37. Co-production Trusts

In this post I want to argue for an approach to community programmes very different to the approach I've been used to.

Specifically I want to suggest that, instead of setting up community regeneration partnerships or projects that look to fix something about a community, we should instead be looking to set up organisations that look to fix the way services are provided to that community.

We Need to Talk About Community Regeneration

When we use the term ‘community regeneration’ we are immediately implying that the problem is with ‘the community’ and that it is ‘the community’ that needs to be fixed. The term is already taking our attention away from society as whole and ‘system wide’ issues such as inequality.

As a consequence interventions will often be special activities that are only applied to that community such as partnership boards, community centres, capacity building projects etc etc. While I’m sure these things are all valuable in their own right, what the Marmot Review tells us is that, if we are serious about tackling inequality, then we need to be thinking about proportionate universalism, not interventions that focus only on the most deprived.

It is also worth pointing out that the effectiveness of community regeneration programmes is highly questionable. As Alasdair Rae argues, Governments have not been good at learning from research. If they were it might help them to locate area based programmes much more effectively in broader social programmes. As a result objectives have often not been met.

The Co-Production Deficit

For me co-production means that all public services depend on the contribution of both the service provider and on the contribution of the public. It is the relationship between provider and public which determines the extent to which the assets of both are utilised and the subsequent effectiveness of the service in question. If you start from this perspective it comes as no surprise that services ‘delivered’ equally to all can nevertheless result in an inequality of outcome. What you get is a co-production deficit because some people are able to get more out of services than others.

Hastings and Mathews have been doing some really interesting research that highlights the various ways in which the middle classes are able to reap the benefits of services more efficiently than the working classes through, for example, joining groups such as parent teacher associations, complaining effectively and interacting with bureaucrats, teachers, doctors etc who are usually middle class themselves.

On the other side of the coin I was really struck by this piece by Clare Galloway. It illustrates perfectly what happens when the relationships between providers and public break down. More than that it shows how an inflexible and judgemental service delivery culture can actively work against effective co-production by stifling attempts to make things better. There is also a well made point in this piece about people being expected to work as unpaid volunteers to sort out community ‘problems’; work that we normally expect paid professionals to do.

Co-production Trusts

My argument is that, instead of regeneration partnerships, we need co-production trusts; organisations that seek to reduce the co-production deficit by working on behalf of deprived areas so that they can see the same service benefits as middle class areas, that they can achieve equality of outcomes. Such bodies would be consistent with proportionate universalism and would contribute to system wide approaches.

I have three suggestions about what co-production trusts might do in practice.

1. Advocacy

The trust would act as a lobbying agency on behalf of the community, campaigning for equality of outcomes and higher levels of service where this is needed, ensuring that policy makers are fully aware of the community and its needs. Making sure that environmental services are targeted in the right way, getting involved in the planning process and arguing for accessible facilities. As with any advocacy, this work would be done by specialists who work to the instruction of their clients; the community.

2. Referrals

The trust would act as a ‘dating agency’ for referrals. Again, acting only with the permission of those affected, arranging appointments and even attending alongside if that is something people wanted. More generally the trust would be able to identify potentially useful services and share this with the community. This all about ensuring that services are getting to where they are needed and to where they can have the most impact.

3. Changing Relationships

The trust would act as ‘marriage guidance counsellor’, seeking to improve the overall relationship between providers and public. In part this would be about awareness raising and training for public workers (something Hastings and Mathews have suggested), in part this might be about offering advice to residents about how to get the most out of their services. This might also be a form of mediation; getting people together to explore how things might work differently.

As organisations these trusts should be democratically connected to the communities that they are working for including being properly linked to local politicians at all levels. 

The one bit of this I’m sure isn’t right is the name 'co-production trusts' - lets just call them something else when we are out in the real world...

Photo credit:  http://www.flickr.com/photos/artefatica/4630521467/

35. Reduce Inequality with Universal Services

Proportionate universalism is a very, very important idea in my opinion. 

