Public services co-production in Scotland:

Challenges, policies and good practice cases

All in this together: co-production, co-creation & public service delivery Cardiff, 23 February 2012

Governance International www.govint.org

How to move from top-down service delivery?

Cartoon Ruderer

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... to co-produced personal and social outcomes?

A question for you …

A. Improve the quality of public services for citizens?

or

B. Help citizens to improve their quality of life?

What will be the most important challenge for your organisation in 2012...?

Let’s be more specific:What do older people with visual impairments need most?

Study on the needs of elderly people with visual impairments

What public managers and staff think elderly people need: More information about public services (64%) More information about specific support (54%) Get to know people and make friends (36%) To talk with someone about personal issues (18%)

What elderly people really want: Get to know people and make friends (91%) To talk with someone about personal issues (62%) More information about public services (53%) More information about specific support (47%)

Source: Martin Willis and Eileen Dunstan, University of Birmingham, 2009 6

Scottish Context

• Demographics – population increase of 50% of over 60 years population and 84% in over 75 between 2008 and 2033.

• Extrapolating from estimates of growth in demand would mean Scotland’s care budget for older people growing from £4.5bn to £5.6bn (2016), and £8bn (2031).

• Background is that there appears to be a very large structural fiscal deficit in Scotland over next 16 years.

Response

• Scottish Government developed a 10 year change programme for ‘Reshaping Care for Older People’ – promoting co-production and community capacity building as a key work stream.

• Investment – to drive this programme, Scottish Government created a four year Change Fund for older people’s services of £70m p.a. as a catalyst.

• Coordination – to support this work stream, the Joint Improvement Team provides support for 32 locally based NHS, Council, Third and Independent Sector Partnerships.

Policy influences Sir Harry Burns (Chief Medical Officer for Scotland) – health and social care

based on ‘mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values ...’ .

Christie Commission – ‘unless Scotland embraces radical new collaborative culture throughout our public services…budgets and provision will buckle under the strain’.

The Governance International Co-Production Star

Governance International Co-Production Star Training

• JIT commissioned Governance International to provide three two-day training workshops in January, and a further five in April.

• Participants came from LAs, NHS, Independent and Third Sector Partnerships.

• Gave participants a clear understanding of what co-production can achieve, how it is being used on the ground, and how they can roll out co-production in their organisation and partnerships.

http://www.govint.org/english/main-menu/our-services/co-production.html

National Community Capacity Building and Co-production Conference, 26 January in Dunfermline

Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing

‘The Scottish Government is committed to supporting older people to enjoy full and positive lives in their own homes, or a homely setting, within their own communities, for as long as possible… the involvement of older people and other members of these communities must be at the heart of both shaping how this is achieved and of the renewed public services that do and will support that achievement. Community capacity building and co-production are central to these endeavours…’

Case Study 1: The Food Train1) Objectives of co-production approach

Survey of older people in Dumfries -> struggling with grocery shopping. 2) Change management processo Partnership of local shops and volunteers began to make deliveries in Dumfries

Town in 1995. o From 2002, after 4 years of Scottish Government funding, national scaling-up:

o From 3,500 deliveries/year in 2002 and 60 customers by 11 volunteers to 15,000 deliveries/year to 596 customers by 200 volunteers in 2008/09

o Annual membership is £1, each grocery delivery is £2 and extra jobs range from £1 - £2.

o Alongside delivering groceries, the Food Train has responded to needs for befriending and household support services to enable older people live in their homes as long as possible.

Case Study 1: The Food Train3) Outcomes• Independence 76% • Health 50% • Isolation 35% • Wellbeing 27% • Safety 21%

“The ladies and gents are so polite and kind, I do look forward to seeing them. I look forward to the happy visit even for such a short duration… It’s the company, having a banter. I joke with the volunteers and they with me.” [Lady, aged 80-89, lives alone] .

Source: Community Food and Health (Scotland). Evaluation of The Food Train interms of its Economic Value by Marion Lacey, ROCK SOLID SOCIAL RESEARCH LTD.

Case Study 2: Family Nurse Partnership in NHS Lothian and Tayside1) Objectives of the co-production approach• improve maternal health, child health and development, and

family economic self-sufficiency • focus on health inequalities, child poverty and early years

2) Change management process• Relationship between the family and the nurse is key with an

approach focusing on:o the strengths of the client o respect that they are the expert in their own lifeo developing goals for the family

Case Study 2: Family Nurse Partnership in NHS Lothian and Tayside3) Outcomes• In Lothian and Tayside: 12 nurses and 3 supervisors will have

reached over 450 families by this summer

• Strong evidence base for the model :o Improved development and academic achievemento Reduction in children’s injuries, neglect and abuseo Improved parenting practices and behaviouro Increased maternal employment and reduced welfare useo US studies have suggested a return on investment of between

$2.8:1 and $4:1 (http://www.pueblochc.org/services/NurseFamilyInfo_Benefits.pdf)

Other good practice cases in Scotland

• West Edinburgh time bank• Fife SHINE project on tailored

care packages for frail, elderly people

• The Friday Night Initiative at Pollok Library and Leisure Centre in Glasgow

• Lend a Hand (Fife Social Work Departments Child and Family Team)

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Co-Production good practice cases wanted from Wales!