Co – producing healthier outcomes

COMMUNITIES IN CONTROL

Paul BallardDeputy Director of Public Health

Honorary Senior LecturerDundee University Medical School

Customer understanding

We don’t see things as they are; we see them as we are

(Anais Nin)

Medical Nemesis

The health care system “expropriates the power of the individual to heal himself and to shape his or her environment” (Ivan Illich Medical Nemesis 1975).

What isn’t co-production?

Consultation Informing people

Co-designing services

Representation on service boards and panels

Evaluating services

User led organisations

Personal budgets

Volunteering

What is co-production?

“Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.” ( nef 2008)

Communities in Control

The challenge is to work with communities, not to find out what they want and then provide it, but to enable them to take control and provide their own solutions. This is called co-production.

Elements of co-production

Building on people’s existing capabilitiesRecognising people as assets

Reciprocity and mutuality

Peer support networks

Blurring distinctions between people and professionals

Facilitating rather than delivering

Asset Approach

“A health asset is any factor or resource which

enhances the ability of individuals, communities and populations to maintain and sustain health and well-being. These assets can operate at the level of the individual, family or community as protective and promoting factors to buffer against life’s stresses.”

Changing roles: current service delivery model

• Planners specify what the services will look like, procure them and then monitor the services using targets

• Practitioners assess need, ration resources and deliver services to passive recipients

• Users and communities are defined by what they lack and receive care based on how needy they are perceived to be

Changing roles: co-production modelPlanners, Practitioners, Users/Communities

• All three have a role in assessing needs, mapping assets, agreeing outcome targets, planning allocation of resources, designing and delivering services, monitoring and evaluating impact

• Professional and experiential knowledge are valued and combined, everyone’s capacity is developed.

• Minimises waste by developing solutions with users

• Can often reduce costs by focusing on person-led community- involved services, relieving pressure on expensive specialist services

Co-production in action

• Time banking• Family Nurse Partnership• Healthy Communities Collaborative• SHINE• Keyring

HEALTH EQUITY STRATEGY

Paul BallardDeputy Director of Public Health

Honorary Senior LecturerDundee University Medical School

“achieving health equity within a generation is achievable- it’s the right thing to do- now is the right time to do it”

Key Elements of the Health Equity Strategy

• Contributing to Health Equity within a generation

• Utilise co-production and assets based approach

• Focus energy and resources on early years• Focus greater effort on behavioural change• Agree with partners measures of progress

and outcomes• Build co-ordinated health intelligence

The Design Process• Early 2009 – Creation of multi-agency Steering Group and

Board

• April – June 2009 – Ongoing engagement with communities

• September 2009 – Endorsed by Health Board

• October 2009 – January 2010 – Period of formal consultation

• March 2010 – Endorsed by Health Board

• April – July 2010 – Implementation Plan constructed including template for CHPs/CPPs

• August 2010 – Health Board endorsedImplementation (Optimisation) Plan

Key areas for implementation

• CHP/CPP action plans

• Segmenting data/population health data zones

• Organisational development plan for NHS Tayside

• Early years

• Acute service perspective

Measures• Life Expectancy (at birth)• Premature Mortality (those aged under 75 years)• Mortality (15-44)• Mortality by cause of death• Infant Mortality• Admissions by diagnosis (CHD, Cancer, CVD, COPD, Alcohol)• Multiple Emergency Admissions• Diabetes Type II Prevalence• Teenage Conception• STIs – Chlamydia• BBV – Hep ‘C’• Obesity• Screening (bowel, cervical and breast)• Community Resilience/Social Capital• Co-Production (Indicators to be developed)

Remember

People are the heart of the solution,not the problem.

Introduction to SHINE projectDr Margaret HannahDeputy Director of Public HealthNHS Fife

SUB HEADING

Micro market for highly tailored care packages for frail, elderly

Personalised, humanistic care Timely, preventative supportMicro-enterprises

Fits with wider reshaping care agendaFamily empowermentCo-production with communitiesTechnology with a human face

WORKING WITH COMMUNITIES IN FIFE

Heather Murray Senior Policy Officer Fife Council

• Deck access flats

• Dampness and disrepair

• Poor environment

• Low confidence and aspiration

ECONOMIC REALITIES OF CO-PRODUCTION

Gerry Power National Lead - Co-production and Community CapacityJoint Improvement TeamScottish Government

‘... co-production is essentially about the delivery of public services

being shared between the service provider and the recipient ... co-

production is nothing new ... what makes ... (it) ... topical in the

current financial crisis is the expectation that effective user and

community involvement may help to improve outputs, service quality

and outcomes and reduce costs ...’

Barker, Adrian., 2010, Co-production of Local Public Services. Local Authorities and Research Councils’ Initiative. Available from <http://www.rcuk.ac.uk/document/innovation/larci/Larci.CoproductionSummary.pdf> (accessed 31 March 2011)

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Governance InternationalTHE CO-PRODUCTION STAR TOOLKIT

1.Target it.

maps what co-production is already taking place, the benefits its having and how this can be built on.

2.Focus it.

identifies the activities where there are likely to be big savings and/or service quality improvements in areas which are organisational priorities.

3.Incentivise it.

who wants to work with you in co-producing your services including service users and potential service users to find out.

4.Market it.

encouraging behaviour change by people who use services, other citizens and by provider staff, citizens, frontline staff and managers.

5.Grow it.

focuses on scaling up the co-production activities that work, including spreading good practice to other services and other organisations

http://www.jitscotland.org.uk/news-and-events/e-newsletter/

Gerry Power (Gerry.Power@scotland.gsi.gov.uk)National Lead - Co-production and Community CapacityReshaping Care for Older People ProgrammeJoint Improvement TeamScottish GovernmentArea 2ESSt Andrew's HouseRegent RoadEdinburghEH1 3DG0131 244 2374