledge. The Stroke Association in the UK has co-designed ‘My Stroke Guide’ with stroke survivors and care-givers to encourage users to strengthen their own support network: “It permits and encourages information–sharing by giving every survivor two additional log-ins – for a family member and a carer – who can follow and support progress. As well as deepening bonds, the system prompts users to expand their support network, connecting with other survivors online and in local clubs” (Nicholas and Broadbent 2015, 45). It also manages the flow of information across healthcare providers and the informal support network of the patient.

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Digital volunteer networks supporting public services are another increasing trend, for example, in emergency and disaster management. As the case study of the 2015 Nepal earthquake by Park and Johnston (2019) shows, digital technologies enable local communities to participate in and contribute to disaster management of public services in a meaningful way. In particular, volunteer digital networks are often able to gather disaster data in ‘real time’, with ‘on-the-ground’ views of the issues and problems people face and often allow them to share their data with public service organisations. According to Park and Johnston (2019) in many cases, such data sharing may increase the capacity of public service organisations for dealing with disasters more effectively. On a more global scale, the emergence of the Covid-19 pandemia in 2020 mobilised communities to join forces to engage in online hackathons in order to #hackthecrisis. This movement started as community self-help in Estonia under the leadership of Accelerate Estonia, Garage48, and Guaana which launched a hackathon from 13 to 15 March 2020. Within 48 hours, 1000 volunteers across fourteen time zones joined this inititiave, resulting in over thirty projects (Gigler 2020). This has inspired over 40 countries to launch their own hackathons—among them Ukraine, Finland, India, Turkey, Georgia, Poland, Nigeria and Brazil with about 200,000 people participating in these hackathons. In order to foster and scale this digital network the European Commission provided support to the Global Hack event on 9–12 April 2020, which was supported by international organisations as well as big tech companies (Gigler 2020). Finally, digital technologies enable more flexible and real-time forms of co-assessment —both by users and communities. This may involve citizen reporting based on web-based assessments of public services (Linders 2012). For example, the UK website ‘Care Opinion’ (https://www.car eopinion.org.uk/) provides an independent feedback service which signpost the experiences of health or care users to service providers as well as regulators and watchdogs and makes their response public. As Mckenna (2020) comments, this is a form of citizen sourcing that can help public services to be more responsive to citizens. Both ‘FixMyStreet’ and ‘Care Opinion’ not only make it easier for citizens to give feedback but also provide service users with transparency as to whether other people have similiar complaints and how public services have responded to the feedback. In France, public sector organisations at central government level have been publishing the results of user surveys but also objective performance data on their website since 2018—this public reporting will be

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rolled out to all central public services by 2020 (Direction de l’information légale et administrative 2020). Increasingly, co-assessment also takes place through more informal user and community feedback based on social media such as Twitter and Facebook. Furthermore, there is a wider range of remote health-monitoring tools enabling patients to co-assess their state of health. When users self-assess in collaboration with public service organisations this is a form of coassessment. In Hungary a pilot project tested wearable sensors of the health conditions of patients with chronic cardiac conditions. The information system provides real-time feedback both to patients and medical staff: In the case of ‘yellow’ alerts, only the patient gets a personal notification from the ICT system but in the case of ‘red’ alerts, health care staff are informed immediately (Gábor and Gausz 2018, 135). A type of digital community co-assessment, drawn from Linders (2012), is open book government. As Linders (2012, 449) suggests: “Advancements in data management, dissemination, and analysis have equipped individual citizens and civil society organizations with the capability to sift through vast amounts of government data”. As Mckenna (2020) points out this approach has been trialled by national government in England who, at the same time as abolishing the Audit Commission, required local government to publish all expenditure above £500 with the intention of empowering an army of ‘armchair auditors’. However, there is little evidence that this kind of transparency has resulted in much community co-assessment, never mind that it formed an adequate substitute for the Audit Commission. The Austrian initiative ‘Offener Haushalt ’ (Open Budget) (KDZ 2020) provides a more user-friendly visualisation of the budgets of the more than 1000 local authorities which have joined this initiative. But even in this case no information is available on the extent to which citizens have made use of this information to challenge their local authority. This means that community co-assessment may be weak even though the potential is there. (Indeed, the earlier example of the UK coalition government replacing the Audit Commission by ‘armchair auditors’ may have had the goal of reducing the level of scrutiny to which the government was exposed, another example of the potential abuse of co-production.) Drawing on Linders (2012), Mckenna (2020) also discusses the new trend of citizen-to-citizen platforms enabling self-monitoring of public services. As stressed throughout this book, we will only consider this as a

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form of co-assessment if public services organisations make a contribution as well (e.g. by funding the online platform). Digital technologies enable communities not just to monitor the quality of public services but also other issues of interest. Cila et al. (2016) describe experimentation with a web app in a deprived neighbourhood of Amsterdam to undertake participatory data collection for monitoring community health, which includes a co-assessment of the prototype resulting from the experimentation. As Cila et al. (2016) stress, the commitment of the participants to report data continuously makes creating an appropriate menu of incentives for people to collect data very important. These examples show that digital forms of all Four Co’s are an emerging field which will impact on how users and communities cocommission, co-design, co-deliver and co-assess public services and outcomes. 3.7.3

Potential Impacts of Digital Technologies on User and Community Co-production

In order to assess the impact of digital technologies on user and community co-production there is a need to differentiate between different types of digital technologies. In his overview of digital co-production research Lember (2018, 116) states that most studies have so far focussed on social media but there is now an increased interest in the use of smart digital technologies, such as electronic sensors and ‘smart home’ or ‘smart city’ applications, as well as emerging technologies, such as blockchain. Furthermore, it is also important to consider how a specific digital technology is used. For example, social media (which are part of ‘web 2.0’) enable local communities to connect with each other more effectively, which may strengthen community co-production—for example, a co-production initiative of the Dumfries & Galloway Health and Social Care Partnership has encouraged women who were affected by breast cancer to provide peer support to each other through a closed Facebook page (Halliday 2019). But as Mergel (2016) points out, public service organisations often use social media simply as a traditional information outlet, providing information one-way, without connecting and communicating with other social media users (a significant imbalance in official Twitter accounts between followers and people followed often reveals low interactive use of social media by public service organisations).

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The potential impact of specific digital technologies on the extent of user and community co-production is not necessarily positive: while the use of some digital technologies may indeed increase the level of user or community co-production, there are also examples where the use of specific digital technologies has actually reduced the extent of coproduction, which means that the impact is substitutive (Lember 2018, 119; Lember et al. 2019, 1680). As far as the former is concerned Lember (2018, 117) and Lember et al. (2019, 1680) further differentiate between new technologies which potentially only augment traditional co-production or transform or diversity co-production. According to this typology, some digital technologies “just add a digital layer on top of the traditional human-centred processes” (Lember 2018, 117). Examples include government e-platforms which allow citizens to make complaints online in addition to traditional forms of reporting complaints. More sophisticated digital complaints systems such as ‘FixMyStreet’, which enable complainants to see how many other people have reported the same issue, may strengthen their sense of agency, and make transparent whether the issue has been solved, which therefore goes further by putting more pressure on the local authority to do something about the complaints registered on the website. This means that in many cases more mature e-government solutions no longer just duplicate analogue administrative processes online but aim to improve public services and/or co-production with citizens. While public service transformation through e-government focusses mainly on increasing efficiency, other forms of digital co-production based on the digital transformation paradigm also aim to improve public value, as highlighted in Fig. 3.3. Examples of digital user co-production with a wider focus on public value are the use of ‘smart home’ technologies in social care and e-health applications. The provision of online platforms for crowdsourcing and crowdfunding by local authorities provide examples of digital community co-production which aim to improve the quality of life at the local level. Finally, as Lember (2018) and Linders (2012) point out, the use of some digital technologies may reduce the extent of co-production. For example, when students take part in online post-graduate programmes, at least part of the teaching is replaced by the provision of online literature or video-clips, so that the inputs of university staff are reduced to the design of the study material and student assessment. In the other direction, citizen co-production may be replaced by provision purely from public

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service professionals (for example, when electronic sensors send information 24/7 from a patient to hospitals, so that citizens no longer need to provide this information but only consent to the gathering and analysis of data from the digital device) or community self-organisation (for example, through the use of open or commercial platforms by citizens). This means that digital technologies can change public service provision in either direction—either from traditional professional-led or selforganised activities towards user and community co-production or vice versa. In particular, as the dynamic model in Fig. 3.4 visualises, digital technologies create more opportunities for public sector organisations to move toward co-production following the ‘outside-in’ pathway to coproduction from user self-help or community self-organisation. At the same time, as shown by the arrows moving away from co-production

Fig. 3.4 How digital technologies can support moves towards and away from co-production (Source Author)

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in Fig. 3.4, digital technologies may reduce, and, at the extreme, end co-production by substituting co-production through community/user self-help or professional-only service provision. We will provide here some examples of how digital technologies can support moves between different service provision arrangements in Fig. 3.4, without claiming to be exhaustive as far as the range of digital technologies is concerned. Starting from how digital can help the move from government service provision to community co-production, the use of government online platforms, open government data but also increasingly technologies associated with the concept ‘smart cities’, open up new opportunities for public sector organisations to move towards community co-production by bringing citizens into public services—the ‘inside-out’ pathway to coproduction. An example of such a community online platform is the Dutch BurgerNet (Meijer 2012) through which the police can quickly provide information about issues of public safety to citizens concerned by these issues and through which citizens signed up to this platform can also help the police by reporting crime more effectively. Furthermore, open government data is often considered as a powerful driver of community co-production, as it allows citizens and other stakeholders to co-design new services and tools (Lember 2018, 117). For example, a number of local authorities such as the London Borough of Lambeth and Ulm in Germany have sponsored ‘Hackathons’ with citizens, in order to co-design new online services or apps. Finally, many cities around the world have become part of the ‘smart city’ movement, whether engaging in EU-funded projects or ‘smart city’ networks with other cities. While in many cases, ‘smart cities’ have been very much driven by business interests, the City of Barcelona has adopted a much more co-productive smart city vision by “focusing on what it can do to serve the people, instead of a technology push agenda” according to Francesca Bria, Barcelona’s chief technology officer and digital commissioner (Tieman 2017). However, as indicated by the inverse arrow from community coproduction to government service provision in Fig. 3.4, digital technologies associated with the ‘internet of things’ may also make the contributions of citizens obsolete, as they allow governments to monitor continuously the behaviour of communities in public spaces and provide governments with predictive analytics (e.g. in policing), often without citizens being

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engaged directly in assessments (Athey 2017) or even becoming aware that they are being monitored. Starting from community co-production but moving towards community self -organisation there are now also many hyperlocal private sector or open source platforms which enable local communities to connect with each other without engaging with the government. A well known example is the internet platform Wikipedia but there is also an increasing number of small-scale citizen initiatives based on digital technologies, which are a form of community self-organisation. As part of an ‘outsidein’ co-production approach, such community-led digital initiatives may be harnessed by governments to improve public value. An example is the citizen initiative “Welcome to Utrecht” set up by some Utrecht citizens to coordinate help for refugees arriving in the city (Datema and Feldman 2015). Since it has been developed, the local authority has been making use of it to coordinate the support made available in the refugee shelters. However, such ‘outside in’ moves toward community co-production remain rare for public sector organisations. A number of digital technologies have a more direct impact in helping the move from government service provision to user co-production than to community co-production. For example, effective digital platforms such as online market places for personal budget holders in adult social care which provide high quality information to service users and connect users and providers could increase the level of user co-production. But as Pritchard (2018) comments critically about the implementation of personal budgets at the UK local level: “… only half of all personal budget holders believe their local authority had made it ‘easy’ to get the right information and advice”. Furthermore, ‘smart home’ and digital care and support systems such as CleverCogs™ in Scotland (Carnegie UK Trust and Just Economics, n.d.) enable older and vulnerable people to improve personal and public outcomes by providing them with support to deal with daily issues and allowing social care workers to monitor and connect with their users more easily. CleverCogs™ also focuses on digital participation by providing ‘simplified access’ to the internet so that service users with few digital skills can connect with their local communities, helping health and social care services to move toward both user and community co-production.

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There may also be trends favouring the move from user co-production toward user self-help, e.g. through the availability of commercial ‘smart home’ apps and monitoring devices, which may mean that at least some people who need support can access self-help through the market or free open source solutions, and will no longer need to co-produce with public service providers. However, the reverse move is also likely to be important for some citizens, who may move from having to rely on self-help to co-producing with public services—e.g. digital technologies such as hotlines, e-care or e-health solutions may lower the threshold for vulnerable people and people in rural areas to access services which have previously been hard to access. Summing-up the lessons from Fig. 3.4, depending on the digital technology involved and how it is used in specific contexts, more service arrangement options are opening up for citizens. Digital public service provision is no longer simply the province of public service organisations—now user and community co-production through digital means are also becoming become increasingly important. Moreover, service provision through user self-help or community self-organisation are also becoming enabled by digital means, which not only increases the options for citizens but also provides more opportunities for public service organisations to develop co-production approaches based on the ‘outside-in pathway’ by harnessing the growing strengths, assets, knowledge and experience of citizens to improve public value. 3.7.4

Characteristics of Digitalisation and the Four Co’s

In order to understand the potential of digital approaches to coproduction, it is important to explore in greater detail how exactly digital technology can impact on different modes of co-production. Table 3.7 provides examples of potential impacts of digital technologies drawing on the recent taxonomy offered by Aceto, Persico, and Pescapé (2018), who delineate four main instrumental characteristics of modern digital technologies: sensing, communication, processing and actuation:

Source Author

Co-assessment

Enables more comparisons between objective and subjective assessments

Better captures (emotional) reaction of users to co-designed prototypes Allows better identification of where service delivery is failing

Co-design

Co-delivery

Better captures needs and assets of service users and communities

Sensing

Enables better matching of citizen resources to services they are interested in and better matching of citizens for community co-production Better analysis of citizen feedback

Facilitates story-telling and dissemination of stories of co-producers

Assessments of individuals can be shared more easily on platforms

Not applicable

Better understanding of needs and their drivers Better scenario-mapping based on big data Allows analysis of large bank of ideas (crowdsourcing)

Widens community engagement (e.g. online participatory budgeting) Boosts self-efficacy Allows targeting of those ‘who know and care’

Enables devices to record user assessments

Enables people with special needs to do more activities which improve personal/public outcomes

Allows rapid visualisation of design options

Actuation

Processing

Communication

The potential impacts of the characteristics of digital technologies on the Four Co’s

Co-commissioning

Table 3.7

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• Sensing technologies such as wearable devices and smart objects provide new opportunities to collect information about almost every aspect of social life. • Communication: Digital technologies such as social media, but also the new generation of web 5.0 applications based on the tactile internet, create new opportunities ubiquitously to interact, not only for people, but also for machines. • Processing: The availability of new processing technologies, in particular Artificial Intelligence (AI), allows the processing of large amounts of government and citizen data. AI can be defined as “the programming of computers to do tasks that would normally require human intelligence (Mehr 2017, 3). Currently, AI in public services is mainly used to deal with tasks such as: “answering questions, filling out and searching documents, routing requests, translation, and drafting documents” (Mehr 2017, 1). • Actuation: Using robotics and other technologies capable of mechatronic actions. This taxonomy has also been applied effectively by Lember et al. (2019) in their analysis of the potential impact of digital technologies on key elements of the co-design phases of co-production. These four elements include establishing direct interaction between citizens and staff working in public services, motivating each other to engage in the co-production process, making a contribution, and sharing decision-making (Lember et al. 2019, 1668–1669). Their detailed analysis shows that the impact of specific categories of digital technologies on most co-production elements is quite varied. The only exception is the impact on resource sharing, as digital technologies create new resources and ways of sharing resources. But as Lember et al. (2019, 1674) comment “Whether they are actually used for that purpose is another matter”. However, Table 3.7 takes a different perspective, analysing the potentially positive or negative impact of these characteristics of digital technologies on the Four Co’s.

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Characteristics of Digital Approaches to Co-commissioning

Digital sensing technologies allow much better capture of data which is relevant to needs analysis and asset mapping and can make public services more relevant and more rapidly available. Whether this leads to more co-production is, however, context dependent—this could happen if AI leads to the development of algorithms which reflect priorities negotiated between citizens and commissioners, e.g. by drawing up a short-list of potential providers bidding for contracts in a consistent and unbiased way, which reduces the prejudice and ignorance which often makes procurement inefficient. However, AI could conceivably lead instead to public professionals taking decisions on the basis of less personal interaction with service users; and it might even lead to service users becoming independent from public services (or even from services in general). The communication improvements offered by on-line participatory budgeting exercises can make them much slicker and cheaper to run, reaching much greater numbers of citizens, than face-to-face exercises (although loss of the social interactions may reduce the intensity and therefore the quality of the discussion). AI could also strengthen self-efficacy of citizens, and therefore increase the confidence with which citizens take part in the co-commissioning process, by linking them with like-minded citizens. Hecht (cited in Mehr 2017, 9) discusses the example of a citizen contacting their elected representative about a piece of legislation. A bot could then follow up, letting them know the number of citizens who contacted the representative about the same issue. It could also update the citizens on new developments regarding the legislation or future citizen engagement options. “Once you’ve self-selected yourself as an engaged citizen, there is something special about strength in numbers, and increasing your own engagement because so many people have already acted to make their communities better,” explains Hecht (cited in Mehr 2017, 9). (Actually, similarly uses of AI to promote citizen self-efficacy in each of the other 3 Co’s would be possible). The advantages offered by digital processing might also lead to better understanding of needs and their drivers and better scenario-mapping, based on big data, so that co-commissioning can be based on an improved evidence base.

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3.7.6

Characteristics of Digital Approaches to Co-design

Digital communication allows more precise targeting of potential participants in the co-design exercise, while digital processing allows rapid and thorough analysis of a large bank of ideas emerging from that process. Moreover, the scenarios and service options which can be fashioned from these ideas can be visualised or turned into prototypes much more vividly and rapidly. Then sensing technology can better capture the reaction of potential service users to the co-designed prototypes. However, it has to be admitted that co-design has thus far made only limited use of these potential digital applications. 3.7.7

Characteristics of Digital Approaches to Co-delivery

Digital sensing allows quicker and better identification of where current services are failing (e.g. litter on streets or people experiencing loneliness). Digital processing allows better coordination between those members of the community who have capabilities which they are willing to share and those people who need some support from the community—the ‘matching process’ which we have noted previously as a potentially problematic aspect of co-production. (As mentioned earlier, a vivid illustration of the problems presented by matching is given by the fact that of 750,000 ‘volunteer responders’ who offered to help out the NHS in the Covid-19 emergency in March 2020, only 20,000 could be allocated tasks during the first, crisis-ridden month). At present, databases of third sector organisations typically only provide information about specific offers of citizens who are registered as volunteers and do not map the knowledge and experience of service users who are already in contact with public service organisations. This greatly limits how well they can identify possible matches between citizens with similar interests or whose ‘offers’ correspond to the requests for support by other citizens or public service organisations. A superior matching process could greatly boost time banks, which are based on reciprocal exchange: “For every hour participants ‘deposit’ in a timebank, perhaps by giving practical help and support to others, they are able to ‘withdraw’ equivalent support in time when they themselves are in need. In each case the participant decides what they can offer” (Timebanking UK 2018). AI could reduce the need for time bank members to search for relevant offers of other time bank

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members and reduce the need to employ a paid time bank manager who acts as a ‘match-maker’. Furthermore, digital communication allows the opportunities and benefits of co-delivery to be much more widely and vividly shared, so that more people are prepared to take part. Finally, the actuation aspect of digital can enable people with special needs to do more activities which improve their personal and public outcomes. 3.7.8

Characteristics of Digital Approaches to Co-assessment

Digital actuation can provide appropriate devices for recording service user assessments, while digital processing can allow better analysis of citizen complaints (e.g. through on-line systems or digitally enabled callcentres) and, by summarising large data sets quickly and thoroughly, it can throw up patterns which might otherwise be missed. Digital sensing can enable more comparisons between objective and subjective assessments of a service (e.g. when service users complain that a care-giver is not spending as long helping them to wash and dress in the morning as they should). Finally, shared digital platforms can allow service users to communicate their service assessments (positive ‘thank-yous’ and negative complaints) with staff from different services, so that a joined-up response can be developed. This analysis shows that the characteristics of the range of digital technologies discussed have the potential to overcome some of the barriers of traditional forms of co-production such as lack of information of public service providers about motivational factors of citizen co-producers. However, the overall impact of digital technologies on co-production depends on how well these characteristics are utilised, how risks of digital co-production are managed and to what extent potential pitfalls of digital co-production can be avoided. 3.7.9

Risks of Digital Co-production

While digital co-production may provide benefits to users and communities, not everybody will be able to make use of these new opportunities, so digital exclusion is a risk which must be taken seriously. Some citizens may not be able to access modern digital technologies at all and others may not be able to use them effectively. The research by Bezuidenhout et al. (2017, 464) on the use of open data in Africa highlights “the persistence

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of deep inequalities within the seemingly egalitarian-inspired open data landscape”. But, as Seidelin (2018) points out the era of Big Data adds a new dimension to the digital divide: those who can make sense of and engage with data, and those who can’t. The lack of data literacy implies that some members of local communities but also smaller organisations may not able to use the potential of data to improve public value. In order to reduce the risk of digital exclusion, not only do resources need to be provided but digital capacity-building needs to be undertaken with disadvantaged groups and organisations. Co-production through peer support may provide a more effective approach to digital capacitybuilding than formal professional-led training programmes. An example of co-produced digital skilling are so-called ‘social media surgeries’, which bring local people together in an informal setting to learn and teach each other about how to use social media (Hine-Hughes and Booth 2012). What is particularly attractive about this model is its ‘viral marketing’ character, whereby one person learns how to use social media and then teaches other people in their social network. The participants of these social media workshops feel empowered because the participants learn about each other’s digital strengths and weaknesses—so, for example, it actually helps when a new participant sees a more experienced participant ‘googling’ to get an answer to a question—“Just like I would!”. Social media surgeries also often result in a number of wider outcomes, as they help communities to organise themselves more effectively. However, as Nicholas and Broadbent (2015, 5) point out, many new digital tools, in particular e-health tools, mainly strengthen individual coproduction, while “neglecting innovative solutions to assemble, construct and distribute clinical knowledge among collectives”. In particular, more (affordable) e-platforms are needed which not only allow groups to share information and enable conversations between members but are more effective at analysing and aggregating data so that community groups and public services can make better use of ‘collective wisdom’ (Nicholas and Broadbent 2015, 29). Otherwise, there is the risk that internet platforms are dominated by a few ‘usual suspects’ with similar contributions. Nieuwenhuizen and Meijer (2020) discuss the potential implications of different forms of digital co-production on public values. In particular, they distinguish between values related to ‘proper governance’, ‘performing governance’ and ‘responsive governance’. Their analysis shows that any form of co-production may lead to public value conflicts. For example, the use of AI in public decision-making processes may reduce

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human bias (provided the algorithm is not biased) but the improved ‘due process’ and potential efficiency gains through faster decision-making may be at the expense of reduced participation opportunities for the service user and wider communities. 3.7.10

Potential Pitfalls of Digital Co-production

As the above analysis has shown, we should not assume that digital coproduction is beneficial per se. As with any change process, the use of digital technology in co-production implies winners and losers. Some pitfalls of digital co-production are linked to the lack of improved personal or public outcomes, especially where the digital intervention has been poorly planned, designed or implemented. Other pitfalls are related to negative impacts on public governance such as a violation of privacy or lack of security. For example, a letter from 300 academics from 26 countries warned governments that digital contact tracing in the context of Covid-19 is likely to fail unless governments build the technology in a way that respects user privacy. As the letter stated: “It is crucial that citizens trust the applications in order to produce sufficient uptake [at least half of the population] to make a difference in tackling the crisis. It is vital that, in coming out of the current crisis, we do not create a tool that enables large-scale data collection on the population, either now or at a later time” (cited by Hern 2020). Moreover, co-production, like citizen participation, needs to grapple with social exclusion issues, as not all service users (or indeed staff) have the capabilities to make full use of the potential of digital technologies. Another question is the extent to which digital technologies will actually be used to enable more user and community co-production. While digital technologies such as AI can indeed relieve staff of repetitive administrative tasks and free up staff time to engage more intensely with citizens (in particular those with complex needs) through co-production, austerity pressures may result instead in digitalisation resulting in downsizing and the dehumanising of personal public services. The literature has also identified a change in culture, skills and mindset as important conditions for digital transformation (Mergel et al. 2019). When this is missing, even where co-production—enabling digital technologies are available, they may not be used for this purpose. At the time of the foundation of the Open Government Partnership there was a lot of optimism about the co-productive potential of

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open government data for co-designing new services and solutions with local communities. However, a recent OECD (2018) report on the state of open data argues that beyond countries’ commitment to opening up good quality government data, the creation of public value requires engaging user communities from the entire ecosystem, as well as partnership working between a range of organisations in the public, private and non-profit sectors. The UK Government Transformation Strategy 2017–2020 recognises the need to “continue to design and build new services that are usercentred, focused on meeting their users’ needs from start to finish and in whatever channel users need, evidence-based, delivered using agile methods and high quality” (Cabinet Office and Government Digital Service 2017). However, this does not imply a commitment to codesign with service users—the Digital Service Standards (Government Digital Service 2016) only encourages research about user needs, not co-produced research. Clearly, if digital innovation in public services is not based on user and community co-production, there is a risk that many digital apps and public services may not be ‘fit for purpose’ and that the digital gap between public services and the young generation—generally ‘digital by default’—will widen over time. While it is encouraging that many governments have been supporting new digital community initiatives such as the Global Hack—an online hackathon designed to share and rapidly design new ideas to respond to the Covid-19 pandemic (Gigler 2020), the question is whether this move from community self-help toward community co-production will be sustained after the Covid-19 crisis to tackle other wicked problems such as climate change. Furthermore, while it is likely that the Covid-19 crisis will result in a push of public services toward digitalisation it is unclear to what extent public service organisations will be willing to co-produce the next generation of digital services for the post-Covid world with users and communities. 3.7.11

Conclusions on Digital Co-production

While there is emerging evidence that digital technologies have the potential to enable the development of new forms of co-production and to improve non-digital forms of co-production, two paradoxes emerge. First, in spite of the increasing speed of technological change in recent years, take-up of digital technologies in the public sector has typically

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been slow (Mehr 2017, 3). This has resulted in a digital divide between the public sector and civil society, or at least those growing parts of civil society which are digitally literate. Second, in spite of the importance claimed for this agenda by many public service organisations, there is a lack of evaluation of digital coproduction initiatives. In particular, there is often an uncritical assumption that social innovation processes based on digital technologies are desirable in order to deal with wicked problems without a critical analysis of the distribution of costs and benefits among stakeholders.

3.8

Conclusions

The four modes of co-production—co-commissioning, co-design, codelivery and co-assessment—provide a conceptualisation for the possible range of co-production approaches. Most importantly, the Four Co’s highlight that co-production is not only about citizen voice but also about citizen action. This is a key characteristic which makes co-production different from public participation. At the same time, the borders between the Four Co’s are fluid. One ‘Co’ may lead to another ‘Co’, depending on co-production opportunities and the motivation of co-producers. For example, co-assessment of existing public services often changes the strategic direction of cocommissioning and feeds new ideas into co-design, through which new solutions can be identified. While full co-production implies that user and communities are enabled to contribute through all Four Co’s, it would be unrealistic to expect public service organisations to implement all modes of coproduction at the same time—this smacks of a lack of strategic focus, since it is unlikely that all Four Co’s are going to be equally important in a specific context at any particular time. Nevertheless, having the Four Co’s as a template serves to remind stakeholders that a much wider range of co-production activities may be possible than is currently being undertaken. Moreover, over a period of time experimentation with all Four Co’s is likely to be important. Empirical research is needed to identify whether such ‘full co-production’ leads to higher public value than more partial co-production initiatives. Taking the perspective of the Four Co’s helps us to undertake a more nuanced analysis of governance issues such as the ‘representativeness’ of co-producing citizens and the role of politicians. As discussed in this

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chapter, the question as to which citizens should be involved and how ‘representative’ they should be plays a key role in co-commissioning processes given the macro-decisions involved. This is much less of an issue in co-delivery as long as priority governance principles are respected. Furthermore, the role of politicians in co-commissioning and co-assessment is likely to be significant, whereas in co-design and codelivery it is likely to be sufficient if politicians take the role of the ‘guardian of good governance’ and ‘community mobiliser’ (Bovaird and Loeffler 2016a). Clearly, the role of politicians in empowering citizen voice and action requires further research. The analysis in this chapter reinforces an insight which Loeffler and Timm-Arnold (2020, 20) identified in their empirical study of social care services and community safety provision in Germany, namely that the balance between citizen voice (co-commissioning, co-design and coassessment) and citizen action (co-delivery) may be very different in practice from that which is perceived by those viewing it from within public services. As they conclude: “Taken together, the evidence from the focus groups suggests the paradox that there is more talk than action about ‘citizen voice’ in German local public services”—and more action than is often recognised by those voices calling for more citizen action. Finally, digital technologies have the potential to enable the development of new forms of co-production and to improve non-digital forms of co-production. However, take-up of digital technologies in the public sector has typically been slow, so there is the danger of a growing digital divide between the public sector and citizens in civil society. Moreover, there is still a lack of evaluation of digital co-production initiatives, and often an uncritical assumption that social innovation driven by digital technology is desirable without a critical analysis of the distribution of costs and benefits among stakeholders—and, as we will discuss later, attention has to be paid to the extent to which the application of digital technology to co-production has enabled or undermined the achievement of public governance principles.

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Governance International case study. Birmingham: Governance International. http://www.govint.org/good-practice/case-studies/london-boroughof-lambeth/performance-indicators/. Accessed 20 Nov 2018. Thompson, J., & McConnachie, E. (2019). Stepping forward together— Co-production for falls prevention in Aberdeen. Governance International case study. Birmingham: Governance International. http://www.govint.org/ good-practice/case-studies/stepping-forward-together/. Accessed 13 Dec 2019. Tieman, R. (2017, October 26). Barcelona: Smart city revolution in progress. The Financial Times. https://www.ft.com/content/6d2fe2a8-722c-11e793ff-99f383b09ff9. Accessed 23 Jan 2020. Timebanking UK. (2018). Timebanking Types. http://www.timebanking.org/ what-is-timebanking/what-is-timebanking/. Accessed 27 Oct 2018. Tisdall, C. (2014). The transformation of services for young people in Surrey County Council. Governance International case study. Birmingham: Governance International. http://www.govint.org/good-practice/case-studies/ the-transformation-of-services-for-young-people-in-surrey-county-council/. Accessed 17 Sept 2018. Torfing, J. (2016). Collaborative innovation in the public sector. Washington, DC: Georgetown University Press. Urban Transformations. (2019). Jam and Justice: Co-producing urban governance for social innovation. https://www.urbantransformations.ox.ac.uk/pro ject/jam-and-justice-co-producing-urban-governance-for-social-innovation/. Accessed 12 June 2019. User Voice. (2018). http://www.uservoice.org/. Accessed 4 Oct 2018. Vackerberg, N. (2013). The Esther approach to healthcare in Sweden: A business case for radical improvement. Governance International case study. Birmingham: Governance International. http://www.govint.org/good-practice/ case-studies/the-esther-approach-to-healthcare-in-sweden-a-business-case-forradical-improvement/. Accessed 13 June 2019. Van Eijk, C., & Steen, T. (2016). Why engage in co-production of public services? Mixing theory and empirical evidence (Special issue: Coproduction of public services). International Review of Administrative Sciences, 82(1), 28–46. Vennik, F. D., van de Bovenkamp, Hester M., Putters, K., & Grit, K. J. (2016). Co-production in healthcare: Rhetoric and practice (Special issue: Co-production of public services). International Review of Administrative Sciences, 82(1), 150–168. von Lucke, J. (2016). Deutschland auf dem Weg zum Smart Government – Was Staat und Verwaltung von der vierten industriellen Revolution, von Disruptionen, vom Internet der Dinge und dem Internet der Dienste zu erwarten haben. Verwaltung & Management, 4(22), 171–186.

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Weiss, C. (1998). Have we learnt anything new about the use of evaluation? American Journal of Evaluation, 19(1), 21–33. Wells, J. (2011). Stockport Council’s new adult social care website ‘My Care, My Choice’: A business case for service co-design. Governance International case study. Birmingham: Governance International. http://www.govint.org/ good-practice/case-studies/stockport-councils-new-adult-social-care-websitemy-care-my-choice-a-business-case-for-service-co-design/. Accessed 5 Oct 2018. Wenene, M., Steen, T., & Rutgers, M. R. (2016). Civil servants’ perspectives on the role of citizens in public service delivery in Uganda (Special issue: Coproduction of public services). International Review of Administrative Sciences, 82(1), 169–189. West Lothian Council. (2018). Citizen-led inspection “Look See” feedback report: Corporate communications web, print & social media communications. https://www.westlothian.gov.uk/media/26078/CLI-Look-See-Rep ort—Communications/pdf/CLI_’Look_See’_Report_-_Communications. pdf. Accessed 17 Oct 2018. Willis, M., & Bovaird, T. (2012). Commissioning for quality and outcomes. In J. Glasby (Ed.), Commissioning for Health and Wellbeing, 145–165. Cheltenham: Edward Elgar. Willis, M. H., Douglas, G. G. A., Dunstan, E., & Pavey, S. (2003). Evaluation of Pocklington day services in the West Midlands: Final research report for Thomas Pocklington Trust. Birmingham: INLOGOV und VICTAR, University of Birmingham. Woodruff, K. (2010). Preventing polypharmacy in older adults. American Nurse Today, 5(10). https://www.americannursetoday.com/preventing-polypharm acy-in-older-adults/. Accessed 13 June 2019. Wright, D. N., Hopkinson, J. B., Corner, J. L., & Foster, C. L. (2012). How to involve cancer patients at the end of life as co-researchers. Palliative Medicine, 20(8), 821–827. https://doi.org/10.1177/0269216306073110. Accessed 13 June 2019.

CHAPTER 4

Co-production in Health, Social Care and Public Safety

4.1

Introduction

In this chapter we explore how co-production actually operates in three sectors of public services—health, social care and public safety. These sectors have been chosen for two reasons—first, they cover a wide range of public services, each of them of high priority to many citizens. Second, they are sectors in which the author has conducted significant research and where there are important research results which can throw light on the strengths—and weaknesses—of co-production. The chapter looks at co-production in each of these service sectors in turn. In each service sector we begin by exploring the role of citizen action in co-delivery. In order to explore in depth the potential and actual role of co-delivery in each sector, we first present a generic model of public intervention to deliver improved outcomes. The following sections then highlight how co-delivery can, in principle, contribute to each of these types of intervention, sector by sector. In each sector, we then highlight some of the ways in which citizen voice, through co-commissioning, co-design and co-assessment can also play a role. The key empirical evidence which we explore in each service sector are: • The extent of co-production at national and local levels • Evidence on the effectiveness of co-production.

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In this way, this chapter presents a much more holistic and joinedup approach to the actual and potential role of co-production in these services than has generally been presented in the literature. Finally, the chapter looks at the conclusions which emerge across these three sectors.

4.2 A Generic Public Intervention Model to Deliver Improved Outcomes Public interventions are typically undertaken in order to tackle problems which have political salience, the solution to which will improve publicly desired outcomes. In Fig. 4.1 we model the different ways in which interventions can contribute to solving problems—essentially, the main

To reduce social harm from problems

To prevent occurrence of problems

To bring about behaviour change amongst those likely to suffer from problems

To reduce the prevalence of conditions in which the problems are likely to occur

To improve treatment

To improve detection of the problems

To ensure reporting of potential problems

To improve rehabilitation after treatment

To ensure rehabilitation programme is followed To design appropriate rehabilitation programme

Fig. 4.1 A generic model of public service interventions (Source Adapted from Loeffler and Bovaird [2019a, 249])

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interventions comprise prevention, treatment and support for recovery or rehabilitation from the problem. For each of these main pathways, in turn, we can identify a number of potential contributing pathways. In order to prevent future occurrence of a problem, the public sector can either reduce the prevalence of the social conditions which make the problem more likely to occur; or it can promote behaviour change amongst those likely to suffer from the problem. To improve treatment, it is important to detect the problem as early as possible and then to find appropriate treatments. To improve recovery and rehabilitation, appropriate public interventions and community support have to be designed which reduce the negative consequences from problems and/or strengthen the resilience of people experiencing a problem. Then people suffering from the problem have to be convinced to follow the rehabilitation pathway. In the following sections, we therefore consider, sector by sector, evidence relating to how co-production through citizen action contributes to prevention, treatment and rehabilitation/recovery. In each sector, we then consider how citizen voice, through co-commissioning, co-design and co-assessment can also play a role.

4.3 4.3.1

Co-production in Health Co-delivery of Health Outcomes

Prevention of health problems: It has long been recognised that people can make a very large contribution to their own health by behaviours which help prevent future health problems. Indeed, the role of citizens in preventing health problems is often much greater than the role of health professionals, even to the extent that some of these activities by citizens and groups of citizens can be seen as essentially self-help or self-organisation, rather than co-production with the professional health service. However, many prevention activities are triggered by public sector action, such as recent public campaigns about the importance of ‘hands hygiene’ to reduce the risk of passing on Coronavirus infection or, more generally, professionals advising people whose bad habits risk damaging their health to change their lifestyle. Other prevention activities may involve direct collaboration with public service organisations and citizens, as in the falls prevention initiative of the Aberdeen City Health and Social

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Care Partnership, which involves volunteers working as ‘Falls Ambassadors’ and health professionals co-delivering so-called ‘Stepping Forward Together’ sessions in local communities (Thompson and McConnachie 2019). In particular, paying attention to a healthy diet, avoiding overconsumption of alcohol and keeping fit are generally considered to be key to better health by public health services. Moreover, these contributions to better health are not simply achieved by individuals acting alone—a person’s future health can also be improved by the support of others, both in their family and outside the family (e.g. in encouraging family or friends to eat a healthy diet, limit their alcohol consumption and take exercise). An indication of how common individual preventative measures are in health is given by our survey of five EU countries, which shows that over 50% of citizens interviewed reported changing to a healthier diet and trying to take more exercise during the previous year (Loeffler et al. 2008, 18). Rather more serious attention to health prevention, as in getting a health check from a doctor, was reported by over 30%. In the subsequent Australian rerun of this survey, two-thirds of respondents reported trying to exercise, while over half reported changing to healthier diet and almost a half had seen a doctor for a health check (Alford and Yates 2016, 165). These results appear a little more optimistic than some UK government research which suggested that in 2008, 70% of adults were not meeting at least two of the government guidelines which were then in place on smoking, alcohol use, diet or physical activity (Buck and Frosini 2012, 13). Moreover, this UK research was even less optimistic with respect to citizens with lower education and from lower socio-economic groups, who were more likely to fail to meet three or four of these guidelines. Given recent claims by the NHS to be focusing more on prevention, it might be expected that this picture would be improving over time. However, more recently in 2015, 48% of the England population were still not meeting the daily recommended guideline of consuming five portions of fruit and vegetables per day (and this was 57% in the lowest health life expectancy areas), despite a national health campaign (ONS 2017, 55). The urgent need for more action by citizens to prevent health problems arriving is therefore evident. Health treatment: Co-production of better health treatment is often called ‘self-care’. Self-care has been defined by the Department of Health as the care taken by individuals towards their own health and well-being,

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in which DoH includes the care extended to the individual’s family and the community (Department of Health 2007). People who are practising self-care can also gain from the support of ‘experts by experience’, since citizens who have suffered from a condition can be particularly helpful in educating and giving skills training to people who have recently contracted the condition and to professionals who need to know how best to support people who are practising self-care (Hairon 2007). Self-care comprises two key areas—detection and reporting of illhealth; and contributing to the successful healthcare intervention. In both of these areas, the role of professionals remains strong—but in both areas there is nevertheless scope for significant citizen input. In particular, in the case of highly infectious conditions such as Coronavirus, self-reporting to the NHS and strict adherence to self-isolation is key to containing the disease. Furthermore, early detection of conditions such as breast cancer by performing self-examinations, in combination with other screening methods, significantly improves likelihood of later successful professional interventions. There is little quantitative evidence on either of these elements of co-production of better health treatment. However, a case study of Highlands Hospital in Jönkoping in Sweden provides evidence of significant improvements to mortality rates when patients are helped to identify and to report more quickly and more clearly on potentially dangerous ‘flareups’ in their condition (Bovaird and Tholstrup 2010). Self-monitoring of health conditions can be substantially improved by use of a growing range of technologies, including strap-on apps, such as MyFitnessPal, Fooducate and Instant Heart Rate, which monitor body functions in ways which were previously only available in doctors’ surgeries or hospitals. For example, a study of patients with congestive heart failure who used telemonitoring (a weekly nurse phone call to patients, with automated telephone questionnaire) found that over one year there was an 83% decrease in hospital admission rates for patients (Department of Health 2007). In health care, self-treatment (e.g. through drug injection or dialysis) has become much more common in recent years. Nevertheless, for all the discussion of the potential of self-treatment, its level still appears to be much lower than it might be (Patel and Patel 2014). Although 90% of people in the UK use over-the-counter medicines to manage minor conditions without going to their GP, and in 2010 973 million over-the counter medicine packs were sold by pharmacists, this was still less than

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the 1028 million prescription items dispensed (Proprietary Association of Great Britain 2011). Moreover, it has been estimated that GPs currently spend an hour a day (57 million consultations per annum) seeing patients with minor conditions that could be self-treated—and this has been estimated to cost the NHS £2 billion per annum (Proprietary Association of Great Britain 2010). Indeed, according to the Department of Health, 39% of GP consultation time is spent treating patients who present with self-treatable minor ailments (Colin-Thome 2004, 11). Could this be changed? In 2007, over 90% of people were interested in developing selfcare skills and over 75% believed they would be more confident if they had support from a professional or peer (Department of Health 2007). Looking at people living with chronic obstructive pulmonary disease, the Centre for Reviews and Dissemination (2014, 2) summarises the results from three systematic reviews into the effectiveness of self-care as demonstrating that multi-component interventions reduce respiratoryrelated hospital admissions and improve quality of life for people. Another way in which self-care can be co-delivered is through trained community health volunteers (CHVs). In a very different context, namely rural areas in Kenya, a recent study into training CHVs to deliver integrated preventive and curative packages of care to manage common childhood illness in hard-to-reach communities showed that the proportion of CHVs exhibiting appropriate skills to examine for signs of illness improved from 4% at the baseline to 74% after 6 months of training and the proportion of care-givers who first sought treatment from a CHV increased from 2 to 31% (Shiroya-Wandabwa et al. 2018). However, despite these potential benefits, there is evidence that healthcare professionals do not fully explore the potential of self-care. In 2005, a national survey in the UK found that more than 50% of patients who had seen a healthcare professional in the previous six months had not been encouraged to develop self-care skills and one-third said they had never received any advice regarding self-care (Department of Health 2005). Rehabilitation/recovery from health problems: there are three key coproduction activity areas in rehabilitation and recovery of health—coproduction activities which aim to improve and recover general health, activities aimed to continue (either short-term or long-term) conditionspecific treatment, and activities aimed to protect against recurrence of the condition. The first of these co-production activities is similar to the set of prevention activities which we covered earlier and the second of these activities is similar to the set of treatment activities covered earlier.

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However, the third set of co-production activities, which are about the contribution of patients to preventing the occurrence of their health problem may involve some different kinds of inputs. Perkins et al. (2012, 2) define recovery (in a mental health context, but this definition applies more generally) as follows: “It involves making sense of, and finding meaning in, what has happened; becoming an expert in your own self-care; building a new sense of self and purpose in life; discovering your own resourcefulness and possibilities and using these, and the resources available to you, to pursue your aspirations and goals.” This immediately highlights the centrality of co-production to the recovery process, with its emphases on a person’s own interpretation of the position, the role of self-care and the importance of resourcefulness. A key role in rehabilitation and recovery is often played by people with similar conditions giving peer support. Mead (2003) defines peer support as a system of giving and receiving help, founded on key principles of respect, shared responsibility and mutual agreement of what is helpful. Summarising systematic reviews of the role of peer support in mental health recovery, Repper and Carter (2011, 400) conclude that “What [peer support workers] appear to be able to do more successfully than professionally qualified staff is promote hope and belief in the possibility of recovery; empowerment and increased self-esteem, self-efficacy and self-management of difficulties and social inclusion, engagement and increased social networks. It is just these outcomes that people with lived experience have associated with their own recovery; indeed, these have been proposed as the central tenets of recovery: hope, control/agency and opportunity.” The Health and Social Care Partnership of Aberdeen City has recognised the potential of peer support for better self-care and has supported co-delivery of more peer support with and for people living with diabetes in Aberdeen. This included the funding of a training course for volunteers who wished to develop skills on how to run peer support groups and provide more effective peer advice. As one volunteer, who had already been working with Diabetes Scotland previously, states: “I learnt a lot about my condition from talking to other people who were living with diabetes as well as health care professionals. The knowledge I gained really helped me self-manage and live well. … I had received a lot of support from the charity [Diabetes Scotland Aberdeen] and other people living with diabetes. I wanted to volunteer and give something back” (Dave Curry, quoted by Murray 2019).

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For people living with long-term conditions (including arthritis, asthma, cancer, cardiovascular disease, diabetes, HIV/Aids or pain), Hairon (2007) summarised a Department of Health study which reported that a significant improvement in coping was achieved by multicomponent self-care interventions, such as behavioural therapy, coping strategies and support groups. The Department of Health therefore encouraged the development of psycho-social self-care programmes to increase coping for people with long-term conditions, which would help people deal with stressful situations and improve well-being and quality of life. Co-commissioning of health care: Co-delivery of prevention, treatment and rehabilitation/recovery are essentially part of the co-production of health care by service users and their communities. However, there are also important roles for citizens in the other three Co’s—cocommissioning, co-design and co-assessment—all of which entail the use of citizen’s voice. We look first at approaches to co-commissioning of health care. • Personalisation—a form of micro-commissioning, through which health care patients are able to determine (within predefined guidelines) how the funds available for their health care should be spent, including prioritisation of the outcomes which they seek to achieve (Musekiwa and Needham 2020). The number of people in England with personal health budgets has been rising year on year since they were launched in 2014, with nearly 23,000 people receiving one in the first nine months of 2017/18 (Madsen 2018). They have been particularly available to people with long term health conditions but also increasingly to people with ongoing mental health needs, learning disabilities and autism. The personal health budgets initiative was proposed in an official government strategy in 2008 and re-affirmed in a 2010 White Paper, Equity and Excellence (Department of Health 2010). An evaluation of the personal health budgets pilot in England reported that they were associated with significant improvement in patients’ care-related quality of life and psychological well-being after 12 months, although they did not appear to have had an impact on health status, mortality rates, health-related quality of life or costs during this period (Exworthy et al. 2017). Revealingly, qualitative research suggests that it takes time (perhaps a year or more) for health service staff working with patients who

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have a personal health budget to overcome their initial reluctance to cede control and respect the ‘expertise by experience’ of patients (Musekiwa and Needham 2020). A systematic review (Coulter et al. 2015) of a range of personalisation approaches to health care summarised the results of 19 randomised trials published before 2013 covering conditions such as diabetes, mental health problems, heart failure, kidney disease, and asthma, finding that involvement in personalised care planning probably led to small improvements in some indicators of physical health (better blood glucose levels, lower blood pressure measurements among people with diabetes, and control of asthma) and also probably reduced symptoms of depression, and improved people’s confidence and skills to manage their health. However, it found no effect on cholesterol, body mass index or quality of life. It appeared that the process worked best when it included preparation, recordsharing, care co-ordination and review, involved more intensive support from health professionals, and was integrated into routine care, which indicates the key role of a co-productive approach. The study concluded that personalised care planning was promising and could lead to better health outcomes but that more research was needed into which aspects are most effective for specific patient groups. • Participatory budgeting (PB)—i.e. giving citizens or groups of service users the chance to decide collectively on priorities and budget allocations between key outcomes sought, services or projects to be delivered. As discussed in Chapter 3, PB has been actively implemented in many countries and in many services since the 1980s. It is often undertaken at neighbourhood level and sometimes focuses specifically on specific groups. The Department of Health (2017, 34) asserts that: ‘Making progress on our priorities and addressing the challenges the NHS faces over the next two years cannot be done without genuine involvement of patients and communities”. However, at least in England, there have not been many PB examples which have focused specifically on priorities in health care or health outcomes, as a national evaluation shows (Department for Communities and Local Government 2011, 42). Examples which have taken place include the prioritisation of health care projects by local communities in the neighbourhood of Thornhill in Southampton, following a pilot in 2008 (Department for

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Communities and Local Government 2011, 60–62). Similarly, in the PB process in Paris, health was one of the local issues where residents could propose projects and, since PB started in 2014, seven health-related projects have been given high priority in the voting and therefore been implemented—but this was only a low proportion of all projects chosen (DICOM 2020). Clearly, in spite of the positive examples which have occurred, PB is far from becoming embedded within health commissioning processes in most OECD countries—and certainly not in the UK. Indeed, a recent summary of the state of play in English health system planning (the so-called ‘Sustainable Transformation Plans’ or STPs) concludes that patients and the public have been largely absent from the STP process so far—partly because of the limited time available and partly because national NHS bodies had asked leaders to keep their draft STPs out of the public domain (Exworthy et al. 2017). Moreover, despite worldwide implementation of PB, a recent review of all the academic evidence finds that the implications of PB for health and wellbeing have not been the focus of attention in public health literature and there is therefore little reliable evidence (Campbell et al. 2018). • Appointing service users and other citizens to procurement panels — this gives citizens a direct role in the choice of providers. For example, when the local NHS England public health commissioning team completed a procurement exercise in Cornwall for school-based vaccination services, they brought in a group of 12–14 year-old students, who actively participated in presentations from bidders and asked very challenging questions, which enabled commissioners to see how providers communicated with their service users and also resulted in the successful provider making some changes to the service delivery models and future service user engagement. Although the students didn’t score the procurement bidders, their feedback on the presentations and Q&A session was fed into the final scoring and decision-making about the successful bidder (NHS 2017). A variant of this approach was used by Bedfordshire Clinical Commissioning Group, where stakeholder panels comprised of service users and care-givers met with the shortlisted bidders for commissioned health services and asked questions around the contents of the bid and how the bidders would deliver the new services, with their views being fed into the procurement process (Hoyle 2014).

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• Co-planning of services —e.g. deliberative fora such as Citizen Assemblies. A UK variant of this approach was NHS Citizen, which has the overall aim of ensuring that people and communities have an increasing say in health policy development, and how NHS services are commissioned, designed, and delivered. A programme of activities was initiated in 2012/13, including the design of democratic participation methodologies. Over four years, more than over 4000 people were involved from across the country, in both face-to-face and online conversations (NHS 2020). As part of its work, NHS Citizen in 2014 ran a full-scale Citizens Assembly, which consisted of around 200 patients, care-givers, activists, volunteers, third sector and public services workers, coming together in an informal setting with the NHS England Board to discuss agenda items prioritised by citizens. Participants had volunteered, with most having had a history of active participation in the health system, for example as employees or as patients and care-givers. They split into five ‘issue groups’ which had been selected from over 80 potential issues submitted in advance. After the detailed work in each issue group, all participants and the NHS England Board reconvened in a plenary, where two representatives of each group highlighted the key insights from their discussion and heard a response from a Board member to each group, with ensuing discussion. The organisers described the conversations as rich and constructive, although more time would have been needed to cover the broad scope of issues and to form clear solutions (Local Government Association 2016). A simpler version of co-planning is exemplified by an initiative involving five full-day meetings of a 28-member citizen panel convened to establish hospital restructuring priorities in Ontario (Chan and Benecki 2013). A survey of participants found they were enthusiastic about the experience (although some patients were anxious about the magnitude and complexity of the task); participants thought the panel had accomplished something important of benefit to the community and the hospital, and that the citizen panel was an effective approach. Moreover, the hospital board approved nearly all the recommendations from the panel, including the closure of 26 beds and two outpatient programmes, contributing to a budget improvement over two years.

