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Commissioning for co-production in Camden


Commissioning for co-production in Camden

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									              Commissioning for co-production in Camden
The term ‘co-production’ is increasingly used in policy circles to describe the greater
engagement of ‘service users’ in the design and delivery of services, particularly in social
care. However, there is currently very little guidance for commissioners on how to
include co-production in the commissioning and procurement of services. This article
describes the first attempt by commissioners to systemically embed co-production in to
an adult social care contract – a £2m centre-based day support service for people with
mental health problems in Camden. This model was developed as part of a project
between nef (the new economics foundation) and the London Borough of Camden.

Introduction and context – what is ‘co-production’?
‘Co-production’ is built on the understanding that public services are best delivered with,
and not ‘to’ people. Co-production creates deeper, more durable change than other
methods of public service delivery which fail to recognise the value of involving service

 Co-production actively involves those we are trying to ‘help’ as co-workers. Co-
 production shares responsibilities and knowledge between professionals and users,
 and sometimes with the user’s family and neighbours.

 Co-production goes beyond consultative or representative approaches, to tap the
 vast but currently under-engaged assets that surround all public services, the
 individuals and communities who use them.

 Co-production is a challenge to a model of public service delivery that is detached
 from the community by the professional nature of the services, the hierarchical
 structure of the delivery organisations and the increasingly technocratic systems of

 nef believes that co-production is the critical mechanism through which individuals
 and communities can work alongside ‘helping professionals’ to make public services
 more effective.

nef in the London Borough of Camden
The Camden project, funded by the Government through the Invest to Save Budget, set
out to improve the way public services are ‘commissioned’ and procured by local
councils so that the wider social, economic and environmental impacts of services are
systematically taken into account in the decision making process.

nef created a ‘Sustainable Commissioning Model’ which moves commissioners towards
commissioning for outcomes at both service level and wider community level, using
social, economic and environmental outcomes drawn from Camden’s Sustainable
Community Strategy. This model includes co-production as a means of better engaging
with, and leveraging, existing social assets and networks to improve public service
outcomes for service users, and to ensure that those outcomes are enduring and
embedded in local communities. nef is now piloting the model with a number of different
services in Camden, and here we case study the first pilot, for a mental health day
services contract.

First Pilot: Day Care Services for People with mental health problems
Camden, an inner city London Borough, has high levels of mental health problems
amongst the working-age population and above average levels of alcohol addiction and
suicide. Historically, Camden’s Adult Social Care department funded four day care
centres specifically focussed on helping people with mental health problems. These
centres were run by specialist mental health charities.

 Mental Health in Camden

 •   There is high incidence of mental ill-health: in 2000 16 per cent of adults had a mental
     health problem and Camden has the Highest Mental Illness Needs Index (MINI) score in
 •   Camden has the second highest suicide rate in London: For the period 2003-05 the
     suicide rate for Camden was 14.4 per 100,000 of the population, compared to a 2002-04
     rate of 8.7 for England and Wales and 8.3 for London.
 •   Camden has the highest proportion of men dying of alcohol consumption in London (third
     highest nationally) and the highest rate of female suicides
 •   It has a larger proportion of people of working age with a limiting long-term illness (9.3 per
     cent) than both the London (7.8 per cent) and national averages (8.3 per cent)
 •   More than 12,000 working age residents receive Incapacity Benefit or Severe Disability
 •   Proportionally fewer residents provide unpaid care than the London and national averages
     – 7.8 per cent in Camden compared to 8.5 per cent in London and 10 per cent nationally
 •   There is an overrepresentation of patients from Black African or Black Caribbean
     backgrounds admitted to psychiatric hospital; 50 per cent compared to the expected 8 per
     cent based on the prevalence in the Camden population (2002 audit)

A best value review of the Council’s existing mental health day centres in 2006 found
that services were not meeting the needs of some groups of Camden citizens - in
particular younger people and ethnic minority groups suffering from mental ill-health.
The review also suggested that Camden’s Day Care Services should do more to
promote the independence and recovery of service users, and that there should be more
direct involvement of service users in the design and delivery of services.

These findings are mirrored by national changes, as mental health policy moves from a
model of diagnosis and cure, towards a social model that values ‘recovery’ and social
inclusion. This social model recognises that recovery is an ongoing process, and that to
be successful it must both enable individuals to take control of goals they have set
themselves to improve their own life, and involve those around them in the choices they
make. This is based on an understanding that each person plays a part in his or her
recovery and that everyone’s recovery is unique.

