Co-production, social care and participatory democracy

This article examines the dual class character of co-production, a key concept in current policy for public services. Its focus is on social care, the largest area of local government spending. It uses Birmingham as a case study.

Neoliberalism has two complementary dynamics – ‘roll-back’ neoliberalism and ‘roll-out’ neoliberalism.[1]  Roll-back neoliberalism entails the dismantling of the welfare state.  It includes the massive cuts in the budgets and powers of local councils. Roll-out neoliberalism entails the construction of new policies, often in response to the problems created by roll-back neoliberalism. This is a crucial issue for local councils in England, which are now in the process of attempting to develop a new political project for local government in the context of austerity.

One key element of this new roll-out project is a new model of social provision by councils. I’m going to use Birmingham, where I live, as an example. In 2014 the government sent Sir Bob Kerslake, Permanent Secretary at the Department for Communities and Local Government, to Birmingham to review the governance of the city because of the failure of the Labour Council to carry out the internal restructuring needed to deliver the neoliberal agenda efficiently. The review was published in December 2014. It contains three key requirements which have driven the council up till today:

  • More efficient central corporate leadership and management of the Council. This Includes the management of, and drastic cuts in, the workforce.
  • External partners – private and third sector – not only as external providers of services but as partners in the governance of the city. As the report says, the council ‘needs to work much harder to align its priorities with its partners’.
  • A new relationship with the community. The report says: ‘By working together with local communities relatively modest steps can help pressure on resources by reducing the consumption of services and supporting local communities to help themselves and, where necessary, giving people the tools they need to do so.’ (p48). [2]

In 2018 Locality, a government-funded body, published People Power. [3] The Foreword is by Kerslake, now Lord Kerslake, Chair of the Commission on the Future of Localism. He says:

Power doesn’t belong to decision-makers to ‘give away’: we need a localism agenda which makes the case that power starts with people. It lies in our communities. The task of the political system and our local leaders is to harness this power through ongoing relationships, engagement and co-creation. (p5)

Kerslake’s pronouncement exemplifies the concept at the centre of this project for public service reform: co-production.

Co-production has a dual class character: it has been a feature of progressive public policy for several decades but it has also become a dominant ideological theme and key instrument of social policy under the current neoliberal austerity regime. (An early version was Cameron’s ‘Big Society’.)

In the UK […] the National Health Service (NHS) Five Year Forward View (NHS England, 2014) advocates the importance of local co-design in the implementation of new care models, working with local communities and leaders. The Care Act (2014) also highlights the importance of co-production within social care, defining it as when individuals or groups influence the support and services that they receive, or influence how services are designed, delivered or commissioned. (Michelle Farr 2018, p624) [4]

Who controls the co-production agenda?

What role do service users have in defining and shaping the co-production agenda? This is the theme of Michelle Farr’s recent research into ‘Power dynamics and collaborative mechanisms in co-production and co-design processes’:

Co-production is a contested concept. In practitioner and policy literature co-production is often promoted as a ‘normative policy good’ […] endorsing a partnership approach and equal relations between staff and citizens that can facilitate innovation and improvement within public services […]. In contrast, at a discursive level co-production has been analysed as an extension of neoliberal free market economics and a fix for austerity […], where citizens may be substituted for paid personnel within public services […]. Radical perspectives see that ‘real co-production’, where alliances are forged between practitioners, service users and carers, may offer the best route to challenge ‘damaging policies’ and promote ‘genuinely user-led services’ (Beresford, 2016). (p624)

Is co-production ‘legitimating and deepening’ managerialism and neo-liberalism, giving ‘a false impression of citizen power’ […]? Or does co-production support small-scale service improvement, or have the potential to transform power relations and structures? (p626)

Co-production and co-design techniques may be critiqued as ‘grafting deliberative processes onto a neoliberal framework’ […], where service improvements are made, yet at the same time wider structural issues within public services, generated through austerity measures and neoliberal marketisation may not be challenged. (p627)

As Michelle Farr says:

This question of whether co-production leads to empowerment, or may further engrain inequalities, is a matter of empirical investigation, rather than its intrinsic nature being either empowering or dominating […]. (p626)