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• Co-financing of services —an approach which demonstrates a strong commitment to the value for money of public services. The simplest and most direct way this can be done is through payment of a charge for a service. However, as this is usually seen as a coercive mechanism, rather than a voluntary activity by citizens, it is generally not included within the category of ‘co-production’. Voluntary financial contributions to public services, projects or infrastructure, however, do constitute co-production. Recently, a more general approach enabled by the internet has emerged in the form of crowdfunding, where a large number of small contributions are pooled to support a specific initiative, a practice used both in the private and public sectors. For example, the London Borough of Lewisham (Hilton and Blake 2011) successfully used crowdfunding to support its annual fireworks celebration, as discussed in Chapter 3. Furthermore, crowdfunding has proven especially effective and popular for supporting self-organisation with charitable causes, particularly around health—many top-earning online crowdfunding campaigns are for medical causes, including campaigns to pay directly for an individual’s medical care or to accelerate research on and access to experimental treatments, particularly as sophisticated search tools allow campaigns to locate potential donors and also allow these donors to find campaigns of interest to them (Young and Scheinberg 2017). However, even simple approaches can be very successful, as Captain Tom Moore demonstrated with his campaign to raise over £30 m for the NHS during the coronavirus crisis (see Chapter 3). While, for the most sympathetic cases, medical crowdfunding can save lives, it likely to be of little help for those cases which evoke less sympathy from typical citizens (Snyder et al. 2016). Co-design of health care: Interesting approaches to bringing citizens into the co-design of health care include: • Designing communication tools (websites, flyers, newsletters) with experts by experience—for example, Diabetes UK worked with young people with type 1 diabetes in Scotland in the co-design of the website JUST.DUK.1T (NIHR 2016). The website gives young people the facts on key subjects about which they need to

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know—advice on leaving home, going out, travelling abroad, and risks associated with driving, tattoos, eating disorders, drugs and alcohol. • Designing preventative activities with people accessing services and care-givers—e.g. in the Aberdeen City Health and Social Care Partnership, a falls prevention initiative was initiated as part of a Governance International Coproduction Star training programme (Thompson and McConnachie 2019). After a few meetings between the involved professionals and older people who had experienced a fall, the group made the joint decision to take the falls prevention message to people ‘in their own spaces’ (lunch clubs, coffee groups, and community clubs). Within less than a year the Stepping Forward Together co-production initiative had grown from two initial volunteers to 14 so-called ‘Falls Ambassadors’. They have co-delivered falls prevention sessions to eight community groups. According to Thompson (2019), who supports this initiative as a Senior Occupational Therapist, “this amounts to over 200 participants who have heard about services, tried some strength and balance exercises, listened to their ‘peers’ talk about the falls journey they have made and taken away resources to inform and educate them regarding falls prevention.” • Designing service improvements —e.g. through Experience-Based CoDesign (ECBD), in which experiences are gathered from patients and staff through in-depth interviews, observation and group discussions, identifying key emotionally significant points, which are then summarised in a short edited film shown to staff and patients, who then explore the findings in small groups together, identifying and implementing activities that will improve the service or the care pathway (Robert et al. 2020). Up to 2014, at least 59 EBCD projects had been implemented in six countries covering clinical areas such as emergency medicine, drug and alcohol services, cancer services, paediatrics, diabetes care and mental health services (Donetto et al. 2014). In an international survey of EBCD users in 2013, 90% of users who responded said that “it really engaged patients”, 78% that “it really engaged staff”, 54% that “it led to clear improvement priorities” and 51% that “it really made a difference to the way we do things around here” (Donetto et al. 2014, 28). At the same time, almost 50% of respondents considered that the

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main weakness of the co-design approach was that “it took too long” (Donetto et al. 2014, 5). Another example of a comprehensive service redesign process the in Madrid region is the development of personalised medication schemes with elderly patients who need to take multiple medications, so that they don’t forget to take them or get confused on what should be taken and when (Gil and Parrado 2012). Personalised medication plans are co-designed by health professionals and patients, incorporating regular reviews by local primary care centres and pharmacies. To ensure compliance with the personalised medication plan, health visitors and pharmacy staff continue to engage with the patient in several follow-up activities. In the first four years after the start of the programme, more than 100,000 patients benefitted from the programme, with more than 1000 pharmacies participating (35% of all pharmacies in the Madrid region), with very positive improvements in the health of patients. By the end of the second year of the programme, the proportion of patients aged over 74 who were at high risk of adverse effects from their medication (according to the so-called ‘Beers criteria’) fell from 16.3% in 2006 to 14.4% in 2008. A survey of the 127,206 patients engaged in the programme in 2011 (with response rate of 64%) indicated that 91.6% of respondents knew how they were supposed to take their prescribed medications, 92.4% knew the prescribed dosage and 95.37% exhibited good compliance (indicated by the Morisky test) (Gil and Parrado 2012). However, a more sobering indication of the role of co-design in health care is given by the Q Initiative, a long-term UK health initiative supporting individuals and their improvement work, which started in 2015 and by 2018 had grown to include more than 2500 people in a multi-strand initiative, delivered in partnership with NHS Improvement and organisations from across the UK. In this largescale improvement community, only 3% of members were ‘patient leaders’ or ‘experts by experience’ (Pereira and Creary 2018, 11). Co-assessment of health care: Interesting approaches to bringing citizens into the co-assessment of health care include:

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• Filling in surveys on health care—although this is not always a highintensity activity, many surveys do involve considerable time and even thoughtful and imaginative responses on the part of service users or other citizens, in which case they qualify as a form of co-production. For example, since 2007 the UK has conducted an annual GP Patient Survey and published the results, showing patients’ experience of GP healthcare services, including access to GP surgeries, satisfaction with opening hours and use of out-ofhours GP services, with over 800,000 returns, a response rate of around 40% (IPSOS MORI 2017). This survey has had an impact on government policy and practice—the national regulator of health care quality has used patient experience scores as part of its performance assessment of primary care provision and the Care Quality Commission includes patient experience surveys as an indicator of standards to be expected of all GP practices. The Department of Health has used the data collected by patient surveys, including the GP Patient Survey, to review the needs of marginalised groups such as ethnic minorities, and to establish teams to respond to GP practices and Primary Care Trusts with the lowest scores (University of Manchester 2014). • Patient-led or community-led health surveys or research—for citizens, this is much more intense as an activity and can be a particularly valuable form of co-production. An interesting example from Italy is provided by a survey led by the third sector organisation Cittadinanzattiva to enable patients to assess rehabilitation services in their region to inform health care policies of the National Ministry of Health. The questionnaire has been co-designed by patient organisations and health care professionals (Cittadinanzattiva 2019). • Web-based rating of health services —this has been a valuable offshoot in recent years from the rapid growth of health care websites. In the UK, all GPs had to register on a website after 2008, so that every visit could be rated by service users (Smith 2009). However, this platform was dropped by the new coalition government after 2010. Subsequently, a number of public sector and independent web-based platforms were set up in England, such as NHS Choices, Patient Opinion, and iWantGreatCare, some of them on mobile phone apps such as the iPhone-based Great Care (Patel et al. 2015), so that users could rate their experience with a general practitioner (service, hospital, dentists, and other health care services). It was hoped that

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this would give patients a voice so that there could be improvements in transparency and the quality of care. The use of online patient ratings for GP surgeries was later reintroduced by the Care Quality Commission as part of their inspections (CQC 2013). In the USA, there is a range of websites which publish ratings of health care organisations, including the websites of government organisations such as Medicare (‘Hospital Compare’), CDC and the Agency for Healthcare Research and Quality (AHRQ). Interestingly, the website WebMD (WebMD, n.d.) in its section on ‘How to Use Online Ratings for a Hospital’, advises that “information from users on a web site is the least reliable”, although it gives no evidence for this statement. • Complaints systems in health—Clwyd and Hart (2013) presented a good practice case from Birmingham Heartlands Hospital, where patients and relatives arriving at the front door see a “Tell us what you think” poster and then come to a Patient Services desk inside in the foyer, with eye-catching booklets such as Tell us what you think about our services —a guide to giving feedback or reporting a concern. Another is: How are we doing? Compliments, comments, concerns. These booklets, which also appear elsewhere throughout the hospital, explain in user-friendly language how to raise a concern or complaint and include relevant forms. The hospital promises to acknowledge complaints within three days and answer them within 25 days. Recent examples of changes in clinical practice arising from feedback include the redesign of the patients’ care pathway in A&E and new procedures in the gynaecology department for women suffering miscarriages. • Citizen or patient inspectors —In October 2014, the Care Quality Commission started a comprehensive programme of inspections of GP practices, often including in the inspection teams an ‘Expert by Experience’ (someone who uses a GP practice or has a particular experience of this type of care). As part of the inspection, teams spoke with patients to assess the quality of care in a practice (Care Quality Commission 2017a). • Peer review of health services —An example of peer reviews with ‘Experts by Experience’ is provided by Sheffield South West Primary Care Trust, where a panel of patients and carers was trained to be actively involved in clinical audit and service improvement projects

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through a clinical audit patient panel (Challans 2008). The subsequent evaluation of its impact concluded that the panel was able to assist the Trust in developing and improving services within primary care, although it faced significant challenges in changing the culture towards actively involving patients and carers. • Another form of peer review of health care in the UK is given by Health Impact Assessment (HIA), involving stakeholders and experts (including ‘Experts by Experience’) who may be affected, involved in the implementation of, or have specialist knowledge of the ways in which policies, programmes and projects impact on the health and wellbeing of the population (Chadderton et al. 2008). However, a review of practice in Wales suggests that: “In all of the HIAs used as part of this research, levels of public participation compared to that of the statutory and voluntary sector were low, with on average three or four members of the public involved in each one (excluding the community initiated HIA)” (Chadderton et al. 2008, 82). Nevertheless, they concluded that “The majority of the [members of the public] who were interviewed as part of this research reported that they had found their involvement in the HIA to be a positive experience”, while “public sector representatives interviewed as part of the research focused on the fact that it is members of the public who are affected by the issues or projects relating to the HIA, that the proposed changes would take place within their communities, and that they held the knowledge and value of personal experience to be able to effectively inform the HIA, and highlighted that these positive contributions outweighed any of the more problematic issues” (Chadderton et al. 2008, 81). 4.3.2

Conclusions on Co-production in Health

Summing-up, the available evidence suggests that the extent of coproduction with patients and the public in health care is still very limited, at least in the UK. While there is a lot of talk about the need to focus more on prevention, most health care providers only engage with citizens when they require treatment and devote few resources to preventative coproduction approaches. Furthermore, the evidence from the UK shows that only a small minority of healthcare professionals help their patients to learn effective self-care practices.

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At the same time, there have been a number of high profile NHS publications and policy-papers with a commitment to give patients and citizens a ‘voice’ to improve public services and outcomes. However, most co-commissioning, co-design and co-assessment initiatives which are reported in the literature are still not widespread. One partial exception is Experience-Based Co-Design which, at least, in the UK has been applied in a wide variety of health care contexts (Robert et al. 2020), although admittedly only involving a small minority of NHS patients as yet. Some authors suggest that the lack of individual and organisational health literacy has been one of the main obstacles to the implementation and limited effectiveness of co-production in health (Palumbo and Manna 2018). Of course, the lack of (access to) relevant information and the use of inappropriate language are persistent problems encountered by service users of the NHS. Dealing with this miscommunication could involve education of both patients and staff. However, at least in most OECD countries, health professionals have already received formal training, so the priority may be rather to enable them to tap into the tacit knowledge and resources of ‘experts by experience’. Finally, there is strong evidence that the culture of health services still privileges the technical knowledge of ‘expert staff’ over the everyday knowledge of ‘experts by experience’, and that this cultural barrier only recedes slowly, even where co-production in health is being practiced (Musekiwa and Needham 2020).

4.4 4.4.1

Co-production in Social Care

The Potential Role of Co-production in Social Care

Tackling social problems through social care covers a wide spectrum of interventions. A useful taxonomy of these interventions is provided by the Social Work Theory and Methods Comparison Table of the Social Work Learning Forum (n.d.). This identifies eleven different theories and methods of social care intervention (see Table 4.1) and all of them involve some contributions from people who use social care. Two clear lessons emerge from Table 4.1. First, these theories and models are, in principle, appropriate to all phases of social care intervention, including prevention and treatment of social and psychological problems, and rehabilitation/recovery from such problems. However, this theoretical position has to be contrasted sharply with current social

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Table 4.1 The potential role of co-production in social work theories Social work theory or method

Key concepts

Potential role of co-production

Systems theory

People operate as part of a wider network (formal or informal), not simply as individuals Problems may arise from lack of ‘fit’ between a person and their network The network can be changed to support the individual more effectively People are interdependent with each other and their environment As people go through life, stressors arise which make them feel less able to cope People employ coping mechanisms … … and draw on their own resources … and resources in their environment and network Social work involves a collaborative approach between worker and service user (a ‘contract’) Problems are defined as ‘unsatisfied wants’ Actions are agreed which are expected to achieve mutually agreed results within time limits Brief interventions deal with immediate rather than longer-term issues Based on ego-psychology and cognitive-behavioural models—serious events impact on how people think about themselves and react emotionally

Community co-production

Ecological approach

Task-centred approach

Crisis intervention

Community co-production Community co-production

User co-production Community co-production User co-production

User co–production

(continued)

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Table 4.1 (continued) Social work theory or method

Cognitive-behavioural approach/rational emotive behaviour therapy

Motivational interviewing

Key concepts

Potential role of co-production

Assumes people can cope with change Although crises interrupt normal coping mechanisms, they provide opportunity to improve skills and resilience A period of disorganised thinking and behaviour is to be expected Crises can reawaken unresolved issues from past—but can also offer chances to correct non-adjustment to past events Based on the assumption that thoughts, beliefs, images and attitudes influence our behaviour and if these are changed, our behaviour will change. Involves worker helping service user to identify, challenge and reframe ‘unhelpful beliefs’ Can involve modifying behaviour using rewards and incentives Involves using such approaches as DEF (Dispute beliefs, replace beliefs with Effective rational belief, describe the Feelings which will result) Worker adopts an empathic and non-confrontational, but nevertheless directive, approach Worker is alert to language used, particularly looking for language of change Worker provides information relevant to the problems of the service user Worker encourages service users to list benefits and costs of lifestyle and alternative lifestyles

User co-production User co-production

User co-production

User co-production

User co-production User co-production

User co-production

(continued)

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Table 4.1 (continued) Social work theory or method

Solution-focused approach

Person-centred approach

Psycho-social model

Key concepts

Potential role of co-production

Both parties explore barriers to achieving the agreed goals The service user is encouraged to reframe past events, focusing on more positive aspects Focus on understanding solutions rather than on problems The person is not the problem Distinguishes between ‘problems’ (which can be addressed) and ‘unhappy situations’ (which have to be coped with) Post-modern therapy based on theories of language and meaning Talking can construct experience Uses knowledge of service users

User co-production User co-production

Assessment is based on strengths, not deficits Encourages sense of ‘personal agency’ Avoids diagnostic labelling, since this can be disempowering Focuses on difference and exceptions Based on principles of empathy, congruence and unconditional positive regard as necessary to the helping relationship Based on belief that everyone has capacity to develop and grow Non-directive approach Based on belief that people have inner worlds and outer realities Certain events remind us of past events we have tried to block out

User co-production User co-production

User co-production User co-production User co-production

User co-production

(continued)

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Table 4.1 (continued) Social work theory or method

Recovery model

Narrative approach

Key concepts Events can take on greater emotional significance ‘Faulty personality development’ in childhood can affect responses and personality development later in life Considers ‘defence mechanisms’ we deploy to protect the ego Used in mental health services which emphasise recovery rather than illness Recovery means regaining a sense of control and purpose, not necessarily becoming ‘symptom-free’ Recognises strengths of the individual Open to possibilities for future (e.g. return to employment or education) Encourages the person to describe their life in their own words Opportunity to tell their story, in the process defining their identity Supports the person to feel in control of the narrative Draws attention of person to possibility of a different narrative for the future

Potential role of co-production

User co-production User co-production User co-production

User co-production User co-production User co-production User co-production User co-production User co-production

Source Adapted from Social Work Learning Forum (n.d.)

work practice in the UK, especially in recent decades. Here, social work budgets have become ever more constrained in relation to the level of problems presenting to the public sector, so that social work has often focused much more on treatment, and to a lesser extent on rehabilitation/recovery, with less attention to prevention. This has meant that co-production has often been more evident in the treatment phases and, to some degree, in rehabilitation—which, in turn, suggests that the potential benefits of co-production might currently be highest in regard to prevention, if public policy were to give prevention a higher priority.

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Second, much social work theory and practice focuses specifically on the individual (‘the service user’) rather than on wider social relationships. Consequently, where co-production is promoted, it is mainly individual co-production by the service user, rather than collective co-production arising from inputs from the wider community. Indeed, consideration of the potential role of community inputs is largely missing from Table 4.1— this aspect of co-production has not been fully taken on board by most approaches to social work. It is much more characteristic of community development (see Russell 2020) which generally distinguishes itself sharply from social work. A detailed taxonomy of behaviour change interventions across behavioural domains has been provided and tested by Abraham and Michie (2008). These interventions all support self-management of adults living in the community (although without specialised histories in relation to the target behaviours, so excluding adults with known mental or physical health problems). It is clear from this taxonomy that few of these behaviour change interventions rely on highly professional expertise or specialised training— only a maximum of six interventions seem to fall into this category. Consequently, 20 of the interventions seem potentially appropriate for co-delivery with service users. Moreover, although this is intended to be a taxonomy of how care providers can help ‘self-management’, where co-production from the service user is directly relevant, it is clear that some of the interventions are likely to be benefit from support by members of the service user’s network or of the wider community. We can clearly see from Table 4.1 that, in principle, there is enormous scope in ‘social work’ interventions for contributions from service users and members of their networks and communities. We now turn to consider what is actually happening in practice. As with health in the previous section, we now consider the role of co-delivery separately in problem prevention, treatment and rehabilitation/recovery before we consider citizen voice within co-commissioning, co-design and coassessment. Prevention of social problems: The kinds of problems for which social care is appropriate can be triggered by a very wide variety of external circumstances, most of which are at least partly outside the control of any individual. Preventing these problems therefore requires a correspondingly wide range of inputs. In particular, as well as the support which

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social care professionals can give, there is a need for a wide range of contributions on the part of the person concerned. It is also important to recognise that many of the influences which can give rise to mounting social problems (e.g. poor housing, poor health, poor educational attainment, low employability) can only be solved by other public service professionals, not necessarily by social workers. Prevention of social problems therefore has to be seen as a task for joinedup public services, not for social care alone. Moreover, this means that citizen co-production to prevent social problems arising can, and should, occur within all the relevant public services, not simply in social care. This further means that social care services need to have the capacity both to signpost people who are at risk of developing social problems to other services which can help them to avoid such problems, and must also have the skills to work closely with these other services, so that all services are focused on achieving the social outcomes which are desired. In practice, most social care services only become applicable once a problem has already arisen and a person has been referred for care. (This has become increasingly the case as social services have suffered from resource cuts under ‘austerity’ budgets). Prevention approaches tend therefore to be under-developed. What is often understood by ‘prevention’ in social care is prevention of existing problems becoming worse, which we will deal with under the heading of ‘rehabilitation/recovery’. Looking at the wider role of prevention, namely preventing potential social problems developing to the level where they cause actual problems for a person or their ‘significant others’, it is clear that the role of the person concerned, and their network, in preventing these problems becoming significant is generally much more important than the role of social care professionals. Indeed, some of these activities by citizens and groups of citizens can be seen as essentially self-help or self-organisation, rather than co-production with the professional social services. When self-help or self-organisation works well there may be no need for investing extra public sector resources through co-production. However, in contexts where self-help or self-organising is not sufficient or not effective, co-delivery by professionals may enable much bigger improvements of outcomes. However, there is clearly a chicken-and-egg issue here—because there are usually too few social care workers to deal with current demands for social care (at least in the UK), only high needs cases can generally be

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accepted for intervention, with the result that support to prevent problems from developing is under-financed. However, this means that much larger numbers of people will present with major social care needs in the future, although these needs might have been nipped in the bud by earlier intervention through co-production. This suggests that the role of co-production in social problem prevention is under-used and, indeed, under-recognised. One challenge may be the lack of resources (or willingness to reallocate resources) for problem prevention. Another challenge for social care staff is to how reach out to citizens to encourage them to participate in co-produced prevention initiatives, where they have not yet been referred to social care services. In some cases, the target groups are even hard to define, where the question arises whether co-production should focus on the wider group of people who are a risk or on people already experiencing specific, if still mild, problems. Predictive analytics are likely to inform this debate much more in the future and enable public service commissioners to gather more evidence on the effectiveness of co-production related to prevention in social care. Where only low levels of professional social care can be devoted to prevention activities, then there should be a high priority on those codelivery initiatives which are likely to achieve a big improvement in outcomes for important target groups. This is perhaps most vividly demonstrated in relation to the huge social problem presented by isolation and loneliness. Even fifty years ago, it was recognised that a significant proportion of admissions to elderly residential care were for people who did not need the specialist care available in those homes but who were so isolated and lonely in their own homes that residential care seemed the easiest solution (Wager 1972). In 2016/17, 1.4 m or about 8% of adults over 50 in England reported often feeling lonely (Age UK 2018). As Age UK (2018, 10) argues: “Tackling loneliness is about building communities with the social and physical infrastructure that can help build resilience; ensuring widespread awareness of and access to organisations, activities and support; creating neighbourhoods that are welcoming and feel safe; enabling people to identify, work with and develop tailored support for lonely individuals. Social activities are a part of this, yet alone they are insufficient.” As this analysis clearly suggests, inputs are needed both from professionals and citizens, with community inputs being particularly important. However, this has been an area where public sector interventions have

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traditionally been sporadic and patchy. Many initiatives have indeed been undertaken to tackle loneliness and social isolation and a very useful taxonomy from Windle et al. (2011) includes: • One-to-one support—e.g. through befriending and mentoring programmes • Group-based services—e.g. day centres, social group schemes for people with shared problems (e.g. bereavement or specific health conditions) or interests (e.g. craft or cultural activities). • Wider community engagement—e.g. participation in sport, use of libraries and museums, volunteering, using and joining outreach programmes, using and contributing to timebanks—nowadays often promoted through ‘social prescribing’ or ‘community connector’ schemes (Age UK 2018, 13). As can be seen, almost all of these initiatives have considerable elements of co-production. Unfortunately, there is very little evidence available on the overall picture of how many lonely and socially isolated people are benefitting from such initiatives, although there is a large literature on specific case studies across the UK and internationally. One of the few insights into the volume of such approaches is provided by a public health study in Kent County Council into the group of older people (over 50) at risk of social isolation and loneliness (as suggested by their socio-demographic characteristics). Of this group, only 10% reported contacts with social care services and only 25% reported contacts with professional community health workers (Abi-Aad and Kennard 2018, 24). These proportions were higher than for the overall population of older people, where the figures were 5 and 19% respectively. However, this highlights that both social care and community health care only get to a minority of older people. (This analysis omits, however, third sector inputs which support public sector services, policies, and outcomes). This concern is reinforced by other research which shows that 17% of older people are in contact with family, friends and neighbours less than once a week and 11% are in contact less than once a month (Victor et al. 2005). However, there is no research yet which explores the reach of the large number of initiatives by public services which have attempted to tackle loneliness—this remains a serious gap in the literature.

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Other prevention initiatives at local and national levels with elements of co-production include interventions such as ‘Early Help’ programmes and Local Area Coordination (LAC). The former includes different kinds of support provided by professionals to a family when a problem first emerges, with the objective to improve the outcomes of children or young people. According to evidence gathered by the Department for Education (2018) and the Early Intervention Foundation (2018) it is more effective to provide early help when problems first arise than to intervene later. The LAC community connector scheme uses a preventative, personcentred approach toward developing individual and family resilience by offering one-to-one support with a Local Area Coordinator who connects people with local communities, networks and services (Billingham and McEleney 2016; Broad 2015). An external evaluation by Derby University of initial LAC schemes in the local authorities of Thurrock and Derby found “diverted or saved costs between £800,000 and £880,000 in the first two locations, in the first 10 months” of the scheme (Broad 2015, 40). Treatment of social problems : Given that prevention of social problems has been rather starved of resources in recent times, at least in the UK, most of the theories of social intervention in Table 4.1 have traditionally been interpreted as approaches to treatment of existing social problems, rather than ways of preventing them. A useful taxonomy of social work treatment approaches is provided by Popple and Leighninger (2011)—see the first two columns of Table 4.2. In the third column of this table, we also highlight some ways in which co-production by service users can contribute to these different treatment approaches. While Popple and Leighninger (2011) focus mainly on one-to-one working, we draw out in the fourth column of the table the potential role of community co-production in all phases of social work intervention. If the social work intervention is successful, social care services may become obsolete, which would end the cycle of co-production as outlined in Table 4.2. As with prevention, there is very little empirical evidence on the extent to which local communities contribute to the kinds of social care and support activities which are outlined in Table 4.2. However, some interesting evidence comes from a co-production study in Germany, which surveyed over a thousand citizens about the level of support which they gave to either older people or to young people to meet their needs—see Figs. 4.2 and 4.3. Both Figures show that a high

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Table 4.2 Phases of social work treatment interventions and corresponding potential roles of user and community co-production Phases of social work treatment interventions

Description

Potential co-production by service user

Potential community co-production

Engagement

Social worker must first engage client in early meetings to promote a collaborative relationship

Need for a reciprocal relationship between service user and social worker

Assessment

Data must be gathered to guide and direct a plan of action to help client

Data relevant to the client will normally require significant user inputs

Planning

Negotiate and formulate an action plan

If this action plan is to succeed, it needs co-design and commitment from the user

Implementation

Promote resource acquisition and enhance role performance

Service users can often help in seeking out relevant resources for support. They play the dominant role in performance improvement User feedback on goal achievement is important

Need for understanding of the community networks of the client (‘whole system’) Relevant data should also be gathered from those close to the client Inputs from the client’s networks also need to be negotiated and included in the action plan Community resources need to be explored with those communities themselves

Monitoring/Evaluation On-going documentation of how well client is achieving agreed short-term goals Supportive Counselling

Affirming, challenging, This needs to be encouraging, informing, provided by the social worker with and exploring options an enabling attitude to help the user overcome obstacles

Feedback from the client’s network is often also important This can also be done by the client’s ‘significant others’ and/or by a peer group support

(continued)

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Table 4.2 (continued) Phases of social work treatment interventions

Description

Potential co-production by service user

Potential community co-production

Graduated Disengagement

Seeking to replace the social worker with naturally occurring resources

Over time there will Peer group be increased support contributions of the service user

Source Adapted from Popple and Leighninger (2011)

Fig. 4.2 The level of engagement of citizens with older people (Source Adapted from Löffler et al. [2015, 9])

Fig. 4.3 The level of engagement of citizens with young people (Source Adapted from Löffler et al. [2015, 9])

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proportion of respondents do engage in these support activities, if only a few times per year—although only a relatively small proportion (typically 20% or fewer) engage in them at least once a week. The Figures also show that, both in the case of care activities for older people and for young people, many people provide such support for people outside their family, contrary to suggestions often made that such caring is relatively selfish and largely devoted just to family members (and many people provide such support both for people inside and outside their families). In terms of lessons on co-production, the fact that so many people do engage in these activities at least occasionally suggests the potential for public services to increase the level of community support for young and older people outside their families. However, a rather different picture emerged when we probed the extent to which people engaged in co-production with their local authority in order to improve the wellbeing of young or older people— see Fig. 4.4. Here, the percentages of respondents who say they have engaged in some way with their local authority on issues connected with older people or young people is, at maximum, 14% and, on some issues, only around 7%. This is where co-production at the local level is evident and these figures suggest that in social issues it is not high. There is therefore a very large gap between these levels of coproduction and the overall levels of support, through self-organisation, which people give to older and young people outside their families.

Fig. 4.4 The extent of co-production between citizens and local authorities to improve the quality of life of young or older people (Source Adapted from Löffler et al. [2015, 8])

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This suggests that there is major scope for the public sector, at least in Germany, to tap the energy and commitment of citizens to improve the social life of the more needy of their fellow citizens—but this scope is not currently being tapped. It seems likely that a similar gap—and therefore similar potential for further co-production—also exists in other European countries. Rehabilitation/recovery from social problems: By their very nature, many social problems are long-term or even permanent, so ‘recovery’ is generally not an appropriate description and ‘rehabilitation’ is more about learning to live with the problems, rather than diminishing them. The issues posed by these aspects of social care therefore have much in common with those arising for people living with long-term health conditions (which have been partly dealt with already in Sect. 4.3). As with health, a key co-production approach to rehabilitation which is widely promoted by social work is peer group support. In Sect. 3.4 we have already given some examples. Empirical evidence supports the potential value of peer group approaches—for example, in relation to depression, Pfeiffer et al. (2011, 35) report the pooled results from randomised controlled trials as indicating that “peer support interventions improve depression symptoms more than usual care alone and that the effects may be comparable to those of group cognitive behavioural therapy”. More generally, Davidson et al. (2018, 1) suggest that paid peer support has been around since the birth of psychiatry in the late eighteenth century, and (citing the Institute of Medicine) that various forms of peer support can be found in virtually every branch of medicine dealing with chronic conditions, from asthma and cancer to diabetes and hypertension. They go on to stress that peer support does not ‘treat’ mental illness—rather, it complements clinical care by instilling hope, engaging patients in self-care and health services, helping them to navigate complex and fragmented systems, and promoting their pursuit of a meaningful life. In a rare cost-benefit analysis, Willis et al. (2018) concluded from their study of peer support groups for people living with dementia that the groups had created social value ranging from 1.17 to 5.18 for every pound (£) of investment. People living with dementia experienced increased mental stimulation and less loneliness and isolation, while care-givers reported less stress and burden of care. Given the fiscal austerity regime which has characterised the public sector in many OECD countries since 2008, savings in public service costs have been seen as particularly important by many governments. The effect

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of co-production on costs have been explored in a number of studies. A particularly interesting study by Knapp et al. (2010) estimated cost savings from several co-production initiatives in social care and health. According to their estimates, time banks could bring savings and other economic pay-offs of over £1300 per member, with administration costs of under £450 per year. Befriending schemes, typically costing about £80 per older person to administer, resulted in reduced need for treatment and mental health support, with savings of around £35 per older person in the first year alone. Local community organisers working with hard-to-reach individuals typically cost up to £300 per person but could have economic benefits (e.g. less time lost at work, savings in welfare payments) of £900 per person in the first year alone. 4.4.2

Co-commissioning of Social Care

Co-delivery of prevention, treatment and rehabilitation/recovery are essentially part of the co-production of social care by service users and their communities. However, there are also important roles for citizens in the other three Co’s—co-commissioning, co-design and co-assessment— all of which entail the use of citizen’s voice. Interesting approaches which have been used to bring citizens into the co-commissioning of social care include: • Personal budgets (often with direct payments) for people eligible for social care, a form of micro-commissioning whereby service users can determine their own priorities (within limits) for how the budget should be spent. There are already many countries using this approach. In 2014–15 88% of UK personal social services users had a personal budget from their local authority, and 22% were receiving direct payments (NAO 2018, 4). NAO concluded that the evidence from users showed most, but not all, benefited from having a personal budget. Paradoxically, however, there was no link at local authority level between the proportion of users with personal budgets and overall levels of user satisfaction (NAO 2018, 12). Moreover, there is debate about the extent to which personal budget holders actually play a significant role in deciding how the budget should be spent—it is clear that, in some cases, service staff play a strong role in influencing such decisions or local authorities may not even tell recipients how much money is in their personal budget, so

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some of the co-production benefits are not gained (Slasberg 2017). Moreover, a recent survey suggests that the choice that personal budgets are designed to offer is rapidly disappearing, as local authorities clamp down on how this money can be spent, increasingly requiring it to be used only for ‘personal care’ in the narrowest sense (Abrahams 2017). • Participatory budgeting (PB) to decide priorities in the social care budgets of public agencies (see also Sects. 3.1 and 4.1) has been growing in importance in recent years—for example, in Scotland there are now over 190 PB initiatives, many of them in health and social care (see https://pbscotland.scot/map or Escobar 2020), although there is a debate as to whether many of these initiatives actually contribute to ‘core’ services provided by local authorities (O’Hagan et al. 2017). An interesting case study is provided by Aberdeenshire Health and Social Care Partnership, which since 2015 has tested out participatory methods to engage with communities in budgetary decision making. With support from Scottish Government, £200,000 from the Integrated Care Fund budget was distributed for preventative health and wellbeing approaches through a participatory budgeting process, originally in two communities but then extended in a further 6 PB rounds. One digital element of this programme involved over 2300 participants, who generated over 240 ideas (Democratic Society 2019). However, it should be borne in mind that many of these initiatives take a very wide view of ‘wellbeing’, so they often involve activities which are quite far away from conventional activities of health or social care. • Identifying social care priorities with specific groups of people who have differing social care needs. This includes approaches such as Citizen Assemblies—for example, a group of 47 representative citizens brought together over two days to prepare a report for the Health and Social Care Committee of the UK House of Commons on how to fund adult social care (Involve 2018). • Giving service users and other citizens a role in the procurement of social care. There are interesting examples from around the world of involving citizens in the public procurement process (see Bohorquez and Devrim 2012). This often involves trained service users or other interested citizens contributing to the selection of service providers or even staff recruitment. For example, in Surrey County Council young people worked with local councillors and staff to select the

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providers of local prevention services for young people (Bovaird and Loeffler 2014, 22). • Co-planning of social care services —e.g. deliberative forums, ‘Planning for Real’. As an example, in Western Australia, the non-profit organisation Therapy Focus included two people with a lived experience of disabilities on the Board of Governance in order to hear the voice of ‘people with lived experience’ where decisions had the greatest impact and established a Parent Reference Group with ten parents of children with disabilities who advise the top managers on policy reform and clinical practice (Barrows 2017). • Co-financing of services —e.g. crowdfunding. Social service users are often charged for their use of public services, unless they fall within certain categories of disadvantage, and this remains the case today for social services in the UK. However, this typically more resembles a market transaction than a case of co-production. Furthermore, social services delivered by charities are often funded by charitable donations. More recently, citizens generally have also been able to fund social services through a rapidly increasing range of internet platforms offering crowdfunding opportunities. The success of crowdfunding appears to derive from its ability to get the public excited about specific campaigns in a way that a public service could not if simply requesting the public to make direct donations to it as an organisation. There are three main types of crowdfunding, meeting different needs—donations-based, peer-to-peer, and equitybased (which we will not consider here as it is not generally connected to citizen co-production). – Donations-based crowdfunding involves people funding a project, product or business, without any expectation of seeing their money again. Many local authorities are already promoting this type of crowdfunding successfully to generate funding and some (like Dorset and Plymouth) use it to supplement their own funding for a range of activities, often increasing community engagement and allowing local residents instead of the council to decide which organisations most need grant funding. A different model was used by the London Borough of Lewisham in 2015, where it invited local community groups to bid for a pot of £100,000 by uploading their proposals on the Spacehive website and seeking community

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monetary pledges—the council then pledged up to £10,000 towards the most popular projects (Glover 2017, 8). If the target amount of funding is not reached by the deadline, no money is taken from those who have pledged. If the target is reached, donors are often given a small token of appreciation related to the project or activity supported. An interesting variant of this from Alex Tabarrok, known as the dominant assurance contract, involves a core funding offering all those who make a pledge a small payment if the overall target is not reached, so they have a win-win proposition of either funding something they believe in or making a small monetary gain— this is likely to increase the success of crowdfunding efforts quite significantly—see Green (2017). – Peer-to-peer (P2P) lending, which is more investment than lending, bypasses banks by matching a borrower directly with an individual or organisation with money to lend, allowing higher returns to the lender, and a faster, more flexible (and perhaps cheaper) process for the borrower. Local authorities can use this method to invest in social enterprises, local charities or other organisations, while private citizens can use it to invest in projects from other members of their community. Local authorities could also act as a facilitator rather than an investor, by brokering relationships between local people and community organisations needing funding and those willing to lend, although it is more likely that they will simply act as navigators to the online platforms which is doing the matching process. Of course, many different organisations can provide the underlying platforms which support P2P lending—for example, Triodos Bank, a pioneer of sustainable banking was the first UK bank with a crowdfunding platform enabling people to invest directly in organisations seeking to deliver positive social and environmental impacts (Social Enterprise UK 2020). 4.4.3

Co-design of Social Care

Interesting approaches to bringing citizens into the co-design of social care include:

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• Designing communication tools (websites, flyers, newsletters) with experts by experience—an interesting example is given by the local authority of Stockport in the UK, which redesigned its adult social care website with a sample of its service users, giving rise to a much greater flow of website visitors, reducing the number of easy-toanswer questions being posed to staff by telephone and face-to-face and, in consequence, saving the council around £300,000 p.a. in staff time (Wells 2011). A further example is given by the local dementia network in East Dunbartonshire, which enabled people living with dementia to decide on the frequency of its newsletters and on what stories to feature, tell the stories in their own words, and help distribute the newsletters (Brown et al. 2016, 20). • Designing care plans with service users and care-givers—writing individual care plans is one example of where social care users work with professionals to co-design approaches which will prevent problems from occurring or, at least, from getting worse. For example, in the non-profit Therapy Focus in Western Australia, the therapy team engages in a conversation with service users to find out what they can do and what they need help with. Advice on peer-to-peer service options is now a key element of the Therapy Focus Strategic Plan to co-design services that people need and want (Barrows 2017). • Neighbourhood redesign of services and facilities with community groups to improve social outcomes (e.g. Design Labs). An evaluation of 15 neighbourhood-based projects in England to build community capital and help prevent need for future social services concluded that the community can indeed contribute much but that such initiatives “take considerable time to establish and grow, and the scale of development is often extremely modest”, requiring investment in support and infrastructure (Henwood 2012, 6), warning also that community capital can be fragile and reliant on one or two charismatic individuals. 4.4.4

Co-assessment of Social Care

Interesting approaches to bringing citizens into the co-assessment of social care include:

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• Surveys completed or led by service users or communities—the evaluations which emerge from such surveys give service commissioners and providers information on which they can base service improvements. For example, the annual national Adult Social Care Survey in England and Wales asks people who are over 18 and who use adult social care about their experiences and how these services are helping people to live safely and independently in their own homes (NHS Digital 2019). Other, more local surveys are often run by service users or communities in order to evaluate local services and check if locally desired outcomes are being achieved. Often assessment methods are not as formal as surveys, comprising such activities as focus groups, gathering of stories from service users and carers, etc. A recent study by Omeni et al. (2014) conducted a cross-sectional survey of service users and professionals within community mental health services over three mental health trusts in England covering 4.5 million residents, of whom around 220,000 were in contact with mental health services. Over 56% of respondents indicated that their local authority social care department involved service users in evaluations of their services—this was, by far, the most common way of involving service users. Furthermore, 64% of those respondents involved in evaluations reported that this involvement had a positive impact (Omeni et al. 2014, Table 5). • Action-oriented complaints systems—as Simmons and Brennan (2013) highlight, “complainants may work alongside service providers in the co–creation of ideas, co–production to put those ideas into practice, or co–partnership to promote the extension of those ideas and practices”. They quote an illustrative case study, Dad’s Story, where one woman who had a very negative experience of having to navigate health and care services on behalf of her father, a person living with dementia, told her story through a video, created by the Dementia Services Development Centre in Stirling, which was then widely used in training for staff in the NHS and others with responsibilities for dementia care (Simmons and Brennan 2013, 34). • Citizen inspectors —the drive towards greater transparency in public services (e.g. through the publication of online budget information) has provided citizens with the opportunity to make requests under ‘Freedom of Information’ legislation. However, as Mckenna (2020) points out there is not a lot of evidence that citizens have

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become ‘armchair inspectors’ of public services. One exception is in the co-assessment of public services, including social care services in the Scottish local authority of West Lothian in 2011 (Kelly 2012) and expanded in 2015. The inspections carried out included a coassessment by trained citizen volunteers of a housing service for people with high support and care needs. • Peer review of services with ‘ experts by experience’ —as noted earlier (Sect. 3.6), the Care Quality Commission (2017b, 6), the regulator of health and social care in England, recommends providers “to listen and act on the views and experiences of people who use their services and check on how well they do this”. For example, the Customer Engagement Team of Warwickshire County Council recruited and trained 23 Peer Reviewers in 2011 to co-assess the quality of commissioned services, five of whom had learning disabilities and focused specifically on services used by people with learning disabilities (Hawthorne 2013). Each Peer Reviewer was supported by a Customer Engagement Officer and a member of staff from Changing Our Lives, a local non-profit organisation, supporting social care users. During the process, these support staff gave prompts if reviewers got stuck, but ensured that the Peer Reviewers led the reviews. While none of the reviews uncovered safeguarding or serious concerns, they did highlight various areas across services that could be improved and also some areas to be celebrated as good practice. Following the pilot, providers made regular requests for input from these Peer Reviewers, while the commissioners concluded that Peer Reviewers provided additional information to the qualitative data collected by the Contract Monitoring Team and gave a unique insight from the customer’s and carer’s perspective. However, it has to be recognised that there is still a lack of evaluations of such ‘peer reviews’ and, indeed, some local authorities in the UK have discontinued their ‘peer review’ programmes. 4.4.5

Conclusions on Co-production in Social Care

Summing-up, the evidence on the role of co-delivery of social care in problem prevention, treatment and rehabilitation shows a considerable discrepancy between the potential of co-production, based on key social care intervention theories, and the actual extent of co-delivery in this

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service sector. The comparison of co-production in problem prevention, treatment and rehabilitation pathways in social care also suggests that, at least in the UK, most co-production in social care is still focussed on problem treatment, and to some extent, rehabilitation. While there is evidence of the effectiveness of co-production in problem prevention initiatives, there is little research regarding the extent of such schemes in terms of people reached. In particular, there has been little focus on support of self-management in social care so far. It remains to be seen whether digital technologies in social care will provide professionals with tools to enable their service users to do more self-management within a co-production framework or whether telecare apps will simply promote a shift from a largely professional-led service provision to pure self-help. As far as the extent and effectiveness of co-commissioning, co-design and co-assessment in social care is concerned, the available evidence suggests that, while there is a wide variety of such initiatives, they are often time-limited and remain small-scale in their reach. One exception is personal budget holding in social care (although not all forms of personal budget may be considered as genuine micro co-commissioning). A key barrier to co-commissioning in the social care sector is that needs assessments play a key role in deciding the eligibility of a person for social care services. These needs assessments largely determine which services are commissioned for that person. As a result of reduced budgets in social care, many needs assessments are now only done at a point of crisis—and at this point many service users can contribute little, which reduces the scope for both effective co-assessment and co-commissioning with service users, their family and social network. This strong link between needs assessments and services commissioned applies also to children and young people who are already in social care. While the benefits of placing children and young people at the centre of assessments is well documented in research (Helm 2011) and the meaningful involvement of children and young people in local authority decisions regarding their care and support has now become a legal imperative in the UK (Bennett et al. 2016, 20), many social workers find this challenging. Furthermore, it is widely recognised that in addition to children and young people, parent carers and wider family networks should play an important role within assessment. However, in practice, this co-assessment is not always effective. As Bennett et al. (2016) suggest “…although generally the primary carer will be interviewed as part of the assessment process this does not always ensure that parent carers and

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wider family members feel that their views are listened to or that their experience of the process is positive”.

4.5 Co-production of Community Safety Outcomes 4.5.1

Co-delivery of Community Safety Outcomes

Policing and the criminal justice system have two main aims—first to help the community to feel safe, both by reducing crime and anti-social behaviour and by directly tackling unjustified fear of crime; and second, to achieve justice in the community. These aims are both communitywide, helping to improve quality of life in the community for citizens in general but also stakeholder-specific, attempting to help those most intensively involved, i.e. victims and offenders. In this section we look at how co-production can help to achieve these aims. It needs to be said right at the outset that, while the literature contains some evidence that co-production may often be effective in achieving high level outcomes in community safety, the relevant number of studies remains too small for full confidence (Loeffler and Bovaird 2019b). Moreover, only a narrow range of outcomes are typically addressed in much of the research into community safety production—in particular, much research has focused on crime reduction, perhaps because this is usually a government priority. Consequently, the effect of co-production on the collective outcome of justice in the community and on quality of life outcomes is still under-researched. In addition, many research studies to date have been purely qualitative, illustrating the potential of coproduction but giving only weak indications of the strength of its drivers and impacts. In Loeffler and Bovaird (2019b, 5) we present an overall model of how different outcomes are brought about by activities in policing and the criminal justice system. This model also highlights a range of coproduction activities which contribute to these pathways. Most of the co-production activities in policing and criminal justice (and this is also true of most of the more detailed examples reported below) mainly involve forms of co-delivery. Other modes of co-production such as cocommissioning, co-design and co-assessment are still relatively rare in this field. This section will summarise the findings of an extensive literature review in Loeffler and Bovaird (2019b) on the extent to which

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different types of co-delivery impact on outcomes in policing and the criminal justice. Later sections will then consider evidence relating to cocommissioning, co-design and co-assessment of policing and the criminal justice system. One critically important driver of crime reduction which is highlighted in Loeffler and Bovaird (2019b, 5) is outside of the influence of policing and the criminal justice system, namely the set of ‘social causes’ of crime (Behn 2014) and therefore is not considered further here. 4.5.2

Crime and Prevention of Anti-social Behaviour

In Loeffler and Bovaird (2019b, 5) we highlight a range of pathways to cut crime through reducing social causes of crime (not further explored here), reducing opportunities for crime, deterring crime, encouraging desistance and removing criminals from the community in line with the model presented in Fig. 4.1. The first two of these are often labelled ‘crime prevention’ but actually all five approaches can help to prevent crime. The scope for citizen contributions is particularly strong in reducing opportunities for crime—e.g. through encouraging safe behaviour such as locking all doors and windows when leaving the house. Some of these activities can be seen as pure self-help—but where they have been encouraged or supported by public safety campaigns or other public service initiatives, which is often the case, then we can validly classify them as coproduced. In surveys of citizens in five EU countries, Loeffler et al. (2008, 18) found that a high proportion of respondents in an EU survey claimed to take such steps (e.g. well over 80% reported taking care to lock doors and windows and around 40% kept an eye on their neighbour’s house and asked them to do the same). However, our literature search highlighted that relatively few community crime prevention initiatives have been evaluated. Interestingly, in the EU survey, at the very bottom of the responses on prevention activities was ‘seeking advice from the police on safety issues’ (Loeffler et al. 2008, 18). Only 5% of European citizens often asked the police for advice on how to best protect their property, while 14% sometimes do so. UK citizens were most inclined to make use of this free service provided by the police, whereas Danish and Czech citizens were the most reluctant (Loeffler et al. 2008, 18). The Czech case

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is particularly interesting—only just over 1% of Czech respondents in the survey often contact the police for crime prevention advice. As the survey also showed, Czech citizens felt relatively unsafe in their neighbourhood, while national crime statistics showed that property-related crimes made up 70% of all crimes in 2004. The Czech focus group suggested that the most important barrier to more active involvement of citizens in community safety was historical: “Most people still feel that the police are not a friend and are not serving the citizen, but rather are a repressive power” and, although a range of government initiatives have been launched to rectify this, trust in the police is still low. Similarly, opportunities for citizens to contribute to deterring crime are important, especially through citizens alerting the police to potentially criminal activities. In the USA, Groff et al. (2013) found that foot patrols in a controlled experiment achieved a 23% reduction in violent crime in Philadelphia, working on a model which provides more proactive community contacts and more community intelligence. Foot patrols reacted more consistently than car patrols to signs of social disorder in their patch, in line with the ‘broken windows’ hypothesis that foot patrol officers, by their presence and through tackling social disorder, can (re-)establish normative order in a community and encourage greater informal community control. Neighbourhood Watch schemes provide another example—in England and Wales they cover 3.8m households with 173,000 volunteer coordinators, and in the USA they cover over 40% of the population. A systematic review of Neighbourhood Watch schemes around the world (Bennett et al. 2008) concluded that Neighbourhood Watch schemes were associated with a reduction in crime of between 16 and 26% (with 19 studies indicating it was effective in reducing crime and only 6 producing negative results). In Germany, police in the County Council of Mettmann have been training elderly people to provide advice on public safety issues to other elderly people (Löffler et al. 2015, 31). The training puts strong emphasis on the enabling role of these ‘security advisors’—they do not behave as ‘experts’ who know everything but rather as a partner to help other elderly people to identify risks and potential solutions. There is a long history of community policing, through which the police make use of community inputs, e.g. through community-based crime prevention, or even civilianization (Skolnick and Bayley 1988, 5). However, its implementation in the USA has been described by Cordner

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(2014) as superficial—in 2002 fewer than 25% of agencies had adopted robust elements of community policing, such as involving citizens in recruitment and evaluation of police officers or reviewing complaints against the police. Even more worrying is the accusation by Taylor (2006) that recent US ‘zero tolerance’ policing practices have undermined policecommunity collaboration, fundamental to ‘broken windows’ approach, and exacerbating exactly those problems which co-production has been designed to tackle. Community policing can also be the site of conflict in the community—it is sometimes captured by the most active community groups or can become part of the power struggle between community groups representing different interests. Another co-production approach to crime prevention directly is demonstrated by Mentors in Violence Prevention in Scotland, which operates in more 150 secondary school in over 20 local authority areas, aiming to empower students to safely speak out against all forms of violence from rape and sexual harassment to bullying and abusive behaviour. Based on an original template from the USA, the Scottish Violence Reduction Unit successfully piloted and developed the approach from 2011 onwards. It sees students as a school’s greatest resource in tackling violence and trains senior pupils as peer mentors, who then deliver sessions to younger students. Over the last five years over 6000 mentors have been trained and have delivered around 2000 lessons a year, targeting issues such as bullying, gender norms, domestic violence, knife crime and harmful sexual behaviour. More recently it has been adapted to higher education settings, workplaces and even Scotland’s night time economy, with pubs and clubs embracing the scheme as a way to help keep customers safe (Violence Reduction Unit, n.d.). More recently similar approaches have been proposed in London and other cities. 4.5.3

Encouraging Desistance

Co-production can also have an important impact on crime by encouraging desistance, which is a process of behavioral change, helping individuals at risk of committing crime to desist sustainably from criminal activity. Weaver and McCulloch (2012, 7) highlight empirical evidence from the seminal work of LeBel (2007, 2009), later confirmed by other studies, which established that volunteering or advocacy behaviours by (potential) offenders had a positive correlation with increased self-esteem

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and life satisfaction, and a negative correlation with criminal attitudes and behaviours. A meta-analysis of US studies into focused deterrence strategies undertaken by Braga and Weisburd (2012) concluded that they are associated with an overall statistically significant, medium-sized effect on crime reduction. The emphasis in these strategies was not only on decreasing offending (although they did involve intensive police contact with, and pressure upon, known and suspected criminals, such as drug dealers) but also on a wide range of other activities aimed at making crime less likely to take place or to be successful, such as decreasing opportunities for crime, deflecting offenders away from crime (e.g. by focusing services and support on dealers, so that those willing to change their lives have the support they need), increasing the collective efficacy of communities, and increasing the legitimacy of police actions. Indeed, Braga and Weisburd suggest that the large effects observed from these strategies came precisely from its multifaceted influence upon criminals. Moreover, these approaches to focused deterrence had an important impact upon collective efficacy—the belief that the community could make a difference—in the relevant communities, by engaging members of the community in the strategies developed. This is likely to have been highly important, given that self-efficacy has emerged in many studies as a key driver of co-production in all public services, including community safety (Parrado et al. 2013; Alford and Yates 2016; Loeffler and Bovaird 2019b). Turning to research on desistance in relation to youth crime and antisocial behavior, mainly from rigorous US studies, Ross et al. (2011, 68–70) identify child skills training as a distinctively effective early intervention programme. By teaching children “social, emotional, and cognitive competence by addressing appropriate effective problem solving, anger management and emotion language”, this training prepares them for a greater role in the co-production of their own future welfare. A different co-production approach to encouraging desistence is highlighted by Bright et al. (2015), who summarise empirical research evidence from US teen courts. Adolescents hear the cases, which concern low-level crimes, and usually also make decisions about sanctions to be applied to teen perpetrators. The interaction with positive peers, together with the subsequent community involvement which is often part of the sanctions applied, have meant that teen court ‘completers’ experience relatively low rates of recidivism up to one year after their hearings,

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suggesting that they have been encouraged to make positive changes to their lives. Two promising co-production programmes for encouraging desistance are also identified by Ross et al. (2011, 68–70)—in the first, a peer mentor from the community spends time with a young person who is at-risk. The peer acts in a non-judgmental, supportive capacity, but is also a role model. In the second, young people experience and learn skills in a range of non-academic activities in their after-school recreation time, overcoming their low self-esteem through taking part in highly structured activities co-produced with professional support. Weaver and McCulloch (2012, 13) also highlight a successful peer support approach: the Routes Out of Prison project in Scotland employs Life Coaches (who are mainly reformed offenders or ex-substance abusers) to give emotional and practical peer support to short-term prisoners before and after they are released from prison. The Life Coaches also act as advocates, helping to deal with issues like housing debt, benefits advice, health, addiction, training, education and work experience. This peer support has been positively evaluated by all key stakeholders, including prisoners—indeed, 43% of the prisoners involved in 2009–10 signed up to continue their engagement after they were released. Finally, Weaver and McCulloch (2012, 11) discuss a St. Giles Trust project which employs former prisoner peer advisors, after they are released, to work intensively with newly released prisoners to help in their resettlement, focusing in particularly on preparation for work. An evaluation by ProBono Economics (2010) estimated that this peer support approach reduced re-offending by 40%, with savings of £10m in 2009, together with significant quality of life improvements for ex-prisoners. 4.5.4

