Co-production needs to move from the margins of the NHS into the mainstream to help patients actively, rather than passively, access the healthcare they require, argues Halima Khan.
Reducing unplanned admissions. Supporting people to live at home for longer. Taking more responsibility for our own health and wellbeing. These aims are widely accepted, but have we seen as much progress as we’d like?
At NESTA we believe co-production can help, which is why we think it’s essential to take co-production beyond the margins and into the mainstream of the NHS. To put this into practice we have launched a new programme called People Powered Health.
People Powered Health will involve NESTA working with the Innovation Unit and about six local projects to look at how to scale up co-production to tackle long term health conditions. We are focusing on long term conditions because of steeply rising demand and costs and because there are already good examples of co-production to build on.
So what do we mean by co-production? It’s a term which has sometimes been interpreted as relatively light and intermittent forms of patient participation and involvement. NESTA, on the other hand, are among those that see co-production as a deeper, more sustained and more profound transformation of the professional/patient relationship - where roles are reconfigured and responsibility for health is shared on an on-going basis.
The Expert Patient Programme reflects some of the possible power of co-production. It recognises that health and wellbeing can depend as much on individual behaviour, choice and experience as on clinical input. That there are limits to what clinicians can achieve without individual patients also playing their part - medical professionals need patients as much as patients need professionals.
But co-production is about more than individuals – be they patients or professionals. It is also about deepening social networks and strengthening communities. If people have support networks to turn to, they are less likely to drop into the GP surgery for a chat.
In many ways co-production brings together a number of different approaches that have become widely accepted in other areas of our lives. These include the role of social networks in building individuals’ resilience; sustaining behaviour change through peer to peer networks; and a theme that is central to our work at NESTA, unlocking the assets of people themselves – moving them from passive recipients of healthcare services defined by their need to active producers of their own health and wellbeing outcomes.
NESTA has developed a set of principles from our work with a network of co-production practitioners and the New Economics Foundation: users of services need to be recognised as assets with skills and capabilities to offer; services need to promote mutuality and reciprocity between groups of users, professionals and the wider community, a key part of which is peer support networks and finally, the role of professionals has to change, blurring the distinctions between provider and recipient, with publicly funded professionals becoming facilitators rather than deliverers.
Through People Powered Health, we hope to demonstrate how co-produced solutions, based on these principles, can help people live better with long term conditions. Better in terms of their own health outcomes and better in terms of the financial demands on the health economy.
Co-production can reduce costs. Evidence from disabled people services in Australia shows that cost reductions of 30 percent have been achieved by junking the question ‘what do you need?’ and replacing it with ‘what kind of life do you want?’ The resulting preventative service, called Local Area Coordination, integrates disabled people into existing social networks and devolves budgets to promote independent living. The result has been a reduction in acute interventions and residential care use while outcomes have improved.
We will be exploring the financial benefits of co-production in People Powered Health through business cases based on our practical work.
In fact, the lack of compelling business cases for co-production is one of the barriers we have identified to co-production breaking into the mainstream. The other barriers are workforce culture, commissioning practice and existing models of measurement and accounting for value which do not fully capture the benefits of co-produced approaches. People Powered Health will look at ways in which these barriers can be overcome to enable co-produced solutions to work at a larger scale.
We have received over a hundred applications to be part of People Powered Health. We look forward to working directly with the local projects chosen to take part in the programme and, through a learning network, with the wider set of places that have shown an interest in the programme. Our approach is to involve people in the design and evolution of our programmes and, in the end, we want our findings to be useful, practical and of benefit to those working in and around the health service. We look forward to hearing people’s views throughout the project.
- For more information on People Powered Health visit www.nesta.org.uk/peoplepoweredhealth