Co-production in social care in Birmingham

Birmingham City Council has defined ‘Co-production [as] a way of working where everybody works together on an equal basis to create a service or come to a decision which works for them all. Co-production is a process which involves citizens in the design and delivery of services.’ (December 2018). It is exemplified by the council’s ‘Proposed Strategy for Day Opportunities’ {April 2019):

At every opportunity, Birmingham City Council will use co-production to design services with service users, carers, and service providers within day opportunities. Co-production groups have been established to inform some of the content of this draft strategy. (p7) [5]

The Day Opportunities policy is based on the ‘Neighbourhood Network Schemes’ agreed by Cabinet in November 2017 and currently being put into practice, managed on behalf of the Council by Birmingham Voluntary Service Council.

Neighbourhood Network Schemes are locality and constituency based networks which enable the engagement with and investment in community assets.

This is for the purposes of supporting older people to connect with individuals, groups, organisations, activities, services and places in their local neighbourhood.

This approach is integral to a new community social work model, and the overall investment by Birmingham City Council’s Adult Social Care & Health in “Prevention First”. (BVSC 2019) [6]

To support this an online Community Asset Directory was published in March 2019 listing a thousand local organisations in the city which can offer support, ranging from allotments to Zumba.

According to Birmingham City Council’s Financial Plan 2019-2023, ‘As a result of these changes, the Council anticipates a graduated reduction in demand, starting from a 5% diversion away from formal care in 2018/19 rising to 30% in 2021/22.’ (p30). [7]

This policy exemplifies the dual class character of co-production. Making full use of the support offered by ‘community assets’, in terms of facilities, activities and personal, professional and community relationships, is likely to be of significant benefit to service users. But it is also the case that the policy is driven by the government’s austerity politics, forcing the Council to make year-on-year cuts in spending.  Birmingham is reducing its Adult Social Care budget this financial year by a further 3%, about £10.5million. The role of the co-production strategy of the Neighbourhood Network Scheme in contributing to this, whatever its benefits may be for service users, was made explicit at a public presentation of the Scheme by a senior officer in March 2019. His first argument for it was that it would reduce costs.  It is an example of, as Farr says, ‘a fix for austerity […], where citizens may be substituted for paid personnel within public services’.

A case in point which has received national publicity is the long-running dispute by Birmingham’s Home Enablement service workers. The service helps vulnerable and mostly elderly patients get back their independence after a hospital stay, and employs about 280 staff, mostly women. In 2017 the Council announced the imposition of new working conditions on the staff in an attempt to save £2million. It entailed split shift rotas that would have meant workers undertaking three separate shifts in a day. This provoked a campaign of resistance by the workers and their union, Unison. In July 2018 the Council announced a new series of redundancies and cuts to the wages of the already low-paid staff. The workers responded with a series of 30 one-day strikes. It was only as a result of their campaign lasting almost two years that the Council finally abandoned its plans in May 2019.

There is no guarantee that the anticipated substitution of support based on utilising ‘community assets’ in place of ‘formal care’ will not result in a deterioration in the quality of provision. In this context genuine co-production needs to include full participation by service users and supportive citizens in both the design of the provision, including establishing the performance criteria by which the programme is publicly accountable, and full access to the performance data and financial information in order to evaluate its outcomes.

No co-production at the strategic political level of local government

Michelle Farr suggests that co-production can be used not only as a sticking plaster for cuts but also to give ‘a false impression of citizen power’ while actually ‘’legitimating and deepening’ managerialism and neo-liberalism’’ (p626).

This is a fundamental problem of how co-production can be used by local councils: popular participation is restricted to the lower levels of the policy structure. There may be co-production at the level of interpersonal professional-client relations or community-provider relations but there is no co-production at the strategic level of the design, commissioning and democratic accountability of services, beyond any limited consultation exercises, because there is no participation by the users of services or the workers providing services in the political bodies in the Town Halls and Council Houses where the strategic decisions are made.