Removing Criminals from the Community

Removing criminals from the community depends on the court system and, ultimately, on the detection and successful prosecution of crime. A key contribution which citizens make directly to removing criminals from the community is through their role as witnesses in court, which is generally a voluntary choice by citizens. The importance of this role can be seen from the fact that in 2014–15, there were over 11,000 abandoned criminal trials in England and Wales because of the non-appearance of witnesses at court (although this only constituted 2.1% of crown court trials) (BBC 2016). The work of the Citizens Advice Witness Service in

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England and Wales also constitutes a form of co-production—it relies on nearly 2500 volunteers to complement its 300 staff, together helping over 168,000 citizens per year who are giving witness and are daunted and worried about this potentially traumatizing or even dangerous process (Citizens Advice 2016). 4.5.5

Tackling Crime and Anti-social Behaviour

It is clear from the model in Loeffler and Bovaird (2019b, 5) that crime detection is central to several pathways to outcomes, including crime deterrence and, through punishment of crime, to desistance and removing criminals from the community. Co-production can play a major role here, e.g. through neighbourhood patrols (such as Street Watch) or Speed Watch (where local residents capture evidence of speeding motorists in their streets with a laser speedgun/camera and send a photo of the car with its speed recorded to the police). Such activities can not only detect crime but also deter it by encouraging behaviour change. An evaluated example is provided by the Speed Watch scheme of Wiltshire County Council, which mobilised 765 local residents in 140 volunteer teams to monitor motorists’ speeds (Milton 2016). The evaluation found that there was a 35% reduction of fatal and serious injuries from traffic accidents in Wiltshire, compared to a national fall of 22% during this period. Crime detection is also aided by citizens reporting crime through hotlines like 911 in the US and 999 in the UK, both alerting police more speedily to crimes committed and providing richer information for police investigations. More recently, such mechanisms have been reinforced by internet and social media platforms, which give the police extra tools for gathering citizens’ inputs for the detection and pursuit of crime. For example, since 2004, Dutch police have used an online system, CitizenNet (Burgernet ) (Meijer 2012, 200), which allows them to call for information from citizens on recent crimes (e.g. burglaries near their house) or even crimes currently taking place (e.g. criminals seen running from scene of crime). The system not only helps citizens to feel safe at home but it also speeds up the tracking of suspects or of missing people— and it may strengthen trust in the police. An average of 4.6% of citizens in the nine cities signed up for CitizenNet and 9% of all the cases qualified

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as fit for CitizenNet action were solved with the help of its information— more than 50% of all successful police actions, so an important addition to existing procedures (Meijer 2012, 200–201). Of course, these ‘hotlines’ and online platforms can have both an ‘upside’ and a ‘downside’: on the one hand, they can be seen as a positive example of community organising to reduce harms experienced, but they can also be seen as a form of ‘coveillance’, where citizens are marshalled to play a role in the surveillance structure of the state. Clearly, it is important to remain on the positive side of the fine line between harnessing ‘crowd intelligence’ and simply resonating rumour and prejudice, which would be an aspect of the potential ‘dark side’ of co-production (Steen et al. 2018). While legislation in both USA and UK allows for citizens to directly intervene to stop crime, e.g. through citizen arrests (Robbins 2016), such direct intervention may be dangerous (to themselves, to the assumed offenders, and to bystanders), so police have traditionally discouraged such direct action, unless “it is safe to do so” (Weaver 2018). Nevertheless, when it does occur, it is often strongly commended, both by the press and the media (Nsubuga 2017). Moreover, this may be more important than often realised—recent research by Philpot et al. (2019), using widespread surveillance cameras to record more than 200 incidents in Amsterdam, Cape Town and Lancaster (England) shows that in 9 out of 10 incidents at least one bystander intervened (with an average of 3.8 interveners), with no significant difference across the three cities, in spite of their greatly differing levels of crime and violence. Taken together, this evidence therefore suggests that community coproduction between citizens and the police can indeed play an important role in detecting and tackling crime. However, public governance principles remain important, so some safeguards are necessary, e.g. to ensure that ‘coveillance’ does not infringe people’s right to privacy and that ‘vigilante’ behaviour, where citizens take the law into their own hands or engage in inappropriate action against other citizens, does not occur. 4.5.6

Impact on Fear of Crime

There is generally a large gap between officially reported crime levels and the public’s perception of crime. For example, in 2015 just over 60% of UK adults perceived crime to have risen in recent years (ONS 2015a), whereas in fact recorded crime had reached its lowest level since 1981

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(ONS 2015b). Moreover, Cornaglia et al. (2014) estimate statistically that that the social cost of violent crime is about 80 times the direct impact on the victim, in terms of mental well-being alone (although property crime was found to have no such social cost impact on victims or non-victims). There is some evidence that co-production can influence this gap between perceived and actual levels of crime. Weisburd and Eck (2004, 59) in their review of well-founded academic studies concluded that community policing strategies did not significantly cut crime or disorder but did cut levels of citizen fear of crime. Similarly, Cordner (2010) concludes that most studies of community policing have found that residents like community policing and feel safer when it is implemented where they live and work—but it is more difficult to tease out which particular elements of community policing have this effect. He goes on to suggest that community engagement, in itself, contributes to reductions in fear of crime, possibly by decreasing social distance between residents, increasing social cohesion, increasing informal social control, and raising public confidence in the police. 4.5.7

Achieving Restorative Justice

Restorative justice, which now plays an important role in the UK criminal justice system, is a co-produced approach to delivering justice (Weaver 2011), involving some personalisation for the offender (and, indeed, for the victim). Johnstone (2004) suggests that it comprises four common but rather different practices, with different levels of ambition in terms of what is aimed to be achieved: • offering victims of crime a chance to meet in a safe setting with the person who harmed them, and with a trained mediator, to develop an action plan for repairing the harm caused; • bringing in family members and community supporters of both victims and offenders to support the offender’s reparative efforts and behaviour change to reduce their chance of reoffending; • bringing together community residents, justice and social service staff and family and support networks to consider what the community should do to help both victim and offender, linking restorative justice to community regeneration and capacity building, often making recommendations to the judge;

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• encouraging community members to form support groups around feared ex-prisoners (particularly sex offenders) to help them change their behaviour, to monitor their behavior and ensure safety of the community. Meadows et al. (2012) concluded from an evaluation of a restorative justice programme in South Yorkshire that victims were generally satisfied with the outcome, feeling empowered by their experience, developing a greater sense of control and reporting increased confidence in the police. Similarly, offenders had experienced a positive effect. It also appeared that participating in restorative justice reduced the likelihood of reconviction amongst offenders, although the results were not quite statistically significant. In a similar evaluation of a Youth Restorative Intervention (YRI), run jointly by Surrey Police and Surrey County Council’s Youth Support Service, Mackie et al. (2014) found that the direct costs of running the YRI were lower than processing the offender through the police (which would have entailed youth cautions, youth conditional cautions and prosecution)—the YRI cost £360 per case, compared to £600 per case through the alternative (police) approach, which also had a 6% higher level of offending. Moreover, they calculated further savings to the public purse of £440 from the restorative justice approach, implying a rate of return of 2.86:1 from investment in this co-production initiative. If the reduced social costs relating to each victim (estimated to be some £200) is added, this brings up the rate of return to 3.41:1. 4.5.8

Impact of Co-production on Quality of Life

The figure in Loeffler and Bovaird (2019b, 5) shows that co-production in the policing and the criminal justice system can have an indirect impact on the quality of life of all citizens through reductions in the level of crime and the fear of crime and through the collective benefit it brings from achieving community justice. However, there are two stakeholder groups whose quality of life can be directly improved by co-production of community safety—namely victims and offenders/ex-offenders. However, for offenders many approaches to rehabilitation are not actually conducive to their quality of life. Ward and Brown (2004) characterise the dominant approach to offender rehabilitation in Canada, the UK, Australia, and New Zealand as a risk–need model, in which the risk factors

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associated with recidivism are systematically targeted, seeking the reduction of maladaptive behaviours, elimination of distorted beliefs, removal of problematic desires, and modification of offence-supportive emotions and attitudes. While they accept that this model does indeed reduce recidivism rates, they point out that it does not promote pro-social and personally more satisfying goals, which would be more effective in motivating offenders. In contrast, they highlight the Good Lives Model of offender rehabilitation, originating in Canada but now used internationally, which is a strength-based approach, seeking to give offenders the capabilities to secure valued aspects of human functioning and living. The Good Lives Model incorporates the co-productive capabilities of prisoners: excellence in play and work (including mastery experiences); excellence in agency (i.e. autonomy and self-directedness); relatedness (including intimate, romantic and family relationships) and community; spirituality (in the broad sense of finding meaning and purpose in life); and creativity. However, this approach in the justice system is not common—McCulloch et al. (2016, 441) conclude that for offenders “… the predominant experience described was one of punishment, judgment, humiliation, depersonalization and a ‘total imbalance of power’. For most this was a distancing, disenfranchising and disorientating experience that, for some, directly impeded their capacity to cope, far less co-produce.” In spite of some counter experiences in line with co-production principles, the authors suggest that the criminal justice system in the UK has been drifting from humane, participatory and complex justice practices towards a more punishment-oriented approach, which may be more politically popular but which will not be able so easily to incorporate co-production. However, some of these counter-experiences suggest the possibility of disrupting this trend—for example, Weaver and McCulloch (2012, 10) report an evaluation of Foundation 4 Life, a London-based programme which engages reformed offenders and former-gang leaders to deliver behaviour modification workshops and programmes to young people who are either still offending or at risk of offending—on exiting the programme, 20% of participants said they would actively make a change, and 91% of reformed offenders acting as facilitators had not re-offended and some had obtained related employment.

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Co-commissioning of Community Safety Interventions

In public services like policing and community justice, with a strongly hierarchical governance system, involvement of citizens (whether service users or community members) in commissioning decisions can be expected to be relatively uncommon, compared to services characterised more strongly by network governance (Loeffler and Timm-Arnold 2020). Indeed, Weaver and McCulloch (2012, 10) comment that involving service users in commissioning processes in public safety or law and order is quite exceptional, particularly in community-based criminal justice services. This is in line with the finding from our EU study of five European countries (Loeffler et al. 2008, 20) that only just under 6% of respondents had participated in groups that were working to improve community safety. Nevertheless, there are some interesting examples of cocommissioning. For example, there is an increasing number of commissioning initiatives working with deprived communities, with a focus on improving public safety, such as the “Listening Events” with local communities in North West Kilmarnock in Scotland (Bone 2012). One approach to co-commissioning which has seen several rounds of experimentation in the UK is participatory budgeting (PB). In 2008, the Home Office allocated nearly £500,000 to 24 pilot areas to trial PB at local authority level, with budgets to be allocated to projects contributing towards community safety, although the definition of community safety was broad and was left for each pilot to define (PB Unit 2008). In Scotland there were five Community Safety PB pilots from 2010. In 2013 an online PB platform was used by the North Wales Police and Crime Commissioner to gauge priorities in relation to anti-social behaviour on the part of respondents living in isolated rural communities. Unfortunately, none of these initiatives has been rigorously evaluated. In the UK, the Police Reform and Social Responsibility Act 2011 placed a statutory duty on chief officers to make arrangements for consulting and informing the public on local crime and disorder ‘within each neighbourhood’, with mandatory regular meetings between the public and local police officers (although the format and regularity were not prescribed). The initiation of Police and Crime Commissioners in 2012 opened up extra opportunities for bringing citizens into the commissioning process for community safety—one of its main aims was to introduce democratic accountability to the determination of local

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policing priorities — in words of the Home Office: “We have put policing back in the hands of the public” (House of Commons Home Affairs Committee 2014). For example, the Dorset Office of the Police and Crime Commissioner adopted the approach that no person or group of people are hard to reach. Its Community Engagement Strategy emphasised putting more effort and creativity into reaching these groups and reducing barriers to engagement. Its five ‘levels of community engagement’ included information giving; consultation; joint decision-making (Community Engagement Forums, Victim Groups and Surgeries); joint action (Partnership Decision-Making); and community empowerment (Cabinet Office 2015). The latter three areas clearly entail co-production. However, Higgins (2018, 49) reported that, although many PCCs in the UK had set up Police and Communities Together meetings to consider community priorities. many of these had already fallen into disuse or been discontinued and, where they had continued, they were generally reported to be poorly attended, unrepresentative and illustrative of the tension between the ‘low level’ local issues those attending wanted the police to address, and the ‘higher-harm’ remits created for neighbourhood teams by their forces. This had resulted in explicit, community-set priorities becoming more marginal to the work of neighbourhood teams. This UK experience suggests that, in spite of some interesting examples to the contrary, it clearly remains the case that co-commissioning in community safety remains rather weak. 4.5.10

Co-design of Community Safety Interventions

While co-design methods are becoming increasingly popular in health and social care services, harnessing “user experience to improve the design of services in community safety is still not very common” (Loeffler 2018, 216). However, we will give two examples here. One of the most studied areas is the role of prisoners working on codesign of prison services. The UK-based charity User Voice (2016) is staffed and led mainly by people who have personal experience of the same problems the charity is seeking to solve, namely serving a prison sentence and being on probation. User Voice has promoted the setting up of service user councils in prisons and probation services, so that service users can co-design service improvements. A recent evaluation of prison councils (Barry et al. 2016, 95) concluded that “In terms of impacts on services … the analysis suggests that User Voice activity is associated with

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benefits well in excess of £500,000 across the five User Voice prisons where the team was able to undertake before and after rate comparisons (with comparators)”. Moreover, “community conferencing”, an approach to restorative justice which is used in many European Countries, the USA, Canada and Australia, typically involves all key stakeholders, such as offenders, volunteer community representatives and public services, in co-designing solutions to repair relationships with local people. It is typically used where the community has been the victim through being impacted by illegal and inappropriate behaviour—this is discussed in the Crown Prosecution Service guidance on Restorative Justice (CPS 2019). This guidance cites a community conference which was initiated by a group of shopkeepers outraged by the long-standing misbehaviour of a group of young people who congregated in their shopping centre. The community conference resulted in a win-win for all stakeholders—the behaviour of the young people in the shopping centre was much improved; police call-outs were much reduced; the shopkeepers were satisfied that their complaints had been acted upon; and the young people felt they had been treated fairly and their needs considered. 4.5.11

Co-assessment of Community Safety Interventions

Co-assessment gives service users and communities a voice in the assessment of outcomes achieved and quality of service. This might be seen as particularly relevant in community safety and public order, as objective performance information (e.g. crime figures) does not necessarily reflect citizens’ subjective perception of public safety, as we have seen above in relation to the fear of crime. However, in practice, there are relatively few well-documented case studies of co-assessment of community safety. Sabet (2014, 260) discussing co-production and police services in Mexico suggests that the ‘citizen monitor’ model has the greatest potential for impact at the local level, using crime data to evaluate law enforcement performance, as well as designing better civil society and governmental interventions. He instances Ciudad Juárez, which established the Citizens Observatory for Security and Coexistence in 2008, in association with the federal Health Ministry, the Pan American Health Organization, and the Autonomous University of Ciudad Juárez, which housed the observatory and covered its personnel and administrative costs. It has worked with the city’s traffic police to analyse data on traffic

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accidents, publishing in 2012 three geo-referenced diagnostic studies on violent deaths, traffic accidents, and crime, leading to joint work with government officials to develop a master plan for road safety. In a more narrow sphere, researchers have compared complaints systems of different countries in terms of the degree to which ‘civilian control’ over the complaints system has been embedded, leading to the conclusion that “internationally there is a slow ongoing trend towards the adoption of many features of the civilian control model” (Prenzler 2011, 285). However, there has been considerable controversy over the degree of ‘civilianness’ of these bodies for investigating complaints against the police—Savage (2013) highlights the potential damage to the perceived legitimacy of such oversight bodies from the continued presence of former officers in their ranks and goes on to argue that the formal establishment of a body to provide independent, civilian oversight not only needs members who are clearly independent of the police but also the pursuit of a ‘distinctive organizational culture’, which avoids being dominated by processes which reflect ‘cultural survival’ and ‘cultural continuance’ in terms of embedded police attitudes and orientations, which are inherited in part by the oversight bodies through the employment of former police officers as investigators. Savage (2013) emphasises that, while most agree about the value of police experience in police complaints investigation, virtually all agree also that ‘outsider’ status enables a degree of distance from police culture, bringing benefits for the investigative process in terms of open-mindedness, a more critical approach to police conduct, and closer proximity to the public and therefore to the concerns of complainants and families of those affected by police conduct. In the UK, some of the Police and Crime Commissioners (PCCs) set up after 2012 have developed additional scrutiny and monitoring arrangements. The Cleveland PCC uses mystery shoppers and independent custody visitors to report on the local police force, while the Avon and Somerset PCC established a panel of independent residents which reviewed complaint files against the police force and published reports (House of Commons Home Affairs Committee 2014, 22). Finally, it is notable that police forces are increasingly using social media to engage with citizens, as in the West Midlands Police (HineHughes 2013). As a result, social media are becoming much more important as a two-way communications tool between police and citizens (Ruddell and Jones 2013), including a “soft” co-assessment tool,

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which complements formal complaints mechanisms. However, a recent study of the use of social media by British police forces (Fernandez et al. 2017) found that police tweets that attracted higher engagement talked about roads and infrastructures, events and missing persons, and aimed to raise awareness about important crimes—there was no mention of seeking feedback on police performance. 4.5.12

Conclusions on Co-production in Community Safety

There are still relatively few studies on how co-production affects high level outcomes in community safety and only a narrow range of outcomes is typically addressed, with particular attention to crime reduction, perhaps because this is usually a government priority. The effect of coproduction on justice in the community and on quality-of-life outcomes of victims, prospective victims and offenders is still under-researched. Most of the co-production activities in policing and criminal justice mainly involve forms of co-delivery—other modes of co-production such as co-commissioning, co-design and co-assessment are still relatively rare. More research is needed on how effective user and community co-production can be implemented in services characterised by more hierarchical modes of governance, such as public safety.

4.6 General Conclusions on Co-production in Health, Social Care and Community Safety This chapter analysed the empirical evidence on the extent of user and community co-production in health, social care and public safety and its effectiveness for improving public outcomes. In particular, it provides a conceptual framework of pathways to outcomes, which is dynamic and locates co-production initiatives as part of prevention, treatment and rehabilitation strategies for dealing with social problems. This generic ‘pathways to outcomes-model’ has been refined for public safety and backed up with a literature review (Loeffler and Bovaird 2019b). The analysis in this chapter provides several key insights: First, there is limited evidence of the extent of co-delivery to achieve better public outcomes through problem prevention, treatment and rehabilitation in the three sectors. Most of the literature focusses on case studies. More quantitative evidence is needed on the service users and communities

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reached by national or local co-delivery initiatives and their importance within the public sector in terms of budgets spent on co-delivery. Second, while important public health and social care intervention theories either incorporate elements of co-production or are at least compatible with co-production, the use of co-delivery approaches for problem prevention remains limited. Most co-delivery initiatives in these two sectors focus on problem treatment, and to some degree, on rehabilitation from specific problems or conditions. This is different in public safety where the extent of co-delivery in the detection of crime is limited and most co-delivery focusses instead on prevention or dealing with the consequences of crime. The reason may be that, at least in administrative law countries, problem treatment in public safety is still considered to be the exclusive task of the state. In a German co-production study, a number of focus group participants suggested that co-production is not possible in averting danger, whereas the majority of focus group participants thought that engaging citizens as volunteers plays an important role in the delivery of emergency and preventative services (Loeffler and Timm-Arnold 2020, 18). Further international comparative research is needed on how administrative traditions impact on co-production across sectors such as health, social care and public safety. Thirdly, there is also a difference regarding the range of co-production in terms of the Four Co’s (co-commissioning, co-design, co-delivery and co-assessment) between the three sectors. As this chapter suggests, there seem to be fewer co-commissioning, co-design and co-assessment initiatives in public safety than in social care and, to some degree, than in health services. As Loeffler and Timm-Arnold (2020, 11) argue “services characterised by governance modes with strong elements of network working are likely to enable a wide range of co-production approaches, including co-commissioning, co-design, co-delivery and co-assessment”, contrasting this with public safety services, which are characterised by a more hierarchical mode of governance. Nevertheless, the fact that a wide range of co-delivery initiatives in public safety could be identified in the literature review by Loeffler and Bovaird (2019b) and the focus group research by Loeffler and TimmArnold (2020) shows that co-production, and in particular co-delivery, is possible even within more hierarchical modes of governance. In health services, the mode of governance depends on the intervention pathway. As far as the detection and treatment of conditions are concerned, health services are highly regulated (McMullin and Needham 2018, 157–158),

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whereas many health prevention services tend to be more characterised by network modes of governance. The empirical evidence analysed in this chapter suggests that the key co-production approach identified as most significant in all three sectors is co-delivery. As Loeffler and Timm-Arnold (2020, 20) comment “this is not surprising in public safety, since hierarchical modes of governance are less likely to favour giving a role to external stakeholders in decision making”. However, it may be seen as more surprising in the health and social care sectors, where government intervention has often focused particularly on increasing the role of citizen voice. The evidence from the German case study suggests “the paradox that in German local public services there is more talk than action about ‘citizen voice’—and more action than is often recognised in relation to citizen action” (Loeffler and Timm-Arnold 2020, 20). It remains an open question as to what extent this paradox applies also to the UK and other OECD countries.

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CHAPTER 5

Challenges to Effective Co-production of Public Services and Outcomes

5.1

Introduction

If a systematic and thorough implementation of user and community coproduction is potentially highly effective and can bring a wide range of benefits, as highlighted in Chapter 4, why is it not universally happening? In this chapter we will focus on possible reasons for the ‘implementation gap’ in co-production, in spite of the widespread acceptance that it should be embedded in the theory and practice of public services. Specifically, we look at the challenges facing co-production, including the obstacles which it faces and the risks which are involved in taking a more co-production-oriented approach to public services and outcomes. We focus also on potential strategies for tackling these challenges and dealing with these risks. In particular, we explore how risk enablement and a whole system resilience network can help to make co-production more attractive to public service decision makers. This chapter also discusses the triggers for motivation of citizen coproducers and the requirements of effective leadership for co-production, both in the community and in public service organisations. A core change management tool (the Governance International Co-production Star) is suggested as a way of both understanding and also tackling the implementation gap. Finally, the chapter considers how co-production can have negative consequences, including ways in which it can fail to achieve the quality-oflife outcome improvements it seeks, the possibility that it will contravene © The Author(s) 2021 E. Loeffler, Co-Production of Public Services and Outcomes, https://doi.org/10.1007/978-3-030-55509-2_5

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key public governance principles and the existence of a ‘dark side’ of coproduction, whereby its implementation may involve illegal or immoral actions by public services staff, or service users or the community.

5.2 5.2.1

Overcoming the Implementation Gap in Co-production Identifying Barriers to Citizen Co-production

While there is now growing worldwide interest in the potential of user and community co-production for improving public services and increasing publicly-desired outcomes, policymakers and practitioners are finding coproduction to be very challenging to put into practice. Even when adopted as a policy commitment, a range of major barriers often appear to block the adoption of co-production initiatives as quickly and widely as initially hoped. These barriers arise from several sources—for example, it is often suggested that co-production has been hindered because of the risks attached to greater user involvement in public services, or because of the pressure to generate short-term budget savings, or because of the potentially unfair burdens placed by co-production on vulnerable service users, or because of the resistance of some professional staff to changes in their practice and their power base, or because of the costs of supporting citizens and training staff in more effective co-production practices. However, there has so far not been a systematic exploration of how serious these barriers are in practice, so the literature on barriers to co-production is rather thin. Nor has there been much investigation of how public service organisations have gone about tackling these barriers. This section therefore seeks to provide a conceptual framework for understanding potential barriers to co-production. From our review of the literature we have derived two ‘macropropositions’ which have shaped our development of this conceptual model. First proposition: Given the lack of evidence on effective pathways and barriers to improved outcomes through citizen co-production, we need to focus on perceived barriers to effective citizen co-production, rather than actual barriers. Further empirical testing is urgently needed to identify which specific factors are perceived as barriers in the minds of particular stakeholders. Nevertheless, in the longer-term our research programme

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aims to identify what actual co-production barriers tend to be found in different contexts, based on comparative research across different public services and countries. Second proposition: Not all factors which are considered as ‘ drivers ’ of citizen co-production are necessarily ‘barriers’ to co-production, when they are lacking. This proposition responds to the claim made in some of the literature that ‘barriers’ are simply the obverse or absence of ‘drivers’. Some research on the enabling environments for social innovation (Bloch et al. 2010) is helpful in showing aspects of context which are important in promoting co-production—and that co-production is therefore more difficult in their absence. Moreover, some drivers of co-production seem to be so important that their absence clearly makes co-production less effective. However, this is not always the case. For example, while specific legislation promoting co-production can be considered as a driver of citizen co-production at the macro-level, the absence of supportive legislation does not mean that citizen co-production is no longer possible. The lesson from this proposition is that there is an asymmetrical relationship here, whereby the absence of barriers does not necessarily promote co-production—for example, getting rid of highly bureaucratic regulations which would make citizen co-production difficult may have little effect in practice on the level or effectiveness of co-production, if there are no positive drivers in place. 5.2.2

A Conceptual Framework of Barriers to Citizen Co-production

Three general papers have summarised the research to date on barriers to co-production. OECD (2011, 173) and NESTA (2011) suggest that a lack of funding and commissioning has been a key barrier to implementing co-production in public services in the UK, together with difficulties in generating evidence of value for citizens, professionals, funders and auditors. NESTA (2011) further suggests that there is a need to develop the professional skills to mainstream co-production. Bovaird and Loeffler (2012a) added risk aversion of politicians and many public officers, as well as political and professional reluctance to lose status and ‘control’, as additional co-production barriers. However, these studies found little academic research which specifically focused on barriers to co-production. We have therefore cast our net much wider to cover the literature on barriers and obstacles to community development, social innovation and organisational change and also to

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include the ‘grey’ literature from think tanks and public sector organisations, as well as academic studies. Based on this wider literature, Fig. 5.1 provides an integrated conceptual framework of barriers to user and community co-production. Importantly, this conceptual framework distinguishes between barriers to user co-production and barriers to community co-production— although both types of co-production face barriers arising from similar factors (demographic factors, willingness to co-produce at present and in the future, and ability to co-produce), empirical evidence indicates that the way these factors operate is likely to vary quite significantly between service users and communities. The framework distinguishes between barriers from user and community characteristics, contextual barriers, and internal organisational barriers relating to the characteristics public service organisations. We will now discuss these in turn, starting with barriers to user coproduction. 5.2.3

Barriers to User Co-production

The demographic factors in Fig. 5.1 have been statistically tested in the European five country citizen co-production survey (Loeffler et al. 2008) and the UK five local authority citizen co-production surveys (Bovaird et al. 2016), which revealed that rather different factors affect user and community co-production. A regression analysis of the European citizen co-production survey showed that age is strongly positively correlated with individual co-production (Bovaird et al. 2015, 12). However, the UK survey of five local authorities (Bovaird et al. 2016) suggested that co-production activity is non-linear with respect to age, in that it increases up to a certain age but then drops markedly—not surprising, in the light of the mobility restrictions and other disadvantages which often affect older people. Furthermore, the European study revealed that individual co-production is more common amongst women than men, although this correlation is quite weak (Bovaird et al. 2015, 12). These results differ in a number of respects from those highlighted in the literature on public participation. This literature concludes that “welleducated middle-class adults are most likely to have the time, skills, and experience needed for citizen participation” and that lower income adults, in contrast, are “less likely to be able to participate” (Baum 2015, 629). Clearly, the data from the EU five country citizen survey and the UK

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Fig. 5.1 Conceptual model of barriers to co-production (Source Author)

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local authority survey suggest that this does not apply to co-production— there is only a very weak and inconsistent correlation between level of education and the extent of individual co-production behaviour in public safety, health and wellbeing and the local environment and only a small positive correlation in the case of collective co-production (Bovaird et al. 2015). A literature review by van Lenthe et al. (2009) also concludes that there is little knowledge about the differential effects of the co-production of health promotion across different socio-economic groups, even though it is sometimes assumed that some health promotion strategies may be particularly effective in higher socio-economic groups. This is important for policy, since such a bias towards higher socio-economic groups being more involved in co-production might mean that a co-production strategy could worsen socio-economic inequalities. (Of course, it would always be possible to use a co-production strategy only for those socio-economic groups for which it was likely to be effective, while using other strategies for other socio-economic groups.) Further empirical research is needed to analyse to what extent other demographic barriers operating at individual level such as ethnicity, relationship status, religion, disability or relationship status are relevant to individual or community co-production. Following Alford (2009) we identify the willingness and ability of citizens to co-produce as key drivers of co-production, so Fig. 5.1. puts the focus on the factors which may reduce such willingness and ability to co-produce. Obviously, if people have a low perception of their own capabilities this is likely to reduce their willingness and ability to co-produce. Furthermore, negative past or current co-production experiences are likely to reduce the willingness of service users or communities now and in the future to co-produce. In order to unpack this relationship between past and present co-production we need a dynamic model of co-production—a conceptual framework for this is developed in Bianchi et al. (2017). The factor of political self-efficacy has emerged as a key driver of individual as well as collective co-production in several quantitative coproduction studies (Loeffler et al. 2008; Parrado et al. 2013; Bovaird et al. 2015; Löffler et al. 2015; Bovaird et al. 2016)—specifically, this means that individual or community co-production is more likely on the part of those users or communities who believe that citizens can make a difference. This also implies that, if people have a low sense of political

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self-efficacy, this is likely to be a barrier to co-production and front-line staff need to find ways to combat this, e.g. by giving people positive feedback about their efforts. This strong association of co-production with political self-efficacy does not, of course, tell us which way the causation runs—are people with a strong sense of political self-efficacy most likely to co-produce? If this is the case, then policy needs to focus on finding such people to offer them the chance to co-produce more—and on raising political self-efficacy in other people. If, on the other hand, it is the experience of co-production which leads to a greater feeling of political self-efficacy, then policy needs to focus on the strong association between self-efficacy and other wellbeing outcomes, especially psychological outcomes (Bandura 1997; Flammer 2015; Loton and Waters 2017), so that co-production is recognised as a key way of achieving these other outcomes, through its effect on self-efficacy. If both of these interpretations are justified—in other words, that co-production activities and political self-efficacy mutually reinforce each other—this raises the attractive possibility of a potential virtuous circle in policy terms. It suggests that a positive past experience of having made a difference as a citizen co-producer will increase political self-efficacy, which in turn will increase the willingness of service users or communities to co-produce in the present or in the future … and so on. From the five country EU study, two specific aspects of public services emerge as closely associated with higher levels of co-production, statistically significant at the 5% level: • Satisfaction with government provision of information, which was positively associated with the level of individual co-production (Bovaird et al. 2015, 12). • Good service performance, in the sense of a safe neighbourhood, a clean environment, and good health, which had a negative effect on co-production, suggesting that co-production may be prompted in part by awareness of a shortfall in public performance (Parrado et al. 2013). These results were also confirmed in in the five local authority study in England and Wales (Bovaird et al. 2016). Nevertheless, this does not necessarily imply that good performance of public service providers may be an obstacle to co-production, as good public service performance may, at the same time, have the positive effect of enhancing citizens’ feeling of self-efficacy, thereby indirectly increasing co-production. This possibility has been tested

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by further regressions which show that the association of higher selfefficacy with better performance in each of the three policy areas is always positive (or close to zero) and this relationship is statistically significant in ten out of fifteen contexts (Parrado et al. 2013). However, this set of interrelationships between service performance, self-efficacy and level of co-production requires further research. Another barrier to user co-production is likely to be low levels of trust on the part of users in working with staff—and vice versa. An empirical study of service users of a local jobcentre in the Netherlands by Fledderus and Honigh (2016, 84) established that trust in the local authority was an important precondition for unemployed people to participate in a work programme. The ability of service users to co-produce is likely to depend, at least partly, on past experience of co-production as well as the opportunities for co-production provided by public service providers. When these opportunities are scarce, even service users who are willing to co-produce may be not able to do so. This may be behind the finding from a national citizen co-production survey in Germany that only 7% of citizens had collaborated with their local authority to improve the wellbeing of young people, and only 12% had collaborated to improve the quality of life of older people, but a huge 78% indicated that they were willing to spend at least several hours per year to support young people outside their family, and 70% reported this in the case of older people (Löffler et al. 2015, 34, 39–40). This barrier is, of course, one which is directly within the power of public service organisations to remove. 5.2.4

Barriers to Community Co-production

When analysing barriers to collective co-production, the key demographic variables identified in the five country study that are statistically significant predictors were age and education. Regression analyses showed that age is negatively correlated (although not strongly) with collective coproduction (Bovaird et al. 2015, 12 and 15). This is the opposite of the finding for user co-production and suggests that older people (at least up to a certain age) are less keen on the social side of co-production. Bovaird et al. (2015, 15) suggest that “the increased effort involved in collective co-production may be particularly daunting for older people, while the group nature of collective co-production may attract younger people who

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are interested in making more social contacts”. However, this finding is challenging for public policy, as many public services see co-production as one way of reducing feelings of loneliness and social isolation amongst the most vulnerable people they are supporting. Those active in the workforce are also less likely to be involved in collective co-production (Bovaird et al. 2015, 12), which is not surprising, given that collective co-production often requires citizen co-producers to provide their contributions at specific times which are mutually agreeable, which may be less convenient for those who are still active in the workforce. Finally, among socio-demographic factors, more educated citizens also show a lower propensity to engage in collective co-production. This may again be partly because the more educated are likely to be in the workforce and therefore have less time but it is rather surprising, given that such people might be expected to be more comfortable taking part in activities with people not known to them. A further possible explanation could be that the more educated simply live in neighbourhoods with better public service quality, so they feel less need to make up shortfalls in public services. Clearly, further research is needed here. The willingness of communities to co-produce will be strongly influenced by their perception of their capabilities. While self-efficacy is also correlated with individual co-production, it is even more strongly correlated with collective co-production (Bovaird et al. 2015, 12 and 13). Further research is required to identify the causes of this difference but it seems highly likely that the explanation lies in the barriers to collective co-production. As these are usually likely to be perceived as higher than in individual coproduction, it takes more motivation to attempt to overcome them and citizens with a strong sense of self-efficacy are more likely to persist in this (Bovaird et al. 2015, 18). Another statistically significant driver having some (admittedly not very strong) effect on the willingness of communities to co-produce in the fivecountry EU study was citizen satisfaction with government consultation (Bovaird et al. 2015, 13). This suggests that public consultations which are badly done, e.g. by not giving feedback to citizens, may become a barrier to community co-production. Last but not least, we need to take account of some research evidence on other barriers to community co-production which were not covered in the EU five country study or the UK five local authority study. These include barriers arising from community relationships, including lack of

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social connectedness, low active membership in community associations, lack of trust within civil society and low levels of trust on the part of communities in working with staff. Our German co-production citizen survey showed that ‘having contact with older people outside the family’ was a statistically significant factor promoting co-production to improve the quality of life of older people (Löffler et al. 2015, 49). The same finding applies to young people (Löffler et al. 2015, 41). This suggests that people who do not have contacts with older or young people outside their family may either be less interested or perhaps less able to support older or young people who need help. It might be thought that such community relationships, which are clearly valuable in themselves, as well as being conducive to coproduction, might be strengthened by being an active member in a community organisation. However, in the German co-production citizen survey this correlation was not statistically significant. In fact, the survey showed a low level of citizen engagement in community associations or groups to help older people (15%) or young people (24%) (Löffler et al. 2015, 32). The five country EU study also showed that active engagement in groups taking care of health, public safety and environmental issues was low in all five countries (Loeffler et al. 2008, 40). Of course, it may be that there is a non-linear effect here and that a step-change bringing much higher levels of membership in such associations would indeed make collective co-production easier for many people. If this is the case, then the increasing use of digital technologies may help, since it is likely to lower the threshold to participating in online peer support groups, as discussed in Chapter 3. However, further research on this is needed before assuming that membership in community associations is relevant to community co-production. Trust is often suggested as a sine qua non for citizen co-production, not just a driver. Lack of trust can therefore be expected to be a significant barrier to both user and community co-production. But what do we mean by ‘trust’ and who needs to trust whom in order for co-production to be encouraged? The co-production literature distinguishes between particularised trust, on the one hand, which is related to a particular person, organisation or institution and, on the other hand, generalised trust, which is trust in people in general (Fledderus and Honigh 2016, 77). We suggest that low levels of generalised trust may indeed be a barrier to community co-production but we would expect it to be rather less

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of a barrier in relation to user co-production, where the individual is not interacting with other citizens (although, of course, interacting often with staff from public services). Looking at the issue of trust from the perspective of service providers, the literature provides little evidence on levels of trust by professionals in citizen co-producers—whether they co-produce as individuals or in groups. Since this is also likely to be a barrier to user and community co-production—trust clearly needs to be mutual—research on this aspect of trust is urgently needed. Finally, trust can be dangerous if those we trust are not trustworthy— this has always been seen as a reason why citizens should be cautious in their attitude to government, since some public sector policies and actions may not be as beneficial as they seem. Again, there is little evidence on whether the trust of co-producers, whether citizens or service providers, in their fellow co-producers is justified. 5.2.5

Organisational Barriers to User and Community Co-production

This brings us to potential organisational barriers to user and community co-production. Figure 5.1 provides an overview of the organisational barriers suggested in the literature but there is very little evidence on which barriers are considered as important by different stakeholders involved in co-production. There is even less evidence on the extent to which specific organisational barriers get in the way of effective co-production. A key issue in moving to a co-production approach is usually the level of resources required. It is often thought that a lack of funding has been a key barrier to co-production in public services (OECD 2011 and NESTA 2011). However, an extensive co-production study involving focus groups with professionals revealed that most co-production initiatives identified in Germany were relatively small scale (Löffler et al. 2015), so the extra direct costs associated with citizen co-production were relatively small. Typically, such costs involve direct costs for marketing co-production opportunities (e.g. printing flyers or creating new websites or apps)—this is considered further in Sect. 6.6. Nevertheless, it is clear that most co-production initiatives do require extra staff time. This applies in particular to additive forms of coproduction but even substitutive forms of co-production typically require

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extra staff time for attracting and training volunteers or service users— again, this is considered further in Chapter 6. Since this experience in Germany is also likely to be common in other countries, shortage of staff time may be a much more important barrier to co-production than shortage of finance. Some important organisational barriers arising from human resource management (HRM) issues are suggested in the literature, including the lack of specific co-production and communication staff skills (Tuurnas 2020), the lack of incentives for staff to co-produce with citizens, reluctance of staff to change, and (as mentioned in the previous section) low levels of trust by staff in the capabilities of users and/or communities (Bovaird and Loeffler 2012b). In particular, in personal services “the tendency for caring human service professionals and officials to define the people they are trying to help exclusively in terms of their problems without recognizing or enlisting their vast talents and capacities” (Cahn 2012) is likely to be a barrier to co-production. It is frustrating that there has so far been little focus in the literature on the extent to which HRM regulations and practices support appropriate skilling of staff and incentives for co-production. For example, to what extent do competency frameworks ensure that the right staff are recruited for citizen co-production and that staff behaving as co-producers are rewarded? Another organisational barrier which is typically identified by professionals is poor communication within the organisation, and also with service users and communities (Bovaird and Loeffler 2012b). This may be due to the use of inappropriate technical jargon or the unwillingness of professionals to provide citizens with timely or relevant information. Professionals also identify barriers to co-production arising from the perceived risks associated with giving citizens a co-production role and organisational cultures which are unsympathetic to enabling citizen coproduction (Bovaird and Loeffler 2012b). A particular aspect of culture which may form a major barrier to co-production is the performance management system and how it is applied in practice. Where this focuses on a tight specification of outputs (as in ‘time and task’ contracts), rather than on achieving outcomes, this may make it difficult to achieve a creative and personal approach to encouraging and making the best use of citizen inputs. Performance management systems may be partly driven by national targets, so they may not only be an organisational but also a contextual barrier to citizen co-production.

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More generally, professionals often suggest that regulations are too bureaucratic and that commissioning practices (particularly the approach to contract management) do not encourage citizen co-production (Bovaird and Loeffler 2012b). Again, these potential barriers may be partly contextual, based on governmental or auditing impositions. However, the main problem may often be how national systems are interpreted locally. Ghate et al. (2013) have suggested that the lack of effective leadership, change management and learning—both at organisational and system level—have been barriers to collaboration, although it is striking that these factors have not been identified by professionals working in public services (Bovaird and Loeffler 2012b). A lack of community leadership has been pointed out by Bussu and Galanti (2018) as a barrier to community co-production. The distribution of benefits resulting from citizen co-production between organisations may become a potential barrier if appropriate benefits do not accrue to the organisation which has borne the major costs of developing, improving or scaling co-production. For example, if a local authority invests budget and staff time in gritting footpaths after a snowfall, reducing injuries from pedestrian falls on slippery pavements, many of the benefits may go to the NHS rather than the local authority investing the resources. Moreover, political short-termism has been suggested as an important organisational barrier to citizen co-production (Bovaird and Loeffler 2012b). In particular, in public service organisations where there is political pressure to achieve short-term savings, there may be insufficient time to achieve these savings through citizen co-production. However, even in other contexts which are not so much characterised by austerity, short electoral cycles focus the minds of politicians on quick fixes rather than social innovations which respond to the needs of future generations (Boston 2017). 5.2.6

Contextual Barriers to Co-production

Finally, Fig. 5.1 suggests a number of contextual barriers to citizen coproduction, which are discussed in the literature. It is often suggested that citizen co-production is easier to implement in small rural communities than in metropolitan contexts, on the assumption that people are better connected to each other in rural areas. However, in our study of five EU

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countries, living in an urban area was identified as a statistically significant factor in the case of individual co-production (Bovaird et al. 2015, 12), although it was only a slightly positive factor and was not statistically significant in the case of collective co-production (Bovaird et al. 2015, 12). Nevertheless, this throws doubt on the widely held assumption that communities are more likely to co-produce in rural as compared to urban locations. Another contextual barrier which is suggested in the literature is the lack of scientific evidence of the results of co-production (OECD 2011). While the evidence has, of course, slowly been mounting and is now substantial (Loeffler and Bovaird 2016), it is still the case that there are many gaps in our knowledge about where, when, how and for whom coproduction works in different contexts. This forms an obstacle to any government making a firm and clear commitment to a co-production strategy. However, there are good grounds for hoping that this obstacle will reduce over time. In Chapter 7 we look at the research priorities which will help to ensure this happens. Finally, a comparative country study by Voorberg et al. (2017) has suggested that some state and governance traditions such as the Rechtsstaat orientation and the hierarchical mode of governance in Germany has hampered ‘co-creation’, defined by Voorberg et al. (2017, 1347) as the involvement of citizens in the initiation and/or design of public services, whereas the rather different state and governance tradition in a country such as Estonia stimulated ‘co-creation’. More recently, Loeffler and Timm-Arnold (2020) have explored how different modes of governance (hierarchical, market and network) can all be consistent with some approaches to co-production but concluded that most elements of co-production are, indeed, more likely and easier to implement in the network form of governance. It is likely that many barriers to co-production not only differ between public service organisations but also between public services. For example, McMullin and Needham (2018, 151) suggest that “healthcare is a service sector in which there is particular impetus for co-productive approaches, …, but it is also a setting in which the barriers to co-production may be particularly prohibitive”. This shows the need for more research on differences between service sectors.

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5.3 Risks and Uncertainties Arising from Co-production User and community co-production as a form of social innovation and organisational change management involves risks. As Flemig and Osborne (2017, 179) point out “innovation and risk taking are inextricably linked”. Therefore, risk management is a key issue for the effective implementation of co-production. However, this is not always given proper consideration. Even though the UK-based social innovation think tank National Endowment for Sciences, Technology and the Arts (NESTA 2008, 2) acknowledges that risk is important in social innovation, its recommendations for mainstreaming co-production do not even mention this issue (Boyle et al. 2010). It is striking that little of the academic literature on co-production has focussed on the issue of risks involved with co-production and how to address them. The next section critically reviews the current state of knowledge around risks of co-production and identifies types of risks that need to be taken into account by key stakeholders in co-production. In subsequent sections, we suggest a new model of risk enablement and risk management to develop and scale user and community co-production in a public sector context. 5.3.1

Defining Risk Arising from User and Community Co-production

How can risks be defined in a context of user and community coproduction? Knight (1921) famously suggested that risk is how we measure today the adverse impact or losses we think may happen in the future. This means that risk has two elements: one is the magnitude of the negative effect of an event, the other is the likelihood that an event with adversarial effects is going to take place in the future. Economists traditionally limited the concept of ‘risk’ to elements of uncertainty to which probability estimates can be attached. Similarly, Flemig and Osborne (2017, 183) have recently suggested that risk management approaches should differentiate between risks which are known a priori (and can be attributed a probability estimate) and uncertainty, that is unquantifiable risk that can only be recognised a posteriori. However, risk assessment and management specialists in the ‘risk industry’ nowadays normally use

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‘risk’ to cover all the factors which contribute to uncertainty, whether or not they can be captured by probability estimates. Risks can be defined objectively but are also socially constructed (Renn 2008). The latter have often been dismissed as ‘myths’ and proponents of co-production have sometimes proposed ‘myth busters’ to dispel perceived risks as not based on evidence. However, if we accept the concept of the bounded rationality of human beings, we must acknowledge that the perception of risk may be different from stakeholder to stakeholder and from context to context. A good example is given by focus groups of local residents in a small town with an objectively low crime rate in Switzerland, who perceived a significant higher risk of being the victim of crime than focus group participants in Barcelona where some participants had already been the victim of pickpockets (Parrado et al. 2005). Brown and Osborne (2013) suggest that risk can be conceptualised at three different levels: consequential risk at the level of the individual, organisational risk at the level of the organisation and its staff, and behavioural risk at the level of the community. In practice, consequential risks can be experienced where either individuals or communities do not gain the outcomes they expect. Moreover, it is important to differentiate risks to organisational outcomes from risks to organisational processes. The framework presented in Table 5.1 therefore distinguishes risks to personal outcomes, community outcomes, organisational outcomes, organisational processes, non-compliance with legal and regulatory constraints and non-compliance with public governance principles. It also recognises that an event with a negative impact for one stakeholder may often be a benefit for another stakeholder—a ‘positive risk’ (Seale et al. 2013). It therefore distinguishes how risks are viewed by different stakeholders—this multi-stakeholder approach has been neglected in much public sector analysis of risks. A major problem with risk management is that decision makers around public policy tend to give negative risks more weight than positive risks of the same size (Peters and Slovic 2000). This immediately stacks the cards against co-production, particularly where it is not already being practiced, since its introduction or wider usage involves a degree of uncertainty (as, indeed, applies to any innovation). Moreover, public sector decisionmakers may put a higher weight on potential reputational damage to their organisation from things going wrong, even if they recognise that there could potentially be major benefits for local communities or service

Politicians

Reputation loss and loss of support from voters who don’t want co-production or don’t like its results

Stakeholder at risk/Types of risks

Risks to personal outcomes

Dissatisfaction of community members with results of co-production Community must put in more effort in order to benefit from co-produced service Unequal contribution (some community members contribute more than in proportion to benefits received) Service user dissatisfaction with results of co-production Service users must put in more effort in order to benefit from co-produced service Unequal contribution (some service users contribute more than in proportion to benefits received)

Managers’ loss of support from stakeholders who don’t think co-production is working well Potential damage to managers’ career where co-production is not working well Job loss or hours reduction for front-line staff Less job autonomy for frontline workers where co-production gives more power to service users and communities – and disciplinary action if anything goes wrong

Reputation loss or loss of support from other stakeholders who don’t want co-production or don’t like its results Potential damage to career

(continued)

Wider local communities

Service users

Service providers

Commissioners

Table 5.1 Risks arising from user and community co-production

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Politicians

Failure to achieve effective co-production outcomes in politician’s own community

Loss of power from public sector organisations to citizens

Risks to community outcomes

Risks to organisational outcomes

(continued)

Stakeholder at risk/Types of risks

Table 5.1

Lack of opportunity for a community to make a contribution (social exclusion) Community dissatisfaction with results of co-production NA

NA

NA

NA

Reputation loss, where co-production does not work well or no longer receives funding inspite of positive outcomes Reduced demand for services of the provider, when service users or communities play a greater role Loss of ‘bottom-line’ results if co-production reduces profits (private sector) or turnover (non-profit sector) Loss of contract because of inability to co-produce effectively

Benefits of co-production which is funded may go to unintended communities or to other organisations which have not made an appropriate contribution Reputation loss, where co-production does not work well Costs of court cases where citizens reject decommissioning of traditional services Dissatisfaction of users and communities with implementation of co-production

Wider local communities

Service users

Service providers

Commissioners

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Politicians

Loss of influence on public sector decisions about public services Failure to mobilise effective co-production activities in politician’s own community

Loss of face from court cases arising

Stakeholder at risk/Types of risks

Risks to organisational processes

Risks of non-compliance with legal or regulatory constraints

NA

Lower outcomes may be experienced by communities if statutory minima are not achieved by co-produced services

NA

Lower outcomes may be experienced by individuals if statutory minima are not achieved by co-produced services

Need to retrain staff and educate service users and communities on how they can co-produce services Lack of appropriate procedures to design, implement and improve co-production approach Lack of motivation of staff, service users or communities to make effective contribution Reputation loss and possible damages from court cases arising

Protests from citizens who don’t want co-production or don’t like its results Lack of appropriate procedures to design, implement and monitor co-production approach Lack of motivation of staff, service users or communities to make effective contribution Reputation loss, policy reversal and possible damages from court cases arising

(continued)

Wider local communities

Service users

Service providers

Commissioners

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Reputation loss and loss of support from voters who think co-production has not been implemented well

Risks of non-compliance with governance principles

Source Author

Politicians

(continued)

Stakeholder at risk/Types of risks

Table 5.1 Wider local communities Community dissatisfaction with how co-production has been implemented Co-production may be imposed, non-transparent, unfair, discriminatory, non-accountable or unsustainable in its implementation Unequal contribution of volunteers (some contribute more than in proportion to benefits received) Exploitation Co-production activities may harm the environment

Service users

Service user dissatisfaction with how co-production has been implemented Co-production activities may be imposed, non-transparent, unfair or discriminatory on some or all service users Unequal contribution (some service users contribute more than in proportion to benefits received) Exploitation

Service providers

Managers’ loss of support from stakeholders who think co-production has not been implemented well

Commissioners

Loss of support from other stakeholders who think co-production has not been implemented well

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users. It is essential to explore WHOSE risks are at stake, as traditional risk assessments are typically carried out from the point of view of the commissioner or service provider, and therefore often neglect the risks (and potential benefits) perceived by service users or local communities. This tendency is exacerbated by the fact that commissioners often have few opportunities to spend much time outside their office, and the same may be true of top managers in provider organisations, so that contact with user groups or user representatives may be very limited. Co-assessments are one method for providing a more holistic risk assessment, as they encourage more inclusive consideration of eventualities. In particular, co-assessments may help to identify to what extent citizens are willing to trade off the possibility of higher levels of personal and public outcomes against increased personal and public risks. For example, the California Institute for Regenerative Medicine involves patient advocates in the assessment of grants for medical research on stem cell therapies. Expert scientific reviewers often focus on the high risk of failure. However, patient advocates are more willing to champion ‘outlier’ science and to accept high risk, if it is balanced by the potential for better outcomes. As the patient advocate Jeff Sheehy (2018) reflects, “I pay special attention to grant applications that receive highly varied scores from reviewers. Our influence has sometimes meant that a risky grant has been funded over a safer one with higher median scores”. Furthermore Sheehy (2018) suggests, “patient advocates can also be more sceptical of strategies that consider human physiology but neglect behaviour”. In Table 5.1 we therefore exemplify key risks frequently identified in the literature as associated with co-production, classified by type of risk. In line with the definition of Knight (1921) most risks identified with co-production in the academic literature are the opposites of the benefits of co-production. In particular, a key risk is that there is a likelihood that a co-production initiative may not improve public value to the degree hoped for, or at least does not provide evidence of improved public value. In the worst case, it may even reduce public value. We will discuss negative impacts of co-production in more detail in Sect. 5.5. It would be possible, of course, to complement the risks outlined in Table 5.1 with the set of potential benefits (ideally with their estimated likelihoods) but that would make the Table rather unwieldy. Looking at risks to personal outcomes, elected politicians are likely to give considerable weight to their potential loss of reputation if coproduction goes wrong, leading to a potential loss of support from

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their electors. Commissioners championing co-production are also likely to fear reputational damage if their ‘project’ does not deliver expected results or if they lose support from other stakeholders who don’t want co-production or don’t like its results, with potential damage to their personal ‘careers’. Amongst providers, managers face the risk of lower personal outcomes through loss of support from stakeholders who don’t think co-production is working well, with potential damage to their careers. Front-line staff are likely to fear having less job autonomy where co-production gives more power to service users and communities, while they may even face job loss or reduction in their hours of paid work, where co-production works well and citizens can take over some of the functions which they perform. Front-line staff may also be particularly reluctant to take the risks which they see attached to co-production approaches, fearing they may face disciplinary action or even job loss, if anything goes wrong, unless their line manager or head of service has agreed formally to such actions within a risk management framework. The risks to personal outcomes for service users and communities are, on the one side, that the expected outcomes may not be achieved, while, on the other hand, they may also have to put more effort into getting the services. Furthermore, some service users and community members may believe that they make unequal contributions, in proportion to the benefits they receive (which may make them feel exploited). The main risks to community outcomes are naturally experienced by community members. For some, social exclusion may mean a lack of opportunity to make a contribution. However, even those members of the community who have this opportunity may be dissatisfied with the results of co-production, at least in comparison with the efforts they put in— for example, if ‘free riders’ have reduced the overall effectiveness of the community initiative (and, even more infuriatingly, may have benefited from it in spite of not having contributed). Risks to outcomes for public service organisations, whether commissioners or providers, involve possible loss of reputation if co-production is ineffective, or even worse, if it is dysfunctional. Paradoxically, even successful and mainstreamed co-production initiatives may result in some dissatisfied service users or community members, if traditional services are decommissioned, and this may result in unforeseen costs to commissioners, e.g. from complaints or even court cases. Public service providers face the risk that successful co-production initiatives may reduce the

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demand for their services. Furthermore, service providers, in particular small innovative organisations, may experience worse ‘bottom-line’ results if co-production means that they lose some of the most profitable aspects of their work—or may face the loss of a contract if they fail to co-produce effectively. Public service organisations face risks if their co-production processes fail through lack of motivation of staff, service users or communities to make effective contributions and also through protests from citizens who don’t want co-production or don’t like its results. Providers also may need to retrain staff and educate service users and communities on what coproduction entails. The risks to public service organisations of non-compliance with legal or regulatory requirements mainly involve reputation loss and possible damages from court cases arising—and for commissioners there is the added risk of policy reversal. For service users and communities, there is the risk of lower outcomes if statutory minima are not achieved by co-produced services. Finally, the risks to public service organisations of non-compliance with public governance principles are mainly the loss of support from other stakeholders who think co-production has not been implemented well. For service users and communities, there is the risk of dissatisfaction with how co-production has been implemented—in particular, it may be imposed, non-transparent, unfair, discriminatory, non-accountable or unsustainable in its results and some people may feel exploited—e.g. if they believe that the public sector has ‘dumped’ the responsibility on them (so what has is occurring is essentially self-organisation, not coproduction) or they may simply feel they are being asked to make an unfair contribution. 5.3.2

Risk Management and Enablement Strategies for More Effective User and Community Co-production

In the previous section, we have discussed how co-production is perceived to be risky. However, this is not simply a matter of perception—coproduction is indeed characterised by uncertainty, especially where it deals with complex issues. The Cynefin model of Snowden and Boone (2007) is useful for identifying risks and uncertainty, depending on the knowledge domain in question.

