The document discusses co-production in health and social care in Scotland. It provides: 1) Context on the financial challenges facing the system and calls for more collaborative approaches, as outlined in the Christie Commission report. 2) Details on relevant legislation, including the Social Care (Self Directed Support) Act, which aims to give citizens more control, and the Public Bodies (Joint Working) Act, which integrates health and social care. 3) Examples of co-production in action, such as a program supporting hospital discharges that has avoided admissions and saved over £700,000. It emphasizes culture change and building citizen capacity.

1. “Our vision is for a Scotland where people who
are disabled or living with long term conditions
and unpaid carers have a strong voice and
enjoy their right to live well.”

2. CO-PRODUCTION IN HEALTH
AND SOCIAL CARE:
THE SCOTTISH EXPERIENCE
Gerry Power
Director of Integration
Health and Social Care
Alliance, Scotland
IPH Conference 2017
Working Together for Better Health &
Wellbeing: Understanding What Works

3. The Journey
• Definitions
• Context
• Legislative and Policy Framework
• National Initiatives
• Working Examples
• Reflections

4. Co-production
• “… the delivery of public services in which citizens are
involved in the creation of public policies and services.
This contrasts with a transactional based method of
service delivery in which citizens consume public services
which are conceived of and provided by governments
and institutions... In contrast with traditional citizen
involvement, citizens are not only consulted, but are
part of the conception, design, steering, and
management of services.
(Bason 2010)

5. Co-production
• The public sector and citizens making better use of
each other's assets and resources to achieve better
outcomes and improved efficiency
(Bovaird and Loeffler 2012)

6. Health and Social Care in Scotland
• Health Care - Devolved Matter
• Social Care – Local Authorities
• NHS Boards and Local Authorities
• Integrated Joint Boards
• £12 Billion - NHS
• £4 Billion – Social Care

7. Context (1)
2008 & ALL THAT!
Source: Scottish Government – Public Service Expenditure Limits
32,000
30,000
28,000
26,000
24,000
22,000
20,000
2009-10 16 years 2025-26
£39 billion

8. CONTEXT (2)
Christie Report
“ … Unless Scotland embraces a radical,
new, collaborative culture throughout our
public services both budgets and provision
will buckle under the strain…”
(Report on the Future Delivery of Public Services – Christie Commission 2011)

9. CONTEXT (2)
Christie Report
• Maximise scarce resources by utilising all available resources
from the public, private and third sectors, individuals, groups
and communities.
• Work closely with individuals and communities to understand
their needs, maximise talents and resources, support self
reliance, and build resilience
• Effective services must be designed with and for
people and communities – not delivered
‘top down’ for administrative convenience.
(Report on the Future Delivery of Public Services – Christie Commission 2011)

10. CONTEXT (3)
Legislative Response
• Social Care (Self Directed Support) Scotland
Act 2013
• Public Bodies (Joint Working) (Scotland) Act
2014
• Community Empowerment (Scotland)
Act 2015
• Carers (Scotland) Act 2016

11. CONTEXT (3)
Legislative Response
• Social Care (Self Directed Support) Scotland
Act 2013
• Public Bodies (Joint Working) (Scotland) Act
2014
• Community Empowerment (Scotland)
Act 2015
• Carers (Scotland) Act 2016

12. Public Bodies (Joint Working)
(Scotland) Act 2014
Health and Social Care Integration
• Clinicians and care professionals, along with the full involvement of
the Third and independent sectors, service users and carers, will be
embedded as a mandatory feature of the commissioning and
planning process.
• Consistent with principles of co-production, which underpin the
Government‘s vision for mutual and person-centred public
services utilisation of the talents, capacities and
potential of all of Scotland‘s people.
• Legislation alone will not be sufficient to enable the
cultural shift required for transformation.
(Public Bodies (Joint Working) (Scotland) - Policy Memorandum)

13. Guidance and Support

14. Co-production in Action

15. Current Enablers

16. Home from Hospital Services (Ayrshire)
 Supports hospital discharge and avoidance of (re)admission
 Transport, resettlement and follow up support
(01 April to 22 Jan 2017)
• No of Patients Transported : 1605
• No Admissions avoided: 104
• 4 hours wait breaches avoided 206
• Bed days saved 1774
• Indicative Savings £745,080
(Source British Red Cross)
Cross Sector Co-production

17. Co-production in Communities
Boleskine Community Care
A ‘micro enterprise’ solution
to Care at Home provision in a
rural area where previously it
was difficult to meet care
needs.