Responding to the challenges set out in the best value review, commissioners in
Camden’s social care department took the decision to re-commission mental health day
care provision once the existing term had expired. The contract, worth £2 million over
three years with a two-year extension period, was put out to tender in an open
competition to provide centre-based day support using three of the council’s four

buildings. The fourth was closed, with funds reinvested in early-intervention employment

Building co-production into the tender specification
Co-production alters the role of service providers and service users by shifting the role of
professional staff from ‘fixers’ who focus on problems to ‘catalysts’ who focus on abilities
and meeting service users’ aspirations. This is clearly in keeping with the ‘recovery’

nef worked closely with commissioners and service providers in Camden to draw up a
service specification which incorporated the principles of co-production. For example,
under the service ‘vision’, the tender specified that:

       “We would encourage providers to adopt the model of ‘co-production’ whereby
       services are planned and delivered in mutually beneficial ways that acknowledge
       and reward local ‘lay’ experience while continuing to value professional expertise.
       Service users should be regarded as an asset and encouraged to work alongside
       professionals as partners in the delivery of services.

       Co-production requires professionals and service managers to move out of
       traditional roles as ‘experts’ and ‘providers’ into partnership models that work with
       ‘clients’ and ‘communities’… real and lasting changes are possible with
       approaches that build or strengthen social networks and in turn motivate people
       to learn about and exercise their powers and their responsibilities as citizens.
       Networks of friends and families should also be considered positive co-
       contributors to success in this approach.”

The tender application form also explicitly stated that: the service should be delivered in
partnership with service users’. Prospective providers were required to answer specific
questions on service-user involvement and illustrate their answers with reference to
previous contracts. Questions included:

   1. What role would you envisage for service users in the development and delivery
      of your service?
   2. How does your service identify and mobilise service users’ strengths?
   3. How does your service support clients in finding ways to help/support others,
      including fellow service users, family, neighbours and the local community.
   4. In what ways does your organisation support client-based membership groups
      which can function as informal support groups, peer group or extended family?
   5. What role do you envisage for service user’, carers, family, peer group,
      neighbours and wider community in the provision of your service. How would this
      contribution be measured or rewarded?

Responses to the tender
Camden received four tender responses, three of which were from consortiums of
smaller and medium-sized providers from the third sector and one a larger national third
sector provider. The winning tender was a consortium of Camden-based third sector
   • MIND in Camden
   • Holy Cross Centre Trust

   •   Camden Volunteer Bureau, a mainstream (non-mental health) volunteering

The consortium was not the cheapest tender on a unit cost basis, but commissioners’
overall evaluation was that their focus on wider social and economic impacts would
create the most positive outcomes.

The Consortium openly advocated a co-production approach to running the centre-
based day support service, led by Holy Cross Centre Trust which has a dedicated Co-
production and Time-bank coordinator. In their mission statement, the Consortium stated
their intention to:

   “…achieve social inclusion and recovery outcomes according to the aspirations and
   needs stated by a diverse range of individual services users by:
   •   providing a wide range of activities and support mechanisms from which service
       users can choose what best suits their learning and life styles
   •   enabling service users to take responsibility for achieving their own goals and
       support other people in achieving theirs through co-production mechanisms like
       Time-banks, befriending schemes, mutual support groups, peer support and
   •   by continuously developing involvement and partnership from diverse
       communities, mainstream and specialist service providers, thereby increasing
       the number of stakeholders in mental health day services across the borough”

Involving service users in the development of the tender
 In developing their successful response, the Consortium actively involved service users,
 forming a working group of four service-users to help formulate the tender. The group
 met eight times over the course of the development of the proposal. In addition, the
 consortium held five dedicated early-evening consultation meetings open to all service-
 users of the existing day service in which the proposal was discussed and comments
 sought on ideas from the working group. The consortium claimed that this process
 meant that the ‘majority of the activities outlined in the tender have been produced
 either by or with service users.’

‘A collaborative learning approach’
The consortium stated that it would offer ‘a collaborative learning approach’ which put
monitoring, evaluation and service-user consultation at the heart of all of its activities.
Specifically, the consortium proposed to:

   •   Provide opportunities for personal growth and development to people who have
       previously been treated as collective burdens on an overstretched system, rather
       than as potential assets.
   •   Invest in strategies, which develop the emotional intelligence of people and the
       capacity of local communities through seeking alternative methods and
       environments for service delivery.