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Where co-production aims at tackling problems within the simple knowledge domain, as often in transactional services, we are dealing with ‘known’ cause-and-effect relationships and can expect to apply best practice. This means that there are few risks and little uncertainty. However, when we operate within the complicated knowledge domain, there are ‘known unknowns’ which require further research, so that we are only able to apply good practice. In such contexts, it is possible to estimate the likelihood of adverse future events but we recognise that these estimates only apply within quite a wide margin of error. Things are very different in the complex knowledge domain, which is characterised by ‘unknown unknowns’, so that the relationship between cause and effect can only be perceived in retrospect. This means that we cannot predict likely positive or negative co-production outcomes of the interventions by professionals or citizens—the best we can do is to experiment and sense what works and what doesn’t. In this scenario, traditional risk management tools are not applicable and stakeholders involved in co-production need to deal with major uncertainty. Co-production (and wider collaboration with diverse stakeholders) is a ‘must-have’ in the complex knowledge domain, as no single person or organisation knows the answer to complex problems. However, many organisations have not yet recognised the need for innovation in the complex knowledge domain, along with the experimentation which innovation involves. Many scholars blame the resistance to innovation in the public sector on the bureaucratic nature of public sector organisations (Yeboah-Assiamah et al. 2016, 388). This is especially likely in public service contexts characterised by hierarchical governance, rather than network forms of governance, although even here innovation, including co-production can sometimes occur (Loeffler and Timm-Arnold 2020). It has to be recognised that an additional factor promoting resistance to innovation may be the difficulties involved in multi-stakeholder decision-making. However, whatever the reason, the reluctance to innovate through experimentation in the public sector seriously undermines its ability to achieve improved outcomes when working in the complex knowledge domain. Finally, in chaotic knowledge domains , there is no discernible relationship between cause and effect at systems level, so nothing can be predicted in relation to policy outcomes—the best we can do is to explore novel practice. Given the uncertainty, no risk management is possible but new co-production initiatives may emerge during or after the crisis. An example is the arrival of a large number of refugees in Europe in 2015

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who were met by a varying (but often unexpectedly high) level of community support. However, many local authorities in Germany were initially unable to take up or even coordinate the support offered by volunteers, as they devoted their resources to crisis management. Out of this situation new co-production initiatives emerged, such as the Refugee Councils in the City of Kehl, consisting of representatives elected by refugees at neighbourhood level to act as a bridge for the different language communities to the local people of Kehl and to co-deliver projects involving other refugees with seed-funding from the local council (Gustafson and Delmas 2017). As Table 5.2 shows, different knowledge domains require different risk management strategies to deal with risk and uncertainty. Bovaird and Quirk (2017, 262) distinguish between the following strategies to manage risk and uncertainty: • portfolio management —this involves choosing a portfolio of activities with lower risk attached, e.g. increasing the level of existing successful co-production initiatives with a similar target group; • risk reduction in the environment —reducing the likelihood that key risks occur or influencing their nature to make particularly negative consequences less damaging, e.g. by ensuring that all citizens taking part in a Streetwatch patrol wear high-visibility vests, so that potential miscreants see them quickly and leave the area; • risk enablement to encourage decision makers in the service system to choose activities with appropriate levels of risk, rather than aiming at risk minimisation, e.g. by engaging people with learning disabilities and their care-givers in the co-design of adventure holidays, sometimes with ‘travel buddies’ included (Go Provence Supported 2019); • building resilience into the service system, so that service provider staff, service users and local communities can recover quickly and learn from the adverse effects of risk and uncertainty, e.g. by providing all peer group mentors with the opportunity to have psychological back-up if something goes wrong with a service user they are supporting. Working in the simple knowledge domain, little actual risk management is necessary and it suffices to stick to ‘best practice’ approaches, as we

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Table 5.2 Risk management strategies for different knowledge domains Knowledge domain

Information available

Risks

Uncertainty

Risk management

Simple

‘Known knowns’

Little uncertainty

• Sticking to available ‘best practice’

Complicated

‘Known unknowns’

Risks can be identified a priori but there is also a risk that complicated or complex contexts are mistaken for simple knowledge domain Risks can be identified a priori

Some uncertainty

Complex

‘Unknown unknowns’ plus some ‘Known unknowns’

Most risks cannot be identified a priori, although some are known in advance

Chaotic

‘Unknown unknowns’

Risks cannot be Complete identified a priori uncertainty

• Portfolio management • Risk reduction • Risk assessment during planning phase (option appraisal) • Risk enablement • Resilience in the service system • Risk assessment during experimentation and review phases • Resilience in the service system • Risk enablement

High uncertainty

Source Adapted from Bovaird and Quirk (2017)

are dealing with ‘known knowns’. However, the biggest risk is that public service organisations mistake a ‘complicated’ or ‘complex issue’ as a simple problem and rush to fix the problem with traditional public sector interventions. This can happen in particular in situations where insufficient time is devoted to framing a problem through discussion with stakeholders—and it is even more likely where public service organisations sign off action plans in spite of divergent stakeholder views on the nature of the problem at stake.

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In the case of complicated issues, portfolio management and risk reduction strategies are appropriate but difficult to apply in practice, as the set of ‘knowns’ that can be modelled is quite limited. Risk assessment typically takes place during the planning phase but should be revisited in later stages of the commissioning cycle as more ‘unknowns’ become ‘known’—and, of course, the experience of the service users, their family and network becomes more relevant as the delivery phase extends, making co-production potentially more powerful. In complex knowledge domains, the risk management strategies based on advance risk assessment are no longer appropriate. What is needed are ‘soft’ risk management approaches, which build resilience into the service system as well as risk enablement. Bovaird and Quirk (2017, 265) suggest the need to build a whole system ‘resilience chain’ with strong links between user resilience, community resilience and provider resilience, rather than just focussing on the resilience of service providers. In complex adaptive systems it is no longer possible to undertake formal risk assessment in the planning stage—instead, it must be part of the experimentation phase, as stakeholders can only sense the positive or negative outcomes of their co-production activities after they have undertaken the activity. In order to capture the learning about outcomes and risks arising from co-production, a joint risk assessment during the review phase of the commissioning cycle is also likely to be beneficial. In chaotic knowledge domains, traditional risk management strategies do not make any sense but a strong resilience chain may help the affected stakeholders to cope with turbulence. Risk assessment is only possible once the crisis is over and, based on the learning, stakeholders may have the opportunity, at least partly, to move into another knowledge domain. In practice, different stakeholders involved in co-production are likely to be working in different knowledge domains. For professional service providers and commissioners, many traditional public services may operate at least partly in the simple knowledge domain—e.g. technical services such as local transport. However, a person with disabilities, for whom even local travel poses many obstacles, may perceive local transport as proffering a complicated knowledge domain, while for people living with dementia it may constitute a complex issue. When the service moves to a co-production approach, however, even local transport is likely to be anchored in the complicated or complex knowledge domains for all stakeholders, because the intensity and dynamics of stakeholder inter-relationships are so much greater.

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This applies even more, of course, to most personal services—there is already interest in modelling health and social services as complex adaptive systems (for example, Health Foundation 2010), so co-production of these services is even more likely to be operating in the ‘complicated’ or ‘complex’ knowledge domains. The lesson is clear—co-production may reduce some of the risks of traditional service approaches, because it brings in the knowledge and experience of service users and their communities but it also means that the service is more likely to be operating in the complicated or complex knowledge domains. This has implications for the treatment of risk— where applications of risk assessment and management stray from the domain in which their approach could be relevant into domains where their assumptions are irrelevant, they are likely to be ineffective. 5.3.3

The Role of Co-production in Strengthening the ‘Resilience Chain’

How can we move from traditional risk reduction strategies to risk enablement, where all key stakeholders involved agree on an acceptable level of risk and a desirable level of personal and public outcomes? This requires both a risk governance framework as proposed by Renn (2008), and later adopted by Brown and Osborne (2013), but also co-production with users and communities to strengthen every link in the chain of the usercommunity-provider whole system resilience (Bovaird and Quirk 2017, 265). By resilience we mean (adopting Edson 2012) adaptation that supports successful achievement of goals and objectives, as well as learning for future planning and preparation. Although this is inherently a systemwide concept, the current literature on resilience has focussed particularly on the resilience of the market, and especially of individual service providers, and less on the resilience of its other agents in the service system. The concept ‘resilience chain’ as defined by Bovaird and Quirk (2017, 264) highlights the resilience of all the agents within the system, in particular citizens (both individually as service users and collectively as communities) and organisations (both service providers and commissioners). Co-production can play an important role in strengthening user and community resilience, which are important elements of the resilience chain. When the capabilities and resources of service users are able to be

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harnessed, in a situation where professionals become temporarily unavailable or have to reduce the role they play, then they are much less vulnerable. For example, in the Japanese City of Saitama, the public fire service developed an action learning programme to prepare young children in nurseries to adopt appropriate forms of behaviour for evacuations in the case of earthquakes (Loeffler 2017). This innovative emergency training was based on evidence from the case of Kamaishi City, where 99.3% of the population survived a big earthquake in East Japan and where emergency training had played a big role. The fire service had decided to start the emergency training in early childhood, as it considered that it would be more difficult to change the behaviour of adults. The fire service officers involved co-designed a fun action learning programme with children of one local nursery to help them learn five key rules of behaviour. They compared the results before and after the action learning, in order to test whether the exercise had worked. This allowed them to prototype a new training programme for children, which could be rolled out across other nurseries in Saitama City. Furthermore, the social support network of users may be able to take on some of the functions of professionals, provided their capacity has been strengthened through previous training or other forms of professional support. Examples are the KeyRing Living Support Networks for vulnerable adults in the UK, which comprise ten people living within walking distance of each other. Nine of these people are vulnerable adults and the tenth is a Community Living Volunteer who lives rent-free in the network area and has been trained by the charity KeyRing to provide support to other network members (Parker et al. 2019). These examples demonstrate individual (service user) resilience. However, the same applies to community co-production. Identifying and mobilising community assets through community co-production enables communities to cope when public services fail to deliver the expected outcomes or need to reduce their inputs. This does not mean that public services disappear (after all, this would no longer qualify as ‘coproduction’). However, when local community assets are weak, some ‘up-front’ investment of the public sector may be needed to develop community assets. This is a role long played by community capacitybuilding or community development. According to the definition of the United Nations (1955, 6), “community development can be tentatively defined as a process designed to create conditions of economic

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and social progress for the whole community with its active participation and the fullest possible reliance upon the community’s initiative”. As Vanleene and Verschuere (2018, 199) point out, community development typically involves professionals and local people working together. However, we suggest that community development does not always conform to our definition of co-production, since it often consists of community self-organisation, with no significant input from public service organisations. (Indeed, some community development workers consider traditional public services to be part of the problem). A good example is the purely resident-led renewal of the neighbourhood Balsall Heath in the 1980s where members of the local communities came together to drive prostitution out of the neighbourhood and raised money to employ their own community organiser (Atkinson 2010). This led to the foundation of the Balsall Heath Neighbourhood Forum in 1994, which subsequently began to work more closely with the public sector and, indeed, eventually received many grants from Birmingham City Council and other local public agencies for community co-production activities. Other important links in the ‘resilience chain’ which need to be strengthened are service provider resilience and the resilience of commissioners (Bovaird and Quirk 2017, 265). Providers can build resilience into their services through internal mechanisms such as quality assurance and performance information systems but also by strengthening their co-production with service users and communities, which gives them alternative provision opportunities when other forms of provision fail. Commissioners need to ensure that the overall market of service providers is resilient, e.g. by setting up recovery mechanisms such as arrangements with providers of neighbouring local authorities, so that alternative service providers can be mobilised quickly if needed. Moreover, they need to make provisions for the negative consequences of future recommissioning decisions or organisational restructuring—for example, they need to assure that the knowledge gained from working with service providers remains available to the service after these changes occur. This is not easy, as many relevant staff may be shifted to other jobs or even made redundant—including, very often, some of the experienced commissioners. Clearly, different types of user and community co-production involve different levels of risk for commissioners, service providers and citizen coproducers and their social networks. At the same time, it is important to recognise that specific types of co-production such as peer support may

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also be promoted in the public sector as a risk enablement strategy—by embedding more co-production, all service commissioning and delivery approaches can move to accepting more appropriate levels of risk, as shown in Fig. 5.2. For example, personal budgets are now common in adult social care in the UK as a form of micro-commissioning to enable service users to make their own choices of public services and service providers (through a direct payment or a self-managed budget), as discussed in Chapter 4. Such co-commissioning is often perceived as highly risky by both commissioners and service users. For Carr (2011, 123) this “implies the need for changes in the way that risk is understood, managed, discussed and negotiated with the person using the service”. One risk enablement strategy in this context may be the development of peer support networks which allow individual service users to benefit from the advice and knowledge of other personal budget holders. This type of co-production can reduce the risk related to co-commissioning at service user level by building user resilience as shown in Fig. 5.2.

Fig. 5.2 A risk enablement co-production cycle (Source Author)

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The implementation of higher risk co-production initiatives needs to be followed by an assessment of future risks and uncertainty. For example, the introduction of digital marketplaces may involve new risks for service users who are not digitally literate. This requires the development of new risk enablement approaches, such as digital training courses, which may be co-delivered by other service users with more digital skills. In the terms of Fig. 5.2, this would initiate a new risk enablement co-production cycle. More research is required on how commissioners and service providers can develop effective co-production with vulnerable groups through risk enablement strategies. In particular, third sector organisations may have a new role to play as ‘resilience builders’.

5.4 Change Management to Implement Co-production 5.4.1

A Change Management Framework

The initiation and dissemination of citizen co-production does not happen by itself but requires change management within and beyond public service organisations. The term change management is often associated with linear change management theories such as Lewin’s (1947) three-step (‘unfreezechange-refreeze’) model or Kotter’s (2012) eight phases of change (‘urgency – coalition – vision - buy-in -empower - short-term wins -don’t let up - make it stick’). However, in this book we adopt a wider definition of change management based on Child (2005), which considers both planned and emergent changes, which may be radical or incremental. As Jacobs et al. (2013, 773) comment, “organizational change is a notoriously complex phenomenon; it is only natural that research on organizational change addressed this complexity from numerous more or less complementary or contradictory, but equally legitimate perspectives. These perspectives stretch across disciplinary boundaries, across methodological camps, and often across contradictory visions of organizations.” Clearly, the change management of co-production goes beyond mere organisational changes and therefore can only be understood from a more system-wide perspective, which incorporates the complexity and multiple stakeholder relationships which typically characterise co-production. In this vein, Evers and Ewert (2020) frame co-production as social innovation, namely as a process, with the dynamics and the factors that mould

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and direct it, allowing new concepts and practices to diffuse, coexist with the mainstream, influence or even redefine it. However, not all types of co-production can be considered as a social innovation in a specific context. For example, if a local authority takes action to expand the numbers of volunteers being active in the local fire brigade, this scaling effort can hardly be considered as a social innovation. However, if a job centre experiments with new types of co-production in employment services, as is the case in the Offenbach Employment Agency (Loeffler and Schulze-Böing 2020), the social innovation perspective does offer an appropriate lens for analysis. Furthermore, it is important to distinguish whether co-production takes place in a simple, complicated, complex or chaotic knowledge domain (Snowden and Boone 2007). As the analysis in Table 5.2 shows, this has implications for risk management in co-production. We also consider that the knowledge domain has implications for the appropriateness of specific theoretical perspectives. Our proposition is that in simple knowledge domains traditional linear change management theories may still be of some relevance (even though co-production goes beyond organisational change). However, the more we move into complex knowledge domains, the more will experimentation be required, which will involve iterative learning processes rather than a linear process with a clearly defined end. Sørensen and Torfing (2011, 850, based on Hall 1993) make a useful distinction between first-order change, which is about producing and delivering more or less of the same kind of goods, services, or solutions, as compared to second-order change, which involves “changing the form, content, and repertoire of goods, services, and organizational routines” and third-order change, which is about “transforming the underlying problem understanding, policy objective and program theory”. In short, we argue here that only second- and third-order changes qualify as social innovation. This implies that change management for co-production needs to draw on different theoretical frameworks, depending on the type of change to which we aspire and the knowledge domain in which we are operating. For first-order change, the implementation and traditional change management literature may provide useful frameworks to some extent, even though scaling co-production across neighbourhoods or stakeholder groups may require new experimentation rather than just multiplying a single prototype. However, for second and third-order changes, the

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literature on the economics of innovation, planning theory, and public administration together may “provide an interdisciplinary framework for further analysis of collaborative innovation” (Sørensen and Torfing 2011, 858). What makes policy design and implementation even more difficult is that, typically, most public service organisations will be faced with achieving first, second and third order changes at the same time, both building on existing co-production initiatives but also initiating new types of co-production. This section will provide a conceptual change management framework for citizen co-production. It draws on the Co-Production Star toolkit of Governance International, which includes a structured change management process to initiate, experiment with and implement effective citizen co-production initiatives. The framework can be used for first, second and third order change processes. In particular, the third step (‘people it’) includes iterative experimentation processes. As is highlighted by the fifth step (‘grow it’), the issue is not to sustain a bespoke co-production initiative but to develop it organically in changing contexts. As shown in Fig. 5.3, the outer ring of the Co-production Star involves five steps: mapping existing co-production initiatives and new co-production opportunities, focussing on those with the highest impact,

Fig. 5.3 The change management process of the co-production star (Copyright © Governance International 2013)

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peopling priority co-production initiatives with ‘people who know and care’, marketing the improved outcomes and/or savings to the sceptics, and growing the successful co-production initiatives within the public service organisation, its partners and local communities. These five steps include three phases: a. An initiation phase to identify windows of opportunity for new co-production initiatives, which includes Steps 1 and 2 of the Co-Production Star; b. an experimental phase for creating ‘Co-Production Labs’ and mobilising ‘coalitions of the willing’, which is what Step 3 of the Co-Production Star is about; c. an implementation phase to widen and deepen those co-production initiatives which promise to provide improved public value—this is the objective of Steps 4 and 5 of the Co-production Star. While new co-production initiatives may proceed in these three phases, change management for existing co-production practices will mainly focus on the implementation phase. We will now discuss each of the five steps of this change management model in more detail (Loeffler and Hine-Hughes 2013 and Loeffler 2015): Step 1: ‘Map it’ As the academic literature demonstrates, co-production is not a new phenomenon. However, public service organisations and local communities are often not aware of the extent to which co-production is already happening. In particular, at times of austerity it is important for public service providers not to ‘re-invent the wheel’ but to build on existing co-production practices. Therefore, the first step—MAP IT—is about identifying existing co-production initiatives—so-called ‘early adopters’— as well as exploring the potential for new co-production approaches to achieve improved outcomes or efficiency savings. Most public service organisations do not have much data on how citizens contribute to their public services or priority outcomes. Therefore, it is often necessary to start a mapping process through staff and citizens exploring with each other the level and quality of coproduction activities in which they are engaged. Such mapping exercises should separate the four modes of co-production: co-commissioning, codesign, co-delivery and co-assessment (as outlined in Chapter 3). This

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allows for a more detailed and nuanced picture of the current state of co-production and often suggests the potential for new co-production opportunities, as it reveals gaps (since one ‘Co’ may lead to another ‘Co’). For example, mapping co-production with focus groups of professionals working in public safety services at the local level in Germany revealed that most co-production initiatives focussed on co-delivery but that codesign and co-assessment were very rare and co-commissioning even more exceptional (Loeffler and Timm-Arnold 2020). Step 2: ‘Focus it’ Given that the resources of citizens and public service organisations are limited, it is important to focus on those co-production initiatives which are likely to bring about significant outcome improvements or efficiency savings. Step 2 is about setting priorities through a structured ‘options appraisal’. In particular, it is about determining what is to be co-produced, who is supposed to benefit from it and for which purpose. This business case—developed with all the stakeholders—can help ensure both community and public resources are used effectively and resources are re-allocated from co-production approaches with a low benefit-cost ratio to co-production approaches with a higher benefit-cost ratio. This allows all relevant stakeholders to agree on what success should look like and to develop a theory of change on how the agreed outcomes are to be achieved through co-production. This prioritisation process ensures that citizen co-production initiatives are consistent with commissioning strategies and linked to priority public outcomes of public service organisations. In some cases, it may be important to give elected politicians an active role, so that they can legitimise co-production initiatives which may be controversial. For example, in the case of a public park, different groups of citizens may wish to pursue co-production initiatives which (due to limited space in the park) may exclude each other: while some friends of the park may wish to plant out banks of spring bulbs and to seed ‘wilderness areas’, other local residents may want to meet up in the park to exercise their dogs and young families may wish to use large parts of the park for their children to romp around in. This is where local councillors come in—having discussed the options with different community groups, a political decision has to be made which balances their interests and gives weight to the local authority’s priorities. In this way, the ‘Focus’ step of the Co-production Star

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ensures that both citizens and public service organisations have an input into the final decisions about the park—neither side is ‘in control’. Of course, the agreed outcomes are likely to require adaptation during the next phase, which involves experimentation through trying out the chosen co-production initiatives. In particular, new stakeholders contributing to the experimental phase may have different personal outcomes which matter more to them. Consequently, co-production has to remain a flexible, dynamic process, which continually adjusts to its complex and changing context. This is likely to encourage stakeholders to focus on ‘quick wins’ as the obvious starting point, which can then act as a catalyst for action, by attracting people who want to make a contribution, and then allowing learning and further adaptation to take place. Step 3: ‘People it’ This step involves a structured process of experimentation with the prioritised co-production initiatives, undertaken by people who are able and willing to make a contribution. At this stage, public service commissioners and providers are challenged to identify those citizen co-producers and staff who will be important in the co-production initiative and then to motivate them to make a contribution. Some public services may already be in touch with the relevant citizens—this is particularly likely where service users have to register with public service providers (e.g. in Job Centres), although even these services may find it challenging to persuade service users to work with them as co-producers (Loeffler and Schulze-Böing 2020). However, many public services experience great difficulties getting in touch with target service users or communities, so this process needs to be carefully thought through. (Incidentally, this provides a reality check for those organisations that claim they are already doing a lot of co-production in close cooperation with citizens—this is less credible when they find it hard to get service users or community members to turn up when they are exploring new co-production initiatives!) Some services clearly have particular challenges in contacting the right people for co-production—e.g. preventative social services, where most citizens only get in touch with social services when they are in need and those who are at risk of needing a future service are still not known to the service. Other public services, such as employment services, may be in regular touch with jobseekers but find that the threat of sanctions may decrease the motivation of jobseekers to co-produce with their job coach,

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unless the co-production initiative is voluntary and clearly beneficial to them. In other public services, data protection regulations may make it difficult for public service providers to contact service users. Therefore, creativity is required in identifying new ways to engage with service users and communities. In some cases, professionals can use existing contact points, such as reception desks, customer service centres or complaints procedures to get in touch with relevant service users. Brandsen (2020) also recommends meeting vulnerable people in surroundings familiar to them, instead of inviting them to public buildings where they may not feel comfortable. Similarly, if an ‘outside-in’ pathway to co-production is chosen, then community groups such as women who have completed a cancer therapy may find it hard to get in touch with public services, since from the point of view of service providers their treatment has finished (Halliday 2019). As Halliday’s case study shows, boundary spanners such as the chair of the Health and Social Care Partnership in Dumfries and Galloway, can play an important role in bridging the gap between communities who are motivated to co-produce and professionals who are prepared to support community initiatives, so that they are transformed into co-production. As part of the ‘People it’ step, it is necessary to identify what service users and communities can contribute and to what extent they would like to contribute more than they do already. Public service staff must be able to identify and develop the strengths of citizens for co-production rather than just responding to citizens’ needs (Burns 2013). However, many public service organisations lack this information. In many cases, asset-mapping exercises focus on organisational assets in the third sector or physical assets in communities but not on the assets of individuals. Nevertheless, some information sources may be available. Where there is a time bank, its members can be particularly relevant. Again, the databases of organisations coordinating volunteers, such as local voluntary services councils in the UK, can provide some information as to who might contribute to new co-production initiatives. Moreover, extra information on actual or potential contributions of citizens may also be collected through community surveys at local level or through capability assessments at the individual level. Clearly, many public service staff will not be used to such processes of ‘capability assessment’ and will need training and support. Still less will they be used to receiving offers to help in service improvement from citizens, which is a sign of self-sustaining growth of the co-production

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approach. What is likely to be even more daunting for most staff is to match citizens who make such offers to demands from other citizens for such help (especially if both groups of citizens have specific ideas as to who they want to co-produce with). Such ‘matching’ skills are not common in private or third sectors and even less so in the public sector. Nevertheless, this is key and there can be real hope that digital solutions will make such a process much easier (after all, Uber and Air B’B are essentially just platforms to enable such matching). A large part of the learning involves ‘learning by doing’ in ‘CoProduction Labs’ where co-producers design and test the new coproduction initiatives in a protected space. In these experimental Labs, it will often be valuable to focus on recruiting citizens ‘who know and care’ (see Sect. 2.4.2), as they are more likely to ‘get it’ and help to make the initiative successful. However, it will also be important in the Lab to tackle the issue of how to convince more reluctant service users and community members and motivate them also to play their part. Clearly, it is also important to recruit those professionals who are most likely to help the experimental initiatives to succeed—they too must be chosen from the ranks of those staff ‘who know and care’. However, all staff, even those committed to co-production, may benefit by prior capacity building, so that they are equipped with the right skills to collaborate with citizen co-producers more effectively. What is perhaps equally important is that professionals need to be given the freedom to make mistakes, to admit them and to learn from them, which is often challenging in public sector organisations concerned about reputational damage, as discussed in Sect. 5.3. Of course, by definition, not all coproduction initiatives are likely to be successful. Learning involves the need to ‘fail early, fail fast, fail cheap’ (Bovaird and Quirk 2017). Consequently, it is important that it is not considered as a failure when some Co-Production Labs redesign or even stop some of their new coproduction initiatives, as long as the co-producers involved have learned from this experience and shared their insights with other stakeholders. Clearly, such an open approach to experimentation and learning requires leaders who do not impose a risk-averse culture and who are prepared to encourage staff to innovate, in spite of the risks. In order to shorten the timescale needed for major operational changes, it is likely that a range of experiments in these Co-production Labs will be helpful, so that the actors involved can reassure themselves that some of their fear of change is unjustified—and so that

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those concerns which indeed turn out to be justified can lead to rapid adjustments before the new co-production approach has gone too far. Step 4: ‘Market it’ Where new co-production approaches have the potential to be successful, it is critically important to market them appropriately. Step 4 is about marketing the improved outcomes and the achievement of public governance principles to existing and potential co-producers. This involves assessing qualitative and quantitative improvements to outcomes and/or efficiency savings in order to demonstrate that the coproduction initiative has already made a difference. While some outcome improvements may only be achieved in the long-term, some may occur quite quickly (e.g. where an isolated person is helped to take part in more social activities) and outcome assessment can often focus on some intermediate outcomes, e.g. indicators which suggest that positive behaviour change has already taken place. To get this message across, creative approaches such as story-telling and other social marketing mechanisms can be used. Of course, the longer-term evaluation of outcomes achieved will also remain important. Another way of predisposing users and communities to take part in a co-production initiative is to promote the new ways in which citizen coproducers and public service organisations can work together. This may be done through the joint development of co-production charters, which explicitly outline desired forms of behaviours and governance principles, responsibilities, and incentives for citizen co-producers and staff but also makes clear what are the limits to co-production. This can reassure potential co-producers that their commitment is close-ended and that key risks concerned (for example, in relation to accident insurance) have been taken care of. It also reminds them of their rights as co-producers (for example, that they should not be coerced into co-production activities) but also of their duties and responsibilities when they agree to contribute to a co-production initiative (for example, that they should pay attention to health and safety regulations). Most importantly, co-production charters also need to include mechanisms to deal with conflicts. If co-production charters are to be taken seriously, they need to be assessed on a regular basis—ideally through co-assessment with users or communities. Furthermore, governance assessments may be helpful to identify to which degree the implementation of priority governance

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principles has been achieved. Ideally, this is done as a 360 degree assessment so that the perspectives of key stakeholder groups can be compared (Bovaird and Loeffler 2007). All of this evidence-gathering is part of the evaluation of co-production, which is covered in detail in Chapter 6. Step 5: ‘Grow-it’ This step concentrates on embedding co-production at both strategic and operational levels in public services and communities through outcomebased commissioning and culture change. Successful co-production initiatives which perform better than other service delivery mechanisms need to be mainstreamed in public services through commissioning. In Sect. 4.2 we discussed how commissioners can tackle social problems by commissioning co-production initiatives focussed on the prevention, treatment and support for recovery or rehabilitation from the problem. This requires a shift towards outcome-based commissioning, so that service providers focus on the achievement of agreed priority outcomes instead of narrow service specifications. In some cases, this may require decommissioning of less successful service delivery models. Of course, this is not always possible—it requires a competitive market with alternative service providers who understand how to put citizen co-production into practice. Above all, it requires courage on the part of commissioners to discontinue historical contracts, launch contracts with new providers and, quite often, face conflicts with long-term providers who may put pressure on local councillors to continue their contracts, even though new service providers may be more innovative and more oriented towards citizen co-production. Furthermore, organisational cultures do not change in the short-term. This also applies to behaviour change in civil society. In order to promote co-productive behaviours among staff and citizens both the ‘software’ and ‘hardware’ of public services need to be changed over time at organisation and systems-level. Following the concept of the ‘cultural web’ of Johnson et al. (2014, 155–157), this requires an alignment of ‘hard’ elements of culture, such as control systems, power and organisational structures, with ‘soft’ elements, such as stories, symbols, rituals and routines. In addressing the ‘hard’ elements of their culture, public service organisations often need to re-assess their performance management systems, in particular, so that co-production is promoted throughout the organisation. Co-production is only likely to be effective if it improves priority

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outcomes. This requires the definition and testing of key outcome indicators and qualitative outcome assessments instead of detailed output indicators, which may be more easily measurable. Ideally, such outcomes frameworks should be co-designed by staff and service users. In addressing the ‘soft’ elements of their culture, public service organisations need to ensure that their human resource management approach is not simply driven by ‘hard’ competency frameworks, tied to quantified skills and performance measurement, but rather recognises and rewards those staff who have particular competencies as community catalysts and enablers. Unless these behaviours are made explicit and clearly valued, it will be difficult to recruit the right staff, to reward staff putting coproduction principles into practice or to identify staff not showing these behaviours. Last but not least, growing co-production also requires a dramatic change in the power balance within public service organisations. In particular, this may require a more active role for local councillors as community connectors and guardians of governance principles, giving citizens more power vis-à-vis the bureaucracy. In tackling changes to the ‘soft’ elements of culture, co-production roadshows may help to change stories, symbols and eventually rituals and routines. What is particularly powerful here is to get presentations from the people involved in the co-production initiative—citizen co-producers and frontline staff. For example, job seekers who have contributed to a co-production initiative in a local employment agency are likely to be more convincing than staff members in persuading other job seekers. Furthermore, they will also feel valued being showcased as ‘co-production champions’ (Loeffler and Schulze-Böing 2020). Research has shown that the most important explanatory variable influencing the motivation of citizens to co-produce is political efficacy—the belief that people can make a difference (Parrado et al. 2013; Bovaird et al. 2016). So a key issue in this step is how can public service organisations strengthen political efficacy? First, this requires that public service organisations highlight much more what difference users and communities are already making through everyday co-production. To get this message across, creative approaches such as story-telling and other social marketing mechanisms can be used. Secondly, extra capacity-building, either individually or in communities, can also increase the self-confidence of service users and other citizens. Sustained behaviour change also needs to be underpinned by a range of financial and non-financial incentives to encourage people using services,

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local communities, managers, people responsible for commissioning and delivering services, along with politicians, to co-produce better outcomes. 5.4.2

Using the Five Steps Framework

While the five steps change management model in Fig. 5.3 suggests a specific sequence for rolling out effective co-production approaches, many co-production processes in practice do not necessarily start with a rational planning process or involve an experimentation phase. Indeed, some coproduction initiatives exist (even though often at a small scale) because co-production enthusiasts believe in them without being able to provide sufficient evidence to convince others to adopt or grow them. Such ‘emergent’ co-production approaches can be very effective—but by their very nature they can be very context-specific and difficult to scale out to other contexts. The change management process in Fig. 5.3 may help to systematise this emergent process, while leaving sufficient degrees of freedom to adapt it to specific contexts. Similarly, a specific co-production initiative sometimes becomes fashionable, so that public sector providers ‘buy in’ to it, hoping to achieve the same results which have been achieved by the early adopters who developed it—this is an accusation sometimes levelled at organisations which have adopted the Esther model from Sweden or the Buurtzog model from the Netherlands. The problem here is that imitation can be a rather crude approach, missing the subtleties which made the original coproduction initiative so successful in the setting for which it was devised and for which it was particularly appropriate, so that pure ‘mimicry’ can be quite unsuccessful. Again, the five steps process in Fig. 5.3 may help to ensure that the approach is tailored appropriately to each new context in which it is applied. A key driver of the effectiveness of the change management process will be the skills and commitment of the staff who are responsible for leading it. This applies to the top management of the organisation, who must not only proclaim that co-production is embedded within the overall strategy and culture but also demonstrate by their actions (and budget allocations) that they believe in its importance. Perhaps even more clearly, it applies also to the frontline staff with most direct responsibility for the relationship between public services and citizens. Without each level of the organisation playing its own specific leadership role in the implementation of co-production, the change management process is vulnerable. In

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some cases, it may be valuable to have a dedicated co-production officer responsible for embedding quality assurance in the co-production process from the start and disseminating lessons learnt. This allows co-production to be disseminated more speedily and clearly, when all stakeholders are playing their roles well. Perhaps more importantly, it also allows gaps in commitment and competence to be spotted early, so that remedial action can be taken. The key role of leadership in co-production is discussed in more detail in Sect. 5.5. Change management always needs to be adapted to local circumstances. A local authority which is already very experienced with citizen co-production may wish to agree a co-production charter, as discussed in Step 4, so that new co-production initiatives are provided from the start with a governance framework. For other local authorities with little co-production experience this may seem premature, as stakeholders first need to engage in small-scale co-production activities to understand what rights and responsibilities are required. Therefore, this change management framework should be used in a flexible way. (We discuss the things that can go wrong with the governance of co-production in Sect. 5.6). 5.4.3

Challenges to the Change Management of Co-production

Managing the change to a co-production approach requires motivated coproducers. Most of the co-production literature has focussed on citizen motivations for co-production (Alford 2009; Van Eijk and Steen 2016). However, effective co-production initiatives require the contributions of a range of stakeholders, who are likely to be driven by different motivation factors. Furthermore, they are likely to have different mechanisms available to them, through which they can influence others to co-produce. The influence exerted by stakeholders on each other is likely be mutual even though not always equally strong. In particular, the way influence relationships are perceived will be different from stakeholder to stakeholder. Table 5.3 sets out some propositions about which factors may motivate key stakeholders to co-produce in their organisation or community, as well as which influence mechanisms stakeholders may use to widen and deepen co-production. It is important to note that, just as citizens are likely to be influenced by other stakeholders (particularly by front-line staff of public and third sector organisations but also partially by managers and local councillors, depending on the issue), they as citizens are also likely to exert an influence, to varying degrees, in the other direction

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Table 5.3 Motivation factors and influence mechanisms for co-production Stakeholder

Motivation factors

Mechanisms for Influencing other stakeholders

Service users

In most cases intrinsic motivation is foremost, but for some co-production activities which can be easily monitored it may be appropriate to incentivise citizens through payments or other material rewards

Communities

In most cases intrinsic motivation is foremost, but for some co-producing activities, co-production can be incentivised by offering funds for local community organisations or improvement of local facilities

Politicians

Better outcomes for constituents Reducing need for unpopular service cuts More votes from satisfied citizens Promoting democracy by engaging citizens more in public sector decisions

Front-line staff in provider organisations

Many staff are motivated by the increased responsibility and job satisfaction they get from working with citizen co-producers

Inspiring others by acting as a role model Lobbying public services to give a greater role to service users Conferring legitimacy on co-production activities by their participation Inspiring others by acting as a template Lobbying public services to give a greater role to communities Conferring legitimacy on co-production activities by their participation Policies which embed co-production Agreeing budgets for co-produced initiatives and re-allocating budgets to successful co-production initiatives Setting and policing regulations which embed co-production Lobbying for policy change in other public service organisations Valuing the contributions of citizen co-producers and showcasing them to others Matching the capabilities of service users to needs of community members (and vice versa) so that citizen co-producers feel useful Identifying and promoting emergent good practice in user/community self-organisation and helping to shape it to become co-production

(continued)

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Table 5.3 (continued) Stakeholder

Motivation factors

Mechanisms for Influencing other stakeholders

Top managers in provider organisations

Improved service performance, because of more reliable pathways to service quality and outcomes Lower costs Winning more contracts

Top managers in commissioning organisations

Improving outcomes for citizens, especially key target groups for public sector Reducing demand for statutory services—and therefore pressure on budgets More scope for social innovation

Embedding co-production in performance agreements with staff Providing staff training and other forms of support for co-production Supporting service users to help them co-produce Embedding co-production in contracts with providers Providing staff training and other support for co-production across public service organisations Supporting citizens and communities to help them co-produce

Source Author

on the other stakeholders. Again, creativity is needed in finding influence mechanisms which have a direct effect on a specific stakeholder—the generic examples given in Table 5.3 are only a starting point. As Table 5.3 shows, motivation factors and influence mechanisms are likely to differ from stakeholder to stakeholder. This needs to be taken into account when designing a menu of incentives for turning stakeholders into co-producers. It is likely that incentive schemes will be more appropriate if they are co-designed with the co-producers concerned. As Alford (2009, 197) points out, in the case of user co-production which involves simple tasks, material rewards may be appropriate. For example, in some countries such as the UK tax agencies have incentivised taxpayers to submit their tax declaration online by granting them more time for submission compared to paper-based filing. Material rewards may also be used in the case of community co-production, where the contribution of the community can be easily specified and monitored, as in crowdfunding schemes. However, if user or community co-production involves complex issues, intrinsic rewards are likely to be more effective (Alford 2009, 1997). Creativity is obviously needed here—an appropriate incentive for young citizen co-producers might be a certificate

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documenting their volunteer contributions which could help in job applications. In the case of elderly citizen co-producers, an invitation to a social evening where their contributions are recognised in public may be more appreciated. The mutual influence mechanisms between citizens and elected politicians are core to co-production in representative democracies. In political systems characterised by democratic governance, citizens may exert political influence on politicians to agree to co-production approaches—this happens most obviously through their voting preferences in elections but it also operates through the use of their voice between elections. In the digital age social media now make voice mechanisms much easier to use, putting people in touch with other like-minded citizens. In the other direction, some local authorities give councillors smallscale ‘community chest’ budgets at neighbourhood level in order to seed-fund community actions—e.g. the Borough of Berlin-Lichtenberg introduced community chests in 2010 to provide seed-funding for coproduction initiatives at neighbourhood level (Loeffler and Martin 2016, 312). In some local authorities, the political leader (in some political systems, the directly elected mayor) invites particularly distinguished volunteers to a meeting or even for a meal to make them feel valued. Many local authorities also run annual awards to show how much they value volunteers—and this also typically provides photo opportunities for local politicians, which can help to cement their commitment, too. Some local authorities have also provided highly engaged volunteers with ‘bonus cards’ as a token of appreciation, giving them free or cheap access to public facilities such as swimming pools. While only a few academic co-production publications have provided a dynamic perspective on citizen co-production (for example, Bianchi et al. 2017) time is a key issue in change management. In particular, different stakeholders often appear to have different perceptions of time. While professionals typically expect that setting up a co-production initiative may take a lot of time, many citizens can’t understand the slow decisionmaking processes in public service organisations, with the risk that they often lose interest. For example, the 750,000 volunteers who signed up to help the NHS in the early stages of the Covid-19 ‘emergency’ were disappointed to find that only 20,000 of them were allocated tasks during the first month (Hodder 2020). Change management of co-production may therefore be more successful when it focuses on small-scale and local experimentation to enable quick learning processes, which then

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quickly influence decision-making. In line with normal design thinking, this suggests that co-producers need to have opportunities and permission ‘to fail early, fail fast, fail cheap’ (Bovaird and Quirk 2017). Another challenge to change management is the lack of resources in contexts of austerity. In public service organisations, where staff are already stretched or experiencing frequent restructuring, it will be challenging to dedicate staff time to citizen co-production. While staff may be committed to implementing citizen co-production, they may also have other strategic and operational priorities, which may seem to them more urgent (and possibly more important) in practice than specific coproduction initiatives. In these circumstances, citizen co-production may typically be considered as a ‘nice to have’, appropriate only where there are sufficient resources in public service organisations for implementation, such as external grants. Clearly, time is of the essence here—if it takes too long for co-production to become considered as a ‘must have’ in an organisation whose circumstances have tempted it to consider putting greater emphasis on a co-productive approach, by the time a positive decision is made, other priorities may have intruded and there may no longer be sufficient staff time or other resources to develop, improve and scale co-production. Therefore, a key challenge for the change management of co-production is to make timely use of any window of opportunity which occurs, so that co-production can be turned into a ‘must have’, while there is still some slack in the organisation to innovate. There is also a major debate about the right mix of ‘inside-out’ and ‘outside-in’ change management for effective co-production. As discussed in Sect. 2.5, co-production may be initiated by public service organisations reaching out to citizens through an inside-out pathway; alternatively, through the outside-in pathway, it can build on local community initiatives. Brandsen et al. (2017) make the point that change management using an inside-out pathway entails the risk that citizen voice and action may be stifled by the typical bureaucratic governance in public service organisations. However, Brandsen et al. (2017) also recognise the danger that ‘truly spontaneous citizen initiatives’ may only focus on private value, which may even conflict with public value. This legitimises public interventions which seek to add professional knowledge, skills and resources to community initiatives through additive co-production, so that public value can also be achieved. Another classical change management issue, which is highly relevant in the context of co-production, is the balance between top-down and

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bottom-up management within public service organisations and local communities. There has been relatively little empirical research on either the extent to which more ‘bottom-up’ organisational structures, with highly participative staff, promote co-production with citizens. More empirical research is also required to identify how front-line staff can be equipped with all the skills necessary to promote bottomup co-production—and also to deal with the unlearning of old habits and practices which is typically also involved. There is evidence that social enterprises, with their more participatory work environment, offer staff greater possibilities of self-development and more responsibility (Pestoff 2019, 182–183) and this may encourage staff to seek increased levels of user co-production. However, more research is needed on how strong is this factor. Similarly, little empirical research has explored the balance between bottom-up and top-down implementation at community level. It is often assumed that community initiatives are bottom-up by definition but this is mistaken. It depends on the leadership of self-styled ‘community leaders’—some may relish their power and seek to crush alternative ideas and initiatives, whereas other, more facilitative ‘community leaders’ may seek to share the role and indeed to bring on other community leaders. Table 5.4 distinguishes between inside-out and outside-in pathways for the initiation of co-production initiatives from the point of view of public service organisations and the implementation of specific coproduction initiatives by a public sector organisation, which may either be driven ‘top-down in a strongly hierarchical process or led by frontline staff, as bottom-up implementation. (A similar table could be constructed Table 5.4 Top-down and bottom-up versus inside-out and outside-in change management strategies Types of change management strategies

Top-down strategies at organisational level

Bottom-up strategies at organisational level

Inside-out strategies

Expert patient scheme in the UK Environmental improvement scheme in Rimini, Italy

Clean City Linköping, Sweden Cycling scheme with care home residents, Denmark

Outside-in strategies Source Author

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for community organisations, substituting ‘top-down’ and ‘bottom-up’ strategies at community level). Co-production initiatives which are initiated by public service organisations and implemented from the top in a centralised way are likely to be most common. For example, in the UK the government pledged to implement an expert patient programme as the new NHS approach to chronic disease management and set out a commitment to implement this lay-led self-care programme in the 10 year NHS Plan published in 2000 (Donaldson 2003). By 2007, the Department of Health had invested £18 m in the programme, with an explicit goal of providing the course to 100,000 patients (Griffiths et al. 2007). An example of a co-production initiative which took an ‘outside-in’ pathway from the local community to the local authority is the environmental improvement scheme CI.VI.VO. in the City of Rimini in Italy, which was initiated by a dissatisfied citizen who took action to tidy up a local part (Artuso and Montini 2016). This was followed by a number of meetings between citizens and the local authority to discuss how to scale this initiative. As a result, the project received formal approval of the Municipal Council on 18 October 2011 and was resourced with two full staff members and a manager to coordinate the volunteer actions—so the initiative was ‘outside-in’ in its conception but became ‘top-down’ in implementation. Of course, some co-production initiatives are driven more strongly by front-line staff. In Sweden a city gardener and youth liaison officer were highly engaged in the launch and implementation of a new co-design project to tackle litter in the city centre of Linköping (Timm-Arnold 2014). This co-production initiative aimed at bringing about behaviour change of young people by co-designing environmental campaigns and improvement actions with them. Here the co-production arose ‘insideout’ but was bottom-up in implementation. An example of a bottom-up but outside-in co-production initiative is a Danish cycling scheme which involves volunteers offering free rides on bicycle rickshaws (funded by the local authority) to older people and people with disabilities who have difficulties getting around (Tortzen 2016). This co-production initiative was started in Copenhagen by a citizen who lived close to a care home in a residential part of Copenhagen and observed the residents out with their walking frames or being pushed around the block in their wheelchairs. His thought up the idea of providing care residents with more mobility, and also more company,

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by taking them around in a bicycle rickshaw. A community worker picked up this idea and marketed it to the local authority, getting funding for five rickshaws initially. The so-called “Cycling Without Age” scheme is now run by a non-profit organisation and has been implemented by more than 60 Danish local authorities, with a total of 2500 volunteers. Furthermore, similar schemes are now being set up in 26 countries, based on an international license. While all four approaches exemplified in Table 5.4 are clearly both possible and potentially interesting, it has to be recognised that coproduction initiatives which are implemented bottom-up in public service organisations may fail to get the buy-in of political and other strategic decision-makers, no matter how well they work or how much they benefit from the hands-on experience of front-line staff. So even if there is evidence of improved outcomes, they do not necessarily continue to be supported by the public service organisation. More research is needed on how to overcome this barrier to scaling effective co-production initiatives which are bottom-up in conception.

5.5 5.5.1

Leadership for Co-production

Distributed Leadership Concepts and a Relational Leadership Perspective

While there has been a lot of debate on the role of power in the context of co-production, there has not been much academic research on leadership in co-production contexts until recently (for example, Schlappa 2017; Bussu and Galanti 2018; Schlappa and Imani 2018; Tortzen 2018; Schlappa et al. 2020). As Schlappa et al. (2020) point out, the dominant perspectives on public leadership tend to be rooted in the notion that leaders are the source of leadership and perform their roles within organisations pursing goals that are pre-defined in political and managerial arenas. However, as we have already discussed in Sect. 5.4, in most co-production initiatives outcomes can only partly be planned and their achievement requires joint deliberation and/or co-ordinated action between professionals and citizens. For Schlappa et al. (2020) coproduction highlights the limited value of the leader-centric perspectives in explaining how leading happens in contemporary public services.

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Instead, concepts of distributed public leadership provide a much more appropriate theoretical lens for understanding leadership in many coproductive settings (Bussu and Galanti 2018, 358). Schlappa et al. (2020) suggest that in a co-production relationship, professionals do not, and perhaps should not aim to, assume a privileged position in relation to citizens, casting them into the role of followers of an appointed, or self-appointed, leader with power. Leading co-production is therefore a shared responsibility, involving professionals and citizens in contributing their skills, resources and authority to accomplish a particular task. Concepts of distributed leadership view leadership not as a characteristic of an individual but as an emergent property of groups or networks of interacting individuals who are enabled to contribute their wide range of expertise to the process (Bennett et al. 2003, 7). Clearly, in a co-production context, potential leaders not only include members of public service organisations but also service users and local communities—it is often overlooked that co-producing citizens may also provide leadership through influencing front-line staff and even managers in a number of ways. For Bartels (2016, 359) “integrative, experiential and holistic” encounters between public professionals and citizens are key for developing effective modes of interactive governance, which enable new co-production initiatives. Within such co-productive settings, “every stakeholder can take a lead on specific issues” (Bussu and Bartels 2014, 2258). For example, in the falls prevention co-production initiative of the Health and Social Care Partnership of Aberdeen City, leadership is shared among group members, depending on their skills and interests. Everyone plays an equal part in the project and this releases a stream of rich and diverse ideas. As a result, there is endless scope to do things differently. One Falls Ambassador has started a ‘Conversation Table’ in the cafe at the Music Hall in Aberdeen and talks about falls prevention to any interested members of the public (Thompson and McConnachie 2019). Consequently, Schlappa et al. (2020) propose an extension of distributed leadership concepts by conceiving a co-production process between professionals and citizens from a relational leadership perspective. This means that the co-production process is inherently negotiated, emergent and reliant on many actors, some of whom may have common motivations, while others have contrasting motivations. Each can exercise some power, which in turn is moderated by the context in which these relations occur (Schlappa et al. 2020). Such a relational perspective implies that co-production is not characterised by ‘equal and reciprocal

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relationships’ between professionals and citizens, as power relationships are fluent and change over time. This conceptual framework allows Schlappa et al. (2020) to consider the context in which leadership occurs, the motivations the co-producers bring to the collaboration, and their power relations, as elaborated further in their chapter. Altogether, this shift from leader-centred leadership theories towards systems approaches in public leadership aligns with an understanding of public leadership as a collective phenomenon (Crosby and Bryson 2018, 1271). So how can public leadership be defined in the context of coproduction? Hartley and Benington (2011, 5) define public leadership as “a set of processes concerned with mobilizing action by many people towards common goals, and the framing of those goals”. This definition puts less focus on the qualities of individual leaders or their formal positions but rather considers leadership as a social process which has the purpose of mobilising collective action to achieve common goals. However, user and community co-production of public services and outcomes does not always need to mobilise many actors, as suggested in the Hartley and Benington definition—indeed, user co-production may involve individual forms of co-production and even community coproduction may only include small groups. Furthermore, leadership in co-productive settings often involves enabling joint learning processes resulting from individual or collective action. This needs to be reflected in the definition of leadership; we therefore define leadership of coproduction as ‘a set of processes concerned with mobilising individual or collective action towards common goals, the framing of those goals and joint learning’. Leadership for co-production by definition transcends all artificial borders. It typically involves “leadership across organizational and geopolitical boundaries, beyond individual professional disciplines, within a range of organizational and stakeholder cultures, and often without managerial control” (Van Dyke 2013, 4). For example, leadership in co-production may come from third sector rather than public sector organisations—especially where third sector organisations are believed to be closer to communities which are hard to reach for public sector organisations and where their specialist expertise gives them more credibility in helping people to change their behaviour and become co-producers. For example, the London Borough of Lambeth has commissioned the third sector organisation Mosaic Clubhouse to co-produce better health and wellbeing with their service users who experience mental health issues.