The vast majority of councils in England employ the Cabinet and Scrutiny model, introduced by Tony Blair in 2000. This has imported into local councils a highly-centralised business model of governance by a small group of leading councillors comprising the Cabinet. They are supposed to be held to account by the Scrutiny Committees, though their effectiveness is questionable. [8] All these bodies are the domain of elected councillors, not officers.  And insofar as decisions are made by officers, they are delegated by the council leadership and subject to the policy framework it has established.

Birmingham provides an example. Its Neighbourhood Network Scheme is organised on a constituency basis.

The networks are organised by a Lead Facilitator, with delegated responsibilities and budgets from Birmingham City Council, to implement and manage the Neighbourhood Network Scheme in each constituency.

Networks will invest in, and support the development of, community assets, as well as the individuals, groups and organisations who are delivering community activity. They will connect, broker and link community assets to citizens and statutory agency practitioners (e.g. social workers and GPs). Networks will also locally commission activity, through a micro and small grants scheme, building on the community offer and/or making it more accessible for older people.

Each constituency has a budget of between £170,000 to £280,000 to cover costs for staff, management, investment in support for community assets, and local commissioning of activity through micro and small grants.’ [9]

The lead facilitators include a number of charity organisations. There has been no participation by users and the local communities – no co-production – in the design of the contracts and which partnership bodies get them, nor in how they will be held publicly accountable.

On 6 June 2019 the following was announced, significantly not by the Council itself but by the contract holder, Birmingham Voluntary Service Council Ltd:

The council has approved spending of up to £4.9 million over the next three years in Prevention and Communities. This approach will invest the Council’s resources in programmes of funding which support “Prevention First” and the Adult Social Care Vision and Strategy. It includes the procurement of Information Advice and Guidance (IAG) services for citizens with new and emerging conditions, as well as several programmes of grant awards to voluntary, community and social enterprise sector organisations for activity and services. [10]

Again the question is will the users of these services have a meaningful role in the drafting of these spending plans, including the design and allocation of contracts? Will there be co-production involving service users and staff at the political level of local government where these strategic decisions are taken?

This is an issue that is typically absent from the co-production literature, including the critical literature. It tends to define co-production as engagement between service users and service providers and omits local government politicians, even though it is they who are responsible for the strategic decision-making that frames co-production. For example, the 2013 TUC report ‘Making co-production work – lessons from local government’ defines co-production as ‘In plain English, how workers and managers can work with local communities to deliver good local services’, and subsequently as ‘citizens and council employees working together’.[11] Bovaird and his fellow authors define co-production as ‘professionals and citizens making better use of each other’s assets, resources and contributions’. [12] Michelle Farr, in the paper I have quoted, defines ‘real co-production’ as ‘where alliances are forged between practitioners, service users and carers’ (p624). Local council politicians are not mentioned.

But an important exception is a new research-based policy brief by Mureddu and Osimo, published by the Lisbon Council (a think-tank) in June 2019. It argues that the hierarchical power of elected politicians prevents effective participation. [13]

In theory, participation empowers citizens through the structural integration of participative and deliberative mechanisms. However, participation through empowerment is restrained by the enduring hierarchical power structures of both representative democracy and public management, with the scope and impact of participation being determined by public-service staff. The implication is that participation is side-lined in public service design and delivery. In short, empowerment through structural change has not been effective in transforming public service production into a participative process, because the conceptualisation of empowerment necessitates that those in government share power. (p15)

This antipathy of politicians to effective public participation is typical of local councils. In 2018 the Local Government Association Labour Group, representing Labour councillors, published a report, On Day One: Labour in local government’s priorities for the next Labour Government. How a Jeremy Corbyn-led administration could work with local government to deliver for the many, not the few. [14] In the whole 72 pages there is only one brief passing reference to participation by citizens at any level.

A new perspective on participation from Labour

A very different position is taken in a recent Labour Party Consultation Paper, Democratic Public Ownership, commissioned by John McDonnell and published in September 2018. It establishes some principles and arguments which have fundamental implications not only for Council public services but for Councils’ governance regimes too. [15]  The report says:

Statements by Jeremy Corbyn, John McDonnell and other Labour frontbenchers, have not only made the case for public ownership, but suggested more diverse and democratic forms of ownership that involve users, workers, and other stakeholders in governance structures.