   •   Use peer support networks instead of professionals as the best means of
       transferring knowledge and capabilities.
   •   Reduce or blur the distinction between clients and recipients, and between
       producers and consumers of this service, by reconfiguring the way services are
       developed and delivered by recognising that services seem to be most effective
       when people get to act in both roles – as providers as well as recipients.
   •   Devolve real responsibility, leadership and authority to service users, and
       encourage self-organisation rather than direction from above.
   •   Offer participants a range of incentives – mostly sourced from creating spare
       capacity elsewhere in the service– which help to embed the key elements of
       reciprocity and mutuality.
The consortium proposed a service development and planning group which would draw
its membership from key local stakeholders, including service users. The service would
also involve service users as full recruitment panel members in the recruitment of all
paid staff positions. Where appropriate this would include planning and developing new
positions and job descriptions, and making presentations to client membership groups
within the centre.

 The Holy Cross Centre Trust currently delivers a “Your Space” project-planning model for
 service users. This model will be rolled out across the whole day services provision under the
 contract. Held each Friday, the model facilitates service user ideas, encourages them to test
 their hypothesis and, by using the SMART (Specific, Measurable, Achievable, Realistic &
 Timed) project planning tool, facilitates service user ideas for projects and services into action
 and delivery with service users themselves playing a meaningful role in turning their ideas into

Proposed Activities
In the tender, the Consortium outlined a number of activities that placed co-production
at their core, including:

 o Self Help/Personal Skills Support Groups
Groups delivered through co-production where a Counselling Coordinator, employed in
the new service, recruits, trains, resources and supports group facilitators, who may be
service users, Support Time and Recovery workers (paid staff) or volunteers (who may
already be working in or using the service, or be outside the system). Facilitators are
provided with group training and support; some may shadow a staff member running the
group initially while others will be permanently co-led.

The structure creates a mixture of fixed-term and experimental groups, some of which
will become longer-term and self sustaining. This creates a dynamic and changing
pattern of events that is able to respond to new and emerging need, as opposed to the
static ‘programme’ of timetabled events of more traditional day services. Suggestions
from service users included:
     • A support group for those in volunteer roles
     • A group for those returning to employment
     • A coping with independence group
     • A group supporting people with transition and change

   •   Mutual support groups for Self harm, Obsessive Compulsive Disorders,
       Depression, Bi-polar and Self Harm
   •   Coping with medication group
   •   Staying out of hospital group

 o Time-banking
The consortium plans to develop a Camden Mental Health Day Services Time-bank
working across the three centre-based services. This Time-bank will enable participants
to earn credits for engagement with the service and for helping each other – on the basis
that one hour of time entitles individuals to one hour of someone else's time. Credits will
be deposited centrally in the Time-bank and withdrawn when appropriate or required.

Evaluation of the success of the service will be an ongoing process undertaken by
service users’ as a “Time-banking” activity. Space will be provided for people to write up
their feedback and suggestions and evaluation will be integrated into regular group
activities so that participants can feed into the evaluation process.

Time-bankers from the LB Camden Mental Health Day Services will use their
experiences to inspire other time-bankers by sharing what they have learnt through the
Time-banks UK Network. There are currently two active Time-banks in Camden: the
West Euston Time-bank and the Kings’ Cross Time-bank, with more to follow. Current
Time-bank activities include:

   •   Biographies: Time-bankers spend their Time credits on acquiring the skills to
       record short films about their lives. A public viewing is planned where the event
       organisers will earn Time credits for organising the event.
   •   Cultural events: facilitated by the King’s Cross Time-bank, Time-bankers are
       earning Time credits by developing a co-production model for the local
       community for the concept, design and execution of 12 events to celebrate the
       diversity of cultures, languages and histories in Kings’ Cross and Camden
       Central. This initiative is designed to develop a sustainable model for the co-
       production of community bridge-building events to foster cultural understanding,
       and promote awareness of mainstream services and activities, breaking down
       barriers to community cohesion.
Progress to date
The consortium has been providing the re-commissioned Day Care Service since the
beginning of October 2007. nef is working with the commissioners and the consortium
members to help develop tools to measure the value the service is creating for its users,
the local community and wider public sector. nef is also promoting this innovative new
commissioning approach to service commissioners in local and national government
across the UK.

nef is an independent ‘think and do’ tank (and a registered charity) that works globally
and locally. nef believes in a new economy based on social justice, environmental
sustainability and collective well-being.

For further information on this work, please contact: or

nef, 3 Jonathan street, London, SE11 5NH, 020 7820 6300


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