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Mosaic Clubhouse is dedicated to a co-production model, based on the principles of the international Clubhouse Network (Ness 2014), and staff and members work side-by-side to carry out the work of Clubhouse— from administration to cooking meals in the Clubhouse kitchen. Again, in some countries such as Sweden, many small social enterprises such as the parent pre-school cooperatives (Pestoff 2019, 182) have developed a co-productive service model, However, not all third sector organisations provide leadership for co-production. Often, big national third sector organisations find it more challenging to reach out to citizens to engage them in co-production—and the influence of service users on corporate decisions of such big third sector organisations may be very limited. However, citizens can strengthen co-productive social enterprises by making use of them or by contributing their time and financial resources or, indeed, by setting up their own new social enterprises in order to co-produce better outcomes. Van Dyke’s point that leadership must often operate “without managerial control” is particularly important. As Hartley and Benington (2010, 19) point out, collaborative leadership theories have typically emphasised the importance of exerting influence and not control. Our suggested definition of leadership for co-production views leadership as a set of processes occurring between those trying to influence and those being influenced with regard to a specific issue. The latter may again influence others to take specific actions, so there is no longer a neat separation between ‘leaders’ and ‘followers’ but a set of relationships of mutual influence. Leadership for co-production also requires appropriate learning processes. In many cases, co-production initiatives will focus on complex issues where stakeholders first need to agree on their framing of the problem concerned, before experimenting with potential solutions. Clearly, co-producing solutions in complicated or complex knowledge domains is a much more challenging leadership task than tackling tame problems in simple knowledge domains, as characterised by Snowden and Boone (2007). Indeed, Heifetz et al. (2009, 19) state, “the most common leadership failure stems from attempting to apply technical solutions to adaptive challenges”. Complex issues are closely linked to complexity theory, which is at the heart of concepts of systems leadership. One of the key propositions of complexity theory is that the characteristics of a system emerge from the behaviour of the system as a whole, and cannot simply be predicted by looking at individual properties of the

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system (Koliba and Koppenjan 2016, 264). One implication for the leadership of complex systems is that it is only by observing the system-wide consequences of leadership actions that we can develop our understanding of the system in which we are attempting to lead. This is illustrated by the case study of Services for Young People in Surrey County Council, which provided a number of third sector service providers with co-production training in order to support them to achieve shared outcomes for young people categorised as NEET (Not in Employment, Education or Training) (Bovaird and Loeffler 2014). The first round of commissioning involved an intense learning process for both commissioners and service providers. For example, the commissioning of the Local Prevention Framework was highly innovative, as young people were involved in the commissioning process and the budget was devolved to Local Committees at borough-level (Bovaird and Loeffler 2014, 22). Where doubts arose about performance of providers delivering the Local Prevention Framework during the first round of contracts, a rapid response was made, changing the model and recommissioning the services in a way which quickly proved to be effective (Bovaird and Loeffler 2014, 36). Here, there was explicit recognition of the complexity of the system-wide interconnections between all the variables influencing the employability of young people and therefore that accurate forecasting of outcomes in advance was impossible. Leaders at different parts of the system were responsible for suggesting, implementing and monitoring experimental ways forward, then learning and adapting in the light of experience. As the example from Surrey CC shows, a key element of systems leadership is action learning. Typically, learning processes in organisations have focussed on cognitive learning. However, user and community coproduction also generates tacit knowledge—a concept widely associated with Michael Polanyi (1966), who focused on the ‘tacit coefficient’ of scientific reasoning, which he conceptualized as the ‘intuitive’ grasp of ‘reality’ grounded in the power of a ‘potential discovery’ to ‘attract the mind’ and ‘impart intimations’ so that it may eventually ‘emerge into reality’. The challenge of systems leadership is to overcome the boundaries between cognitive and tacit knowledge, so that professionals and citizens can learn from each other in co-production processes. Furthermore, action learning implies learning from mistakes. This is a big challenge in many organisations. In particular, many public service organisations are heavily risk adverse and have developed a blame culture, which strongly reinforces this. However, systems leadership requires a culture which

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enables co-producing citizens to take on acceptable risks, rather than simply minimising risks, as discussed earlier in this chapter. A key element of this culture must be trust—and this trust must characterise relationships throughout the system, not just at some levels. For example, while some public managers may have the trust of their political leader to experiment with new types of co-production, so that their leaders simply let the co-producers get on with it, other public managers may have less access to politicians and lack such trust relationships. As a result, the political leadership may decide to cut funding, even of successful co-production initiatives. Clearly power relationships should not be perceived as static but rather as negotiated between people who collaborate to achieve shared outcomes. As Schlappa et al. (2020) point out, this dynamic understanding of power as processes of influence is integral to the analysis of how co-production is being led, as power will shift between professional and citizen co-producers according to their expertise, knowledge, resources and status, as well as the stage which the co-production process has reached. This puts the debate on ‘imbalances of power’ in a different perspective, as relational conceptions of leadership recognise that power is not just based on formal authority but on how co-producers influence each other. For example, the neighbourhood initiative “Pride of Place” in Bristol was initiated by a small number of local residents of a social housing estate who were concerned about littering on the estate and who started to walk around the estate with key staff of the Bristol Community Housing Foundation and noted down issues of concern (Jacobs-Lange 2011). The list of issues was then logged onto a database by the Community Development Worker and farmed out to the relevant staff member or external agency to follow up—a traditional bureaucratic process. After only two months of walkabouts, residents felt they would like to deal with the street litter directly while they actually walked around, so the organisation running the housing estate invested in litter pickers, a pullalong garden truck and high-visibility tabards, so that litter picks could be incorporated into the walkabouts. Walkabouts were advertised in advance and the group started to attract some additional members, including new residents. The Bristol Community Housing Foundation then gave the title of ‘Street Rep’ to the residents volunteering in these environmental activities and started a recruiting campaign, which led to a further 34 residents applying to become Street Reps—giving coverage in the majority of

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streets. A local resident said: “Being a Street Rep has really made a difference to the amount of pride people take in their neighbourhood. Other residents see our group in the area and recognise us as their neighbours; this helps to raise awareness of the need to do their bit to keep the area tidy” (cited in Jacobs-Lange 2011). This co-production approach, which places residents in the driving seat, together with the strong relationships between the volunteers and local police and waste management staff, has helped to change the dynamics of neighbourhood management in the area away from dealing with a simple list of anonymous issues to a setting where relationships drive action and all co-producers start to appreciate each other’s position. However, Garven (2013, 116) cautions that “co-production may be an option only for the most sophisticated and experienced groups and even they may be less than enthusiastic …”. As Alford (2009, 183–201) points out, the two key preconditions for citizens to co-produce are willingness and ability to make a contribution to improve public services or outcomes. Both of these preconditions may be addressed through a stronger emphasis on place-based leadership, including the development and implementation of new kinds of civic leadership programmes, which target under-represented groups at the local level, as currently practiced in the City of Bristol (Hambleton 2019, 276), which involves elected politicians, people working in public services, business, local communities and trade unions co-creating new solutions to public problems. Summing-up, concepts of distributed leadership have the merit of highlighting the role of influence in mobilising collective action to achieve shared objectives through co-production. While there is no lack of taxonomies of collective leadership concepts, further empirical public leadership research is needed to analyse the relationships between influence (or power) and motivation factors for co-production within specific contexts. For example, to what extent are front-line staff willing to work overtime to experiment with new types of co-production in their organisation? This may depend not only on their values and their belief that this is the right thing to do but also on the influence of their top managers. As Alford (2009, 197) points out, inducing citizens to co-produce “is a matter of increasing the salience of the value which the client receives from the service by making its non-material aspects – intrinsic rewards, solidarity incentives, or normative appeals – more explicit”. This requires relational leadership but also knowledge of motivating factors and the right types of incentives for specific stakeholders.

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Last but not least, relational leadership is enabled and constrained by institutional contexts (Schlappa et al. 2020). For instance, co-production in Tortzen’s (2018) Danish case study ‘Zebra City’ in the Municipality of Roskilde is characterised by a mixed governance mode, with elements of ‘new public governance’ and ‘new public management’. On the one hand, professionals aimed to enable community initiatives in public housing estates with a high proportion of vulnerable groups by strengthening community networks—a typical task of public governance On the other hand, staff had to achieve targets such as a specific number of new community initiatives within a specific period and to recruit a specific number of new volunteers for local voluntary organisations (Tortzen 2018, 113)—a typical managerialist approach. More research is needed on how relational leadership from the top may (or may not) support co-production between front-line staff and citizens. And how much leadership from ‘the bottom’ by front-line staff and citizens is possible in a representative political system, where local councillors are accountable for public governance principles and the results achieved?

5.6

Negative Sides of Co-production and Ways of Addressing Them

Not only the results of citizen co-production matter but also the way in which they are achieved. (This will further be discussed under our definition of public value in Sect. 6.2.) Here we first examine how coproduction may, in some circumstances, reduce outcomes; then in the following sub-section we explore how co-production may sometimes contravene key public governance principles. In the final sub-section we look at some aspects of the ‘dark side’ of co-production, where it contravenes legal, regulatory or moral codes. Stakeholders involved in co-production therefore need to balance how it helps to achieve priority public outcomes and governance principles, against the negative effects it may have—this will be discussed in Chapter 6. 5.6.1

Negative Impacts of Co-production on Outcomes and Ways of Addressing Them

In this sub-section, we examine how co-production can have negative effects on public services and outcomes—see Table 5.5. In fact, the

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Table 5.5 Negative impacts of co-production and ways of addressing them: typology and examples Types of negative impacts

Examples

Possible ways of addressing negative outcomes

Publicly-desired outcomes of co-production initiative have not been achieved

Some kinds of volunteer activity is not appropriate to reduce the number of NEET young people in Surrey County Council (Tisdall 2014) The ‘Family-Nurse-Partnership’ Programme has positive results but also high costs for public sector organisations (Loeffler and Trotter 2012)

Re-design of existing co-production initiative Decommissioning of ineffective co-production initiative

Unfavourable or negative cost-benefit ratio

Deterioration of service quality

Loss of jobs by professionals

Exploitation of citizens engaged in co-production initiatives

Reduced costs of paid staff by using more peer support Increased use of digital technology to reduce cost of building and maintaining social networks among young parents Proper induction of Insufficient training volunteers and support or bad Better use of assets of coordination of volunteers volunteers (for example, working with paid staff in language skills) libraries in the UK (Baber More flexible working 2018) times to ensure paid staff and volunteers have convenient and sustainable work schedules Library services increasingly Reallocation of staff to co-delivered by volunteers other tasks (e.g. training (BBC 2016) who replace library users) professional roles in UK Retraining of staff to move libraries to other services (e.g. evidence gathering for service reviews) Volunteers who are effective Widen the number of in co-production are pressed volunteers to get involved in more and Increase the use of digital more co-production technologies, so initiatives (Baber (2018, 6) co-production activities take less time or effort by citizens Better professional support of volunteers Peer support of volunteers

(continued)

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Table 5.5 (continued) Types of negative impacts

Examples

Possible ways of addressing negative outcomes

Creation of new dependencies

Some volunteers working with local authorities in Germany initially solved issues for refugees instead of helping them to help themselves (Schiffauer 2017, 23–24)

Training of volunteers in the principles of co-production Providing citizens in target group with more opportunities to make a contribution (e.g. as peer trainer) Developing peer support for citizens in target group

Source Author

academic literature provides relatively few case studies with evidence of negative impacts arising from co-production with citizens, so the examples here often draw on government reports or other grey literature. In many cases in Table 5.5 the negative impacts highlighted are likely to be stakeholder-specific and may therefore be counterbalanced by positive impacts experienced by other stakeholders. A co-production initiative is likely to be judged unsuccessful if publicly desired outcomes have not been achieved. This is, of course, unfair—the relevant question is to what extent any change in public outcomes has been caused by citizen co-production? This requires the measurement of the level of outcomes before and after a co-production initiative is implemented. This is, however, not so easy—as discussed in Chapter 6, many co-production initiatives lack clearly defined priority outcomes and, even where they exist, they may take a long time to become apparent and may be evident in quite different places and experienced by quite different people from those involved in the original co-production initiative. Moreover, when co-production initiatives involve wicked issues, we need to recognise that not all pathways to outcomes can be defined ex ante and that some changes to outcomes are likely to emerge unexpectedly during the co-production process. Our evaluation approach, therefore, has to recognise emergent outcomes as well as planned outcomes—and even if some intended outcomes have not been improved, co-production may have achieved some publicly-desirable unintended outcomes.

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Notwithstanding these issues with understanding the causes of outcome changes, it has to be accepted that co-production will not always impact positively on outcomes. An example is the support of Surrey County Council for volunteering initiatives in order to reduce the number of young people who were categorised as NEETs (Not in Education, Employment or Training). A review of services for young people undertaken by Surrey County Council in 2010 concluded that whilst there were over 1000 youth organisations in Surrey working with volunteers to deliver over 11,000 hours a week of provision (there is more capacity than young people have free time) young people were not taking full advantage of these (Surrey County Council 2010, 6). In spite of these offers of support, including much volunteering, the number of NEET young people had remained constant around 1000 between 2003 and 2012 (Tisdall 2014). It was recognised as likely that the work of volunteers had created other positive outcomes, such as increased wellbeing of the volunteers and the young people they worked with—but this probably did not bring much benefit to disadvantaged young people, since it was other young people who were already thriving who were mainly able to make use of the available services and support for young people. Surrey County Council therefore decided to transform Services for Young People, based on a new portfolio of services targeted directly at NEET young people (Tisdall 2014). This included the development of new, more effective coproduction initiatives such as the Volunteer Host Service for young people at risk of homelessness and a restorative justice approach for young people at risk of entering the criminal justice system. However, the decommissioning of service providers is quite difficult in the context of public services, where it is often not possible simply to stop or phase out ineffective co-production initiatives (Bunt and Leadbeater 2012). Many professionals and elected councillors are also reluctant to put a stop to volunteering activities, as they consider volunteering as beneficial per se. It is therefore often easier to address ineffective co-production initiatives by redesigning them—and, indeed, systems theory suggests that experimental approaches with iterative redesign and learning loops are key to social innovation. Even if a co-production initiative achieves positive outcomes, the question remains: at what cost? If the cost-benefit ratio for the public sector organisation is negative, commissioners are likely to consider alternative, more cost-effective public service models. The same question

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arises when the cost-benefit ratio of a co-production initiative is positive but at a high cost for the public sector. One example of this is the Family-Nurse-Partnership (FNP) Programme, which is a licensed preventative co-production programme from the USA which aims to improve outcomes for young first-time mothers and their children (Olds 2006). It aims to enable young teenage parents to achieve positive outcomes for their child and their own development. The co-production approach is based on an intense relationship with a specially trained Family Nurse, from early pregnancy until the child is two years old. During a programme of home visits, the FNP nurse builds a therapeutic relationship with the young parents to enable them to strengthen their parenting skills and resources, whilst also developing and realising their own aspirations (Loeffler and Trotter 2012). Even though there is evidence of a range of positive outcomes from the USA (Olds 2006) and Scotland (Ormston et al. 2014), the costs of the programme in Scotland have been estimated to be high, at approximately £3000 per annum per client who completed the programme (Loeffler and Trotter 2012). One way of creating a more positive cost-benefit ratio could be to reduce the contributions which have to be made by the nurse, by developing a peer support network among young parents, which might also be supported through digital technology. While volunteering is often considered as positive per se, co-production with volunteers in public services may also be perceived negatively if it is done badly, so that community co-production leads to a deterioration of service quality (and potentially worse public outcomes). Baber (2018, 4) highlights issues of consistency and reliability when libraries rely on volunteers, such as casual and sometimes erratic attendance, which can result in disruptions to the service and damage to its reputation. Clearly, managing volunteers is quite a challenge, when the role of a volunteering manager is simply added to a person’s day job as a librarian—for example, in North Somerset Council one librarian who previously managed five part-time staff now has to manage one full-time staff member and 102 volunteers (Baber 2018, 4). However, these issues can be addressed in a number of ways: For example, more experienced volunteers may provide support to staff to skill up new volunteers. Effective use of the strengths of volunteers may also enable staff to increase the existing service offer through community activities, in particular, if volunteers come from diverse groups. However, as an interview with a library manager cited by Baber (2018, 7) suggests, the vast majority of volunteers attracted by the

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library services of an English local authority are not fully representative of local ethnic and age groups. Last but not least, more flexible working times and the use of digital technologies could also help to coordinate the co-production of staff members with volunteers. However, substitutive forms of co-production which replace significant staff inputs by unpaid citizen inputs are likely to lead eventually to fewer paid staff in the service. While this may bring about politically desired savings, and potentially increase the efficiency of public service delivery, this impact is likely to be perceived negatively by the staff concerned. While there is, so far, no direct quantitative evidence on the extent of job losses due to co-production in any public service, the analysis of the BBC (2016) concerning the impact of cuts in library services in the UK is revealing: According to data compiled through the Freedom of Information Act from 207 local authorities responsible for running libraries, in the six years after 2010 some 343 libraries closed and a further 174 libraries were transferred to community groups, while 50 were handed over to external organisations to run. At the same time, the number of unpaid volunteers working in libraries doubled from 15,861 to 31,403, while paid staff decreased from 31,977 to 24,044. Clearly, if public libraries are transformed into community libraries without any support from the public sector, this is no longer a case of co-production but rather community self-organisation. However, many public libraries which are run by local community groups do also get support from the Library and Information Service of the local authority, so remain examples of co-production. For example, the transformation of the library services in Vale of Glamorgan Council in Wales led to five libraries run by local community groups with support from council’s Library and Information Service, in addition to 4 remaining libraries run by full-time staff (Vale of Glamorgan Council 2019). There are several ways of addressing the impact of citizens substituting roles previously undertaken by paid staff. The staff concerned may be reallocated to other tasks, for example, training new groups of library users or spending more time with library user groups who have complex needs. In some cases, of course, staff who have been substituted by citizen coproducers may have to retrain in other services. These could be services which can make use of some of the librarian’s old skills, e.g. information management or gathering evidence for analytical activities in the organisation, such as service reviews. However, if there is political agreement that substitutive forms of co-production are undesirable, the implication is

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that co-production cannot contribute to making budget savings in public services. Another negative impact of co-production which is identified in the literature is demotivation of volunteers, which may result in ‘burn-out’. In particular, as Baber (2018, 6) points out, external pressures may push volunteers “to take on more work than they were initially able to, and outside their capabilities. Untrained volunteers may not be able to cope with increased and unattainable expectations and workload”. This may lead to frustration among volunteers and in some cases, make them unwilling to continue volunteering. Such overuse or misuse of volunteers can be avoided through widening the network of volunteers, e.g. by tapping into the social network of existing volunteers, since they often know people with similar interests who may be willing to become co-producers. Even in contexts of austerity citizen co-producers need to be supported properly. Professionals may help them to provide peer advice and support to each other. In particular, professionals need to recognise that the interests of citizen co-producers are likely to change over time and that different co-production offers are needed at different points of time to maintain sustainability. Another emerging but unintended result from ineffective user and community co-production may be the creation of new dependencies between ‘helpers’ and ‘those being helped’. In these cases, professionals or even volunteers working with public service organisations, rather than helping citizens to help themselves, focus on solving most problems on their behalf. At the extreme, where citizens are asked to do little or nothing to help themselves, such relationships would not qualify as coproduction as defined in this book. However, typically there is at least a minimum level of user input but it is not built upon to create the fully co-productive relationship which could be available. An example is the attitude and behaviour of some local citizens who volunteered to help refugees arriving in Germany in 2015. Some public officers suggested that, in some cases, the help offered initially was more than the refugees actually needed and risked creating new dependencies, However, Schiffauer (2017, 23–24) suggest that this changed over time, as engaged citizens shifted to co-producing better integration with refugees rather than ‘taking care of helpless victims’. Finally, the literature also considers ‘deprofessionalisation’ as another negative impact of co-production (Baber 2018, 8). However, as Tuurnas

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(2015) suggests, this may be a necessary step in breaking down professional barriers and enabling professionals and citizens to co-produce more effectively. 5.6.2

Pitfalls in Public Governance from Co-production

The literature also discusses a number of negative consequences on the implementation of public governance principles which can arise from user and community co-production. Most of these pitfalls in public governance are not unique to co-production but can also occur in other forms of collaboration, such as partnership working between public sector organisations and public, private or non-profit organisations. The normative concept of ‘good governance’ highlights a number of governance principles such as accountability, transparency, engagement, sustainability, equalities and the rule of law (Loeffler 2016, 210–211). While there is a considerable similarity between the various lists of good governance principles promoted by international organisations, what good governance means in practice has to be defined in context-specific ways. Given that it is impossible to implement every desirable governance principle simultaneously, stakeholders need to agree on strategic governance priorities. Inevitably, trade-offs have to be made between specific governance principles—and also between the achievement of outcomes and governance principles (see Sect. 6.2 on public value). Clearly, the implementation of agreed public governance principles requires resources. Moreover, public governance implies the adoption of certain rules and regulations governing people’s behaviour, and some of these are often perceived by citizen co-producers (and indeed by staff in public service organisations) as ‘red tape’. For example, accountability requirements may imply that stakeholders engaged in co-production need to write an annual report to give an account of outcomes achieved. We therefore have to recognise that the frequent calls by social innovators for public service staff to ‘break the rules’ need to be treated with some caution, since some rules at least may be critical to ensuring the implementation of agreed governance principles. Table 5.6 considers key pitfalls in public governance resulting from co-production and how to address them.

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Table 5.6 Public governance pitfalls from co-production and ways of addressing them Types of pitfalls in public governance

Public governance challenges

Examples

Ways of addressing public governance pitfalls

Lack of accountability

Service users, communities and volunteers and professionals need to give an account and be held to account for their joint actions and decisions

Providing minimum training of citizen co-producers in regulatory framework and accountability mechanisms Effective professional support to help citizen co-producers in public reporting, e.g. through story-telling Ensuring sufficient delegation of authority to citizen co-producers

Lack of transparency

Need for easily-accessible information and procedures on the contributions of co-producing stakeholders

Lack of sustainable engagement

Maintaining a stable and reliable level of service user and community contribution to co-production

Increasing diversity and addressing inequalities

Attracting a suitably diverse range of citizens who are willing to co-produce

Many volunteer board members of non-profit childcare organisations in Manitoba lack capacity and sufficient delegated authority to give account and receive little government support (funding or training) to understand legal and regulatory frameworks (Levasseur 2018) Confidential peer support group meetings run by ‘experts by experience’ with background in mental health issues (Tatam 2011) In Modena, the energy that went into co-design and co-maintaining the website Stradanove shifted to the social media initiative Youngle (www.you ngle.it) Volunteers working in public libraries in Wirral do not come from many diverse backgrounds (Baber 2018)

Quality control (e.g. through user surveys) Co-Production Service Charter Independent advocacy with powers to scrutinise

Recognising that results need to be sustainable but that co-production initiatives change over time Providing appropriate incentives Bringing on new citizen co-producers Enabling the strengths and skills of citizen co-producers from diverse backgrounds Working with third sector organisations as intermediaries to widen recruitment pool ‘Go where people are’ to recruit a wider range of citizen co-producers

(continued)

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Table 5.6 (continued) Types of pitfalls in public governance

Public governance challenges

Examples

Ways of addressing public governance pitfalls

Rule of law

Ensuring compliance with rules by citizen co-producers and professionals, even though some rules may be perceived as barriers to co-production

Lack of compliance with health and safety regulations, data protection and budget rules

Minimum training for citizen co-producers (for example, health and safety regulations) (Meyer and Grosser 2014) Asking for permission to be exempt from rules (for example, through waivers) Transfer co-production initiatives to the third sector which has more flexibilities

Source Author

One of the so-called seven evils highlighted by Steen et al. (2018, 285) is the lack of clear responsibilities resulting from co-production and cocreation. However, when accountability is shared between public service organisations and citizens in the context of co-production, this does not automatically imply “failing accountability” (Steen et al. 2018, 285). Quite the opposite: Shared accountability may imply additional layers of scrutiny and audit beyond traditional forms of government audits, e.g. through trained citizen inspectors or citizen co-assessments. However, there are also cases where co-production initiatives are not supported by appropriate accountability relationships. Levasseur (2018) provides a case study of child care in the Province of Manitoba in Canada where the government of Manitoba provides child care working with non-profit organisations, whose volunteer board members must also include parents. Interviews with board members revealed that more than half of the board members considered that they lacked the necessary skills and knowledge to adequately meet their accountability obligations (Levasseur 2018, 35). Another constraint upon accountability stems from limited delegation of authority from the government to the boards of service delivery organisations, as tight government regulations on, for example, the provision of childcare restrict the actions available to board members. Levasseur (2018, 41) concludes that “while coproduction is limited to

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service delivery, there is a disproportionate burden of accountability whereby citizen co-producers, and their fellow board members, bear the majority of risk and accountability with little support from their counterparts—government co-producers”. Finally, Levasseur (2018, 37–38) also identifies that parents may have limited ability to hold the service delivery board to account. This means that there may be a triple accountability challenge in a co-production context: citizen co-producers may have difficulties in giving account both to government and to the public for a variety of reasons, while service users may have to deal with a lack of transparency when they try to hold co-producers to account. While these accountability challenges may not be completely avoidable, they can be addressed in a number of ways: First of all, it is possible to strengthen the ability of citizen co-producers to give an account by providing some minimum training. For example, in the Manitoba case study (Levasseur 2018), volunteer board members were provided with such training during their induction. At the same time, it would be unrealistic to expect many volunteers to be keen on accountability-oriented tasks, such as report writing. This is typically the strength of professionals. However, professionals can support citizens to make a meaningful contribution to reporting exercises, e.g. through story telling. At the same time, professionals need to be prepared to give citizen co-producers a genuine role in decision-making, as they cannot be held to account for decisions for which they are not responsible. Lack of transparency and lack of accountability often go hand in hand. If citizen co-producers cannot provide appropriate information about their actions or decisions to governments or the public, there is both lack of transparency and problems in holding them to account. However, transparency is not just about information. It implies that co-producing stakeholders act according to fixed and published rules, on the basis of information and procedures that are accessible to the public. Implementation of this governance principle must also ensure that people have easy and effective access to information or other ways of scrutinising the actions and decisions of stakeholders involved in co-production. An important issue is the degree to which transparency can be implemented in co-production relationships which require a high level of trust. In such contexts, the monitoring of the contributions of service users and communities may be perceived as an indication of lack of trust. For example, when service users who are ‘experts by experience’ in mental

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health issues (and who are trained or supported by public service organisations) provide peer support to people with mental health issues, they need to engage in confidential conversations. If professionals attended the peer-support meetings for monitoring purposes, this might put the trust relationship between the peer supporters and their peer support group at risk. However, there are normally some ways of developing trust relationships while ensuring a mutually accepted level of transparency. For example, in the case of the Lambeth Teenage Pregnancy Prevention Programme, the peer trainers asked their peers to fill out a survey after each training session to allow quality control (Tatam 2011). Another way of ensuring transparency involves stakeholders coming to agreement on a ‘co-production service charter’, as discussed earlier in Sect. 5.4 (under Step 4 of the Co-production Star toolkit), so that there is transparency as to which contributions can be expected by each party and how possible disagreements or conflicts will be dealt with. For example, a draft Co-Production Charter was developed for a co-production project to improve the wellbeing of people living with dementia in a Scottish local authority. It defined the rights and responsibilities which all parties should expect from each other, including standards of behaviour which they pledged to maintain but also what was supposed to happen if these pledges were not met (Brown et al. 2016, 38–39). However, for the implementation of such a co-production charter an independent advocacy function is needed. Advocacy organisations are particularly important to ensure transparency in co-production initiatives where vulnerable service users are involved, who do not know where to access relevant information or how exactly to scrutinise the actions and decisions of stakeholders involved in co-production. Another key governance challenge to co-production identified in the literature is the sustainability of user and community co-production, as social innovation often turns out to be local and temporary (Brandsen et al. 2016). However, from a service user point of view, many public services are also short-term experiences, as delivery models keep changing and some services may even be cut due to austerity, and, importantly, their need for the service may be only temporary. There is, therefore, a need to rethink the concept of sustainability in the context of social innovations. Clearly, in complex adaptive systems it makes no sense to hope that a co-production initiative will stay the same for ever. What should be sustainable are the improved outcomes but not the way in which they are co-produced. This applies in particular to digital innovations in the public

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domain which have evolved over time. For example, Modena Council in Italy had co-designed the youth website Stradanove (http://www.str adanove.it/) with young people in 1997. After some years, while the website was still being maintained by both young people and professionals working together, the number of website visits had dropped, as young people had moved on to social media. The new social media network Youngle (http://www.youngle.it/) in Italy now provides young people in participating regions with a safe social media network to engage with other young people and access services relevant to them. So taking into account that the only thing likely to be permanent is change itself, how can sustainability in co-production be addressed? Obviously, this raises the issue of what motivates citizens (Alford 2009; van Eijk and Steen 2014, 2016)—we discussed this in Sect. 5.4. Furthermore, as citizens are likely to change their interests over time, there is a need to attract new co-producers, rather than just relying on current citizen coproducers to be able and willing to make the same contribution for a long period of time. Of course, current co-producers also have an important marketing role to play in attracting new co-producers through ‘word of mouth’. At the same time, relying on viral marketing through current coproducers may be limited, if we wish to increase diversity amongst co-producers. As a library manager from Wirral, cited in Baber (2018, 7), complains: “The vast majority of our volunteers are elderly, white and middleclass, retired teachers, engineers, etc.”. Similar concerns about who engages in co-production were reflected in the views of representatives of public service organisations who were part of a focus group study in Germany—a very large majority of participants in the public safety focus groups, more than half of the participants in the health and social care focus groups, agreed with the statement that “Citizens often do not want to get engaged – it is always the ‘usual suspects’” [translation by the author] (Löffler et al. 2015, 19, 24 and 29). Therefore, professionals also need to reach out to new groups by meeting them where they are, instead of asking them to attend public meetings in public spaces which many citizens may perceive as an intimidating or uncomfortable environment. Another key governance principle is equality. Steen et al. (2018, 287) raise concerns about reinforced inequalities through co-production, given that not all communities or service users have the same ability to coproduce and that “wealthy and highly educated citizens may come to

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dominate such processes, as is often the case with classical types of participation, because of their superior social and cultural capital”. However, user and community co-production is different from public participation, as it is not only about citizen voice but also about citizen action, which calls upon different aspects of social and cultural capital. If we look at ‘citizen action’, co-delivery most requires the contribution of those ‘who know and who care’. This is even true of some ‘citizen voice’ modes of co-production, particularly co-design and co-assessment. These people are not necessarily those who shout the loudest, nor are most confident or articulate—rather they are the people whose ‘expertise through experience’ is most relevant to improving services and outcomes and who are most willing to put effort into making these contributions on a sustainable basis. Of course, many potential citizen co-producers are not even be aware of their strengths and resources or have the necessary self-confidence to make a contribution through co-production (Garven 2013, 116), so those citizens who initially make themselves available for co-production initiatives may not be those whose contribution is likely to be most useful. This is why more public service professionals need to be provided with enablement skills (Tuurnas 2015), so that they can strengthen the selfefficacy of less confident citizens. At the same time, intermediaries such as third sector organisations may be more effective than public sector staff in engaging with vulnerable citizens. However, public sector staff themselves should be encouraged and helped to become more creative in building relationships with communities. Last but not least, compliance with the rule of law may be a governance challenge in co-production, particularly when rules are perceived as a barrier to co-production. There are two common reasons why this occurs. First, there is the possibility (indeed, the likelihood) that some citizen co-producers (and even some staff in public service organisations) may not be aware that their behaviour violates rules. This is dangerous, since there is presumably a reason for these rules to be in place. One way to avoid this is to provide minimum training to citizen co-producers. For example, volunteers co-delivering environmental initiatives may not be aware of health or safety regulations. For this reason, the Environment Champions Programme of Solihull Council provided health and safety training to new volunteers (Hine-Hughes and Edgell 2013). This is even more important in public safety co-production initiatives, such as the Street Watch Programme in Weyhe Council close to Bremen, where

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volunteers received a two-day training programme during a week-end so that they knew their own responsibilities and the responsibilities of the police (Meyer and Grosser 2014). However, there are also rules which may restrict co-production initiatives or even make them virtually impossible to implement. In such circumstances, citizen co-producers and entrepreneurial public service staff may decide to take some ‘short-cuts’ in order to speed-up coproduction initiatives. While it may be valuable to make sure that co-production initiatives proceed quickly and are tailored to fit the specific circumstances of the context, rather than some abstract regulatory template, there is also the potential that such flexibility may result in some negative consequences—again, that is presumably why the rules were developed in the first place. In these cases, stakeholders may seek exemption, at least for a limited time, in order to experiment and learn. Such waivers do occur for the introduction of managerial approaches—for example, in the 1980s innovative German municipalities could apply to their state government for waivers to their statutory duties, which were supposed to grant innovative municipalities more regulatory freedom (Banner 1987). However, there is not much evidence of legislators (or auditors) granting even time-limited waivers to enable social innovations. Consequently, public sector organisations sometimes have transferred co-production initiatives to third sector organisations, which often have a more flexible regulatory framework. Alternatively, innovative public sector organisations which wish to engage in co-production may change the question they ask themselves—rather than starting with the traditional question: “Are we allowed to do this’?”, they can engage in a new conversation with their legal department by asking: “Given that this is what we want to do—can you show us how to do it within the current regulatory framework?”. 5.6.3

Some ‘Dark Sides’ of Co-production

Discussing the ‘dark side of co-production’ needs to be done with caution. The term ‘dark side’ has acquired a sinister connotation by its use in completely different contexts—for example, the Ku Klux Klan and other hate groups have been described as the dark side of the nonprofit sector, while networks of corrupt organisations, such as the Mafia, have sometimes been classed by network scholars as “dark networks”.

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Some authors have discussed the ‘dark side’ of co-production in the rather less sinister context of the negative public governance consequences which can arise from co-production, such as lack of shared accountability, reinforced inequalities or the weakening of democracy (Steen et al. 2018)—what we have called above the ‘pitfalls of public governance’ arising from co-production. However, we will use the term ‘dark side’ in this book to describe some behaviours which are specifically illegal or immoral. This means that an overall negative cost-benefit ratio of a coproduction initiative is not considered as ‘evil’ or ‘dark’, but simply as a negative result of co-production, as discussed in Table 5.5. One dark side of co-production involves the use of pressure through moral coercion. For example, some public service organisations, particularly in the third sector, recruit young people as unpaid interns and use them for a protracted period of time as core members of the workforce, rather than developing their skills through giving them experience of a range of jobs, e.g. through shadowing staff members in a variety of positions. In many OECD countries there are regulations in order to prevent such misuse of the time and efforts of volunteers such as interns but, even where such treatment is legal, it represents coercion which is likely to be seen as immoral by many stakeholders, since it seeks to take advantage of young people who, in the context of high youth unemployment, are willing to accept exploitative experiences in the hope that these may ultimately provide a pathway to a paid job. Such treatment is therefore a dark side of co-production. Some examples of moral coercion are not quite so clear cut. For example, it is common in many OECD countries that benefit payments to unemployed people are made conditional on job seeking or participating in training activities, even when they have disabilities or illness. Typically, sanctions are imposed if such benefit claimants cannot demonstrate regular attempts to engage in training or job searches. However, this can be problematic. In the UK, for example, over 56% of appeals against such sanctions have been successful in recent years (BBC 2019), demonstrating how inappropriate the original determination of sanctions has been. Yet only a small minority of people who are sanctioned appeal, although it is clear that far more would be likely to win such appeals— here the claimants have bowed to moral pressure to which they have been subjected. This could well be viewed as the use of immoral coercion, and therefore to constitute part of the ‘dark side’ of co-production.

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In other public services, too, it is important that expectations placed upon communities and volunteers by public service organisations are reasonable and that moral coercion is not exercised. This applies, in particular, to vulnerable user groups such as people with health issues who cannot be expected to make a full contribution when they are in the middle of a crisis. However, it is equally remiss to give up on such people entirely as potential co-producers, simply because they have ‘bad days’. The most extreme examples of the ‘dark side’ of co-production occur when professionals or citizens (or both) engaged in co-production do not comply with the rule of law but misuse their role by engaging in illegal activities, e.g. corruption, infringement of privacy or illegal discrimination or harassment. Examples here would include Street Watch volunteers accepting a bribe not to report a crime they come across during a patrol; or revealing information about service users gained in their co-production activities, which should remain private; or harrassment by co-producing citizens of some vulnerable service users. These examples all involve deliberately damaging behaviour by coproducing citizens. However, some illegal co-production behaviours may be prompted by intentions which are originally good. For example, cases of value incongruence can occur when service users, communities and volunteers do not share and conform to the values of the public service commissioners and providers and go too far in attempting to achieve the outcomes to which they are committed. Co-production in public safety is often considered to be particularly risky because vigilante behaviour may break out on the part of coproducing citizens (Loeffler 2018, 219). While the police do, from time to time, praise citizens who directly tackle criminals, it is recognised that this can be very risky. The fact that they are not trained means that they are more likely to be injured in such actions. It also means that they can make mistakes in identifying what crime is being committed and take inappropriate action to tackle it. A widely cited case study demonstrates how this can go seriously wrong, where a member of a Neighbourhood Watch group unjustifiably shot an unarmed teenager in a gated community (Williams et al. 2016). Clearly, such irresponsible and unacceptable vigilante behaviour may jeopardise the public value created by other members of the Neighbourhood Watch group, and thereby may call the whole co-production initiative into question. However, in devising our risk management strategies, we need to take account of the fact that there are also cases of misuse of roles and powers

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in non-co-produced forms of service delivery—for example, there are many recorded cases of misconduct of police officers. This reminds us that all service delivery models entail risks. Setting up a risk assessment and risk management system to reduce cases of illegal or immoral behaviour is a complex task and it would be foolhardy to believe that co-production approaches will, in principle, turn out to be either more or less successful than traditional public service delivery approaches in reducing the risks experienced by citizens in relation to their desired outcomes. Some co-production schemes may also operate in the grey zone of the informal sector. For example, from the point of view of a national tax agency, time banking could be seen to replace paid transactions in the marketplace with non-monetary exchange, based on time. Indeed, Finnish tax authorities adopted new taxation guidelines in 2013 which required taxing skilled work services received through timebanks according to their market value. Helsinki Timebank contested this decision, arguing that it destroyed the essential principle of equality at the heart of timebanking and called for an exemption from taxation (Peltokoski et al. 2017), an appeal that was ultimately unsuccessful (van der Wekken 2019).

5.7

Conclusions

In this chapter we focused on the challenges facing co-production, which must be overcome if co-production is to become more widespread and systematic as an approach to improving public services and outcomes. We developed a conceptual framework for understanding the barriers to citizen co-production, distinguishing between contextual barriers, organisational barriers in public service organisations, and barriers arising from the characteristics and behaviours of both service users and communities. While these barriers are indeed significant, there are many potential strategies by means of which they can be tackled. In particular, we have explored the need for risk enablement, rather than risk aversion, in public services, so that it is not inevitable that low levels of outcomes are aspired to and achieved, because only the lowest levels of outcomes can be fully assured. To make this change to a risk enablement strategy, it is important for public services to put in place a whole-system resilience network,

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whereby each key stakeholder in the network is covered by appropriate resilience mechanisms, including service user resilience, community resilience, service provider resilience and market resilience. This chapter also discussed how a core change management tool (the Governance International Co-production Star) can be used, both to understand the barriers to co-production but also to develop approaches which will overcome these barriers. The various stages of implementing a full co-production strategy—‘Map it’, ‘Focus it’, ‘People it’, ‘Market it’ and ‘Grow it’—need quite different skills and approaches. While we have illustrated the use of this tool by demonstrating that many case studies have successfully undertaken each of the steps in the Co-production Star, it is clear that few public service organisations have been able successfully to implement all of these steps in a coherent strategy—this remains probably the biggest challenge in the field of co-production. Finally, this chapter considered the potential for negative consequences from co-production. Co-production of public services and outcomes with citizens is not a panacea. As discussed above, co-production initiatives may fail to deliver positive results or may lack ‘good enough evidence’ of improved public services and outcomes. Furthermore, co-production involves costs both for public service organisations and citizens. Unless the cost-benefit ratio for the involved stakeholders is positive—at least in the medium or long-term—it is unlikely that the results of co-production initiatives will be sustainable. Moreover, the distribution of costs and benefits of co-production may be unequal. In particular, there is a risk that disadvantaged communities are put under more pressure to contribute to improve public services and outcomes than more affluent communities, which may be more effective in getting the public services they want, with lower contributions from themselves (Brandsen 2020). Last but not least, the way in which co-production initiatives are planned and implemented may not correspond to key public governance principles—and may even be illegal or immoral. There is a need for both researchers and stakeholders involved in coproduction to evaluate the effectiveness of each co-production strategy, including assessment of its benefits but also its potentially negative impacts and governance pitfalls. In the next chapter we turn to this evaluation task.

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(Eds.), The Palgrave handbook of co-production of public services and outcomes. London: Palgrave Macmillan. Seale, J., Nind, M., & Simmons, B. (2013). Transforming positive risk-taking practices: The possibilities of creativity and resilience in learning disability contexts. Scandinavian Journal of Disability Research, 15(3), 233–248. http://doi.org/10.1080/15017419.2012.703967. Sheehy, D. (2018). Ask Patients what to fund. Comment: Co-production from proposal to paper. Three examples show how public participation in research can be extended at every step of the process to generate useful knowledge. Nature, International Journal of Science, 562, 29–31. https://www.nature. com/articles/d41586-018-06861-9. Accessed 8 May 2019. Snowden, D., & Boone, M. E. (2007). A leader’s framework for decision making. Harvard Business Review, 85(11), 68–76. Sørensen, E., & Torfing, J. (2011). Enhancing collaborative innovation in the public sector. Administration & Society, 43(8), 842–868. Steen, T., Brandsen, T., & Verschuere, B. (2018). The dark side of co-creation and co-production. In T. Brandsen, T. Steen, & B. Verschuere (Eds.), Coproduction and co-creation: Engaging citizens in public services (pp. 284–293). New York and Abingdon: Routledge. Surrey County Council. (2010). A needs assessment of young people aged thirteen to nineteen in Surrey. One in ten. Surrey County Council: Woking. Tatam, J. (2011). Peer educators lead the way: How London Borough of Lambeth lowered teenage pregnancy rates. Governance International Case Study. Governance International: Birmingham. http://www.govint.org/good-practice/ case-studies/london-borough-of-lambeth/. Accessed 9 Mar 2019. Thompson, J., & McConnachie, E. (2019). Stepping forward together— Co-production for falls prevention in Aberdeen. Governance International Case Study. Birmingham: Governance International. http://www.govint.org/ good-practice/case-studies/stepping-forward-together/. Accessed 13 Dec 2019. Timm-Arnold, P. (2014). Clean City Linköping: Co-designing innovative solutions with young people. Governance International Case Study. Birmingham: Governance International. http://www.govint.org/good-practice/case-stu dies/clean-city-linkoeping-co-designing-innovative-solutions-with-young-peo ple/change-management/. Accessed 20 June 2019. Tisdall, C. (2014). The transformation of services for young people in surrey county council. Governance International Case Study. Governance International: Birmingham. http://www.govint.org/good-practice/case-studies/the-transf

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CHAPTER 6

Evaluating Co-production

6.1

Introduction

This book has so far given many examples of co-production and cited many results from its implementation. However, do we actually know how successful co-production is likely to be in any given context? To answer this question, we need to evaluate examples we have and find a way to extrapolate those findings to different contexts. This will clearly not be an easy task—indeed, sometimes it will not even be sensible to try. In this chapter we explore how co-production can be evaluated in practice—and what the limitations will be of such evaluations. We begin by proposing a public value framework which positions coproduction as a key option for making public services more effective and demonstrates that co-production can impact directly on outcomes. A range of different types and levels of outcomes is considered, along with the need to balance priorities between outcomes—which, in turn, means that political choices need to be made, in which citizens should be able to play an important role as co-commissioners. The chapter argues that co-production is likely to flourish best within a strategy which gives significant weight to the probability of achieving developmental or transformational outcomes, allowing service users and communities to have a say in the extent to which positive risks are acceptable.

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Approaches to assessing the effects of co-production on quality of life outcomes are then explored, accepting that co-production is usually complex and takes time to produce its full effects. It is argued that, nevertheless, quality of life outcome improvements can be often be measured quantitatively and even sometimes quantitatively, although assessing intermediate outcomes may sometimes be the best that can be done. We then consider the costs of co-production to public service organisations and to citizens, both service users and communities, since these need to be properly taken into account in decisions about how much and what type of co-production should be undertaken. The chapter then considers the impact of co-production on the quality of service, both through objective and subjective measures of quality, focussing particularly on user satisfaction. Finally, the chapter explores how governance principles affect co-production, along with the converse—the extent to which co-production may enable these principles to be achieved. Finally, a framework is provided to distinguish additive and substitutive forms of citizen co-production from a public sector perspective, given the political context of public sector austerity, under which public service commissioners are often particularly attracted by forms of substitutive coproduction which promise short- and long-term cost savings.

6.2

A Public Value Framework

While some normative concepts of co-production consider it to be desirable per se as a key social mechanism to put specific governance principles into practice, this book takes a public value perspective on co-production—co-production is only good if it increases public value. This entails that we evaluate the extent to which and how co-production processes improve public value. This section sets out our approach to public value, in which we develop a cyclical public value framework which takes further Mark Moore’s public value chain (2013, 227). The concept of public value has received increased attention in the academic literature, particularly through the work of Mark Moore (1995, 2013). Moore originally distinguished between, on the one hand, public value created by public managers through deploying “the money and authority entrusted to them to produce things of value to particular clients and beneficiaries …” and, on the other hand, public value created by “establishing and operating an institution that meets citizens’ (and

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their representatives’) desires for properly ordered and productive public institutions” (Moore 1995, 53). This concept of public value is based on an analogy to value in the private sector where according to Moore (1995, 54) “both customers and owners must be satisfied with what the manager does”. However, this duality does not fully take account of the multiple stakeholder context of public sector organisations, which need to balance the interests of multiple stakeholders, who often have conflicting interests and values. In his subsequent book, Recognising Public Value, Moore (2013) aims to make his original approach to public value more operational by developing further his concept of the strategic triangle. According to this framework for strategic management, public managers need to align “1. A new conception of public value they could produce using the assets entrusted to them; 2. Sources of legitimacy and support for that vision of public value and 3. The operational capacity they would need to materially produce the envisioned public value” (Moore 2013, 102). Moore (2013) seeks to operationalise this framework through so-called ‘public value accounts’. The various examples of such accounts which he provides typically include a mix of social (quality of life) outcomes, client satisfaction and justice and fairness. However, this approach is subject to two major weaknesses, one related to the way in which quality of life or ‘social’ outcomes are treated, and the other related to the treatment of public governance principles. In relation to ‘social outcomes’, Moore (2013, 208) is pessimistic about the extent to which these outcomes can be estimated, partly because policy and programme evaluations are so expensive that they typically cover only a small fraction of organisational policies and practices, partly because programme evaluations focus on ultimate quality of life outcomes, which take time to produce, and partly because managers are discouraged from sensible flexibility and adaptation of programmes, so as not to comprise the rigour of the evaluations. Moore (2013, 226) also recognises that “there are also myriad activities and actors that lie beyond (italics highlighted in the original) organizational boundaries that affect an organization’s success”, so that discerning the organisation’s effect on outcomes is difficult. Fair those these criticisms are, they can be overcome and this underplays the role which evaluation of outcomes can play in public management (Bovaird 2012). Moore’s focus on justice and fairness is important—however, these are just a subset of the public governance principles which are typically

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sought by stakeholders working together in a public sector context. Stakeholders may also wish to focus on other public governance principles, such as social inclusion, the equalities agenda, transparency and participation, which Moore does not directly consider. Consequently, the Governance International Public Value Model focuses more directly on the outcomes achieved through public intervention and includes a wider range of public governance principles. Furthermore, it gives a major role to user and community co-production as a mechanism for achieving publicly-desired quality of life outcomes in a political public sector context. We define public value as the balance between the achievement of priority quality of life outcomes and priority governance principles in a resilient system (Loeffler and Bovaird 2019, 242). This definition recognises that trade-offs between quality of life outcomes and public governance principles need to be made and that the balance between quality of life outcomes and governance principles may be adapted over time, as contexts change. As is clear from this definition (and indeed the very name of the concept), public value is not value free. In his famous article ‘A Public Management for all Seasons?’ Christopher Hood (1991, 11) highlights three clusters of administrative values, which include the ‘sigma’ family of values related to economy and parsimony, the ‘theta’ family related to honesty and fairness, and the ‘lambda’ family related to security and resilience. Table 6.1 highlights how our definition of public value relates to the core administrative values identified by Hood (1991). In Table 6.1 the ‘Sigma’-type values recognise that the delivery of public services is not a purpose per se but is meant to improve public quality of life outcomes. From this perspective, the standard of success is improved priority outcomes, since it is usually not possible to improve all quality of life outcomes, given resource constraints. As public quality of life outcomes stem not only from public services but also directly from contributions made by communities, the currencies of success and failure are no longer just public budgets and the time of public service staff—the resources invested by local communities in terms of knowledge, skills and time must also be taken into account. Moreover, in an increasingly digitised public domain, data—whether generated by the public services or local communities—have become a key currency of success and failure. If quality of life outcomes cannot be improved, both public service organisations and local communities will have wasted their resources.

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Table 6.1 The relationship of public value to core administrative values in a co-production context: Hood revisited Criteria for public value

‘Sigma’-type values: “Keep it lean and purposeful”

‘Theta’-type values: “Keep it honest and fair”

‘Lambda’-type values: “Keep it robust and resilient”

Standard of success

Improved priority quality of life outcomes for individuals and communities Waste (of public and community resources)

Improved priority governance principles + fair distribution of costs and outcome improvements Increasing perceived inequalities, unfairness, lack of transparency and accountability

Adaptation based on collective learning processes

Money, time, skills, knowledge, data (Assets of the public, non-profit and private sectors and communities)

Trust and legitimacy

Standard of failure

Currency of success and failure

Breakdown of public service systems and/or community cohesion, sustained breach of governance principles for any priority stakeholder Learning and risk enablement

Source Adapted from Hood (1991, 11)

‘Theta’-type values are about the way in which multiple stakeholders achieve improved quality of life outcomes. The standard of success is the improved realisation of priority governance principles, since not all governance principles can be achieved at the same time. For example, when professionals support peer groups of people with drug addiction issues, there are likely to be trade-offs between the desire of the members of the peer support group to have their privacy respected, even when they discuss issues which have serious implications for their families, while the public service organisation supporting the group will need to respect public guardianship and accountability requirements. Furthermore, the distribution of improvements of quality of life outcomes across different stakeholders is a key aspect of ‘Theta’-type values. For example, if only a small group of stakeholders benefits from improved outcomes, or if vulnerable groups do not benefit at all, this may

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be considered unfair by the wider community. The currencies of success and failure are trust and legitimacy—if public governance principles are not observed, then both trust and legitimacy are lost and this will make it harder to achieve the priority quality of life outcomes, since these qualities are fundamental to collaboration. ‘Lambda’-type values put the focus on resilience rather than sustainability. This assumes that any given balance of quality of life outcomes and governance principles is likely to require adaptation over time, as circumstances change and shocks to the system occur. The capacity of stakeholders to learn collectively from failures and to adapt to changing external contexts is key for achieving improved priority outcomes and priority governance principles. This means that the standard of success is learning and adaptive ability, whereas the standard of failure is the breakdown of systems or the sustained inability to meet minimum assured quality of life outcomes or governance principles for any priority stakeholders. As Hood (1991, 14) points out, “expectations of security and reliability are central to traditional public administration values” but, if security becomes an absolute value, then this may prevent unlearning and adaptation to new contexts. On the other hand, as Maslow’s hierarchy of needs shows, personal and collective development are unlikely to happen in an environment where the public sector cannot guarantee basic security. Therefore, the currencies of ‘Lambda’-type values include learning and the willingness to enable ‘positive’ risks, as discussed in Chapter 5. The Governance International Public Value Model provides a conceptual framework for co-production, based on the public value concept outlined above. As Fig. 6.1 shows, the demands of citizens are prioritised through the political process and translated into needs, in the problem framing part of the model. These needs are often met through public services, which can be commissioned from public, private or third sector provider organisations, or from partnerships. Their delivery brings quality of life outcomes for individual service users (user value), communities (social value) and for businesses (economic value). However, the services which are commissioned must take full account of alternative ways in which needs can be tackled. The upper line of the Public Value Model says ‘needs’ can be addressed in three ways—first, through behaviour change; secondly, through co-production; and third, through commissioned public services, which themselves may incorporate elements of behaviour change and co-production. This upper line in the Public Value Model makes commissioners aware that co-production is not

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Fig. 6.1 The Governance International Public Value Model (Source Adapted from Loeffler and Bovaird 2019, 243)

just an ‘add-on’, consisting of some “nice to have” discretionary services, on top of the statutory core services offered by public service organisations. On the contrary, citizen contributions are often a ‘must have’ to reduce the demand on high-cost statutory public services and to ensure that these services are cost-effective in meeting desired outcomes. Moreover, the model highlights that not all needs of citizens need to be met by ‘public services’—some needs can be met through behaviour change rather than public services. For example, if smokers are persuaded by their social network to stop smoking, this is likely to prevent smokingrelated illnesses, which can lead to a reduction in demand for health services.