The core argument of the report is that:

An organisation, and indeed sector, should be run by the people who have the experience, skills, knowledge, and competence to do this. However, this is always a collective learning process and is done best where the considerable diverse knowledges of the workforce and citizenry are brought together to inform the decision-making process.

This is particularly important in the field of social care where disempowering ideologies and practices, bolstered by neoliberal austerity, are still evident but where, as research by Marion Barnes (2009: 232) has demonstrated,

Collectively, service users have developed alternative ways of understanding disability, mental illness and caregiving, have claimed the right to construct their own identities and have unsettled taken-for-granted assumptions about social relations, not only between providers and users of welfare services at the point of delivery but also in the process of deliberation about social policies. [16]

In June this year the Labour Party developed the policy of participation further in the report From Paternalism to Participation: Putting civil society at the heart of national renewal. [17]

Labour wants people to have a bigger say over the public decisions and the public services that affect them, with more direct accountability to service users where possible.

We will promote collaborative decision making, encouraging public service providers to involve their service users in taking decisions about how those services are run, the outcomes they are working towards, and the support they offer. This cannot be limited to consultation alone – people need the power to assert their voice when those in power refuse to listen, and civil society has an important role in acting as their advocates and champions. This will mark a radical change from top-down approach to public services and put services users and front-line workers in the driving seat. (p10)

This policy should apply not only to civil society providers but also, and crucially, to how councils work: effective participation by service users and service workers – by citizens – in strategic policy-making at Council House and Town Hall level, not just in service delivery at neighbourhood level. And that would open the door to popular challenge to dominant policies and power structures which sustain social injustices.

Five proposals to open up local Council policy-making to citizen participation

How could these policy aims be translated into practice in local government? The alternative we should be arguing for is a combination of representative and participatory democracy in Council Houses and Town Halls through five inter-related reforms:

  1. For Council Committees with participation by the users and providers of services

Each Cabinet Portfolio service sector should establish an advisory committee comprising a group of Councillors together with representatives of service users and the workers providing the service. Sub-committees could be set up if and when needed. Alternatively, Councils could scrap the Cabinet model altogether and return to a Committee system, which they are legally allowed to do, again with representatives of service users and workers.

  1. For participation by the users and providers of services in each Scrutiny Committee

All Scrutiny Committees are allowed to co-opt members and therefore there should also be representatives of service users and the workers providing the service on each Committee. Again, sub-committees could be set up if needed.

  1. For Citizen Forums

It should be a basic civic right that the Council facilitates meetings of citizens with common concerns and interests that extend beyond the boundaries of individual Ward Forums. Citizen Forums, perhaps authority-wide, would enable a vital horizontal connection between service users, workers who provide them, communities and councillors, creating a rich fabric of shared experiences, knowledge and ideas for improvement. (In Birmingham the Council’s recent launch of a monthly open ‘People for Public Services: Citizen Engagement Forum’ on Adult Social Care has set a positive precedent.)

  1. For Community Development.

Community Development (CD) is an approach that enables local people to identify the issues that matter to them and then be supported to negotiate responses and solutions to those issues, harnessing the assets and insights of the communities themselves . It thus enables local people to help set the agenda for planning, working with the statutory sector which may in addition include education, police.  This is a key approach to participatory democracy.

Community Development has been shown to improve health, help tackle health inequalities, encourage positive health behaviours and be good value for money.

Every council, in conjunction with its local NHS, perhaps through its Health and Well-Being Board, should produce a Community Development (CD) strategy. This should deliver a CD presence in every ward. At the same time, there needs to be significant change in the governance of the Local Authority and the NHS to ensure that the system is responsive to the drive to democracy at local level.

  1. For inclusive digital participation in policy-making

As From Paternalism to Participation says, ‘The digital revolution offers radical opportunities to increase public accountability and participation in decision-making’ (p10). In order to make access to the policy process more accessible to all, Councils should set up digital networks to enable online participatory democracy in policy-making, like Decidim – We Decide – in Barcelona.