18. Co - commissioning
Impact of Social Isolation – Fife Health and Social Care Partnership
- Personal Health and Wellbeing
- Economic Impact
- Befriending
- Theory of Change
- Improved Health & Quality of Life
- Resources are optimised
http://www.evaluationsupportscotland.org.uk

19. Evidencing Impact

20. Reflections
• Culture – Consumerism vs Citizenship
• Power – Ceding and accepting
• Salience – Enduring relationships
• Tenacity – Incremental vs seismic
change

21. House of Care
• Reframe professional education and training: to develop a model of
professionalism based on working on a equal basis with users and citizens,
rather than on an assumption of the superiority of expert knowledge
• Build individual and community capacity: to enable informed citizens to
participate and share decision-making and responsibility in their own and other
health and wellbeing.
• Hold organisations to account: require a radical improvement and
systematisation of how we measure both the quality and the outcomes
of involvement.
• More than Medicine – housing, transport, control, life opportunities,
community capacity, health literacy, income maximisation, fuel poverty

22. Thank you

23. References (1)
• Bason C, (2010) Leading public sector innovation: Co-creating for a better society, (Bristol, Policy Press)
• Bovaird T and Loeffler E, (2012), From Engagement to Co-production: How Users and Communities
Contribute to Public Services, in Taco Brandsen and Victor Pestoff (Eds), New Public Governance, the Third
Sector and Co-Production (London: Routledge)
• Bovaird T, Hine-Hughes F, Loeffler E, Power G, (eds) ‘Co-Production of Health and Wellbeing in Scotland’
http://www.govint.org/fileadmin/user_upload/publications/Co-
Production_of_Health_and_Wellbeing_in_Scotland.pdf
• Boyle et al (2010) Right here, Right now -Taking co-production into the mainstream. Available at
https://www.nesta.org.uk/sites/default/files/right_here_right_now.pdf
• Christie, C (2011) Report on the future Delivery of Public Services. Available at
http://www.gov.scot/resource/doc/352649/0118638.pdf
• Foot et al (2014). People in control of their own health and care – The state of involvement. Available
at:www.kingsfund.org.uk/sites/default/files/field/field_publication_file/people-in-control-of-their-own-
health-and-care-the-state-of-involvement-november-2014.pdf
• Glasgow Centre for Population Health(2017) Available at:
http://www.gcph.co.uk/assets/0000/6049/Asset_based_approaches_in_service_settings.pdf
• Evaluation Support Scotland (2016) Threading the Needle. Available at:
http://www.evaluationsupportscotland.org.uk
• Institute for Research and Innovation in Social Services (2012) ‘Strengths-based approaches for working
with individuals’ https://www.iriss.org.uk/sites/default/files/iriss-insight-16.pdf

24. References (2)
• Joint Improvement Team, Scottish Government ‘In Good Faith, Building Compassionate Communities’(2014)
Available at: http://www.jitscotland.org.uk/wp-content/uploads/2014/11/In-Good-Faith-Building-
Compassionate-Communities.pdf
• Joint Improvement Team, Scottish Government ‘Talking Points’ (2012) Available at:
http://www.jitscotland.org.uk/wp-content/uploads/2014/01/Talking-Points-Practical-Guide-21-June-2012.pdf
• NHS Scotland – ‘how it works’. Available at - http://www.ournhsscotland.com/our-nhs/nhsscotland-how-it-
works
• Scottish Co-production Network - http://www.coproductionscotland.org.uk/
• Scottish Government and Alliance Scotland (2008) ‘Gaun Yersel’ The Self Management Strategy for Scotland.
Available at http://www.gov.scot/Topics/Health/Support-Social-Care/Self-Management/GaunYersel
• Scottish Government (2014) Public Bodies (Joint Working) (Scotland) Bill - Policy Memorandum
http://www.parliament.scot/S4_Bills/Public%20Bodies%20(Joint%20Working)%20(Scotland)%20Bill/b32s4-
introd-pm.pdf
• Scottish Government (2011) Reshaping Care for Older People: A Programme for Change 2011 – 2021 Available
at: http://www.gov.scot/Resource/0039/00398295.pdf
• Glasgow Centre for Population Health(2017) Available at:
http://www.gcph.co.uk/assets/0000/6049/Asset_based_approaches_in_service_settings.pdf
• Scottish Government (2015) Scottish Social Attitudes Survey 2015: Attitudes to Social Networks, Civic
Participation and Co-production. Available at:
http://www.gov.scot/Publications/2016/08/5733/downloads#res504535

25. The ALLIANCE projects