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Similarly, some needs may be partly met through co-production. While some smokers may have sufficiently strong will to stop smoking without any support, others may need a peer support group at their elbow to keep them steadfast in turning their desire for behaviour change into action. If this peer support group benefits from resources or professional inputs from public health care providers, it qualifies as co-production. So behaviour change and co-production are often closely linked. Both imply that citizens increase their contributions, which then constitute a higher proportion of the resources devoted to achieving desired outcomes. This is shown in the Public Value Model by the vertical arrow from behaviour change and co-production to user, social and economic value. A dramatic example is illustrated by a health and lifestyle improvement initiative of a General Practitioner from Kirkby, one of the UK’s poorest areas, who wanted to help his obese patients to change their diet and thereby improve their health (van Tulleken 2018). He started by gathering a group of seven overweight and obese patients, with health problems such as type 2 diabetes and read the riot act to them about the possible consequences of not changing their eating behaviour. He then brought in chefs from a local cookery school to prepare a feast for them, showing that healthy food could be tasty and affordable (a clever ‘nudge’). Then he left them for two weeks, encouraging them to alter their diets. They quickly set up a chat group to help each other out with recipes (peer support). When he regathered them after two weeks, he undertook some medical tests which showed amazing results: six of the seven patients had lost half a stone or more in weight and the diabetics had improved their blood sugar so dramatically that one of them was in part-remission. This combination of a ‘nudge’ to encourage behaviour change and co-production through peer support was not achieved through a ‘public service’, though it was triggered and supported by a doctor in the NHS—but was hugely effective. Thus, a co-production approach to demand management can enable a reduction of public sector resources needed for any given level of quality of life outcomes. It reduces demand for high-cost commissioned public services, such as hospital Accident and Emergency services, in two ways— both through both its direct effects on quality of life outcomes and through being embedded within commissioned services. The pathways to outcomes from these different interventions need to be explored and tested, as we demonstrated in Chapter 4, where pathways for outcomes

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for health, social care and community safety were discussed, based on the generic model of public service interventions shown in Fig. 4.1. Three more important dimensions to public value are shown in Fig. 6.1. First, public governance principles must inform the way in which services are commissioned and provided, and the ways in which co-production and behaviour change are mobilised by the public sector— this is a critically important difference between public value creation and the operation of private markets. It also means that the operation of coproduction is fully subject to public governance principles. The evaluation of the extent to which these principles have been honoured will normally involve qualitative as well as quantitative assessment. Second, the sustainability of quality of life outcomes is promoted by appropriate resilience mechanisms as discussed in Sect. 5.3. These ensure user, community and service provider resilience in a whole systems resilience chain, without which many high priority service users would be vulnerable to the failures inherent in service planning and provision (Bovaird and Quirk 2017). Here, resilience is taken as adaptation that supports successful achievement of goals and objectives, as well as learning for future planning and preparation (Edson 2012). For example, a social care commissioner can arrange with a local café to deliver a light lunch at a discount price to clients whose normal meals-on-wheels provider does not turn up—this would be an example of single loop learning (Argyris and Schon 1978). Double loop learning would occur where the mealson-wheels provider installs a system to ensure that such delivery problems are much less likely in the future—and this would make the overall system even more resilient. Last but not least, the Public Value Model represents a dynamic, cyclical process, going beyond common linear input-output-outcome chains, to take account of the way in which new demands, political priorities and intervention mechanisms emerge and interact. Specifically, it highlights that improved quality of life outcomes—whether achieved through public services or the direct contribution of citizens—influence the expressed demand for services. This demand is then negotiated by elected politicians, who prioritise the expressed demands and determine which needs of which social groups are priorities to be tackled by public intervention, taking us back to the decisions on how to meet these needs. At each stage of this cyclical process, the interactions in the system (e.g. between behaviour change and co-production activities) may raise the

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potential of the system to give rise to a new level of quality of life outcomes. Given these characteristics of our Public Value Model, an evaluation framework based upon it needs to meet a number of demanding criteria: • It needs to recognise a range of different types of quality of life outcomes, including individual, community and business outcomes and how these interact with each other. • It requires the development of pathways to outcomes , by means of which we can test the changes in outcomes hypothesised to be brought about by commissioned public services and by the contributions of service users or local communities. • It needs to be dynamic, recognising that public service systems change over time, often quite significantly and sometimes quite radically, so that they sometimes need to be viewed as complex adaptive systems • It needs to assess to what extent priority governance principles have been achieved and which have not. • It needs to assess the capacity of public services to engage in learning throughout the public value process and to propose lessons which emerge from this learning. • As it must cover achievement of not only quality of life outcomes but also governance principles, it requires both qualitative and quantitative methods .

6.3 Increased Quality of Life Outcomes Arising from Co-production The definition of co-production used in this book specifies that improved outcomes or increased efficiency are the two key objectives of user and community co-production. This section will provide a framework for analysing different types of quality of life outcomes which co-production can aim to improve and the evidence for increased quality of life outcomes arising from co-production. We will also discuss critically to what extent co-production initiatives have focussed on assuring a minimum level of outcomes and whether co-production should be used more often to achieve higher wellbeing outcomes (but with levels of risk attached) or even quality of life transformation, taking outcomes to a new level.

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In a later section we will consider the impact of co-production on the other outcome which is important in public value, namely the improved achievement of public governance principles. 6.3.1

Types of Quality of Life Outcomes

While there is now a lot of interest in quality of life outcomes, at least in the UK, there is still quite a lot of confusion regarding the difference between outputs and outcomes. As Bouckaert and Van Dooren (2016, 151) stress, “a sharp distinction must be made between outputs and outcomes. Outcomes are events, occurrences, or changes in conditions, behaviour or attitudes. Outcomes are not what the programme or organization itself did, but the consequence of what the programme or organization did”. In a co-production context it is important to distinguish between, on the one hand, individual (or personal) quality of life outcomes arising from user co-production and, on the other hand, collective quality of life outcomes arising from community co-production. Furthermore, there are often publicly desired quality of life outcomes which are embedded in the strategic objectives of public service organisations and which embody wider social benefits being sought from public interventions. In practice, there are many challenges involved in a shift from a focus on public services towards a focus on outcomes. One issue is difficulties in measuring quality of life outcomes, as not all can be quantified. However, there is increasing awareness that qualitative assessments of changes in outcomes—for example, through storytelling—can also be very effective in supporting collective learning during a change management process. It is often also argued that ‘final’ quality of life outcomes can only be achieved in the long-term (Bouckaert and Van Dooren 2016, 151). While behaviour change does indeed typically take a long time, this is not true of all outcomes. Specifically, changes to intermediate outcomes, such as increased service user or community satisfaction with their support network or increased self-esteem of service users, can sometimes be achieved (and assessed) even in the relatively short-term. Last, but not least, it is clear that quality of life outcomes cannot be ‘controlled’ by a single public service organisation—typically, outcomes are shared between public service organisations and achieving improvements to them therefore involves partnership working between these organisations.

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However, as the Governance International Public Value Model in Fig. 6.1 illustrates, improvements to quality of life outcomes not only arise from public services but sometimes are the direct result of user and community co-production. This is often overlooked by professionals working in public services, particularly as many such forms of co-production do not take place in public spaces and are not visible to most staff involved in the service. The quality of life outcomes in Fig. 6.1 include: • individual outcomes , which make up ‘user value’—the impact of coproduced activities and public services on the personal well-being of individuals, particularly service users; • community outcomes , which make up ‘social value’—the impact of co-produced activities and public services on the outcomes experienced collectively by a group of citizens (where the size of group can vary greatly, from those in a small community association, or in a neighbourhood, or in a city, or in a social movement, all the way up to those who live in a specific country); and • business outcomes , which make up ‘economic value’—the impact of co-produced activities and public services on the outcomes for businesses in the economy. The appropriate approach to co-production in a specific context depends, naturally, on the relative weight to be given in public policy to these three different sets of quality of life outcomes. Not so long ago, much public administration, both academically and amongst practitioners, rolled up both individual and community outcomes under a heading such as ‘public good’ or ‘social benefits’ or ‘social good’ and assumed that this, interpreted as a collective experience, was the fundamental aim of government. A key reason for this, at least in the UK, has been that much of the debate on outcomes in social policy since the 1940s has been shaped by the Beveridge Report, which identified the ‘Five Giant Evils’ of Want, Disease, Ignorance, Squalor and Idleness (Beveridge 1942). This gave rise to a ‘social rights’ view of the desired outcomes of social policy, namely that everyone has a right to be free from these ‘five evils’ (which could be seen as a variation on the ‘four freedoms’ specified by President Roosevelt in the USA two years earlier) (Owen 1943). Such an approach does not ignore the individual quality

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of life outcomes which are desired but, at the same time, suggests that a collective outcome arising from them may be at least as important, namely that no-one should experience less than a ‘social minimum’ level of these rights—this is a collective outcome, rather than an individual outcome (and is, of course, easier to measure). In practice, much of subsequent UK social policy focused not on maximising the level of outcomes for the individuals concerned but rather on ensuring that all reached what was conventionally regarded as the minimum level at the time. The performance indicator for this outcome was then simply the proportion of the population who fell below this minimum and social policy, at least in rhetoric, focused on minimising this number. Moreover, this approach to social rights can be significantly extended. King (2012) suggests the following ‘core human interests’: well-being (e.g. absence of physical suffering, basis of self-respect); autonomy (people having some control of their own destiny throughout their lives); and social participation (meaningful potential for participation in social and communal life), which he links to the resources required for a ‘minimally decent life in their society’. In each case, a social rights approach to these ‘core human interests’ can result in outcomes being defined collectively—e.g. the proportion of citizens who fall below a social minimum level of any of these elements of well-being, autonomy or social participation. Another way of measuring these collective outcomes would be to assess the degree of achievement of some constituent factors which are believed to lie on the pathways to these outcomes (e.g. levels of ‘trust’ and ‘social inclusion’ on the pathway to social participation, both of which can be assessed by survey). We discussed in Chapter 4 a number of ways in which such pathways could be constructed in specific service areas. What is particularly interesting about this ‘social rights’ approach is that not only can co-production contribute to achieving of some of these ‘social rights’ (e.g. through improving the wellbeing outcomes of public services) but that it actually constitutes, in itself, partial achievement of the ‘social participation’ collective outcome. However, since the 1980s, primarily under the influence of New Public Management, there has been a dramatic swing to focusing on individual quality of life outcomes, almost to the extent that it has become hard to think and talk convincingly about ‘social value’ as a collective concept. If co-production is only judged by its effects on individual outcomes, and we do not recognise and take account of its effects on collective outcomes, then we will seriously underestimate its impacts. Especially

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given the UK interest in outcome-based commissioning, this is an urgent area for further research. Business outcomes affect the value created in the economy but we take the stance here that these are only intermediate outcomes, since organisational outcomes of businesses can be seen as leading eventually to individual and collective outcomes for citizens. However, they have the advantage that they are often quicker to appear and easier to identify than the longer-term citizen outcomes to which they eventually give rise. Politicians need to balance the priorities between these individual, community and business outcomes, each of which may involve conflicts with citizens who may have different priorities. Moreover, outcomes frameworks need to be flexible over time, as new needs arise or priorities change. Ideally politicians should work with citizens in this prioritisation process by bringing co-production into the commissioning process, as discussed in Sect. 3.3. Co-commissioning with citizens may help politicians to identify more clearly the trade-offs between these outcomes and bring about a shared understanding of priority outcomes, often working with partner organisations seeking similar outcomes. It can also alert politicians at an early stage to changes in citizens’ priorities. 6.3.2

Levels and Dimensions of Quality of Life Outcomes

When evaluating the effects of co-production on outcomes, those involved in co-production not only have to agree on which outcomes are important but also which levels of outcomes they wish to achieve through co-production. In other words, by how much do outcomes need to increase for citizen co-production to be considered beneficial? The most dramatic case of increased outcomes, achieved partly (although not solely) through co-production is perhaps the Youth Restorative Justice Intervention for young people at risk, run jointly by Surrey Police and Surrey County Council’s Youth Support Service. Between 2009 and 2013, Surrey achieved a 90% reduction in the number of young people who were first-time entrants to the criminal justice system (Tisdall 2014). Most co-production interventions will have to be content with rather less dramatic results. Moreover, as we discussed earlier, it is not always possible to quantify the increase in outcomes that has occurred or is likely to occur from co-production (compared to other potential interventions).

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It is also important to consider the dimensions of quality of life outcomes and how co-production contributes to each of these. A typology of dimensions was developed by Willis and colleagues, in Willis and Bovaird 2012, 153) as part of a co-produced evaluation of day services for people with different disabilities: • ‘Safety’: What enables you to feel safe within your own home and to go out and about in the community? • ‘Happiness’: What enables you to enjoy daily living within your own home and to go out and about in the community? • ‘Development’: What enables you to develop new ways of improving the quality of your life? This categorisation clearly regards these three different dimensions of outcomes as hierarchical, based on Maslow’s hierarchy of needs (1943). In the context of co-production this means that only when a coproduction initiative has enabled citizens to feel safe it is possible to start pursuing the higher-level outcomes of ‘happiness’ and ‘development’. While this fits in with Maslow’s argument, it may be, in some situations, that co-production may work the other way round, namely that co-production may help citizens to feel better about their lives and, as a consequence, begin to take more care in their more harmful behaviours— e.g. drug addicts whose peer support helps other substance abusers may build self-esteem and subsequently indulge in less self-harm themselves. However, there is another typology of dimensions of outcomes which offers a different interpretation. As Fig. 6.2 illustrates, in this typology there are three dimensions to the outcomes we seek, namely their level, their variability and their potential. More specifically: • The level of outcomes determines the extent of our ‘happiness ’. Of course, if we focus on maximising the level of our outcomes, we normally have to accept that there are risks involved and we might, in the event, end up with very low outcomes, instead of the high outcomes which we expect. • The variability of outcomes determines how much ‘safety’ we feel in relation to the outcomes we seek. If we focus on achieving an assured level of outcomes, i.e. on minimising the risk attached to

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Fig. 6.2 Dimensions of quality of life outcomes: Level, variability and change potential (Source Author)

the outcomes we seek, we often have to be content with outcomes which are quite low. • The change potential of the outcomes we seek determines the extent to which we can achieve higher developmental goals, whereby we can transform the range and level of outcomes that we can achieve in the future. This approach suggests that we have three choices in relation to the outcomes we seek, namely to try to maximise their level or to minimise their variability or to explore the change potential they offer to transcend to an altogether higher stage of experience, where outcomes will be quite different (and more desirable). Focusing on the variability of outcomes leads to a ‘maximin’ strategy (maximising the minimum pay-off on offer), which may promise little in terms of outcomes but at least is very likely to deliver what it does promise. This appears a very common strategy in public service provision. A simple example is provided by a care-home manager who discussed the case of a resident who wanted to be able to make her own cup of tea

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in the kitchen. Her request was denied by a member of staff on health and safety grounds, in spite of the fact that the resident did not pose any unacceptable risk to safety, e.g. she was not unsteady on her feet (Warmington et al. 2014, 25). Clearly, such a risk-averse approach, especially where the risks are defined by professionals and managers, rather than by service users and communities, makes co-production much less likely. Focusing on the level of outcomes is a strategy which gives significant weight to the probability of achieving higher outcomes, trading these off against the risk that something might go wrong. Depending on how it is done, this can be seen as ‘maximising the average level of outcomes’ or ‘maximising the expected value of outcomes’. For example, older people who are in danger of having a fall are often encouraged to give up any risky activities, such as dancing. However, an imaginative ‘Dance for Health’ programme actually teaches falls prevention skills to older people by involving them in enjoyable dancing sessions (NAAHW, n.d.). Co-production, where service users and communities have a say in the extent to which positive risks are acceptable, is more likely to flourish where this strategy is being pursued. Finally, focussing on the change potential of outcomes is a ‘maximax’ strategy, which maximises the maximum outcomes which a person could achieve if helped to develop their capabilities to a higher level—with corresponding higher risks attached, of course. Developmental outcomes which have high potential for transforming the quality of life outcomes of a person have traditionally been identified with educational qualifications (getting a university degree, completing an apprenticeship, etc.) and these may indeed indicate transformational changes to capabilities. However, transformation of quality of life outcomes achieved may come not only through improvements to capabilities but also through other developmental outcomes. In particular, they may be triggered by increases in self-confidence (which increase the likelihood that capabilities will be fully exploited) and increases in the level of ambition of a person (since a person who is fully content with their current lifestyle may have no interest in using their existing capabilities fully or developing transformational new capabilities). Lindsay et al. (2018) provide empirical evidence of how an innovative employability programme targeted at lone parents in Scotland succeeded in reaching out to lone parents in their local communities and how stret-level key workers enabled them to co-produce developmental outcomes. “Many described a journey from social isolation

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to engagement with support networks, personal empowerment, and then progress towards employment” (Lindsay et al. 2018, 45). Clearly a strategy of pursuing change potential through developmental outcomes is likely to be highly daunting for service users and communities, as they, by definition, involve change to one’s lifestyle. This will generally involve unfamiliar actions and bring benefits which are only dimly understood. Consequently, there is likely to be significant underinvestment in developmental outcomes. Here we can see that a different co-production impulse may be necessary. In this case, the encouragement that can be given by people with prior experience of such changes becomes especially important. While such people may include public services staff, it is likely that the co-production activities of ‘experts by experience’, acting as peer supporters and mentors, will be particularly effective, since they have themselves undergone such change and can speak convincingly about how it can be achieved and why it is worthwhile. Indeed, it seems likely that co-production will often be the most effective approach to bring about transformational change in outcomes— and may sometimes be the only approach likely to work. Nevertheless, it is important to stay realistic and to recognise that transformational change in outcomes is more often talked about in the rhetoric of public management than illustrated in practical examples. To see how these categorisations of outcomes work out in practice, we will again use the example of the new vision of Services for Young People in Surrey County Council, which required a shift from NEET (Not in Education, Employment and Training) towards PETE (Participation in Employment, Training and Education). In order to translate this vision into practice, Surrey County Council developed a new outcomes framework with key partners and young people, as shown in Table 6.2. We have categorised each of the six outcomes in this framework, specifying whether they were experienced individually or collectively in the community; whether they contributed to the outcome dimensions of ‘safety’, ‘happiness’ or ‘development’; whether the intention in relation to the outcomes was on increasing the level of wellbeing, reducing the variability in the outcomes or maximising the change potential; and how they related to the other outcomes in the framework. While this outcome framework had the advantage that it was easy to communicate, it had a number of weaknesses, as highlighted in an external evaluation by Bovaird and Loeffler (2014, 40–41). For example, there was little that related to the ‘happiness’ dimension of outcomes (and, in particular, it did not have an overall indicator of quality of life of young people, as an overarching ‘happiness’ outcome), and it did not

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Table 6.2 Young People’s Outcomes Framework of Surrey County Council

TO1

SO1

SO2

SO3

SO4

SO5

SO6

Outcomes

Individual or community

Safety, happiness or developmental

Level, variability or change potential

Relationship to other outcomes

Top outcome: Employability for young people Sub-outcome 1: young people are equipped with the skills and attitudes to join the twenty-first century workforce Sub-outcome 2: young people are safe Sub-outcome 3: young people are resilient

Individual

Developmental

Level

Top level outcome

Individual

Developmental

Change potential

Contributes to TO1

Individual

Safety

Contributes to TO1

Individual

Developmental

Variability (safe v. not safe) Change potential

Sub-outcome 4: young people overcome barriers to employability Sub-outcome 5: young people make informed decisions Sub-outcome 6: young people are active members of their communities

Individual

Developmental

Change potential

Individual

Not applicable (Low level intermediate outcome)

Not applicable

Contributes to TO1 + all other outcomes

Community

Developmental

Change potential

Contributes to TO1 + SO2 + SO3 + SO4

Source Adapted from Surrey County Council (2014, 65)

Contributes to TO1 and each of the other outcomes Contributes to TO1 and SO1

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model the inter-relationships between the six sub-outcomes. However, it did have a very strong focus on developmental outcomes and emphasised the change potential offered by these outcomes. This suggests that one reason that Surrey CC was successful in its transformation of Services for Young People was that it focused on outcomes for which co-production was especially appropriate, namely developmental outcomes which had high change potential. 6.3.3

Assessing Improved Outcomes from Co-production

In some cases, outcome improvements can be measured quantitatively and even be given a monetary value, based on cost-benefit analysis. For example, the Community Speedwatch scheme in Wiltshire County Council in 2015 involved 765 local residents in 140 volunteer teams at neighbourhood level, who were working with the police to reduce dangerous driving (Milton 2016). Wiltshire Council estimated that this represented 14,076 hours of volunteer-led speed reduction interventions between September 2013 and January 2016 with a monetary value of £112,608. The Community Speedwatch co-ordinator trained the volunteers to carry out roadside checks on the speed of vehicles, once an area had been identified as suitable and safe for Community Speedwatch. Volunteers from the community recorded the speed and registration numbers of offending vehicles. The owners of speeding vehicles were sent letters by the police, drawing attention to the offence and warning the driver of the consequences of excessive speeding. This resulted in a 35% reduction of fatal and serious injuries from traffic accidents in Wiltshire (compared to a national fall of 22% during this period). The monetary value of these reductions in deaths and injuries was calculated using the values suggested in the HM Treasury guidelines (Loeffler and Bovaird 2018, 273). However, it is not always possible to measure improved outcomes quantitatively. Nevertheless, changes in outcomes can often be assessed qualitatively. For example, the Department of Social Care of Augsburg Council in Germany worked with the local centre for volunteering and the University of Augsburg to document the experiences of volunteers who mentor people in financial difficulties (Klopf et al. 2016). This involved the use of a story telling methodology which provided in-depth insights into the changes of personal outcomes achieved for people experiencing financial difficulties.

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At the same time, testimonials of citizen co-producers may provide ‘good enough evidence’ that co-production has made a difference. For example, the local authority of Umeå in Sweden set up the new unit Kulturverket in 2005 to make learning more creative for all pupils and, in particular, to improve the school performance of disadvantaged children by involving them in arts and culture (Hammar and Breggren 2015). Specifically, it developed an innovative co-production initiative called Kids Tell the Pros What To Do. This supports children aged 6–19 years to develop arts projects with professional artists and cultural organisations, for performance in public. The logic is that the children and young people are the creators, and also take an active part in the professional exhibitions, shows and concerts, but it is adult artists with their experience, knowledge and resources who actually make it happen by implementing the ideas of the children and young people. The testimonials to the wide range of projects developed over the years show how the co-production initiative has made a significant positive impact on the young co-producers involved (Hammar and Breggren 2015)—for example: When Kulturverket was introduced at my children’s school, things started changing. The project took the focus off their illness, and instead the children focused on what happened in their classrooms. Especially for [Name] this has meant a lot. His text was the starting point for the creative work undertaken in the classroom, and was eventually turned into a film! [Name] is very proud to be the protagonist in all this creative work. I can only say that what Kulturverket did with my children is one of the most beautiful things that happened to us in an otherwise very dark and difficult period. Parent of children participating in Healing Art project I didn’t know you can learn mathematics in so many different ways and I enjoyed most of it. Above all I very much liked film making. During the show I was in the chorus—it was fun and not as embarrassing as I thought it would be. Pupil participating in Fair City project

Obviously, such testimonials do not provide a fully representative picture and need to be complemented by other methods of outcome assessment. Nevertheless, they clearly indicate that even the short-term effects of coproduction on outcomes can be important.

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6.4 Increased Efficiency Arising from Co-production Efficiency is generally defined as the ratio of outputs to inputs, for example, the number of inspections per inspector each month, or crimes recorded by a police officer each day (Bouckaert and Van Dooren 2016, 152). (This distinguishes it from effectiveness, which is the value created by the outputs). Obviously, if there is more than one output or more than one input, then the joint level of these outputs or inputs needs to be measured by an index. The most obvious way to compute an index of inputs is to take their costs—then ‘efficiency’ becomes the ratio of outputs to costs (e.g. number of inspections per £ spent). While costs generally provide a good index of inputs, it is not so obvious how to compute an index of outputs. Sometimes, it is again acceptable to compute their monetary value and compare it to their costs, e.g. the income from tax inspections undertaken per £ spent. However, often this will not be relevant, as there is no appropriate monetary value of the outputs, and it will be more useful to compute a range of efficiency ratios, each of which relates to separate outputs which are achieved. In the context of co-production, efficiency could refer, for example, to the number of speeding incidents per year recorded by each Community Speedwatch group. As co-production often does not rely on just one input but rather requires several inputs simultaneously (since it includes, for example, not only the hours of volunteers with the speed-guns at the roadside, but also back-office time processing the speeding infringements recorded by each Community Speedwatch group), there is a need for an aggregate index of these inputs. Again, in many cases, the most appropriate index for inputs will be cost, which raises the question of the costs of co-production. 6.4.1

Costs Related to Co-production

In estimating the costs of co-production, it is clearly important that all inputs are costed, including citizen inputs—not just the inputs for which the public service organisation pays. Those public service organisations with a well-developed cost accounting system may find it relatively easy to calculate organisational unit costs, although even these organisations may have only an approximate system for recording staff inputs by activity. However, very few organisations have an effective system of any kind

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for recording the level of citizen inputs, never mind computing their monetary value. A literature review by Garlatti et al. (2018) reveals little research on the costs of co-production. Garlatti et al. (2018, 18–19) distinguish between one-off set-up costs and running costs of co-production but suggest that there is a need for further research into both (Garlatti et al. 2018, 19). In Table 6.3 we build on their literature review by differentiating between the different types of costs for public sector organisations, citizen coproducers and third sector organisations involved in co-production. This table is not exhaustive (for example, the costs of third sector organisations could also be split into direct and overhead costs) but illustrates typical costs related to co-production. Table 6.3 Costs related to co-production Type of costs

Direct costs for public sector organisations

Overheads (staff time) for public sector organisations

Costs for citizen co-producers

Costs of third sector organisations

Set-up (one off)

External consultants, ICT equipment, other equipment

Planning and coordination Training of volunteers

Spare time spent on training for co-production initiatives

Running costs

External communication (e.g. maintenance of website through external project manager, printing of newsletters) Rent for meeting rooms Insurance of citizen co-producers

Internal communication Support for volunteers (e.g. regular feedback meetings) Ongoing evaluation

Spare time spent to contribute to co-production initiatives Expenses for transport

Recruitment of volunteers Vetting of volunteers (e.g. getting police clearance to work with children) Grant applications Coordination and governance of volunteers Internal and external communication Continuous reporting on co-production activities and results achieved

Source Adapted from Garlatti et al. (2018)

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6.4.2

Evidence of Improved Efficiency from Co-production

In the context of austerity in the UK, co-production has often been motivated by the need to make cost savings by reducing the inputs of public service organisations in terms of budget, staff numbers and staff time. A good example of this is the case study of the redesign of the website of adult social care in Stockport Council with service users, which provided evidence of improved efficiency from co-production. The co-design initiative reduced the number of contacts, enquires and observations at the contact centre by 29% within a short time after the launch of the new website. As a result, an estimated reduction in staff costs of over £300,000 was achieved (Wells 2011). Given the one-time set-up costs of the new website of £75,000, this resulted in estimated net savings of £225,000 and a benefit/cost ratio of 4:1. However, this example from Stockport shows that the savings resulting from co-production are not always cashable—as in Stockport, the freedup staff time may simply be re-allocated to deal with more complex ‘cases’, which require more personal support by staff. Where a move towards greater co-production has the effect of freeing up staff time rather than generating cashable savings, this may reduce its appeal as a strategy for those public service organisations which need to achieve short-term budget reductions. In the long-term, of course, most savings are cashable, so this is not a concern. Moreover, co-production may reduce future costs for the public sector as a result of co-produced prevention activities. The transformation process of the unit of gastroenterology in the Highland Hospital in Eksjoe in Sweden provides a co-production case study with evidence of improved efficiency. In 2001, the ward had long waiting lists and decided to change the way in which staff worked with patients (Tholstrup 2014). The objective of the transformation process was to diminish waste and to focus on activities which created real value to the patients. This led to a far-reaching change of the patient health monitoring system, which had previously emphasised regular hospital visits of the patients. The medical team realised that patients actually knew better than they did when their disease was getting worse, so they changed the contact system, so that those patients with a stable condition were enabled to self-assess their health and wellbeing. This cohort of patients were encouraged to get in touch with the unit immediately, if any signs appeared that the disease was getting worse. As Tholstrup (2014) reflects: “this immediately helped us

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to cut out some of the inappropriate work which had previously been done, even though it had not produced any real value for the patient”. Evaluations showed that the new system of unscheduled calls were much more effective than the previous system of scheduled annual check-ups: a planned extension of the ward proved to be unnecessary, as the number of hospitalisations of patients with inflammatory bowel disease decreased 48% during the period 1998–2005. Tholstrup (2014) concludes: “Not only have we saved the costs of expanding the ward but we have been able to devote far more of our staff time to helping those patients with chronic but non-acute conditions, so that their quality of life is substantially improved and their risk of flare-ups of the condition are reduced”. An important way of making efficiency gains is to reduce expensive inputs. An example of (substitutive) co-production which reduced staff time spent on caring for service users is the co-produced housing and care model for vulnerable adults with support needs which is run by the UK charity KeyRing. Instead of residential care homes, KeyRing provides Living Support Networks which comprise ten people living within walking distance of each other (Parker et al. 2019). Nine of the network members are vulnerable adults and the tenth is a Community Living Volunteer, who lives rent-free in the local area. The volunteers provide at least 12 hours of their time each week to help Members with issues such as bills and budgeting, getting into education, employment or volunteering. They also promote mutual support between Network Members and help Members build links with neighbours, community organisations and local organisations. Each volunteer is supported by a paid support manager who manages a cluster of KeyRing Networks. In 2018 KeyRing commissioned an independent assessment of its coproduction model (Housing LIN 2018), which involved an evaluation of KeyRing Networks in four local authority areas. This calculated the financial benefits of a ‘typical’ cluster of three Networks, supporting 30 people: investment of £1 resulted in a saving of £2.19, which was a net gain of £1.19—this amounted in total to overall cashable savings of £187,168 per year. Another approach to achieving greater efficiency is to increase outputs at a greater rate than inputs, or while holding inputs constant (Garlatti et al. 2018, 15). An example of the former case is the imaginative coproduction initiative of the National Library of Finland which needed to transform millions of pages of old written archive material into digital format. However, optical character recognition software made lots of

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mistakes at transcribing hard-to-read text. Correcting all the mistakes with paid staff would have been very costly. Therefore, the Library decided to work with the crowdsourcing company Microtask, which developed a game called Digitalkoot to motivate volunteers to fix the mistakes. In the first 18 months, more than 100,000 volunteers donated over 400,000 minutes and corrected over 7.5 million mistakes in the online historical newspaper archive (Miettinen 2012). While most of the (small number of) articles on the costs of coproduction which were identified in the literature review by Garlatti et al. (2018) focus on the implications of co-production on labour costs, very few discuss the cost implications of co-production on capital equipment and facilities, supplies, utilities and support services. Finally, the net costs of a public service organisation can also be reduced by finding ways of raising income. Many local authorities in the UK are now considering the commercialisation of public services as trading entities in order to generate income (Local Government Association 2017). Such private sector-influenced approaches are often considered as the antithesis to community-oriented co-produced solutions—and this can indeed be the case, for example, when a neglected community centre is sold or let to a private sector provider for a higher rental than could be afforded by a community group. However, there are also innovative co-production schemes which allow the local authority to raise extra funding. An example, is the financial rescue of a local pub in the Austrian village of Dalaas (16,000 inhabitants) in the state of Vorarlberg. Although it had closed and there were no private investors interested, the pub was considered to be important for strengthening social cohesion in the village. Consequently, the (directly elected) mayor launched a crowdfunding initiative in 2017 to encourage local residents to buy shares of 1000 Euros each (Gemeinde Dalaas 2017). The scheme was marketed in a clever way—investors bought wooden chairs to the value of EUR 1000, which came with consumption vouchers of EUR 125 for ten years. This corresponds to an interest rate of 4.28%, which was rather attractive. The crowdfunding initiative was so successful that after three days 150 chairs had been sold and in ten days more than 200,000 Euros had been raised. The pub reopened within two months of the launch of the crowdfunding project and is now run through a company co-founded by the local authority of Dalaas and a local cooperative brewery. Income can be generated in other ways, too—for example, where co-production initiatives improve a neighbourhood so much that house

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prices and the rents paid to social landlords rise (Loeffler and Bovaird 2018, 275). This enables social landlords in the area to use the resulting higher rental income for activities which improve the quality of life of local communities. Similarly, the local authority can use the increased council tax income which is generated to fund public services in the neighbourhood concerned. This ‘neighbourhood equity premium’ has been calculated in two low income neighbourhoods of Birmingham which have pioneered co-production approaches, amounting to nearly £38,000 per property in Balsall Heath and nearly £10,000 per house in Castle Vale (Slatter 2010, 72). 6.4.3

Challenges in Assessing the Impact of Co-production on Efficiency

Assessing the impact of co-production on efficiency requires measuring the set up and ongoing costs of co-production and how co-production changes other costs for the involved co-producers. However, there is often only awareness of the (minor) direct costs required for coproduction, such as the printing of leaflets to inform citizens or reimbursement of transport costs of citizen co-producers. The analysis of 70 Governance International co-production case studies shows that most public sector organisations do not record how staff time is used, so that there is little information about the impact of co-production on staff time. For example, the co-produced regeneration of Place Austerlitz in Strasbourg involved a multi-stage process over several years, including the use of different media and formats of events to engage with different audiences and feedback to assure stakeholder groups and residents that they have been listened to and to inform them of the decisions taken at each stage, which was done inhouse with the resources of the City of Strasbourg and the Euro-Metropolitan Administration of Strasbourg (Scheek et al. 2017). In spite of the considerable staff time dedicated to engaging with the public, no detailed information is available regarding the extra staff costs of the co-production involved in this regeneration project, the total cost of which amounted to about 2.5 million Euros. It is clear that public sector organisations often consider the time invested by unpaid volunteers as a ‘free resource’. However, this time input involves opportunity costs for the citizen co-producers, as they could do something else during the time they co-produce with professionals. In some cases, citizens may even have to invest time in training

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before they can start co-producing. For example, the citizens engaging in Speedwatch groups first need to undertake training by the police and local authority before they are allowed to join patrols with their Speedwatch group. This training covers not only technical issues, like how to operate a speedgun to measure the speed of cars passing by—it also involves advice on how to stay safe and how to respond to provocation from disgruntled drivers or other members of the public. The monetary value of volunteering time in co-production initiatives can be considerable, as shown by the Wiltshire Community Speedwatch scheme (see Sect. 6.3.3), so it is unfortunate that it so rarely assessed. Last but not least, co-production between volunteers and public sector organisations often produces costs for other organisations, particularly third sector organisations (costs which may or may not be recompensed by the public sector organisation benefitting from the co-production). For example, when public sector organisations wish to recruit volunteers they often need to use the database of third sector umbrella organisations such as Voluntary and Community Service organisations (VCS) in the UK. Furthermore, they often require the support of third sector organisations to train or coordinate volunteers and to deal with governance issues. The extra costs which are thereby imposed on these partner organisations should be taken into account. The question then arises: should a public sector decision on whether or not to undertake a new co-production initiative include in its calculation of costs and benefits the costs experienced by citizens who agree to be part of the initiative (e.g. as service users or community volunteers)? This is a tricky question, which has been long debated in the evaluation literature (e.g. Mishan 1971). The obvious answer may seem to be that, if people agree to be involved, then presumably they expect the benefits to them to outweigh the costs, so there is no need to add their costs to the costs of the overall initiative. However, the implication of this answer is that the net benefit to them should indeed be calculated and included in the overall benefit-cost calculation—and this, of course, will normally entail knowing the costs which they have incurred in being part of the co-production. A further element to this discussion is that a citizen’s decision to participate in a co-production activity may be misguided due to the lack of information or miscalculation of individual costs and benefits. This highlights a failure in the resource allocation system in society (an extension of the welfare economics concept of ‘market failure’). This could be the case, for example, if the citizen has been misinformed about

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the benefits which their volunteering will bring to others in the community or has been misled about the amount of time and effort that will be involved. In such cases, the costs of co-production to the citizen may not be offset by the total benefits which accrue (to the co-producing citizen and other citizens, taken in aggregate). If there is a suspicion that such misallocations of resources are important, then there is a strong case for estimating both the costs to citizens and benefits to citizens arising from co-production. In all cases, of course, public service organisations should ensure that the costs of co-production to citizens are kept to a level which is consistent with efficient use of their time and effort, whether or not this is being measured. In summary, the costs of co-production to public service organisations and to citizens, both service users and communities, are still not clearly understood, nor properly taken into account in decisions about how much and what type of co-production should be undertaken. More research is needed to analyse the full costs of co-production in order to be able to evaluate how it has affected efficiency.

6.5 Increased Service Quality Arising from Co-production 6.5.1

Definitions of Service Quality

While the traditional literature on public service quality puts the focus on the contributions of professionals and public service organisations, co-production highlights the contributions of users and communities to improve service quality. As Zeithaml et al. (1990) point out, a key difference between services and products is that the production and consumption of many services are inseparable. Quality in services often occurs during service delivery, usually in the interaction between the customer and provider, rather than just at the end of the process. Therefore, service quality consists not only of outcome quality but also process quality (Löffler 2019). For example, hospital patients not only wish to recover as quickly as possible but also care that staff treat them with respect and empathy during their hospital stay. Another quality dimension of services is ‘structural quality’, which is access to the service in terms of space and time—however good the service may seem in the abstract, it is useless if it cannot be accessed in a practical way when it is needed.

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But what do we mean by quality? Bovaird and Loeffler (2003, 314) distinguish the following six key quality concepts: • quality as ‘conformance to specification’ (a meaning deriving from an engineering perspective, later extended to contract management); • quality as ‘fitness for purpose’ or ‘meeting organisational objectives’ (derived from a systems perspective); • quality as ‘aligning inputs, processes, outputs and outcomes’ (derived from the strategic management perspective); • quality as ‘meeting customer expectations’ or ‘exceeding customer expectations’ (derived from consumer psychology); • quality as ‘passionate emotional involvement’—that ‘which lies beyond language and number’ (derived from social psychology); • quality as ‘enabling citizens to make an effective contribution’ (also derived from social psychology). While the first four definitions of quality are based on cognitive assessments, quality as ‘passionate emotional involvement’ focusses on the customer service experience and emotions during the delivery process and consumption of the service. However, as Edvardsson (2005, 127) points out, service experiences and customers’ emotions in the production, delivery and consumption of services have been very little researched. In particular, in the case of relational services (as opposed to transactional services) service quality needs to be embedded in processes, interactions and relationships (Edvardsson 2005, 130). The sixth definition of quality reflects a new citizen expectation—citizens not only wish to have excellent public services but also want to make a contribution themselves to improve public services or public outcomes (Hill 2008). As Normann (1991, 83) points out, in an enabling relationship “the business of the provider is to deliver the knowledge and tools necessary for performing the task per se, which is now done by the customer” [italics as in the original]. In this case quality is how well the provider enables citizens (as service users or part of communities) to take over some of the functions that the provider used to perform in a way which is appropriate to the capabilities of those citizens. The myriad of quality definitions given above shows that there is no single agreed definition of quality. However, it seems likely that organisations will find it difficult to bring about substantial quality improvements

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until they have agreed on their own definition of quality (Bovaird and Loeffler 2016, 163). This applies even more in a co-production context, as citizen coproducers and public service organisations may have different ideas of what quality means. In particular, public service organisations may be focussed on quality ‘as conformance to specification’ in order to ensure smooth service inspections. However, citizen co-producers may be more in favour of quality as ‘fitness for purpose’ so that the service concerned meets their requirements or may prefer to see quality as ‘passionate emotional involvement’ in the case of relational services. Actual or potential citizen co-producers may also prioritise quality as ‘enabling service users or communities to make a contribution’. However, while some public service organisations may want to be seen to sign up to this definition of quality, their conformance to detailed service specifications may conflict with the definition of quality as ‘enabling people to make an important contribution’. For example, many domiciliary care services provided by public service organisations are still driven by a ‘time and task’ culture where specific services need to be provided within a narrow time frame, rather than encouraging staff to devote time to enabling their service users to do more for themselves or others. Another issue is how to assess improvements to service quality resulting from user and community co-production. In Table 2.5 of Chapter 2, we explored how the quality of user and community co-production might be assessed on the basis of objective and subjective quality criteria. However, citizen co-producers and public service organisations may have different views of how quality should be assessed: whereas service users may find qualitative evidence derived from story-telling methods more meaningful, public service organisations are likely to focus more on quantitative (although similarly subjective) evidence, such as customer satisfaction data. Inspectorates and audit bodies sometimes require both kinds of evidence to be made available, although they too often give most weight to quantitative evidence. 6.5.2

Evidence of Improved Service Quality Resulting from User and Community Co-production

There is very little research which assesses to what degree citizen coproduction improves objective service quality—most of the evidence of

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improved service quality resulting from user co-production focusses on user satisfaction measures, which are, by definition, subjective. However, one example of an improvement in objective service quality is the extension of the opening hours of a community-run branch library in South Tyneside (2019). The new library service is based on a lease and contract from the local authority which involves co-management of the library facilities. The volunteer-run library will be open to the public for 25 hours a week which is an increase of 1.5 hours on existing opening times. It will also open on Saturday mornings and be available for bookings and events outside of core opening hours. It would be interesting to analyse the impact of citizen co-production on objective service quality dimensions such as tangibles, reliability and service access more systematically. For example, in Belgium, the Federal Public Planning Service for Social Integration has been employing trained ‘Experts by Experience’ in poverty and social exclusion’ since 2004 in order to improve the quality of public services, and in particular, to improve the accessibility of services at the federal level for people living in poverty and social exclusion (Van Geertsom et al. 2017). As a result, the quality of public encounters has changed. At the Federal Public Service Finances agency, an ‘Expert by Experience’ is now available at the information desk, so that visitors who are in a difficult situation can ask the ‘Expert by Experience’ for relevant advice. Furthermore, the information provided in the waiting area has been reviewed, clarified and simplified. Among other administrative simplification actions, a movie clip with icons was produced to help people with reading difficulties to find out which services are available (and which are not available) at the Information Centre. This allows service users to be better informed and potentially reduces their waiting time, as some people realise that their question would be better addressed elsewhere. However, quantitative evidence would be valuable on the extent to which the administrative simplification actions of the ‘Experts by Experience’ have reduced the waiting time of existing service users to receive a specific service or increased demand for Federal public services relevant to people living in poverty and social exclusion. As mentioned above, most co-production research focusses on ‘customer satisfaction’ as the key assessment criterion for improved service quality. In particular, it is expected that greater user satisfaction will result from citizen co-production (Vamstad 2012, 310). However, the relationship between user satisfaction and co-production is far from linear. As Edvardsson (2005, 129) suggests, “service quality is perceived and determined by the customer on the basis of co-production, delivery

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and consumption experiences”. The complication is that citizen coproduction may influence both citizen expectations and also their perceptions of service quality. Specifically, co-production may increase the expectations of citizen co-producers about what is possible. Even if the objective service quality remains constant, the result of co-producing will then be that citizens are less satisfied. Interestingly, Haumann et al. (2015), drawing on a large field experiment with customers co-producing private sector goods and services, demonstrate that co-production intensity reduces customers’ satisfaction with the co-production process—this may, of course, not apply more widely to public services but the possibility needs to be borne in mind. There is also the possibility that one of the factors motivating a citizen to decide to get involved in co-production initiatives is dissatisfaction with the level or quality of public services. We would then expect to find that survey respondents who co-produce more are also more dissatisfied than respondents who are less involved in co-producing. Indeed, this is what we found in previous research—our survey of co-production in 5 EU countries found that co-production was more likely where people felt government response to be unsatisfactory (Parrado et al. 2013; Löffler et al. 2008) and a similar but weaker pattern was found in a survey of 5 UK local authorities (Bovaird et al. 2016). This highlights how the direction of causation is key in interpreting survey results—such a finding would be entirely consistent with co-production bringing about greater satisfaction at a later date, if co-production helps to improve the quality of the services involved. However, no co-production studies so far have longitudinal data of this nature. Bendapudi and Leone (2003, 26) highlight a further factor affecting customer satisfaction, namely that citizen co-producers may be subject to a self-serving bias, so that they attribute successful outcomes more to their own inputs, while they attribute unsuccessful outcomes to other actors or to the context. A similar finding emerged from a study by Fledderus (2015) into student experiences with public service delivery. However, Bendapudi and Leone (2003, 26) also show that this tendency is reduced when service users can choose whether to co-produce or not. Of course, co-production of public services can also be assessed through user satisfaction in some cases. The non-profit organisation Therapy Focus in Australia has conducted several satisfaction surveys to evaluate the impact of co-designed therapy plans with people with disabilities. Of the 3587 clients who received services in 2015-16, 89%

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reported Therapy Focus was delivering the expected quality of support and 85% believed Therapy Focus was achieving the outcomes they expected (Burrows 2017). It may be that most of the users of this service are coming to it for the first time, so that they do not have prior expectations about the quality of the service. For services where users have prior experiences and therefore clear expectations, it may be harder to improve satisfaction through co-production. Clearly, more research is required to unpack the relationships between ‘customer satisfaction’ and citizen co-production—and it is likely that this research will have to take account of a range of other variables in a multi-level model, which will have to include, at the very least, service user expectations and tests for self-serving bias, in a longitudinal research design. 6.5.3

Who Knows About Service Quality?

The discussion about different definitions of quality and the need for both objective and subjective assessments of service quality, including its emotional dimensions, leads to an important admission—“different stakeholders ‘know’ different things about quality, and this has to be built into any quality management system” (Bovaird and Loeffler 2016a, 165). Table 6.4 considers whether quality is privately or collectively experienced and whether quality is simple or complex to specify. As can be seen, this leads to very different conclusions on the issue of who knows about quality. Table 6.4 Who knows about service quality? Quality is privately experienced

Quality is collectively experienced

Quality is simple to specify

Citizens are the best judges of the quality they experience individually

Quality is complex to specify

Both citizens and professionals know about quality (co-assessment)

Politicians are needed to judge collectively-experienced quality No one group is the best judge of quality—–politicians must act as referee between different views

Source Adapted from Walsh (1991, 509)

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In the case where the quality experience is mainly private, with few social knock-on effects, and simple to specify—e.g. the quality of a local government website—service users (or other members of the community with an interest in the subject of the website) know best about quality. Indeed, many local authorities invite website users to rate the quality of the online information provided. However, if quality is complex to specify—as is often the case in relational services—both professionals and service users know about quality. Here user or community co-assessment is required. In particular, professionals may focus on cognitive assessments, while service users may complement the assessment by including the emotional dimension of their service experience. Where quality is collectively experienced but simple to specify, politicians may be the best arbiters. No individuals can capture the collective experience so as to be able to judge quality, while the experience of professionals is generally not relevant, since they deal mainly with individuals. Finally, in very complex services with important social knock-on effects, we might well conclude that no one stakeholder group is likely to be a sound arbiter of quality. In this case, it is likely that all key stakeholders need to be involved and that politicians must act as a referee between different views. This discussion suggests that co-assessment of quality is an absolute ‘must’ in one situation—where quality is privately experienced but complex to specify. It also suggests that co-production is likely to be necessary in one other situation—where quality is collectively experienced and complex to specify. However, we might further conclude from this analysis that it is unwise to exclude any stakeholder from assessing service quality, even if they are not the best judge of quality (Bovaird and Loeffler 2016, 166). After all, they may be aware, from their experience, of aspects of quality which the other stakeholders are likely to neglect. For example, people living with dementia are likely to have a rather different service quality experience from that of the people who care for them—their views are essential to make sure that their experience is made as positive as possible. This even applies to highly regulated services which may often prefer to ignore the voice of service users in quality assessments, putting a strong emphasis on professional assessments through mandatory inspections or, at best, considering arguments made by representatives of the service users (e.g. parents or guardians of children in care). This may well

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have some unfortunate consequences—for example, looked-after children may have intense and negative experiences which are difficult or impossible for professionals (or indeed any adults) to identify, so that highly questionable services are not properly scrutinised, evaluated and changed.

6.6 Improved Public Governance from Co-production Processes 6.6.1

Definitions of Public Governance

Public governance principles remind us that improved quality of life outcomes are not enough in themselves—‘the ends do not justify the means’ (Loeffler and Bovaird 2018, 275). In particular, normative concepts of citizen co-production (see Sect. 2.3) consider co-production approaches as a vehicle for putting governance principles into practice. So, to what extent does user and community co-production promote good governance? Obviously, this depends on the definition of good governance which typically consist of lists of governance principles. But often not all governance principles can be implemented at the same time. For example, the Council of Europe (2018) has defined a list of 12 principles, which are key to its Governance Excellence Certification Scheme but it does not specify how these are related to each other. Some of these principles such as principle 3 (‘efficiency and effectiveness’) and principle 8 (‘innovation and openness to change’) are not fully compatible with each other, as not all innovations are efficient and effective, at least not in the short-term. Vice versa, specific performance management systems and audits may not support higher risks, which are inherent with innovation processes. Furthermore, it is important to recognise that not all governance principles are equally important. As the priorities and strategies of public service organisations change, some governance principles may become more important than others. Therefore, good governance has to be understood as context-specific. Most importantly, stakeholders need to agree together on which governance principles have priority (Loeffler 2016, 211). For example, in the context of a participatory evaluation of the quality of life and quality of governance of a local housing estate in Cornwall, the priority governance principles which were considered in the evaluation had been agreed with the board members, which also included resident representatives (Bovaird and Loeffler 2007, 295). This already

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involves co-production—specifically, in the co-commissioning process service users and other relevant citizens should have the opportunity to influence the priorities between key governance principles. The following public governance principles are likely to be important in countries with a representative democracy (adapted from Bovaird and Loeffler 2003): • • • • • • • • • • •

Democratic decision-making Citizen engagement Transparency Accountability Inclusiveness Equalities agenda Equity (fairness and honesty) Respect for the rule of law Respect for the rights of others Respect for diversity Sustainability of quality of life outcomes.