This is a digital platform for participatory democracy that allows citizens to make proposals, deliberate on them, promote them and collectively defend and improve them. It was used to build the strategic plan for the city of Barcelona, and to develop some prototypes of processes such as participatory budgeting. [18]

A Council could put all these five policy proposals into practice tomorrow, even under the present government. It’s just a matter of political will. As the Lisbon Council policy brief says, ‘the conceptualisation of empowerment necessitates that those in government share power’.

 

Richard Hatcher

July 2019

Contact: Richard.Hatcher@bcu.ac.uk

Many thanks to Brian Fisher for suggesting proposal 4 on Community Development.

This article is also available on the Health Campaigns Together website at https://www.healthcampaignstogether.com/pdf/1907%2019%20RH%20co-production%20article%20v3.pdf

References 

  1. Peck, J. and Tickell, A. (2002) Neoliberalizing Space. Antipode 34:3, 380-404. http://socialproblems.voices.wooster.edu/files/2011/08/peck.pdf
  2. Kerslake report (2014). https://www.gov.uk/government/news/kerslake-report-birmingham-council-must-radically-improve
  3. People Power https://locality.org.uk/wp-content/uploads/2018/03/LOCALITY-LOCALISM-REPORT-1.pdf
  4. Farr, M. (2018) Power dynamics and collaborative mechanisms in co-production and co-design processes. Critical Social Policy 38(4): 623–644. [In this and other quotes I have omitted the author’s literature references.] https://research-information.bristol.ac.uk/files/139271852/CSP_1485_Farr_Power_dynamics_in_co_production_and_co_design.pdf
  5. Birmingham City Council (2019) Adult Social Care Draft Day Opportunities Strategy https://www.birmingham.gov.uk/info/20018/adult_social_care_and_health/1522/adults_social_care_day_opportunities_consultation_2019 
  6. BVSC (2019) Neighbourhood networking schemes https://www.ageingbetterinbirmingham.co.uk/neighbourhood-networking-schemes 
  7. Birmingham City Council (2019) Financial Plan 2019-2023. https://www.birmingham.gov.uk/downloads/file/12046/financial_plan_2019_to_2023
  8. For example, Communities and Local Government Committee (2017) Effectiveness of local authority overview and scrutiny committees. https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/369/369.pdf
  9. BCC (2019) Neighbourhood networking schemes. https://www.ageingbetterinbirmingham.co.uk/neighbourhood-networking-schemes
  10. Birmingham Voluntary Service Council (2019) https://www.ageingbetterinbirmingham.co.uk/learn-more-get-inspired-by-stories/stories/new-prevention-and-communities-grants-programme
  11. TUC (2013) Making co-production work – lessons from local governmenthttps://www.tuc.org.uk/sites/default/files/APSE%20making%20co-production%20work%20in%20local%20government.pdf
  12. Bovaird, T., Stoker, G., Jones, T., Loeffler, E. and Pinilla Roncancio, M. (2015) Activating collective co-production of public services: influencing citizens to participate in complex governance mechanisms in the UK. International Review of Administrative Sciences 82 (1) 47-68.
  13. Mureddu F. and Osimo D. (2019) Co-Creation of Public Services – Why and Howhttps://lisboncouncil.net/publication/publication/156-co-creation-of-public-services-why-and-how.html
  14. Local Government Association Labour Group (2018) On Day One: Labour in local government’s priorities for the next Labour Government. How a Jeremy Corbyn-led administration could work with local government to deliver for the many, not the few. https://www.local.gov.uk/sites/default/files/documents/On%20Day%20One%20SR%20190318.pdf 
  15. Labour Party (2018) Consultation Paper, Democratic Public Ownership.
  16. Barnes M (2009) Authoritative consumers or experts by experience? User groups in health and social care. In: Simmons R, Powell M and Greener I (eds) The Consumer in Public Services: Choice, Values and Difference. Bristol: Policy Press, pp. 219–234.
  17. Labour Party (2019) From Paternalism to Participation: Putting civil society at the heart of national renewal.
  18. Barcelona en Comú (2019) Fearless Cities. Decidim is at https://decidim.org/ . See also https://meta.decidim.org/?locale=en . Both are in English. Madrid has a similar digital platform: see https://blog.p2pfoundation.net/beyond-protest-examining-the-decide-madrid-platform-for-public-engagement/2018/05/09
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