It is one of the key concepts to have come out of the Marmot Review.  If you are not familiar with this review then, well, why not? It is a comprehensive and thoroughly well researched statement of what causes health inequality and what we have to do if we want to reduce it.

The report that came out of the review, Fair Society, Healthy Lives, argues that inequalities in health cannot be tackled effectively if we only focus on the most deprived:

To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism. Greater intensity of action is likely to be needed for those with greater social and economic disadvantage, but focusing solely on the most disadvantaged will not reduce the health gradient, and will only tackle a small part of the problem.

Here are a couple of charts which seek to illustrate the point (I have borrowed them from a presentation by Dr Fu-Meng Khaw that can be found here):

Instead of thinking about equality of service output, as local government has traditionally done, we need to be thinking about equality of service outcome.  Even more than this, remember that services are already universally in-proportionate by virtue of the fact that the middle classes are able to draw down public services more effectively than those lower in the social scale.  This research by Matthews and Hastings is a really interesting exploration of exactly that issue.

How Can Universal Services be Made Proportionate?

As Llaria Geddes points out in her presentation to the Greenwich Health and Wellbeing Partnership (that can be found here), practitioners and professionals get proportionate universalism as a concept but find it less easy to understand how it can be put into practice. 

Using some of the examples in that presentation I want to offer some tentative suggestions about how proportionate universalism might be applied in practice.  In part this is about breaking down services into types according to the way that they are delivered. 

Seven Strategies

1.  Invest in Services that are Intrinsically Proportionate

As Llara Geddes notes in her presentation, some services have proportionalism built in.  Some services, such as GP services for example, are tailored to individuals and should automatically respond to levels of need.  Other services, such as the provision of green spaces in urban areas, can be more attractive for those who need them most and will have less of an impact on people with the resources to travel or to live in greener areas.

2.  Specify Service Zones

For ‘place based’ services such as street cleansing, street lighting and planning, outcomes can be ‘equalised’ by concentrating services at different levels in different areas.  ‘Service zones’ would work just like planning or environmental areas, conferring a particular status on a geographic area with maybe three or four levels.  For street cleansing this might mean having different frequencies of service depending on the level of risk for an area.  For other services it might mean different speeds of response times for repairs or dealing with graffiti etc.  For planning it might mean more intense advice or consultation in areas less likely to have the resources to engage with planning processes. 

3.  Build the Right Referral Systems

For services that are provided directly to households or to individuals (e.g. benefits advice, pest control and home energy advice) referrals can be used to ensure that access is increased amongst those less likely to ask for services or respond to advertising or marketing campaigns (it may be better not to do these at all).  Referrals can take place across any services but ‘first line’ services such as GPs and health visitors will be particularly important. 

4.  Provide Enhanced Services

The presentation gives the example of the fire service giving additional support for vulnerable people.  In the same way any service provided directly to households / individuals can include triggers for extra layers of service.

5.  Carefully Target Population Groups

Providing services to certain population groups will have a proportionate affect because of the nature of those groups.  The presentation gives the examples of providing effective contact to, and support for, young people who are not in employment, education or employment.  Carers and care leavers are other examples of these types of group.

6.  Ensure that Service Centres are Community Sensitive

Many services are delivered via physical centres - in other words from a building within a community.  Examples include health centres, schools, libraries, leisure centres and community centres.  The way that these centres provide their services can be varied, whether in terms of opening hours, access, associated groups (PTAs, friends of), community involvement or facilities.  A proportionate approach would ensure that centres are sensitive to the needs of the community where they are located and that their services are adjusted accordingly.  They can also provide an excellent point of referral for other services.  

7. Provide New Service Centres

It might be that existing service centres are not enough to ensure that access is being ‘equalised’.  Sure Start centres are an example of an initiative that concentrates universal services.  The spatial distribution of these types of centre can ensure a proportionate approach.