In the emerging context of digitalisation, privacy and confidentiality may need to be added to this list of key governance principles. The question then becomes: how do these principles influence co-production? And does co-production help in the achievement of some or all of these principles? 6.6.2

Effect of Public Governance Principles on Co-production

Governance principles may influence citizen co-production in several ways—they may act as an enabler of citizen co-production but they may also become a barrier to co-production, depending on the context. For example, the rule of law may imply regulations which are perceived as unnecessary bureaucracy in some contexts but as a benefit in other contexts. Health and safety regulations may imply that volunteers need to undergo training before they are allowed to co-produce. If the training requirements for volunteers are very extensive, this may become a barrier to co-production. In the case of the local ‘Environmental Champions scheme’ in Solihull, the local council kept the training of volunteers to two hours (Hine-Hughes and Edgell 2013), as citizens who were interested in undertaking environmental improvement activities were not

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prepared to spend any more time on training activities. However, if the ‘rule of law’ implies a duty for public sector organisations to protect citizen co-producers by paying for an insurance scheme, this governance principle may be considered as an enabler. Weyhe Council, a small town close to Bremen, runs an evening Streetwatch scheme with trained volunteers in order to reduce anti-social behaviour by young people in local ‘hot spots’. The local council treats the citizens working as ‘Streetwatchers’ as ‘volunteer employees’, in order to extend the insurance benefitting their own staff to the volunteers (Meyer and Grosser 2014). Given the risks involved in the activities of Streetwatchers, the insurance scheme is welcomed by the volunteers and even considered by some as a ‘must have’. Governance principles can also constrain co-production processes, which need to respect the parameters which they set. In the case of the Solihull ‘Environmental Champion’ scheme all trained volunteers had to agree to respect a charter which set out the duties of the volunteers and the local authority (Hine-Hughes and Edgell 2013). For example, the guidelines ensured that all of the agreed environmental projects were known to and supported by the co-ordinator. Co-production projects had to demonstrate that they were bringing benefits to the whole community, and were targeted to be undertaken in areas that did not have the financial or physical capability to do the work themselves, without help from the local authority. The projects also had to maintain political neutrality. The most systematic way of assessing the effect of governance principles on co-production would be to evaluate the extent to which a Co-production Charter has been implemented in practice, where such a charter has been agreed. 6.6.3

Effect of Co-production on Achievement of the Principles of Public Governance

Co-production may also strengthen the implementation of public governance principles. For example, in the case of the co-produced fall prevention scheme ‘Stepping Forward Together’ in Aberdeen City efforts are made to recruit volunteers working as ‘Falls Ambassadors’ from a wide range of groups in the community, so that these groups can benefit from awareness raising sessions (Thompson and McConnachie 2019). This not only ensures better health and wellbeing outcomes of groups which may

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be hard to reach for public service organisations, but also increases the diversity of the volunteers contributing to this co-production initiative. The impact of co-production on the achievement of governance principles may also depend on the co-production mode, namely cocommissioning, co-design, co-deliver and co-assessment. Table 6.5 summarises a more detailed analysis of how the “four Co’s”, as discussed in Sect. 3.1, might contribute to key principles of democratic public governance (Bovaird and Loeffler 2016). Co-production may be used as a mechanism to strengthen democratic decision-making. In particular, citizens involved in co-commissioning may help elected politicians to make difficult decisions on which outcomes, services and beneficiaries to prioritise. The impact of co-design, codelivery and co-assessment on democratic decision-making is not so strong as in co-commissioning, as elaborated in Chapter 3. Nevertheless, each of the other Four Co’s can support politicians in ensuring public value from public services, which is a key element in maintaining the legitimacy of democratic decision-making. As Table 6.5 illustrates, all four modes of co-production are likely to contribute positively to the achievement of each of the other governance principles. When citizens are involved in the improvement of public services and quality of life outcomes, transparency is naturally increased—and this is particularly the case with digital approaches to co-production. Co-production may also be used as a mechanism to strengthen accountability by engaging citizens in holding public service organisations to account but also by enabling citizen co-producers to give a public account on their actions. Furthermore, co-production may improve social inclusion when empowering disadvantaged or vulnerable groups as co-commissioners, co-designers, co-deliverers or co-assessors and can promote conformance to the equalities agenda. The governance principle of equity is about fair procedures and due process. In all ‘Four Co’s’ the role and rights of local communities and users must be clearly defined to ensure fairness and due process. When citizens or users are involved in shaping these rules this is likely to increase the perception that rules are fair. For example, the Berlin borough of Lichtenberg introduced ‘neighbourhood budgets’ (Kiezfonds ) with small pots of money to provide community activists with seed funding to organise social events and other activities to improve the quality of life in the neighbourhood (Loeffler and Martin 2016, 312). A citizen jury decides on the allocation of funds based on clearly defined rules.

Co-commissioning

Citizens/users help elected politicians determine priority outcomes, services and target groups

Citizen/user representatives question potential service providers during bidding process

Citizen/user representatives monitor the performance of service providers (e.g. school parent- governors, young people as members of youth club management boards)

Democratic decision-making

Transparency

Accountability

Citizens/users involved in user groups consult widely on their service improvement proposals

Citizen inspectors/peer reviewers monitor service quality

Citizen/users help elected politicians to identify the impact of services and co-production on personal and public quality of life outcomes, governance principles and resilience Service users’ ratings of public services are published

Citizen/users help elected politicians to draw on community/ user resources to achieve better public value Stories of volunteers/ users contributing to public services or outcomes are published in newsletters of public service organisations Citizen co-producers report on how they used public money and results achieved

Citizens/users help elected politicians ensure that public services are tailored to community/user needs to improve public value

Online suggestion schemes of public service organisations enable citizens (and staff) to see which citizen proposals have been made

Co-assessment

Co-delivery

Co-design

Modes of governance and key principles of democratic public governance

Governance principle

Table 6.5

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Co-commissioning

People from disadvantaged or vulnerable groups are involved in commissioning services (e.g. young people characterised as NEET co-decide on selection of service providers)

Minority populations have equality of opportunity in contributing to commissioning of public services and outcomes and ensure that service specifications are non-discriminatory

Roles and rights of community/user representatives in commissioning are clearly defined and citizens are involved in shaping the rules (e.g. decision-making processes in participatory budgeting)

Governance principle

Social inclusion

Equalities agenda

Equity (fair procedures and due process)

Roles and rights of user groups in co-design exercise are clearly defined and users are involved in shaping the rules

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(continued)

Roles and rights of citizens/users in co-assessment are clearly defined (e.g. no discriminating language) and citizens/users are involved in shaping the rules

Citizens report incidences of discrimination, harassment or victimisation of minority populations

People from disadvantaged or vulnerable groups co-assess public services or outcomes, which are particularly relevant to them (e.g. people with learning disabilities carry out peer reviews of their services)

People from disadvantaged or vulnerable groups contribute to improvement of public services or outcomes (e.g. Community Health Trainers from deprived communities) Minority populations have equality of opportunity in contributing to delivery of public services and quality of life outcomes and can guard against discrimination, victimisation or harassment in service delivery Roles and rights of volunteers in co-delivery are clearly defined and citizens are involved in shaping the rules for volunteers People from disadvantaged or vulnerable groups are involved in design of services (e.g. people with mental health issues co-design mental health services)

Minority populations have equality of opportunity in contributing to design of public services and outcomes

Co-assessment

Co-delivery

Co-design

6

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Citizens/users are encouraged and enabled to ‘whistle-blow’ in case of illegal commissioning practices

Respect for the rule of law

Source Adapted from Bovaird and Loeffler (2016, 264–266)

Co-commissioning

(continued)

Governance principle

Table 6.5 Co-assessment Citizens/users are encouraged and enabled to highlight inappropriate complaints management to Ombudsman or advocacy organisations

Co-delivery Citizens/users are encouraged and enabled to ‘whistle-blow’ in case of illegal service delivery practices

Co-design Citizens/users are encouraged and enabled to ‘whistle-blow’ in case of illegal service design practices

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Last but not least, co-production may help to reinforce the rule of law by enrolling citizens as watchdogs to ensure that laws, regulations and rules are observed. This is the rationale for encouraging citizens to ‘whistle-blow’ if commissioning, design, delivery or assessment practices involve illegal activities. The ‘whistle-blowing’ may involve the use of complaints systems of public agencies or, in some cases, may require independent advocacy organisations to ensure that the voice of vulnerable citizens is heard. However, there are also contexts where citizen co-producers may perceive the rule of law as a barrier to co-production so they may ‘stretch the rules’ or ‘work around them’, as discussed in Sect. 5.6. While we have explored here the evidence for a positive impact of citizen co-production on achievement of public governance principles, there can also be governance pitfalls from co-production, as discussed in more detail in Sect. 5.6. In order to assess the effects of co-production on these public governance principles, we need not only investigations into each principle separately but also a tool which allows the overall picture to be displayed, Given that not all of these principles can be achieved at once, and that priorities have to be established between the principles, a ‘balanced scorecard’ provides the most appropriate tool for presenting the results of such an assessment, so that the trade-offs between these governance principles can be taken into account. An example is provided by the evaluation of quality of life outcomes and public governance principles around the Beacon housing estate in Carrick District Council (Bovaird and Loeffler 2007), which had been characterised by a strong co-production approach in the preceding years. Figure 6.3 presents the final summary account from this analysis. In this approach, focus groups made up of relevant stakeholders were asked to discuss the extent to which one quality of life outcome and one public governance principle had been achieved on Carrick Housing estates (or on the estate where they lived, in the case of residents). The quality of life and public governance issue was chosen to be particularly relevant to that stakeholder focus group. Clearly, more detail can be gathered if the number of focus groups relevant to each issue is increased. As Fig. 6.3 illustrates, stakeholders gave a mixed response to the issues discussed in relation to public governance principles—while there was only one ‘unhappy’ icons to designate a weak performance, there were

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Fig. 6.3 Perception by different groups of the quality of life and governance on Carrick Housing estates (Source Copyright © Governance International 2005)

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also only two ‘happy’ icons to signify a strong performance. The advantage of this reporting tool, however, is that it gives an overall picture and acts as a framework for discussion. Overall there is little research on the implications of co-production on public governance. As Verschuere et al. (2018, 243) point out, one governance issue which deserves particular attention is the extent to which co-production is ‘democratic’ in nature (which we discussed in relation to Table 6.5 earlier). Furthermore, more research is required to analyse the relationship between co-production and the rule of law. This is in particular an issue for co-production related to ‘law and order state’ (Rechtstaat ) issues such as public safety services, which tend to be more regulated than many other public services (Loeffler 2018).

6.7

Additive Versus Substitutive Citizen Co-production

As discussed in Sect. 6.4, there is not much evidence on the impact of citizen co-production on public service efficiency. At the same time, there is a vigorous debate about the role of citizen co-production in the context of austerity and the distribution of costs and benefits from co-production. We can distinguish three propositions in the current literature: Proposition 1 Co-production is a key policy response to austerity, allowing public sector resources to be replaced by citizen resources in public services, even in the short term. Proposition 2 Co-production is not ‘free’ but requires public sector organisations to invest additional resources , at least in the short term—and these are particularly difficult to mobilise in times of austerity. Proposition 3 Co-production leads to improved quality of life outcomes, the value of which are likely to exceed the extra resources invested by the public sector. Clearly the first two propositions cannot be true simultaneously, while the third proposition can only be tested in the longer term. So, do co-production initiatives result in providing services more cheaply, by mobilising citizen contributions to replace paid staff? And, if yes, what is the evidence for public sector savings resulting from co-production? Or is it simply a destructive cost-reduction tactic, oblivious of the damage done, as suggested by a stakeholder quoted in Durose et al. (2013,

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2): “It is damaging if [co-production] becomes associated with a costcutting mentality”, given that such an aim mobilises many political and social forces to resist it. Does this imply that a cost-cutting aim for co-production should never be promoted in public policy? As Durose et al. (2013, 2) conclude “the drive for efficiency is often insufficient to mobilise people if it is detached from a wider dialogue around developing a shared vision for change”. Or can co-production result in the transformation of public quality of life outcomes, if public sector organisations are prepared to increase the resources they devote to it, in order to make it more effective? In order to shed light on these propositions, and get away from over-simplistic assumptions about the resource effects of co-production, a conceptual framework is needed which helps us to analyse how the balance of citizen and public sector inputs is likely to change when different co-production strategies are adopted. Table 6.6 provides this framework, distinguishing additive and substitutive forms of citizen coproduction from a public sector perspective. In a context of austerity in the UK, local authorities have struggled with the pressure to achieve short-term savings and to deliver a longer-term transformation of public services. In this situation, some local authorities have used co-production as an efficiency strategy to replace a part of their public sector resources by increased inputs from service users and local communities. From a public sector perspective, substitutive forms of co-production involve a reduction of net resources of public sector organisation. This means that the resources saved in the public sector through co-production exceed the set-up costs or recurrent costs, as discussed in Sect. 6.4. Table 6.6 Additive and substitutive forms of citizen co-production from a public sector perspective Shift of resources for public sector organisations

Change in public sector resources

Change in citizen resources

Pathway to co-production

Substitutive Additive

Decrease Increase

Increase Decrease or increase

Inside-out Inside-out or outside-in

Source Adapted from Löffler and Timm-Arnold (2016, 309)

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A common example of substitutive co-production in the UK is the case of ‘community-supported’ libraries (Department for Digital, Culture, Media and Sport 2018), which usually have paid staff but receive significant support from volunteers. A more radical case of substitutive coproduction is given by ‘community-led’ libraries (Department for Digital, Culture, Media and Sport 2018), which are largely community-run libraries, rarely with paid staff (but with some professional input and other forms of ongoing support from the local authority, such as the financing of the book stock). Of course, in cases where the resource input of public services has been reduced to zero and the provision of the specific services has been shifted completely to citizens, this becomes community selforganisation and the term ‘co-production’ is no longer justified, even though it may sometimes be used by the public sector organisation as a euphemism for the radical cessation of public services. Clearly, ‘independent libraries’ which are completely community-managed with no public sector support fall into this latter category. Additive citizen co-production, on the other hand, consists of adding professional support to user and community activities to turn them into co-production. As a result, citizen inputs may decrease—for example, when unpaid care-givers receive respite from public service providers, so that they do not have to provide care around the clock. However, increased professional support may sometimes enable service users or communities to contribute more resources to co-production—for example, a service user who is an ‘expert by experience’ in mental health issues and who already provides ad hoc peer advice to other people with mental health issues through social media may be enabled to provide more intensive face-to-face support to peers by running a peer support group—and may even be introduced to a wider range of peer groups who can benefit from that person’s experience. Therefore, in the case of additive co-production, citizen inputs may either decrease or increase. From this analysis, we can see that the ‘outside-in’ pathway to coproduction is likely to require additive co-production, as public sector organisations have to invest recurrent resources to support citizen action or voice activities. However, the ‘inside-out pathway’ to co-production is ambiguous in terms of resource implications for public sector organisations: It may imply substitutive co-production—for example, when local authorities replace some paid library staff by unpaid volunteers. In other

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cases, the inside-out pathway to co-production may involve additive coproduction—for example, when social services recruit, train and support ‘experts by experience’ to perform peer inspections of service providers to complement regulated inspections by professionals. This framework therefore allows us to refute the accusation which is sometimes made that co-production always ‘dumps on’ citizens to do more—this is indeed true of substitutive co-production but additive coproduction opens up the possibility that that government can help citizens to gain more benefit from their efforts, both by improving outcomes and sometimes even by being able to decrease their inputs. (And ‘dumps’ is a pejorative term—we should be aware that it is sometimes justified but also sometimes inappropriate, since there are indeed occasions when the inputs supplied by citizens in substitutive co-production are both more effective than the professional inputs they replace, and willingly given). 6.7.1

Benefits and Challenges of Substitutive and Additive Citizen Co-production

In political contexts characterised by a focus on short-term savings, such as the UK since 2010, public sector organisations will naturally be attracted by forms of substitutive co-production. At the same time, the commitment to a preventative strategy in health and social care implies the need to shift more public sector resources to supporting users and communities to achieve behaviour change, which constitutes additive coproduction. Which of these tendencies is paramount will clearly differ from context to context. The choice between additive and substitutive co-production requires a dynamic perspective on citizen co-production. In the case of additive co-production, the savings are likely only to become manifest in the medium- or long-term. In the short-term, public sector organisations need to invest more resources, which is a major deterrent to local government action at a time of austerity. Moreover, it may be uncertain how rapidly additive co-production can prompt the behaviour change that is needed to bring about the ultimate outcome improvements and cost savings. These concerns naturally favour specific co-production initiatives, which are either low-cost in the initial phases or are likely to show some positive effects relatively quickly. In the case of substitutive co-production, public service organisations may achieve savings in the short-term, where the new co-produced offer

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requires fewer resources from them. However, the issue is how sustainable these savings are—a major factor will be the continued motivation of engaged citizens to co-produce. Moreover, short-term savings may not be enough when the public sector is in a long-term process of retrenchment. In practice, some public sector organisations have decided to start additive co-production, even though it is unlikely to lead to budget savings, because they put a high value on the improved public quality of life outcomes. The Rimini case study, where the local authority coordinates volunteers who clean up the local environment, is an example of a local authority which spends budget on promoting and supporting a regular, intensive volunteering activity which achieves improved public and personal outcomes (Artuso and Montini 2016). The local authority supported this initiative even though it had not previously looked after these public spaces, so it experienced no cost savings as a result. However, such an approach brings the challenge for such organisations of how to demonstrate that the public value created is greater than the public resources invested. As discussed in Sects. 6.2–6.6, there are still relatively few cost-benefit analyses of co-production, which attempt to put a value on the outputs and outcomes achieved and compare them to the costs involved. A strategy which might be used in these situations is for the public sector to start initiatives based on substitutive co-production, in order to generate at least some of the extra resources required for funding additive co-production initiatives. Vice versa, of course, if additive forms of co-production enable service users and communities to improve their outcomes, so that they need less support from social care staff in the medium and long-term, commissioners and providers can then switch to substitutive co-production—but this requires some spare resources for the initial investment in additive co-production activities. More generally, in an era when savings dominate much of the public policy agenda, a much more concerted attempt is needed to illustrate the benefits of spending public money on public interventions such as co-production. The digitisation of public services may provide an opportunity to open up significant public funding for co-production initiatives ‘through the backdoor’, as public service commissioners and providers start to harness digital technology in service delivery. This is particularly the case in health and social care, where demographic changes affect both the levels of demand by service users and the supply of workforce, so that

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commissioners and providers are looking for new solutions to provide better care with fewer staff. The example of the project CleverCogs™ in Scotland demonstrates how the use of digital technology in homes and care services for people with disabilities helps service users to take better care of themselves and others (Carnegie UK Trust and Just Economics, n.d.) and enables staff to work more efficiently. CleverCogs™ is delivered via a handheld touchscreen device (tablet) with the ‘Cogs’ representing aspects such as lifestyle, home automation, safety, health, wellbeing, entertainment. The digital device not only increases digital participation for adults who have been digitally excluded but also enables staff to use digital technologies to liaise better with their service users and other service providers. An evaluation showed that the increased internet use enabled (among other intermediate outcomes) better self-management by service users and efficiency savings for service providers, even in the short-term (Carnegie UK Trust and Just Economics, n.d., 8). Indeed, the evaluation found that “staff using CleverCogs™ saved approximately five minutes on average per visit in time spent on administrative tasks”, Carnegie UK Trust and Just Economics 2019, n.d., 11). The evaluation estimated the financial benefits from efficiency savings made by Blackwood, the organisation which is piloting this technology, amounted to £157,000 per year, Carnegie UK Trust and Just Economics, n.d., 12). This is obviously very positive— however, the evaluation suggested that the overall return to Blackwood was negative, as a result of the size of the initial investment. This example shows that additive co-production can indeed result eventually in substitutive co-production but it may take some time and should not be assumed to be the case—the likely financial pros and cons must be weighed up carefully. Clearly, more research is needed on both the changes in outcomes and financial impact of digital co-production.

6.8

Conclusions

In this chapter, a public value framework has been proposed which positions co-production as a key option for making commissioned services more effective and which demonstrates that co-production can impact directly on quality of life outcomes, without necessarily working through the medium of public services. The chapter has also explored how co-production impacts on different types of outcomes. The need to balance priorities between individual,

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community and business outcomes, each of which may involve conflicts with citizens who may have different priorities, means that political choices need to be made, in which citizens should be able to play an important role as co-commissioners. A key issue is the strategy which is adopted towards quality of life outcomes—a risk-averse approach, which aims at a high level of certainty in achievement of the desired outcomes, especially where the risks are defined by professionals and managers, rather than by service users and communities, makes co-production much less likely. More conducive to co-production is a strategy which gives significant weight to the probability of achieving higher outcomes, allowing service users and communities to have a say in the extent to which positive risks are acceptable. An even more ambitious approach to outcomes, pursuing transformational change through developmental outcomes, is likely to be highly daunting for service users and communities, as well as high risk for service commissioners and providers, and here it seems likely that co-production will often be the most effective approach—and may sometimes be the only approach likely to work. Assessing the effects of co-production on quality of life outcomes is necessarily challenging, since co-production is usually complex and takes time to produce its full effects. Indeed, in public services which are complex adaptive systems, it may never be possible to predict the cause-and-effect relationship of co-production interventions and longterm outcomes. Nevertheless, where we are dealing with public services in the simple or complicated knowledge domains, it may indeed be possible to measure outcome improvements quantitatively and even to give them a monetary value, based on cost-benefit analysis. In many other cases, assessing intermediate outcomes may be the best that can be done. Co-production has often been motivated by the need to make cost savings by reducing the inputs of public service organisations in terms of budget, staff numbers and staff time. However, it is clear that the costs of co-production to public service organisations and to citizens, both service users and communities, are still not fully understood, nor properly taken into account in decisions about how much and what type of co-production should be undertaken. All inputs should be costed (at least in outline), including citizen inputs—not just the inputs for which the public service organisation pays. Moreover, public service organisations should ensure that the costs of co-production to citizens should be kept to a level which is consistent with efficient use of their time and effort, whether or not this is being measured. More research is needed to

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analyse the full costs of co-production in order to be able to evaluate how it has affected efficiency. The impact of co-production on the quality of service is underresearched, particularly in relation to objective measures of quality— most of the evidence of improved service quality resulting from user co-production focusses on user satisfaction measures, which are, by definition, subjective. While it is generally expected that greater user satisfaction will result from citizen co-production, the relationship between user satisfaction and co-production is far from linear. There are a variety of intervening variables, such as user expectations and ‘self-serving bias’ on the part of co-producers, which mean that successful co-production may not increase satisfaction with the quality of a service. Moreover, people who co-produce may be motivated by dissatisfaction with the existing quality of a service, so that there is a correlation in surveys between coproducing and being dissatisfied—only longitudinal studies can identify the direction of cause-and-effect in this relationship. Governance principles may influence citizen co-production in several ways—they may act as an enabler of citizen co-production but they may also become a barrier to co-production, depending on the context. No systematic assessment has yet been undertaken into the effect of governance principles on co-production but this would be possible through evaluation of the extent to which a Co-production Charter has been implemented in practice, where one has been adopted—this remains a task for the future. Similarly, as yet there has been little research on the implications of co-production for public governance. While interesting examples can be found of improvements to public governance which have been carried out through the Four Co’s, it is also important to recognise that there can also be governance pitfalls from co-production, as discussed previously in Sect. 5.6. We provide a framework to distinguish additive and substitutive forms of citizen co-production from a public sector perspective. In the political context of public sector austerity, public service commissioners will naturally be attracted by forms of substitutive co-production. However, this will not necessarily be true of public service providers. Moreover, commissioners who wish to move to a more preventative strategy may accept the need to shift more public sector resources into supporting users and communities to achieve behaviour change, which constitutes additive co-production. To reconcile these conflicting pressures, a combined

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strategy might be worthwhile. One option is to start initiatives based on substitutive co-production, in order to generate extra resources required for funding additive co-production initiatives at a later time. Another option for public service organisations is, of course, to invest in additive co-production initially but to cover the extra costs involved through substitutive co-production at a later stage—but this depends on the availability of spare resources for investment. There is some evidence that digital co-production initiatives are currently using the latter strategy, but more evidence is needed regarding the financial impact of these initiatives. In general, the current climate of public sector austerity in many countries means that savings have often been the driver in public service reform. A much more concerted attempt is therefore needed to illustrate the benefits of spending public money on public interventions such as co-production, if the case for more co-production is to be convincing to decision makers in public service organisations.

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CHAPTER 7

The Future of Co-production: Policies, Strategies and Research Needs

7.1

Introduction

This book has so far focused on the development of co-production as an idea and vision from the 1980s onwards, and on the current situation in relation to co-commissioning, co-design, co-delivery and co-assessment. This has been a fascinating journey, marked by some rapid spurts and then some slow periods of consolidation. So now the time has come to consider the future—what might be the role of co-production over the next decade and longer? And how can we ensure that this role makes good use of the potential of the concept, while not being blind to its limitations? In this chapter, we first consider the potential role of co-production in future public services and improving public outcomes, then the kinds of policies and strategies which are likely to support the mainstreaming of effective co-production. Finally, we make some recommendations on a research agenda which can help to grow the evidence-base for co-production.

7.2

The Future Role of Co-production

We presented in Fig. 6.1 our public value model, which highlights the potential role of co-production, both in making public services more effective and in directly affecting publicly desired outcomes.

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This is not only a model—it also encapsulates a vision of the future, in which intensive co-production does not happen simply by accident, or because of the commitment of a small number of enthusiastic frontline staff, or because of the pushiness of some switched-on service users or community groups. Rather we believe that, in the future, effective user and community co-production of public services and outcomes needs to be mainstreamed by integration into the public value chain instead of ‘project-managed’ in a partial and sporadic way. This does not imply ‘co-production by default’ in the sense that every public decision, public service and every outcome needs to be co-produced or that public service organisations need to implement all the four Co’s in all services simultaneously. However, it does have three implications: • First, citizen co-production should be the assumed starting point for social and digital innovation in the public domain. At present, the decision whether or not to seek intensive co-production is often left to public managers and staff. This is not good enough—they have too many reasons to rush this decision or take a negative view of it (or even ignore it completely). In social and digital innovation processes citizens should be involved as active partners with opportunities to contribute to the commissioning, design, delivery and assessment of social and digital innovation and not just as an end-user. It may turn out that, after consideration, more intensive co-production is not the best way forward—but that consideration should be undertaken by multiple stakeholders, including citizens, and not simply by those in a position of power in public service organisations. • Second, co-production needs to be implemented as a holistic transformation approach instead of an add-on project to specific services. This will raise awareness of how different public services and communities contribute to public value. In other words, coproduction could become a powerful driver of the public services integration agenda, not just in health and social care. Moreover, a holistic approach means considering service users and members of communities as ‘whole people’, not simply as one-dimensional objects of public policy or public service intervention. Since citizens are obviously much more ‘experts in their own lives’ than professionals can be, this immediately makes co-production a central

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method of considering how best to design and implement public interventions. • Third, public service organisations need to pursue more the ‘outsidein’ pathway to co-production. So far, many co-production initiatives have started as co-production projects within public service organisations which have sought to bring in citizens to contribute to existing activities by professionals, rather than looking at people’s everyday lives and asking what public services can contribute to raise the quality of those lives. We will elaborate on each of these perspectives in turn. Co-production as the assumed starting point for social and digital innovation in the public domain: Even though there is now more talk about ‘user-driven design’ of public services, service users or communities are still often brought in at the end of change management processes or simply perceived as ‘research objects’ rather than co-producers of social or digital innovation. However, achieving effective behaviour change and digitisation of public services requires a different approach to public service transformation—a new paradigm is needed, which embeds coproduction from the start. In Mergel et al. (2018, 3) it is suggested that, “previous efforts have left public administrations with problems of non-adoption or even rejection of public services, so that citizens opted to use analogue services instead of online services”. At the same time, many citizens are eager users of online services provided by Amazon and other new players in the gig economy. The public sector clearly needs to find a way of making its digital public services as attractive to users as the private sector already has. Digital transformation in the public domain therefore implies a shift towards an external, open and co-productive logic of improving public services and outcomes. Similarly, social innovation generally requires behaviour change, as innovation means changing old attitudes and behaviours. Co-production is a key way of achieving behaviour change, as the Public Value Model in Sect. 6.2 suggests. Moreover, given the current challenges of climate change, the ageing society, migration and the gig economy, behaviour change is likely to figure even more strongly on the policy agenda in the next decade and co-production will be essential in identifying, implementing and disseminating effective social and digital innovation

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to cope with these wicked issues. Of course, just because more intensive co-production should be the assumed starting point of social and digital innovation does not mean that it will, in the end, be the only way to develop and improve public services. There will be times when other approaches—nested more in hierarchical or market modes of governance—will be more appropriate. Furthermore, co-production with citizens may be even more effective when combined with organisational partnership arrangements, as highlighted in a Scottish case study on employability services (Lindsay et al. 2018). The role of co-production in public services must always be subject to challenge, as with any other approach to service commissioning and provision. However, the current practice of considering co-production as ‘an extra’ makes no sense, when new ideas are needed urgently and when citizens’ knowledge, skills and resources are being wasted so flagrantly. Co-production as a holistic approach to public services: We have stressed in Chapters 4 and 6 that co-production must, in the end, be judged by its effect on the quality of life of citizens and public governance principles. We have also discussed the wide range of quality of life outcomes which are likely to be valued by citizens (see Fig. 6.2). This means that many different public service organisations are likely to be involved in helping to achieve these outcomes. However, outcomes are not experienced separately—the quality of life which people experience is holistic. Furthermore, many public governance principles are experienced collectively. A central benefit of co-production is that the holistic understanding which service users have about their own lives is automatically embedded in moves to more intensive co-production of public services. So if service users add their tacit knowledge to service planning, the results are likely to be a great deal better (‘people know more than they can tell’). Similarly, community members are aware of what assets the neighbourhood has available and what capabilities are embedded in community members, so their contribution also adds to a holistic understanding of how service outcomes can be improved. It is essential that public services staff in the future get a better understanding of what users and their networks already contribute and could contribute more to improving individual and collective quality of life outcomes. This means that co-production can become a real driver of service integration by providing a holistic perspective. More ‘outside-in’ pathways to co-production: So far, most co-production initiatives have been launched by public service organisations by bringing citizen voice and action into public services. In the future, public service

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organisations need to at least try more the ‘outside-in’ pathway to coproduction by mapping what users and communities are already doing and co-designing ways of supporting these activities to improve their outcomes. So far, service user and community asset mapping has only scratched the surface in most areas, as the modern welfare state is culturally biased towards a dependency culture and still thinks in a paternalistic way. This needs to change, as current ways of providing public services are clearly not coping with the challenges facing public policy around the world. In these circumstances, appealing to citizens to come and contribute to these services naturally constitutes an unattractive offer. Fortunately, digital technologies can now enable public service organisations to gather and analyse more data on what citizens are doing to help themselves and others—and where the gaps are. This has to play a much larger role in the future. Of course, this does not mean that governments need to get involved in everything citizens are doing. Nor does it imply that governments should monitor (‘spy on’) everything that citizens are saying and doing. However, government data which is already collected can be used in more effective ways while respecting privacy and data security. The enormous opportunities for governments to support and enhance the activities in daily life of citizens, particularly the most vulnerable citizens, will require a major shift in public service systems towards an enabling role. In the rest of this chapter, we therefore look at how the promise of much more effective public services which co-production offers might be made real. In the next section, we consider how more intensive coproduction might be promoted through medium of public policies and the strategies of public service organisations, both commissioners and providers.

7.3

Policies for Mainstreaming Effective Co-production

So which policies need to be put in place in order to mainstream effective user and community co-production initiatives? Based on the evidence identified in previous chapters, we develop here a set of recommendations for key stakeholders involved in co-production, including policy-makers, public sector organisations, third sector organisations and citizens (in their roles both as service users and members of local communities). We classify most of these recommendations under the specific headings

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of the Four Co’s of co-commissioning, co-design, co-delivery and coassessment of public services and outcomes but we start with a number of recommendations which apply to all four modes of co-production, Recommended co-production policies applying to all Four Co’s There are three families of policies and strategies which are needed to make co-production more successful: • making more favourable the context and external environment in which co-production happens; • improving the drivers which make co-production successful; and • removing the barriers which impede co-production. First, shaping the context and the external environment of user and community co-production is a responsibility of policymakers across different levels of government, both at the political level (making policy and exercising scrutiny) and at the managerial level (formulating strategy). This context-shaping lies directly within the remit of the organisations which are responsible for policymaking and commissioning—both at the political and official level. However, it is also subject to influence even by individual public service providers (whatever sector they may be in). Moreover, regulators, auditors and inspectors also have a significant influence on commissioning. The views of all these stakeholders therefore need to be taken into account in policymaking and strategy, so that all stakeholders need to form a view about the benefits which potentially accrue to co-producers but also the possible organisational, community and user risks involved. There is a range of policy changes in the external environment of public service organisations which have been highlighted in previous chapters, each of which is likely to help co-production to become more successful: • Policy reforms strengthening network governance in public services, for example, through a new welfare mix in social services, which give space to co-production as an alternative to the purely in-house provision of public services which was characteristic of traditional public administration or the full privatisation of public services which was often associated with New Public Management. • Legislating that public procurement processes should enable service commissioners and providers to involve service users and/or

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communities in each of the Four Co’s—or have to demonstrate why this may not be appropriate. Development of national quality of life outcome frameworks for all levels of government and all sectors, so that national agencies and public service organisations focus not only on services but also on politically important priority quality of life outcomes, determined in conjunction with citizens. Institutionalise seed funding for experimentation with innovative co-production initiatives in order to develop capacity for social innovation in public services and local communities, in particular at the local level of government. Creation of digital and non-digital learning platforms at all levels of government which facilitate social learning processes and the dissemination of effective co-production initiatives. Changing the risk appetite in the public sector, so that risk aversion is less common—in particular, auditors and inspectors have an important role to play in encouraging experimentation and system-wide learning from new co-production initiatives. Developing an insurance framework for co-producing citizens, so that public service providers can access public insurance cover for citizen co-producers more easily.

Second, promoting the drivers of co-production can be undertaken at all levels—national and local, in commissioning and providing organisations, by service users and local communities. Furthermore, professional associations and organisations involved in education and learning have a particularly important role to play in skilling up the current and future workforce in co-production. Some of the key policy changes which have been highlighted in previous chapters as being needed here include: • Policy-makers at all levels of government need to adopt more enablement approaches to help citizens (particularly vulnerable citizens) to help themselves and to mobilise leadership for co-production across the public, non-profit and private sectors and local communities. • Local commissioning organisations need to enable and encourage service providers to experiment with co-production (in all four Co’s), in particular in prevention and rehabilitation, by shifting

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toward outcome-based commissioning. This may also imply recommissioning of public service contracts, and in some cases, even decommissioning, so that appropriate service providers are in place to respond to this shift. Local providing organisations need to invest in training and action learning to skill up staff in co-production (in all 4 Co’s) and to recruit staff with co-production skills or at least commitment to co-production. Local public service organisations need to develop greater trust and a greater sense of self-efficacy in service users and communities, so that they are more willing to become co-producers. Professional associations need to develop new competency frameworks for co-production and to ensure that co-production is embedded within the training programmes for new and existing professionals. Universities and other education providers need to integrate coproduction into their curricula (e.g. in human resource management and public administration modules), so that all those involved in public services are more aware of the potential value of coproduction. Local communities need to spread the news about how their contributions to collective co-production initiatives have made a difference to the quality of life in their communities (e.g. through blogs, vlogs, local newsletters, hyperlocal websites and storytelling generally). Service users need to tell other service users how their contributions to individual co-production have improved their own quality of life—and platforms for this dialogue need to be put in place by many of the other stakeholders in this list.

Third, while some of the above drivers may become barriers when they are absent, there are a number of specific co-production barriers which have been suggested in the literature (see Sect. 5.2). Policies and strategies for removing barriers to all four Co’s should consider the following set of actions at different levels: • Policy-makers in all public service organisations —mapping both the contributions currently being made to all their activities by service users and communities, with a view to understanding how

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widespread these contributtions are, and also the barriers which reduce the volume or effectiveness of the most valuable of these contributions, and also mapping approaches which have been taken successfully to eliminate situations where citizens’ time and effort is being wasted in unnecessary or ineffective co-production activities. National level (including government and research funding bodies )— sponsoring research and dissemination of knowledge on coproduction barriers and how to overcome them across a wide range of outcomes and services. Local commissioning and providing organisations —shifting from risk minimisation towards risk enablement. This also implies a change from single loop toward double-loop and triple-loop learning. In all public service organisations , stopping the communications department having a monopoly on external communication but rather training at all levels to engage in effective conversations with citizens (with appropriate safeguarding policies). Local providing organisations —making use of ‘inside-out’ pathways to co-production but also ‘outside-in’ pathways by adding their resources to those of community self-organisation and user self-help. Service users —communicating barriers experienced in user coproduction and making proposals on how to remove them. Communities —communicating barriers experienced in community co-production and making proposals on how to remove them.

However, there is still very little empirical evidence as to which coproduction barriers are significant in specific contexts and how they might be overcome—this needs much closer attention from co-production researchers. Other recommendations for mainstreaming effective co-production policies and strategies are more specific to each of the Four Co’s. Recommendations for policies to mainstream co-commissioning • Legislating that public sector organisations don’t have to put all public services out to competitive tendering but are able to develop alliances with service providers (Bovaird 2016), so that service users and communities can be more easily treated as potential co-producers of public services.

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• Legislation on public procurement needs to include provisions which enable commissioners to focus tenders on public value and not just on value for money, with a clear role for service users and communities in helping to decide what constitutes public value. This would build on the social value provisions of the Public Services (Social Value) Act 2012 in the UK, which calls for all public sector commissioning to factor economic, social and environmental well-being into public services contracts but which, in many public service commissioning processes, still does not result in clear public value policies, nor significant weightings to public value in evaluation of contract tenders (Battle 2019). • Policy-makers need to trust in the ability of citizens to cocommission public services and/or outcomes, giving them much more extensive roles in planning, prioritisation and procurement decisions with respect to outcomes, services and budgets. In order to build trust, positive experience is usually needed. To ensure that such experiences occur, even in the face of reluctance on the part of one or other side, it might be made mandatory for all public service commissioners to undertake a certain quota of all public service commissions (constituting perhaps just 1% of expenditure in the first phase) through co-commissioning mechanisms. Indeed, the Scottish Government has already agreed with its local authorities that 1% of all local government budgets will be allocated by participatory budgeting by 2021 (Escobar 2020). (Of course, this means that if the experience does not turn out to be positive, trust will not be successfully established and co-production is likely to be that much harder in the future—but at least this will be based on evidence from experience, and not just on ignorance or prejudice). • Public service commissioners and providers need to engage closely with each other during all phases of the commissioning process (except during the procurement process where this might constitute anti-competitive conduct) in order to learn how to commission co-production effectively.

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Recommendations for policies to mainstream co-design • Social innovation requires some slack. In particular, busy front-line staff need to be provided with some time for reflection and discussion with other staff and citizens to develop new ideas for improving public services and outcomes. • In highly regulated services policy-makers and auditors may need to grant waivers to create space for experimentation and learning in co-design. • Local commissioning and providing organisations need to become more agile and to set up mechanisms to enhance creativity in the process of designing public services and outcomes—this could involve, for example, imaginative suggestion schemes, ideas competitions, online platforms for citizens (and staff) to discuss new ideas or the creation of spaces in local communities such as informal breakfast clubs where staff can meet with citizens to identify new ideas. • As experimentation involves the possibility of failure, policy-makers need to ensure that resilience mechanisms are co-designed to be in place to reduce the harm done by failure when it occurs. • Policy-makers need to balance the interests of ‘experts by experience’, who are engaged in the co-design of new solutions, with the interests of the wider public, so that important public governance principles are respected. Recommendations for policies to mainstream co-delivery • Policy-makers and all public service organisations need to identify ways in which behaviour change (from macro-shifts in conscious attitudes to micro-changes to unconscious behaviours) can be encouraged so that co-production becomes more natural and acceptable to service users and communities. • Policy-makers and all public service organisations need to sponsor a public insurance scheme to cover the risk for citizens co-delivering public services and outcomes. • Policy-makers and public service organisations need to agree a governance framework with citizen co-producers (for example, a co-production charter) which specifies mutual responsibilities in co-delivery and accountability when co-delivery goes wrong.

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• Public sector commissioners need to recognise that third sector organisations have a key role to play in mobilising service users and communities to make a bigger contribution to co-delivery. Recommendations for policies to mainstream co-assessment • Policy-makers need to make it mandatory for public service organisations operating under regulatory frameworks to gather citizen feedback and make it public. • Public service organisations need to make it both easier and more fun for citizens to provide feedback by using communication tools which are appropriate to specific groups and by building in attractive elements, such as gaming, competitions, online voting, etc. In particular, this is likely to involve increased use of user-friendly digital technologies. • Policy-makers, local commissioners and provider organisations need to build co-assessment into their organisational reporting and performance management systems, so that the effectiveness of coproduction initiatives is discussed at both strategic and operational levels. 7.3.1

Strategies to Mainstream Co-production

The purpose of mainstreaming co-production is, of course, to bring about bigger improvements of outcomes and/or efficiency savings. However, there is a danger that this may also involve a loss of flexibility and creativity compared to small-scale co-production initiatives. As discussed in Sect. 6.4, if co-production initiatives are to be scaled more widely, it is essential that the co-producers involved agree on a set of rules and quality manuals, so that new co-producers understand what they can expect from others and what is expected of them. This is also reflected in a number of the above recommendations. However, if standardisation and formalisation are overdone there is the risk of creating a new bureaucracy, which may squeeze the creativity out of co-production. In a co-production context, the Mintzberg (1994) differentiation between deliberate and emerging but also opportunistic and unrealised strategies may offer a useful framework. This provides space for some degree of structured planning, which is inherent in traditional change

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management models such as the eight step model of Kotter (1996). At the same time, Mintzberg’s emergent strategies sit well with conceptualisation of co-production as a social innovation process which does not progress neatly through successive stages, given that it challenges established institutions and pathways of development (Evers and Ewert 2020). Of course, these four very different sources of strategy need to be balanced within any given organisation; in our current state of knowledge about strategic management, this is an art, rather than a science. Moreover, we know from Chapter 5 that, if we are working in the complex knowledge domain, as is more likely when we are using multi-stakeholder approaches such as co-production, then pre-planning of how we are going to deal with every eventuality is not possible. In these circumstances, mainstreaming of co-production means ensuring that co-production is a feature of all the experimental ways in which we try to navigate the complex environment to get closer to desired outcomes, rather than being a single approach to which we rigidly hold constant during the change process. A change process almost always means constant change in the way we change, so a co-produced change process means changing together the way we change together. There is also an obvious tension between the requirements of smallscale, locally-tailored co-production initiatives and initiatives which are meant to be rolled out more widely. Ostrom (1996) suggests the need “to keep rules general”. Based on Ostrom’s ‘polycentric’ governance paradigm, Durose et al. (2013, 30–31) recommend adopting a ‘scaling-out’ rather than a vertical ‘scaling-up’ strategy to mainstreaming co-production. This involves adapting co-production initiatives to local contexts, which makes them more likely to be effective in each locality but does, of course, mean more work—and more uncertainty—in applying the lessons in other contexts. In some situations, the question for commissioners is how much scope there is for local variation when buying licensed co-production schemes such as the Family-Nurse-Partnership Programme (Loeffler and Trotter 2012), which have been validated by a number of external evaluations. The decision will typically rest on how successful these ‘scaled-up’ programmes have been elsewhere and how different is the context in which we now want to apply it. A similar question about flexibility versus standardisation applies in administrative law countries, such as Germany, where legislators may be considering mandating co-production by law in specific services or situations. A solution which sits between a purely laissez-faire approach

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(‘let them co-produce if they want’) and legislative fiat (‘co-produce or face the courts’) has been applied in health services in Ireland, where co-production has been made one of the four principles of a more recovery-oriented framework for mental health, with more detailed guidance provided through a ‘Co-Production in Practice Guidance Document 2018-2020’ (Advancing Recovery in Ireland et al. 2017) which supports the implementation of ‘A National Framework for Recovery in Mental Health 2018 – 2020’. Something similar has been embedded in Welsh legislation in the Social Services And Well-Being (Wales) Act 2014, which highlights co-production (defined as “encouraging individuals to become more involved in the design and delivery of services”) as one of the main principles underlying the Act (Social Care Wales 2017). Most of the recommendations for policy and strategy change in this section build on existing research presented earlier in this book. However, the research base is still relatively new and quite fragmentary. It would be wrong to place too much confidence in it for the moment. In the next section we explore some of the directions in which it would be particularly valuable to push the research agenda on co-production.

7.4 Growing the Evidence-Base for Co-production: A Research Agenda Even though we have witnessed an almost exponential increase in the amount of co-production research in recent years, there are still important research gaps on user and community co-production of public services and outcomes. For example, the fast digitalisation of public services throws up new research issues for co-production but so far this research area has been rather neglected. Again, scholarship on public administration has in recent years witnessed a very fast growth in the area of ‘behavioural public administration’ (Kang and Van Ryzin 2020)—but this, too, has not yet been reflected in most of the co-production research published in recent years. These disjunctions between research trends in different areas are typical of fast-growing fields. In this section we therefore suggest a research agenda for growing the evidence-base for co-production and propose research questions and themes based on research gaps identified in each of the chapters in this book (Table 7.1).

1.

Why co-producing public services and public outcomes with citizens is timely—political, economic, social, technological, environmental and legislative macro-drivers of co-production in policy and practice

(continued)

There has been limited research on most macro-level factors in the PESTEL framework: P: The important role of elected politicians in co-production has received little attention. More analysis is needed of their motivation for co-production, the political risks it brings, and how politicians can avoid public governance pitfalls of co-production. Furthermore, does this differ between different politicians (e.g. by party or by role played) or between different political systems (in terms of centralisation)? Finally, does co-production strengthen local democracy, though both citizen voice and citizen action, or does citizen voice challenge traditional structures and relations of representative democracy (Pestoff 2019)? E: There has been little co-production research from an economics perspective, even though co-production is often criticised on the grounds that it is used by public service organisations to cut costs and dump responsibilities on citizens. More research is urgently needed on the costs of co-production to citizens and on the economic value of improved outcomes resulting from co-production S: There has been considerable research on the social drivers of co-production with a focus on citizen motivation (for example, Alford 2009; Van Eijk and Steen 2016). However, there is still a need for more research which explores how the level of social capital influences citizens’ willingness and ability to co-produce, distinguishing its effect on each of the Four Co’s separately T: There has also been recent research on how digital public services impact on co-production—this is discussed below in relation to Chapter 3 E: As far as environmental and ecological factors are concerned, there is an urgent need to research the potential of co-production to address climate change, which will require a multi-level governance perspective

Further research suggested

A research agenda for co-production from the chapters of this book

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2.

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Distinguishing types and levels of co-production Concepts, definitions and disciplinary roots of co-production

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L: Legal and legislative impulses for co-production have been relatively few to date, but some research has probed how different governance modes have impacted on co-production, e.g. Voorberg et al. (2017) and Loeffler and Timm-Arnold (2020) on how co-production is treated in hierarchical, market and network governance modes. More detailed comparison of co-production across services would allow this analysis to be taken further. In particular, comparisons of co-production within private and public services (e.g. in the health sector) would be timely. Furthermore, international comparative research would shed more light on the role of legislative frameworks in contexts of co-production, contrasting, for example, administrative law countries and Westminster-type countries. This research needs to distinguish the impacts of governance mode and administrative tradition on each of the Four Co’s, as Loeffler and Timm-Arnold (2020) have illustrated Finally, research is needed into the potential role of co-production in tackling ‘wicked problems’, which usually derive from multiple sources of the PESTEL framework and involve multiple stakeholders with multiple objectives As the body of co-production research grows, so does also the opportunity for inter-disciplinary perspectives, taking us beyond current research approaches which have been, at best, multi-disciplinary Depending on the specific research focus, co-production definitions may be either rather narrow, with a focus on public service co-production or broader, with a focus on outcomes. It is unlikely that the academic research on co-production will converge towards one agreed definition. Indeed, ideally, any definition of co-production should be co-defined by the stakeholders involved in a co-production initiative to ensure ownership and sensemaking and these different definitions should therefore give rise to differing approaches within their associated research programmes

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Pathways to outcomes through co-production

(continued)

Since both co-production and public participation are a form of citizen engagement, more research is needed on how both forms of citizen engagement differ—and on how they may reinforce each other How can public service organisations make better use of citizen voice and action, either through co-production or public participation, and which citizens are more likely to engage in one way or the other? Can user and community co-production be used to engage those citizens who are not considered as the ‘usual suspects’ in public participation? And vice versa, will those who often shout the loudest in public participation exercises change their views if they are incentivised to co-produce effectively, e.g. by playing more of a role in co-delivery? More research is needed on how co-production impacts on the achievement of important public governance principles such as the equalities agenda, following up recent explorations into ‘governance pitfalls’ (Loeffler and Bovaird 2019) or ‘dark sides’ of co-production Steen et al. (2018) To do this, there is a need for research on how these governance principles can be operationalised so that the degree of their implementation can be assessed There has already been substantial research into how public service organisations can more effectively bring citizens into public services and get them to contribute to public sector pathways to outcomes—the ‘inside-out’ pathway (Loeffler 2020). However, the ‘outside-in’ pathways towards co-production, whereby public service organisations seek to add value to activities already being undertaken by service users and communities, is currently seriously under-researched More empirical research is required on how to improve the quality of co-production. In particular, quality management models need to take into account that service quality not only depends on how well service provider organisations are managed but also on the contributions of service users and communities and their collaboration with service providers. As an aid in this research, in Sect. 2.5 we proposed a dynamic quality framework for user and community co-production

Differences and overlap between co-production from public participation and consultation

Governance implications of co-production

Further research suggested

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3.

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Co-design

Key co-production approaches: Co-commissioning, co-design, co-delivery and co-assessing public services and outcomes Co-commissioning

Content of chapter

Table 7.1

While the Four Co’s (co-commisioning, co-design, co-delivery and co-assessment) are generally rather different in their intentions, mode of operation, range of stakeholders involved and results achieved, they have some important inter-relationships but these have so far been under-researched More research is needed on the interactions between politicians and citizens in co-commissioning processes and their impact on public value. In particular, the question arises why some elected politicians are willing to share power with citizen co-producers and have even gained a reputation as citizen engagement champions while others are reluctant to let citizens influence commissioning. Empirical co-production research on the extent of co-production in social services for younger and older people and public safety at the local level in Germany showed that co-commissioning may be viewed as a threat to the budgetary rights of local councillors (Löffler et al. 2015, 28). These issues concern the fuzzy relationship between representative and participatory democracy, which remains problematic both in theory and practice As Robert et al. (2020) point out, more rigorous research into the implementation and impact of design thinking in the public sector is needed. This reinforces the suggestion by Torfing (2016, 94) that “design thinking has yet to establish itself as an academic field of research with a clear set of research questions, theoretical underpinning, and a methodological toolbox that facilitates empirical studies of design processes”

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The academic literature on co-delivery is woefully thin. Further research is needed on the benefits and costs of co-delivery and its impact on governance principles in order to improve the evidence base. At the same time, we need more empirical research on drivers and obstacles of co-delivery. This needs to take into account socio-economic factors such as the role of gender and education but also organisational and contextual factors as discussed in Sect. 3.5. While there is some empirical evidence on the motivations of citizens to co-deliver (for example, the Dutch neighbourhood watches in Van Eijk and Steen (2016) we still do not have much knowledge on staff motivations for taking joint actions with citizens. As Wenene et al. (2016)’s study on staff perspectives on the actual and potential role of citizens in service delivery in Uganda shows that context matters. The challenges to co-delivery are likely to be different in political systems where a large part of a population lacks access to public services, compared to highly developed welfare states where many service users have become dependent on receiving state support Table 6.4 provides a theoretical framework for co-assessment. It shows that if quality is complex to specify but privately experienced—as is often the case in relational services—both professionals and service users know about quality, so that co-assessment is clearly necessary. While UK regulators of social care have been recommending that service users should be brought into assessment, and this practice has become more common, such ‘peer reviews’ remain largely unevaluated. Moreover, as a literature review undertaken by the Joseph Rowntree Trust states, there is still very little research on the assessment of risk by service users, in particular, from different groups of service users, such as those from Black and Minority Ethnic communities (Mitchell et al. 2012), although this might seem an area particularly likely to benefit from user insights As Lember et al. (2019) suggest, there is a lack of hard evidence on how digital technologies impact on co-production. Given the increasing interest of public service organisations in the use of digital technologies in a range of sectors, it will be important to consider their impact on the quality of life of citizens as well as on the achievement of important public governance principles such as accountability, social inclusion, privacy and security. In particular, there is a need for critical analysis of the risks and distribution of costs and benefits of digital innovation among stakeholders. This also concerns the use of data generated from or by citizens which is not always used to increase public value

Co-delivery

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Social care

Co-production in health, social care, public safety Health

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In spite of the burgeoning literature on the ‘social model for health’, the medical model of health is still dominant in the UK. Further theoretical and empirical underpinnings are needed for how co-production can improve public and individual health Given that personalisation in health means that professionals have to accept that their service users have legitimate knowledge and the capability to make important health care decisions on their own behalf, more research is needed into how this influences professional attitudes and behaviours with regard to co-production and which aspects of personalisation are most effective for specific patient groups (Musekiwa and Needham 2020) There is a need for more empirical evidence on the effectiveness of co-production in prevention and rehabilitation, which are still underused pathways to improve social care (and wellbeing) outcomes In particular, given the seriously debilitating effects of loneliness and isolation on many people, the lack of evidence on the overall picture of how many lonely and socially people are benefitting from public service initiatives remains a serious gap in the literature—and research into co-production approaches, in particular, is urgently needed German research (Löffler et al. 2015) has highlighted the very large gap between, on the one hand, the current levels of citizen co-production with public services, and on the other hand, the overall levels of support which people give to older and young people outside their families in self-organised activities, suggesting major scope for the public sector to tap more successfully the energy and commitment of citizens to improve the social life of the more needy of their fellow citizens. Research needs to explore whether there is similar potential for further co-production in other countries

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The longstanding emphasis on individual case study analysis in co-production research means that there has been no systematic identification of barriers to effective co-production. Such a systematic model was presented in Chapter 5 but it needs to be turned into a dynamic model in order to identify relationships between drivers and barriers to co-production, sensitive to different contexts, and consistent with the motivations and perspectives of multiple stakeholders In particular, there is a need for systematic empirical testing of how important the barriers are in practice to each stage of the initiation, implementation and/or scaling of both user and community co-production of public services and outcomes and what strategies have been successful in overcoming these barriers More research is also needed to analyse the circumstances in which co-production with citizens is likely to be promoted by increased staff commitment and capability, as compared to increased citizen commitment and capability

While the literature contains some evidence that co-production may often be effective in achieving high level outcomes in community safety, the relevant number of studies remains too small for full confidence and needs to be increased Moreover, only a narrow range of outcomes are typically addressed in much of the research into community safety production—in particular, much research has focused on crime reduction while the effect of co-production on the collective outcomes of justice in the community and on quality of life outcomes is still under-researched (Loeffler and Bovaird 2019). In addition, many research studies to date have been purely qualitative, illustrating the potential of co-production but giving only weak indications of the strength of its drivers and impacts There have also been few studies on whether co-production can reduce police costs There has been relatively little research to date on the potentially undesirable consequences of co-production of community safety, including the potential neglect of public governance principles or illegal practices (often referred to as ‘the dark side’ of co-production) and more research here will be important

Public safety

Challenges to effective co-production of public services and outcomes Barriers to co-production

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It is striking that the academic literature on co-production has not focussed much on the issue of risks involved with co-production and how to address them Furthermore, research is required on how commissioners and service providers may develop effective co-production with vulnerable groups through risk enablement strategies. In particular, third sector organisations may have a new role to play as ‘resilience builders’ There is not one single model for the change management of co-production. As Sørensen and Torfing (2011) suggest, change management for co-production needs to draw on different theoretical frameworks, depending on the context and the scale of the desired change Research needs to highlight how change management is likely to be different for deepening and widening existing (small-scale) co-production initiatives and putting new co-production initiatives in practice. To what extent do new co-production initiatives imply incremental change or require ‘disruptive’ change, which may be difficult to achieve in a public service context where reliability of public services is a core administrative value? What is the motivation of all co-producing stakeholders involved (not just that of citizens, whose motivation has now been quite widely studied)? In a system defined by complex interactions, given that no single person knows the answer to emerging problems, understanding can only come by observing the consequences of leadership actions, so leadership for co-production typically involves collective learning processes. Crosby and Bryson (2018, 1277) point out that there is a paucity of leadership theorising and research on intersectionality and that “more explorations are needed of how particular systems and technologies help produce collective leadership” Moreover, leadership for co-production typically takes place in a political context. More research is needed on what kind of leadership is required ‘from the top’ in order to support co-production between front-line staff and citizens. On the other hand, how much leadership from ‘the bottom’ by front-line staff and community representatives is possible in a representative political system where local councillors are accountable for public governance and results?

