By Paola Pierri, Published: July 29, 2012
Patients are the health service’s biggest untapped resource (Department of Health, 2006).
The health sector is becoming more and more aware of the importance of involving users (its patients) in the delivery of the service. ‘Personalisation’ has become widespread, with policy makers and clinicians claiming that this is the future of healthcare.
Designing health care from the perspective of the patients (patient-centred) to ensure they have more independence, control and choice on their care has been a key concept in the recent improvement strategy in the NHS: “Care should be about helping people maintain their independence, leaving them with control over those lives, including service they use” (Green Paper Independence Well-being and Choice - Department of Health, 2005).
But what is this ‘personalisation’ actually about? In which stage of the design process is the patient’s perspective actually taken on board? And how does personalisation of services relate to ‘Co-production’ (if it does)?
Personalisation means thinking about care and support services in an entirely different way.
The traditional one focused on the application of expert’s knowledge to treat illnesses and on service efficiency, has proved not to be so effective in providing patients with the right care at the right time.
Personal budgets have been the tool to give to patients the opportunity to spend their budget to shape their own care but personalisation should be about more than that.
In order to shape the health system in a ‘user centred way’, patients should have not only a greater say but a greater role in it.
The central idea is about having services that can empower individuals, enabling them to take more control of their time and their skills to run their own care together with professionals.
A good example is the Richmond Users Independent Living Scheme - RUILS. They help the users to pool their personal budgets, increasing their purchasing power and also helping them to expand their networks in the community. This is done because they bring people with similar needs around activities that they enjoy together. Pooling personal budgets is a good example of how a relatively individualistic policy can be made more cooperative, more co-produced and achieve better outcomes for people. (NESTA, 2012)
Without the true engagement of patients since the very first stage of the design process, personalisation risks to be not more than a market based, individualised approach that leaves people alone and dis-empowered.
“The privileging of choice over any other consideration (such as equity, quality and continuity) puts the ‘patient consumer’ model at the forefront” (Hudson, 2012)
Finding the right combination between personalisation of services and patient’s involvement is the way forward.
The optimum lays where patients are partner in equal with professionals, realising a Mass Co-production of public services as highlighted in the upper right quadrant.
“Co-production helps re-focus on what skills and expertise both people and professionals can contribute, changing the way people are supported, rather than changing the way in which services are purchased and consumed” (Slay, 2012)
Co-production has proved to be quite effective in making available additional resources toward personalisation. It is not all about financial support, is also about skills, flexibility, time and other non-economic resources. Everybody can contribute to make sure that services are designed around the user.
The SUN – Service User Network project in Croydon shows how involving patients could provide the services that they need when they need them and help those who feel isolated and let down by mainstream services. This is done by bringing people who share the same experiences to support one another in formal and informal ways together.
Co-production is also about improving the ‘offer’ of services available: people taking up of personal budget expect to have greater choice of what to buy with their money. Yet in reality the same care agencies are offering the same care as before, because there is no advocate promoting a more individualised service and service’s users have not a role on this side.
Community groups or voluntary organisations offering different services to their users (see for example the Skillnet Group, based in Kent) have experienced some challenges in convincing commissioners that their different approach, often integrating local community assets and providing a more active role for users, is a good choice to buy in.
Introducing co-production in commissioning should be the next step. There are already examples of commissioners systemically embedding co-production in to adult social care contracts (see the experience of the centre-based day support service for people with mental health problems in Camden http://www.hcct.org.uk/). But more has to be done to find better ways of commissioning co-produced services.
There is an emerging evidence base that co-production works at level of communities (People Powered Health Co-production Catalogue – Nesta Social Care Institute for Excellence’ research briefing and others listed among the references); we need now to build up the business case to show that these examples can be replicated in a mainstream approach to public services.
In the economic system of mass-production, professionals were the ‘creator’ while users where ‘destroyers’ of value, like sponge able only to receive and consume. The shift in the paradigm within the service economy of mass co-production sees professionals creating value with users that are no more seen just as single consumers but actors, immersed in their community, with their own assets and a role to play.
The question we should ask ourselves at this point is not if we can afford to move co-production to the mainstream, but if we can afford not to.
“Reducing people’s dependence on health professionals and increasing their sense of control and wellbeing is a more intelligent and effective way of working” (De Silva, 2011)
About the author
Paola Pierri works with Mind to improve the co-production of local services for mental health together with the network of local Minds. She is also studying for her PhD with the King’s College on using Experience Based Co-Design for improving the care of patients with genetic rare diseases.
Also by Paola Pierri: Designing a better experience for patients
- Department of Health (2006), Supporting people with long-term conditions to self care. A guide to developing local strategies and good practice
- Bovaird, T, Hine-Hughes, F, et al, 2012 “Making health and social care personal and local. Moving from Mass Production to Co-production”, Governance International
- De Silva, D. (2011), Helping people help themselves. A review of the evidence considering whether it is worthwhile to support self-management, Health Foundation
- Nesta, (2012) People Powered Health Co-production Catalogue, in collaboration with the Innovation Unit and nef – new economic foundation
- Needham, C., (2012), Co-production: an emerging evidence base for adult social care transformation, Social Care Institute for Excellence
- Slay, J. (2012), Budgets and Beyond: Interim Report A review of the literature on personalisation and a framework for understanding co-production in the ‘Budgets and Beyond’ project, nef – new economic foundation and Social Care Institute for Excellence
- NHS Alliance PPI Group, National Voices and Turning Point, (2012), Raising the Bar: Driving Co-production through clinical commissioning
- Freire, K. and Sangiorgi, D. (2010), Service Design & Healthcare Innovation: from consumption to co-production and co-creation, Second Nordic conference on Service Design and Service Innovation
- Nef - New Economic Foundation, (2007) Commissioning for co-production in Camden
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