Risks and co-production

Leadership of co-production

Change management for co-production

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Negative sides of co-production

Content of chapter

(continued)

Methodologically, we identify three important directions for further research on leadership for co-production: - More studies with a mix of qualitative and quantitative research which untangle causal relations between the contextual factors, power relations and motivation factors that influence leadership of co-production initiatives, building on the conceptual framework developed by Schlappa et al. (2020) - More longitudinal studies which analyse how power relations and motivations of co-producers change during the different stages of the co-production process, and the implications for leadership - More comparative studies which take into account different public service contexts with different modes of governance and their implications for the extent to which leadership for co-production is possible More evaluations of co-production are needed which focus on unintended negative side effects and the public governance pitfalls of co-production, not just on quality of life outcomes and governance improvements. In particular, since co-production is a dynamic transformation process which will benefit some stakeholders but may make other stakeholders worse off, the equity implications need to be explored (Clark 2020), as do the implications of co-production for vulnerable groups (Brandsen 2020). Research is also needed on the effects of co-production on accountability, transparency, due process, social inclusion and sustainability—and on how co-production can contribute to the achievement of these public governance principles More research is also required to identify factors and contexts which trigger profit-seeking behaviour by one stakeholder at the expense of other stakeholders involved in co-production Future research will also have to consider to what extent digital co-production not only generates economic and social benefits but also enables rent-seeking behaviour by private sector companies, for example, by using big data from citizens and/or government for commercial purposes

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6.

(continued)

Evaluating the outcomes and public governance of co-production

Content of chapter

Table 7.1

In this book, the public value model proposed provides researchers with a framework which positions co-production as a key option for making public services more effective and which demonstrates that co-production can impact directly on quality of life outcomes, without necessarily working through the medium of public services. The concept of public value allows researchers to consider both impacts and the trade-offs involved In particular, more empirical research is required to identify pathways to improved outcomes and public governance through specific co-production interventions. Of course, contexts matter and some parts of outcomes pathways may depend on context-specific variables. However, such empirical evidence of HOW to improve public value through co-production (or other types of public interventions) would be invaluable for practitioners In mapping pathways to outcomes, it will be important to consider how co-production improves collective outcomes, not just individual outcomes, and its potential effects on developmental outcomes, which promise transformational improvements to wellbeing but imply higher risk, and not just on incremental improvements to wellbeing, with lower risks (Loeffler and Bovaird 2018, 272) Furthermore, our Public Value Model also raises the question of how to improve the resilience of involved co-producers, particularly vulnerable people, in order to ensure that limited harms occur from unsuccessful co-production initiatives There is still little evidence on whether improved service quality results from user co-production, particularly in relation to objective, as opposed to subjective dimensions of quality. Further qualitative research is needed to unpack the relationship between co-production and citizen satisfaction (Loeffler and Bovaird 2018, 273). We also need to identify how forms of relational co-production impact on service quality as ‘passionate emotional involvement’ and to explore the quality of enablement which is core to relational forms of co-production, for which the dynamic quality framework for user and community co-production in Sect. 2.6 should prove useful

Further research suggested

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Source Author

Content of chapter More research is needed on the costs of co-production, including not just the inputs of service commissioners and providers but also the inputs of citizens (Loeffler and Bovaird 2018, 274–275). Where substitutive co-production is taking place, how much staff time can be saved when co-production is effective and how can the value of this be compared to the extra inputs needed from citizens? Where additive co-production is taking place, how many extra resources from public service organisations are needed to achieve significant outcome improvements? While more asset mapping is clearly needed, more research is also needed on the effectiveness of existing mapping tools and how to balance the need for asset mapping with the respect of citizens’ privacy and confidentiality Last but not least, more research is needed to evaluate the impact of co-production on governance principles (Loeffler and Bovaird 2018, 275), including public governance pitfalls and the ‘dark side’ of co-production (Steen et al. 2018). The digitalisation of public services and digital co-production will raise new public governance issues such as privacy and security issues

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7.4.1

Research Methodologies

Finally, it is clear that research into co-production has so far been based on a rather narrow set of research methodologies, particularly on qualitative case studies. While a number of studies have used quantitative methods, based on general surveys of citizens (Loeffler et al. 2008; Parrado et al. 2013; Bovaird et al. 2015, 2016) or surveys of users of digital platforms (Clark 2020), further research using these approaches still seem to offer great opportunities for deeper insights. Ideally, research on co-production initiatives should consider both quantitative and qualitative evidence, as some stakeholders such as citizens may be more influenced by stories and other qualitative evidence, whereas commissioners will be keen on some numbers so that they can justify increased spending of taxpayers’ money on effective co-production initiatives. Moreover, comparative studies such as the research of Pestoff (2020) into co-produced and traditional models of health care in Japan has combined staff surveys with patient surveys across multiple hospitals in a mixed approach which appears highly promising. Furthermore, internationally comparative research helps to explore the role of contextual variables such as administrative traditions and the wider public governance framework. Other aspects of research methodology also seem likely to play a greater role in the future, including longitudinal studies, experimental research, co-produced research and digital co-production research. Longitudinal studies would offer particularly valuable insights into causal mechanisms and the longer-term effects of co-production—up to the present there have been few such research studies. In particular, longitudinal studies would allow exploration of how in the long-run, public governance structures are changed through co-production processes. Experimental research designs are similarly valuable in distinguishing causal mechanism and may also identify the extent to which different drivers (at macro- and micro-levels) are necessary and which drivers are sufficient to promote co-production. Early examples have recently been summarised by Kang and van Ryzin (2020) but much more research can be anticipated along these lines, as experimental research into behavioural public administration is one of the areas of explosive growth in the discipline.

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Co-produced co-production research is still in its infancy but important contributions have already been made, for example by Durose et al. (2017) and the potential for such research is explored by Durose et al. (2020). Such research is especially strong in allowing vivid story-telling methods to be employed. Digital co-production may also require new epistemological approaches. As Schnapp and Blätte (2018) suggest, the availability of big data may challenge traditional approaches to the development of hypotheses, as big data enable relationships to be uncovered based on quantitative analysis, even though it may be difficult to explain these relationships theoretically. Finally, there is the issue of timeliness in policy relevance research, which affects research into co-production as much (or even more) than research into other public governance themes. The recent Covid-19 crisis has once again revealed the importance of co-production but, more than this, it has also demonstrated the need for academic research to deliver helpful insights (if not ‘solutions’) much faster than through traditional peer reviewed research. In particular, there is a need for truly inter-disciplinary research, with medical and health scientists working together with social scientists. This also suggests the need for a new format of academic conferences, through which researchers can be enabled to step out of their silos to co-produce much needed co-production research with colleagues from other disciplines but also with interested citizen co-producers, who bring in their tacit knowledge. It is likely that the potential for such interdisciplinary co-produced research will be much higher in the future, given the new availability of much more interactive communication tools driven by digital technologies. However, the supply of such opportunities will need to be matched by a corresponding demand from willing academics.

7.5

and Finally---The Future of Co-production Practice and Research Post-Covid-19

This book has taken the reader (and the author!) on a journey through the highways and bye-ways of co-production. This territory was largely unexplored until around 40 years ago, so it is remarkable how much has already been discovered and systematically mapped, as the references to the literature throughout this book testify.

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However, we should not forget that this territory was never uninhabited, nor were those who lived there unaware of the value and power of their contribution to making their world a better place. The fact that researchers took so long to find out and understand what was everyday practice for millions of public servants and many more citizens makes the point very forcibly that citizens know more and do more than they tell researchers—as do many public servants. With the emergence of the Covid-19 pandemic, our world has changed and thrown up new issues for co-production research—both in terms of the research agenda and also research methods. While it is clearly too early to predict the impact of Covid-19 on the state of citizen co-production, two interesting and contradictory trends can already be identified. On the one hand, the response to the crisis requires both contributions from public service organisations and citizens. In many OECD countries, governments have called on citizens to volunteer to provide support for vulnerable people who have to self-isolate. In the UK over 750,000 citizens have responded to the call for volunteers—so many more than the 250,000 expected by central government that a halt had to be called to the registration of new volunteers (Royal Voluntary Service 2020). Local authorities and third sector organisations, in particular, will be in charge of matching supply and demand for help at the local level. Research is required on how these new forms of co-production can be implemented and scaled effectively. Moreover, digital technologies such as apps for matching volunteers to people who need help are likely to play a key role in supporting such new co-production approaches. This huge extension of co-production but also of community self-help at the micro-level may have a lasting impact on modes of public governance and may even conceivably support the development of a more collaborative state. On the other hand, we are also witnessing the emergence of a more coercive state, which constrains human rights for the sake of collective health outcomes and expects compliance of citizens with unprecedentedly restrictive regulations on social and economic behaviour. Compliance is enforced through a mix of nudges, such as public campaigns to stay at home, and sanctions which are enforced by the police. This trend has rewoken the old debate on the extent to which co-production has to be voluntary. In the Covid-19 context, this debate needs to be framed by consideration of governance principles such as solidarity. However, it also raises the question of the role of voluntary co-production (rather than coercion) to generate behaviour change on an unprecedented scale—e.g.

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to what extent can governments encourage shoppers to maintain physical distancing (and to ask others to do so), and public transport passengers to wear masks and keep sufficiently distant from each other? Furthermore, the COVID-19 crisis also requires researchers to reconsider traditional research methods, given that we’re dealing with a truly complex issue, and this is clearly an example of a complex adaptive system. As Astill and Cairney (2015, 141) suggest, new methodological tools may be required, which “understand data not as dry observations but as emergent from systems of agents interacting with each other and the rules that follow”. In particular, they emphasize the need to learn more, through qualitative inquiry, about systems and how they interact. Finally, researchers may have to question their epistemological stance and recognise that “complexity research may not be about definitive explanation or maximising ‘explanatory power’” (Astill and Cairney 2015, 137). Indeed, research on behaviour change has recently embarked on much more extensive use of experimental methods (Kang and Van Ryzin 2020). Research can help to disseminate what is being done and to support practitioners in the honing of practice to make it more effective. Given the young age of co-production studies within the discipline of public administration, we may expect that current and future research into co-production will greatly increase its potential benefits (and reduce its costs). And this, in turn, suggests that the contribution of co-production to the improvement of public services and publicly-desired outcomes has, as yet, only scratched the surface.

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Index

A Access to public services, 126, 413 Accountability, 38, 93, 137, 227, 311–314, 319, 339, 371, 373, 374, 405, 413, 417 lack of accountability, 312, 314 shared accountability, 313, 319 Action learning, 60, 275, 301, 402 Active Complaints Management in Arnsberg, Germany, 133 Administrative law countries, 11, 232, 407, 410 Administrative values, 338, 339, 416 ‘Analyse, Plan, Do, Review’ (APDR) sequence, 90 Anti-participation, 16 Anti-social behaviour, 216, 217, 222, 227, 372 Artificial Intelligence (AI), 152–154, 156, 157 Asset-based approaches, 38 Assets, 36, 38, 39, 54, 66, 78, 90, 94, 153, 284, 419 Austerity, 4, 5, 104, 108, 110, 112, 119, 126, 132, 157, 200, 207,

259, 281, 294, 310, 315, 336, 358, 379, 380, 382, 386, 387 Authority, 7, 46, 53, 54, 93, 100, 103, 108, 118–120, 124, 125, 129, 130, 140, 141, 144, 146, 149, 206, 208, 212–215, 219, 227, 250, 252–255, 259, 279, 282, 290, 296–298, 302, 309, 312, 313, 315, 336, 355, 359–362, 366, 372, 381, 383 B Barriers to co-production contextual barriers, 250, 259, 321 from user and community characteristics, 250 internal organisational barriers, 250 Behaviour change, 9, 10, 32, 45, 47, 66, 114, 115, 118, 120, 179, 199, 222, 224, 286–288, 296, 340–343, 345, 382, 386, 397, 405, 422, 423 Better Living in Offenbach, 78 Bias, 44, 113, 157, 252, 367, 368, 399

© The Editor(s) (if applicable) and The Author(s) 2021 E. Loeffler, Co-Production of Public Services and Outcomes, https://doi.org/10.1007/978-3-030-55509-2

429

430

INDEX

Big data, 151, 153, 156, 417, 421 Bloomington School, 3, 13, 24, 25, 76 Brieselang citizen bus in Germany, 125 Building capacity for co-production, 121, 156, 280, 285 C Capabilities, 12, 24, 38, 39, 52, 53, 61, 65, 76, 78, 80, 86, 94, 121, 144, 154, 157, 226, 252, 255, 258, 274, 284, 291, 310, 351, 364, 372, 398, 414, 415 Care planning, 82, 185 care and support plan, 149, 203, 215 Carrick Housing estates, 377, 378 Change management, 43, 62, 67, 76, 78, 95, 247, 259, 261, 278–281, 289, 290, 293–295, 322, 345, 397, 407, 416 in Governance International Co-production Star, 76, 107, 247, 322 initiation, experimental and implementation phase, 121 Chartered Institute of Public Finance (CIPFA), 5 Childcare services, 112 Choice, 13, 25, 31, 32, 41, 79, 80, 87–89, 95, 113, 141, 186, 191, 209, 221, 277, 335, 350, 382, 385 Citizen citizen action, 12, 23, 75, 76, 79, 80, 84, 114, 126, 137, 159, 160, 177, 233, 317, 381, 409 ‘citizen-centric turn’, 12 citizen engagement, 23, 38, 44–47, 66, 96, 97, 103, 111, 153, 256, 371, 411, 412

citizen inspections of public services, 83, 133 citizen motivations, 290, 409 citizen reporting, 137, 139, 143 citizen rights, 12 citizen voice, viii, 12, 23, 47, 75, 79, 80, 84–86, 135, 137, 159, 160, 177, 199, 233, 294, 317, 398, 409, 411 Citizen Assemblies, 100, 102, 106, 187, 209 Citizen contributions, 23, 29, 76, 217, 341, 379 Citizen-led service inspection in the local authority of West Lothian, 130 CitizenNet (Burgernet), 222, 223 Citizen participation, 23, 30, 79, 114, 157, 250 Citizens as ‘co-workers’ and ‘financiers’, 78 evaluators, 79 innovators, 78 legitimators’ and ‘testimonial providers’, 78 strategic thinkers and funders, 78 Citizenship, 3, 28, 33, 34, 66 Civil rights movement, 12, 33, 34 Clean City Linköping, Sweden, 295 CleverCogs™ in Scotland, 149, 384 Co-assessment barriers to co-assessment, 103 complaints as co-assessment, 83 through digital technologies, 143, 145, 406 Co-commissioning, 23, 40, 42, 45–47, 49, 50, 67, 75–79, 81, 82, 84–86, 89–91, 93–97, 121, 137–139, 151, 153, 159, 160, 177, 184, 194, 199, 208, 215– 217, 227, 228, 231, 232, 277,

INDEX

281, 282, 348, 371, 373–376, 395, 400, 403, 404, 412 co-commissioning micro co-commissioning, 215 participatory budgeting as cocommissioning, 86, 89, 137, 138 Co-creation, 31, 77, 260, 313 Co-decision making, 56 Co-design Experience-Based Co-Design (EBCD), 110, 112, 189, 194 ‘four orders of design’, 98 long-term and incremental, 99, 100 long-term and radical, 99 of public projects, 82 of public services, 47, 75, 76, 82, 98, 111, 137, 145, 400, 412 of public spaces, 82, 99, 102 short-term and incremental, 99, 100 short-term and radical, 99, 100 Co-development, 81, 99–101, 106, 107 Co-financing, 81, 82, 86, 90, 188, 210 Cognitive, 60, 99, 195, 196, 207, 220, 301, 364, 369 assessment, 364, 369 knowledge, 301 Co-housing, 99, 101 Co-implementation, 81, 114–116 Co-influencing behaviour change, 81, 83, 114, 115, 118, 119 Collaborative, 8, 39, 40, 66, 109, 131, 195, 204, 280, 300, 422 Collective learning, 24, 60, 65, 339, 345, 416 Co-management, 81, 114–117, 366 of projects, 81, 115 of public facilities, 114, 116

431

Commercialisation of public services, 360 Commissioning, 42, 51, 79, 85–88, 90–97, 130, 186, 227, 249, 259, 273, 277, 282, 287, 289, 292, 301, 348, 375–377, 396, 398, 400, 401, 404, 405, 412 decommissioning, 264, 287, 305, 307, 402 outcome-based, 7, 287, 348, 402 Commitment, 17, 32, 45, 47, 66, 110, 133, 145, 158, 188, 194, 204, 207, 248, 260, 286, 289, 290, 293, 296, 382, 396, 402, 414, 415 Common Assessment Framework (CAF), 55–57 Commons, 24, 29, 34, 36, 43, 78, 85, 101, 114, 180–182, 207, 209, 213, 224, 226, 228, 250, 258, 277, 285, 296, 298–300, 317, 319, 343, 381, 401, 413 Community community assets, 38, 92, 104, 115, 117, 275, 399 community building, 38 community groups, 156, 189, 210, 212, 219, 282, 284, 309 community inputs, 199, 201, 218 ‘conferencing’, 229 ‘connector’ schemes, 202 development, 3, 199, 249, 275, 276, 302 engagement, 202, 210, 224, 228 inquiries, 81 local communities, vii, 8, 38, 40, 47, 53, 54, 66, 85, 89, 90, 92, 103, 104, 106, 108, 116, 130, 140–143, 145, 149, 156, 158, 180, 185, 203, 208, 227, 262–267, 271, 276, 281, 289, 291, 294–296, 298, 303, 338,

432

INDEX

344, 351, 361, 373, 380, 399, 401, 402, 405 neighbourhood planning, 86, 87 research, 81 self-help, 55, 121, 143, 148, 158, 422 Comparative studies, 417, 420 Competency frameworks, 258, 288, 402 Complaints, 41, 78, 81, 83, 128, 129, 133, 137, 139, 143, 146, 155, 192, 219, 229–231, 268, 284, 376, 377 Complementarity, 333 Complex adaptive systems, 78, 273, 274, 315, 344, 385, 423 Complex knowledge domain, 60, 111, 270, 273, 274, 279, 300, 407 Confidentiality, 38, 371, 419 Consultation, 12, 23, 44–48, 66, 90, 102, 113, 182, 228, 255, 411 Contextual factors, 1, 126, 413, 417 Co-ordination, 114, 185 Co-performing, 81, 114, 115, 117 peer support, 81, 114, 117 of services by volunteers, 81 Co-planning, 25, 26, 77, 81, 82, 86, 87, 92, 187 Co-prioritising, 81, 82, 86 Co-producers Board members, 314 core, 39, 49 disadvantaged people, 78, 373 ‘doers’, 79 enthusiasts, 49, 50 frontline staff, 43, 288, 396 managers, 302, 316 marginalised groups, 191 politicians, 29, 40, 83, 282, 289, 302, 412 practitioners, viii, 43, 57, 248

professional, 5, 36, 39, 50, 114, 257, 302, 310, 312–314, 361 ‘regular’ producers, 24, 27, 29, 30 ‘talkers’, 79 unenthusiastic, 49 vulnerable people, 149, 418 willingness to co-produce, 250 Co-production ability to co-produce, 250, 252, 316 additive v. substitutive coproduction, 28, 336, 380, 382, 386 analytical concepts, 24 as an equal and reciprocal relationship, 26, 36, 41, 299 collective co-production, 10, 25, 199, 252, 254–256, 260, 402 community co-production, 1–3, 5, 9, 12, 14, 23, 26–28, 30, 32, 33, 37, 40, 48, 52, 55, 58, 60, 62, 63, 65, 80, 81, 114, 139, 145–151, 157, 158, 195, 203, 204, 223, 231, 247, 248, 250, 252, 255–257, 259, 261, 263, 269, 275, 276, 292, 299, 301, 308, 310, 311, 315, 317, 338, 344–346, 365, 370, 396, 399, 400, 403, 408, 411, 415, 418 co-production charter, 41, 63, 64, 135, 286, 290, 315, 372, 386, 405 co-production definitions, 23, 410 costs of co-production, 336, 356, 357, 360, 361, 363, 385, 386, 409, 419 monetary costs, 356, 357, 362, 385 ‘dark side’ of co-production, 223, 248, 304, 319, 320, 415, 419 differing time horizons between co-producers, 79

INDEX

disciplinary roots, 30, 32, 410 effects of co-production, 60, 336, 348, 355, 377, 380, 385, 417, 420 evaluation of co-production, 5, 59, 158, 287 Governance International Coproduction Star, 76, 107, 247, 280, 322, 361 in health and healthcare, 193, 260 individual, 25, 142, 156, 199, 250, 252, 253, 260, 402 inseparable from service delivery, 363 ‘inside-out’ or ‘outside-in’, 54 intensity, 76, 83, 133, 367 levels, 206, 253, 410 negative consequences of coproduction, 8, 42, 247, 311, 322 normative concepts, 23, 33, 36, 42, 66, 336, 370 origins of co-production, 3, 289, 306 pathways to outcomes of coproduction, 51, 222, 231, 306, 411 perceived lack of added value, 314 pitfalls, 75, 155, 157 principles, 33, 36–40, 43, 57, 62, 66, 84, 248, 286, 288, 300, 306, 336, 371, 372, 386 relevant expertise, 37, 84 research agenda for co-production, 409 resources for co-production, 152, 193, 200, 257, 282, 302, 342, 380, 381, 383 in social services, 97, 412 synergies of co-production, 32 top-down or bottom-up?, 295, 296

433

types, 66, 250, 276, 279, 280, 302, 303 user co-production, 299, 345, 366, 386, 403, 418 within private and public services, 410 Co-productive logic, 397 Co-selecting, 81 Costs of co-production cost-benefit analysis, 385 - costs for citizens, public sector organisations and third sector organisations, 27 set-up and running costs, 140 Covid-19, 9, 126, 139, 140, 143, 154, 157, 158, 293, 421–423 Creativity, 98, 99, 108, 109, 111, 226, 228, 284, 292, 405, 406 Crime detection, 222 prevention, 217–219 reduction, 216, 217, 220, 231, 415 Criminal justice, 118, 216, 217, 224–227, 231, 307, 348 Crowdfunding, 81, 86, 139, 140, 146, 188, 210, 211, 292, 360 Donations-based, 210 Peer-to-peer (P2P) lending, 211 Crowdsourcing, 99, 137, 139, 146, 151, 360 Culture, 102 co-productive, 287 Cycling, 295, 296 Cynefin model, 269 D ‘Dark side’ of co-production, 4, 223, 248, 304, 319, 320, 419 Deliberation, 31, 47, 79, 297 Demand management, 342 Democracy, 49, 80, 137, 291, 319, 409

434

INDEX

participatory democracy, 13, 47, 97, 412 representative democracy, 13, 39, 371, 409 Democratic, 39, 40, 49, 66, 80, 187, 227, 371, 373, 374, 379 decision-making, 13, 41, 371, 373 public governance, 66, 371, 373, 374 Design thinking, 98, 110, 113, 294, 412 participatory design, 106 user-centred design, 158 Desistance, 217, 219–222 Development, 12, 30, 33, 34, 39, 80, 83, 87, 93, 94, 98, 99, 104, 117, 123, 135, 137–139, 142, 153, 158, 160, 184, 187, 190, 198, 212, 248, 277, 278, 286, 303, 307, 308, 340, 344, 349, 352, 395, 401, 407, 421, 422 Digital citizen reporting, 137, 138 co-assessment, 75, 130, 142, 144, 155, 413 co-commissioning, 75, 137, 138, 153 co-delivery, 75, 121, 135, 142 co-design, 2, 99, 107, 139, 140, 142, 154 innovation, 139, 141, 158, 315, 396–398, 413 innovation labs, 141 instrumental, transformative and substitutive, 146, 150 marketplaces, 139, 278 modes of co-production, 50, 67, 75, 138, 150, 373, 400 neighbourhood monitoring, 139 ‘open book government’, 139 platforms, 138, 149, 155, 420

technologies, 2, 9, 84, 99, 106, 121, 135, 136, 140, 142, 143, 145–152, 155, 157–160, 215, 256, 305, 309, 384, 399, 413, 421, 422 risks of digital technologies, 155 sensing, communication, processing and actuation, 150 transformation, 2, 135, 137, 138, 146, 157, 397 volunteer networks, 139, 143 web 1.0, web 2.0, web 3.0, web 4.0, web.5.0, 135 Digitalkoot in Helsinki, Finland, 360 Direct payments, 87, 208, 277 Disability movement, 33, 35 Disciplinary perspectives, 410 interdisciplinary research, 421 multi-disciplinary research, 410 Discrimination, 12, 320, 375 Diversity, 10, 34, 35, 37, 54, 65, 146, 312, 316, 371, 373 ‘Double Diamond’ model, 106 Drivers, 1, 5, 7, 9, 11, 25, 46, 61, 115, 117, 119, 120, 125, 126, 136, 148, 151, 153, 216, 217, 220, 249, 252, 255, 256, 289, 354, 362, 387, 396, 398, 400–402, 409, 413, 415, 420 macro-level, 5 political, economic, social, technological, environmental and legislative, 1, 409

E E-democracy, 135, 137 Effects of co-production on efficiency, 57, 128, 146, 286, 358, 361, 380

INDEX

on public governance, 3, 49, 67, 377 on quality of life outcomes, 3, 123, 336, 342, 347, 385 on service quality, 57, 58, 60, 67 Efficacy, 220, 288 self-efficacy, 252–255, 317 Efficiency, 5, 15, 26–28, 43, 52, 54, 57, 65, 76, 126, 128, 135, 137, 157, 281, 282, 286, 309, 344, 356, 358, 359, 363, 370, 379, 380, 384, 386, 406 E-government, 135–137, 139, 142, 146 Emotions, 220, 226, 364 Employability services, 398 Enabling ‘Enabling logic’ v. ‘relieving logic’ in services, 31 Equalities agenda, 38, 96, 338, 371, 373, 375, 411 Equality equal access to public services, 36, 375 equalities agenda, 38, 96, 338, 371, 373, 375, 411 equality of participants, 41 equal relationships, 36, 37, 41 Equity, 38, 184, 371, 373, 375, 417 ‘Esther’ network in the County of Jönköping, Sweden, 100 Ethical and honest behaviour, 38 Ethics ethical behaviour, 38 Evaluation, 34, 62, 67, 80, 83, 93, 107, 109, 110, 117, 119, 122, 123, 127, 128, 130, 132–134, 159, 160, 184, 185, 193, 203, 204, 212–214, 219, 221, 222, 225, 226, 228, 286, 306, 322, 335, 337, 343, 344, 349, 352,

435

357, 359, 362, 370, 377, 384, 386, 404, 407, 417 of co-production, 59, 287 Evidence-based policy making, 5 evidence-based co-production, 106 Exclusion, 155, 156 social exclusion, 157, 268, 366 ‘Exit, Voice, Loyalty and Co-delivery’, 79 Experimental research, 420 Experimentation, 38, 39, 82, 106– 109, 111, 112, 141, 145, 159, 227, 270, 272, 273, 279, 280, 283, 285, 289, 293, 401, 405 prototyping, 99, 106 in public services, 270, 283, 401 ‘Experts by Experience’, 37, 50, 93, 96, 104, 132, 181, 190, 192–194, 214, 312, 314, 352, 366, 382, 405 ‘Experts by Experience in poverty and social exclusion’ in Belgium, 366 Exploitation, 266, 305 F Facilitation, 6, 34, 57, 58, 105, 112–115, 118, 124, 151, 401, 412 Fairness, 59, 337, 338, 371, 373 Family-Nurse-Partnership (FNP) Programme, 305, 308, 407 Flexibility, 58, 126, 136, 318, 337, 406, 407 Four Co’s, 75–81, 84, 136–138, 145, 150–152, 159, 232, 373, 386, 396, 400–403, 409, 410, 412 Future research agenda, 417, 423 G Gamification, 406

436

INDEX

Good governance, 13, 37, 38, 40, 50, 54, 66, 96, 111, 160, 311, 370 Governance of co-production, 290, 418 framework, 11, 274, 290, 405, 420 governance at macro, meso and micro levels, 11, 420 governance modes, 232, 304, 410 governance ‘pitfalls’, 311–313, 318, 322, 377, 386, 409, 411, 417, 419 governance principles, 33, 37, 40, 42, 43, 60, 61, 64, 79, 111, 123, 124, 126, 127, 137, 160, 223, 248, 262, 266, 269, 286–288, 304, 311, 314, 316, 322, 336–340, 343–345, 370–377, 386, 398, 405, 411, 413, 415, 417, 419, 422 principles, 33, 37, 40, 42, 43, 60, 61, 64, 79, 84, 111, 123, 124, 126, 127, 137, 160, 248, 262, 266, 269, 286–288, 304, 311, 314, 337–340, 345, 370–374, 377, 386, 398, 405, 411, 413, 415 Governance International case studies, 55, 361 Co-Design Toolkit, 109 Co-production Star, 76, 77 Public Value Model, 28, 338, 340, 341, 346 Government failure, 340 platforms, 139, 146, 148, 191, 401 H Happiness, 349, 352, 353 Health care, 93, 95, 144, 181, 183–185, 188, 190–194, 202, 342, 414, 420 primary, 128

‘Healthy Kinzig Valley’, Germany, 115, 120 Holistic approach, 396, 398 Housing, 7, 101, 102, 115–117, 119, 133, 200, 214, 221, 302, 304, 359, 370, 377 Human rights, 38, 422 I ‘Imbalances of power’, 302 Implementation, 34, 42, 54, 59, 66, 77, 78, 84, 109, 111–113, 121, 136, 149, 186, 193, 194, 204, 218, 247, 248, 261, 264, 266, 278–281, 286, 289, 294–296, 303, 311, 314, 315, 335, 372, 408, 411, 412, 415 of co-production, 33 implementation gap, 248 Improvement, 4, 43, 52, 61, 62, 65, 81, 82, 89, 93–95, 99, 100, 102, 105, 110, 112, 128, 131, 132, 134, 135, 153, 181, 184, 185, 187, 189, 190, 192, 200, 201, 204, 213, 221, 228, 247, 282, 284, 286, 291, 295, 296, 336, 339, 342, 345, 346, 351, 354, 364–366, 371, 373–375, 382, 385, 386, 406, 417, 418, 423 of outcomes, 200, 406 of public services, 373, 375, 423 Incentives, 145, 196, 258, 286, 288, 292, 303, 312 Inequalities economic, 252 health, 124 political, 51 social, 124, 316 Influence mechanisms for co-production, 291 Innovation disruptive innovation, 81, 82

INDEX

Lab HibriturSelva in Catalonia, 106 labs, 100, 101, 106, 110–112 Labs in the Offenbach Employment Agency, 39, 100, 101, 107, 279 processes, 6, 159, 370, 396 social innovation, 79, 81, 99–101, 107, 108, 110, 141, 159, 160, 249, 259, 261, 278, 279, 292, 307, 315, 318, 397, 401, 405, 407 Inspection, 64, 130, 131, 192, 214, 356, 365, 369, 382 Interaction, 26, 27, 31, 32, 47, 80, 97, 98, 113, 121, 133, 138, 141, 152, 153, 220, 343, 363, 364, 412, 416 Internet of data, 137 Internet of services, 137 Internet of things, 137, 148 J Joint action, 81, 114, 115, 119, 126, 228, 312, 413 to improve public outcomes, 52, 115, 126 to improve public services, vii, 41, 76, 78, 79, 90, 114, 115, 119, 146, 194, 303, 322, 364, 398 Joint research, 81, 131, 133 K KeyRing ‘Living Support Networks’ , 123 ‘Kids Tell the Pros What To Do’ in the City of Umea, 100, 103 Knowledge domain chaotic, 270, 273, 279 complex, 60, 111, 270, 273, 274, 279, 300, 407 complicated, 270, 273, 385

437

simple, 111, 270–273, 279, 300 L ‘Ladder of Participation’, 12, 44 ‘Law and order state’, 379 Leadership distributed leadership, 297, 298, 303 place-based leadership, 303 public leadership, 297–299, 303 relational leadership, 109, 297, 298, 303, 304 systems leadership, 300, 301 Learning double-loop, 61, 403 platforms (digital and non-digital), 401 single-loop, 61 system-wide, 274, 401 triple-loop, 61, 403 Legislation, 33, 34, 153, 213, 223, 249, 404, 408 Legitimacy, 110, 220, 230, 291, 337, 339, 340, 373 Lived experience, 105, 115, 183, 210 M Mainstreaming, 79, 261, 395, 403, 406, 407 social innovation, 79, 261 Managing co-production, 290 Manchester Community Health Trainers, 115 Marginalised groups, 191 Market failure, 362 Maslow’s hierarchy of needs, 340, 349 Matching volunteers, 142, 422 Mentoring, 81, 83, 115, 119, 125, 202 Mentoring people and families in difficulties in Augsburg, 125

438

INDEX

Mosaic Clubhouse London, 115 Motivation citizens’ motivations, 32, 126, 247, 288, 290, 413 factors, 290–292, 303, 417 intrinsic and extrinsic, 37, 50, 291 professional support, 39, 123, 221, 275, 305, 381 Mutual responsibilities, 405 N National quality of life outcome frameworks, 401 NEET (Not in Education, Employment or Training), 6, 94, 307 Neighbourhood ‘equity premium’, 361 watch schemes, 126, 218 NESTA, 26, 99, 109, 112, 249, 257, 261 Network governance, 227, 400, 410 new economics foundation (nef), 14, 26, 36, 41 New Public Governance (NPG), 304, 419 New Public Management (NPM), 13, 14, 40, 304, 347, 400 Non-profit organisation, 89, 105, 111, 119, 210, 214, 297, 311, 313, 367 Nudges, 342, 422 O Open book government, 139, 144 Organisational reporting, 406 Outcome based commissioning, 7, 287, 348, 402 collective outcomes, 67, 216, 347, 348, 415, 418

community outcomes, 262, 264, 268, 346 individual outcomes, 346, 347, 418 level, variability and potential, 350 pathways to outcomes of coproduction, 51, 222, 231, 306, 411 quality-of-life outcomes, 33, 49, 66, 247

P Participation citizen participation, 23, 30, 79, 114, 157, 250 participatory democracy, 13, 47, 97, 412 public participation, 16, 44, 47, 48, 66, 76, 137, 159, 193, 250, 317, 411 Participatory budgeting (PB) in health, 185, 186, 209 in public safety, 227 in Recife, Brazil, 89 in social care, 209 Pathways ‘inside-out’, 23, 24, 54–56, 121, 148, 403, 411 to outcomes, 51, 78, 81, 108, 139, 222, 231, 306, 342, 344, 411, 418 ‘outside’in’, 23, 24, 53–56, 67, 141, 147, 150, 284, 294–296, 381, 397, 399, 403, 411 to public value, 56, 150, 418 Peer education, 115, 117 group, 204, 205, 207, 271, 339, 381 mentor, 219, 221 review, 88, 93, 130, 132–134, 192, 193, 214, 375, 413

INDEX

support, 9, 39, 82, 83, 114, 115, 117, 118, 139, 142, 145, 156, 183, 207, 221, 256, 276, 277, 305, 306, 308, 312, 315, 339, 342, 349, 381 support groups in the Offenbach Employment Agency, Germany, 39 training, 117 training of learner drivers by offenders in Austria, 115 People living with dementia, 103, 207, 212, 273, 315, 369 Performance management, 129, 258, 287, 370, 406 system, 258, 287, 370, 406 Personalisation personal budgets, 53, 88, 139, 149, 208, 209, 215, 277 personal health budgets, 184, 185 user control over personal budgets, 149 PESTEL framework, 1, 5, 9, 10, 17, 33, 409, 410 Pitfalls in co-production, viii, 377, 386, 409, 417 Policies for mainstreaming effective co-production, 399 Policy evidence-based policy making, 5 reforms, 105, 210, 400 Politicians, 6, 27, 39, 40, 42, 47, 51, 53, 66, 76, 83, 96, 97, 113, 122, 127, 159, 160, 249, 259, 263–267, 282, 289, 291, 293, 302, 303, 343, 348, 368, 369, 373, 374, 409, 412 role in co-production, 40 Politics political leadership, 302 role of politics in co-production, 29, 51

439

Power, 24, 35, 41, 82, 97, 218, 219, 248, 254, 263, 268, 287, 288, 295, 297–299, 301–303, 396, 412, 417, 422 power dynamics, 302 power imbalance, 226 Predictive analytics, 148, 201 Prevention, 85, 86, 114–116, 120, 179, 180, 182, 184, 189, 193, 194, 198–201, 203, 208, 210, 214, 215, 217, 218, 231–233, 287, 298, 351, 358, 372, 401, 414 Priorities co-prioritisation of outcomes frameworks, 82, 86, 87 setting priorities in cocommissioning, 40, 282 Prioritising co-production principles, 40 Privacy, 38, 60, 157, 223, 320, 339, 371, 399, 413, 419 Private space, 48 Procurement panels, 86 Professionalism professional boundaries, 301 public funding favouring professional over citizen inputs, 79 Proximity, 230 Public choice, 31, 32 Public goods, 30, 32, 346 Public governance, 24, 40, 55, 60, 66, 67, 83, 95, 139, 157, 223, 304, 311–313, 319, 322, 377, 379, 386, 416, 418, 420–422 democratic governance, 293 Public participation, 16, 44, 47, 48, 66, 76, 137, 159, 193, 250, 317, 411 Public procurement, 209, 400, 404

440

INDEX

Public safety, 11, 46, 84, 97, 122, 148, 177, 217, 218, 227, 229, 231–233, 252, 256, 282, 316, 317, 320, 379, 412, 414, 415 Public service demand and control, 79, 269, 340, 342, 366 ‘enduring’ public services, 121 organisation, 2–4, 6, 8–10, 17, 23, 24, 27–29, 31, 37–40, 45, 47–49, 51–55, 57, 60–62, 65–67, 76, 78, 81, 84, 86, 90, 92, 95, 109, 112, 115, 118, 119, 121, 124–129, 133–135, 137, 139, 142–145, 150, 154, 158, 159, 179, 247, 248, 250, 254, 259, 260, 268, 269, 272, 276, 278, 280–284, 286–288, 291–298, 301, 310, 311, 313, 315–317, 319–322, 336, 338, 339, 341, 345, 356, 358, 360, 363, 365, 370, 373, 374, 382, 385, 387, 396–403, 405, 406, 409, 411, 413, 419, 422 organisational reform, 56, 259, 321 outputs, 28, 57, 64, 67 public service delivery, 24, 31, 309, 321, 367 public service logic (PSL), 31 public service reform, 387 quality, 57, 58, 64, 67, 255, 363 Public Services (Social Value) Act 2012 in the UK, 404 Public space, 45, 81, 82, 99, 100, 102, 130, 148, 316, 346, 383 Public value framework, 335, 336, 384 Governance International Public Value Model, 28, 338, 340, 341, 346 tradition, 11

Q Qualitative methods, 14 Quality as ‘aligning inputs, processes, outputs and outcomes’, 364 assessment framework, 24, 55–57, 67 as ‘conformance to specification’, 364, 365 of co-production, 62, 281, 411 as ‘enabling citizens to make an effective contribution’, 364 as ‘exceeding customer expectations’, 364 as ‘fitness for purpose’, 364, 365 as ‘meeting customer expectations’, 364 as ‘passionate emotional involvement’, 364, 365, 418 privately or collectively experienced, 368 quality management, 56, 57, 59–62, 67, 130, 368, 411 quality manual, 57–59, 406 simple or complex to specify, 368 Quality Care Commission, UK, 128 Quality of life outcomes business outcomes, 344, 346, 348, 385 community outcomes, 346 individual outcomes, 346, 347 Quantitative methods, 344, 420 R ‘Rational management cycle’, 77 READ (Research in Educational Achievement and Development) in Aarhus, Denmark, 124 Reciprocity, 36, 37 reciprocal relationships, 26, 36, 41, 204, 299

INDEX

Recovery, 10, 11, 117, 118, 179, 182–184, 194, 198–200, 207, 208, 276, 287, 408 Regulations, 57, 63, 126, 249, 258, 259, 284, 286, 291, 311, 313, 317, 319, 371, 377, 422 Rehabilitation, 1, 85, 86, 99, 179, 182–184, 191, 194, 198–200, 207, 208, 214, 215, 225, 226, 231, 232, 287, 401, 414 Representative, 41, 47, 48, 89, 95, 97, 107, 113, 134, 153, 160, 187, 193, 209, 229, 267, 271, 293, 304, 309, 316, 337, 355, 369, 370, 374, 375, 412, 416 ‘Representativeness’, 48, 49, 113, 159 Reputation loss, 263–266, 269 Research design and methods behavioural public administration, 408, 420 co-produced research, 158, 420, 421 creative methods, 288 experimental research, 420 funding bodies, 403 interdisciplinary, 16, 280 international comparative research, 232, 410 longitudinal studies, 386, 417, 420 mixed methods in research, 420 multi-disciplinary, 410 story-telling, 99, 151, 286, 288, 312, 365, 421 Resilience market resilience, 61, 65, 322 provider resilience, 273, 276, 322, 343 ‘resilience builders’, 278, 416 service user resilience, 322 system resilience, 24, 62, 247, 274, 321

441

Resources, 4, 6, 15, 24, 26, 27, 41–43, 51, 53–55, 58, 63, 65, 66, 78, 82, 85, 86, 92, 94, 103, 104, 111, 125, 126, 140, 141, 151, 156, 183, 189, 193–195, 200, 201, 203–205, 219, 257, 259, 271, 274, 282, 288, 294, 296, 298, 300, 302, 308, 311, 317, 338, 339, 342, 347, 355, 361–363, 374, 379–383, 386, 387, 398, 402, 403, 419 Responsibilities, 4, 5, 53, 96, 123, 135, 136, 183, 213, 269, 286, 289–291, 295, 298, 313, 315, 318, 400, 409 Restorative justice, 224, 225, 229, 307, 348 Rights budgetary rights of local councillors, 412 human rights, 38, 422 social rights, 346, 347 Rimini CI.VI.VO. project, 54 Risk assessment, 91, 261, 267, 272–274, 321 to community outcomes, 264, 268 enablement, 247, 261, 271–274, 277, 278, 321, 339, 403, 416 management, 63, 261, 262, 268–273, 279, 320, 321 non-compliance with legal and regulatory constraints, 262, 265, 269 non-compliance with public governance principles, 262, 269 to organisational outcomes, 262, 264 to organisational processes, 262, 265

442

INDEX

to personal outcomes, 262, 263, 267, 268 reduction, 271–274 Routes Out of Prison project in Scotland, 221 Rule of law, 38, 311, 313, 317, 320, 371, 372, 376, 377, 379 Rules formal and informal, 57 Rural, 106, 115, 119, 120, 125, 150, 182, 227, 259, 260 S Safeguarding policies, 121, 403 Savings, 4, 5, 54, 64, 90, 123, 207, 208, 212, 221, 225, 248, 259, 281, 282, 286, 309, 310, 336, 358, 359, 379, 380, 382–385, 387, 406 Scaling of co-production, 259 ‘scaling-out’, 407 ‘scaling-up’, 407 Scrutiny, 127, 144, 230, 313, 400 Seed funding, 373, 401 Self-care, 115, 120, 139, 180–184, 193, 207, 296 Self-efficacy, 151, 153, 183, 220, 402 Self help, 37, 53, 81, 88, 114, 118, 121, 143, 147, 148, 150, 158, 179, 200, 215, 217, 422 self-help groups, 124 Self-interest, 113 Self-monitoring, 123, 144, 181 Self-organising, 52, 53, 114, 200 Service cycle, 76 Service delivery, 8, 15, 24, 27, 43, 76, 78, 113, 122, 126, 131, 151, 186, 287, 313, 314, 321, 363, 375, 376, 383, 413 Service design, 32, 59, 376 Service quality outcome quality, 363

process quality, 363 ‘structural quality’, 363 Services for Young People, 6, 7, 10, 11, 86, 210, 301, 307, 352 Service users service user inputs, 3, 15, 24, 25, 28, 30, 31, 35, 37–40, 47, 50–55, 59–64, 66, 79–83, 85–88, 90–95, 97–101, 104–109, 112, 113, 115, 116, 118–121, 123, 127–130, 132–134, 136, 140, 141, 143, 149, 151, 153–155, 157, 158, 184–186, 191, 194–197, 199, 203–205, 208–210, 212, 213, 215, 227–229, 231, 248, 250, 252–254, 258, 263–269, 271, 273–278, 283–285, 288, 291, 292, 298–300, 312, 314–316, 320, 321, 335, 336, 340, 343–346, 351, 352, 358, 359, 362–369, 371, 374, 380, 381, 383–385, 396–406, 411, 413, 414 vulnerable and dependent service users, 39, 107, 248, 315, 320 Skills for co-production communication skills, 258 enabling skills, 39, 50 skills of citizens, 312 skills of staff, 125, 289 Smart City Labs, 139 Social capital, 31, 34, 57, 60, 61, 65, 67, 116, 409 Social care, 2, 8, 35, 36, 38, 52, 87, 91, 93, 98, 104, 105, 119, 121, 123, 124, 129, 135, 140, 141, 146, 149, 160, 177, 194, 199–203, 207–209, 211–215, 228, 231, 232, 277, 316, 343, 358, 382, 383, 396, 413, 414

INDEX

Social Care Institute for Excellence (SCIE), 37 Social inclusion, 38, 55, 183, 338, 347, 373, 375, 413, 417 Social innovation, 81, 99–101, 107, 108, 159, 160, 249, 259, 261, 278, 279, 292, 307, 315, 318, 397, 401, 405, 407 Social Innovation Lab Kent (SILK), 101, 108 Social isolation, 82, 142, 202, 255, 351 Social justice, 33, 66 Social media social media surgeries, 156 ‘Social model for health’, 414 Social policy, 346, 347 Social prescribing, 202 Social psychology, 364 Social services, 27, 44, 48, 53, 84, 114, 116, 132, 141, 200, 208, 210, 212, 224, 274, 283, 382, 400 Social work theory, 195–199 Social work treatment interventions, 204, 205 Speedwatch, 120 groups, 11, 115, 356, 362 in Wiltshire County Council, 120, 222, 354 Standardisation, 59, 67, 406, 407 Stepping Forward Together’—coproduction for falls prevention in Aberdeen City, 114, 180, 189, 372 Story-telling, 99, 151, 286, 288, 312, 365, 421 Strategic commissioning, 54 Strategic management, 337, 364, 407 strategic planning, 86 Strategies for co-production, 289

443

deliberate, 406 emergent, 407 opportunistic, 406 unrealised, 406 Streetwatch scheme, 125, 372 of the local authority of Weyhe, 125 Surrey County Council, 6, 7, 9–11, 86, 209, 225, 301, 305, 307, 348, 352, 353 Sustainability, 38, 57, 122, 124, 310, 315, 316, 340, 343, 371, 417 of results, 38, 122 Synergy, 61

T Tacit knowledge, 79, 118, 125, 194, 301, 398, 421 Therapy Focus in Western Australia, 100, 105, 212 Third sector organisations, 7, 14, 26, 27, 53, 85, 87, 92, 124, 126, 134, 154, 191, 278, 290, 299, 300, 312, 317, 318, 357, 362, 399, 406, 416, 422 Time banks, 34, 37, 42, 154, 208, 284 Training, 5, 11, 46, 48, 88, 93, 94, 107, 114, 117–119, 121, 122, 125, 131, 134, 156, 181–183, 194, 199, 213, 218, 220, 221, 248, 258, 275, 278, 284, 292, 301, 305, 306, 309, 312–315, 317–319, 357, 361, 362, 371, 372, 402, 403 Transformation, 6, 57, 82, 94, 105, 137, 138, 146, 309, 344, 351, 358, 380, 396, 397, 417 transformative change, 352 transforming Services for Young people in Surrey County Council, 6, 94, 354

444

INDEX

Transparency, 38, 137, 143, 144, 192, 213, 311, 312, 314, 315, 338, 339, 371, 373, 374, 417 Treatment of social problems, 203 Trust in citizens by public services, 2 generalised trust, 256 in government by citizens, 30, 257 particularised trust, 256 Types of co-production of co-assessment, 83, 128, 130–133 of co-commissioning, 90, 138 of co-delivery, 9, 83, 114–118, 120–123, 125, 217 of co-design, 99–101, 110 U Urban, 9, 31, 82, 102, 106, 120, 131, 138, 141, 260 User driven-design, 397 feedback, 128, 204 monitoring, 139, 149, 314 rating of public services, 133 satisfaction, 139, 208, 336, 366, 367, 386 self-help, 81, 147, 150, 403 Users with a specific lived experience, 115, 118 User Voice, 115, 118, 228 V Value creation, 56, 343

Voluntary and Community Service organisations (VCS), 362 Voluntary sector, 4, 118, 141, 193 Volunteer, 7, 9, 10, 24, 28, 30, 38, 46, 52–54, 60, 61, 79, 80, 82, 83, 87, 92, 100, 103, 105, 111, 114–120, 122, 124–126, 142, 143, 154, 180, 183, 187, 189, 214, 218, 222, 229, 232, 258, 266, 271, 275, 279, 284, 293, 296, 297, 303–310, 312–314, 316–320, 354, 356, 357, 359–362, 366, 371–375, 381, 383, 422 insurance policy, 125 volunteering, 10, 52, 79, 92, 103, 114, 117, 120, 124, 307, 308, 310, 354, 362 Vulnerable people, 149, 150, 255, 284, 418, 422

W Web-based rating of public services, 191 Welcome to Utrecht , 149 Welfare state, 127, 399, 413 Well-being, 10, 35, 88, 89, 180, 184, 224, 346, 347, 404 Wicked problems, 11, 158, 159, 410 Witton Lodge Community Association, UK, 115–117 Work environment, 295