6. Do you really know best? Service users are experts too.

Chris Sherwood - 01.11.2010

Partnership with service users is part of the day job for many frontline staff. Teachers can’t teach if students don’t learn. Doctors can’t heal if patients don’t comply with treatments. And yet public services are rarely designed with these principles in mind. The implicit assumption – in design terms at least – is that service users don’t want to play more of a role, and that it’s only the domain of professionals to take decisions and direct resources.

Yet confronted by complex and often quite personal problems such as mental health or physical conditions, isn’t every patient an expert patient? It’s difficult for even the most experienced professional to know the ins and outs of people’s lives and how they manage their conditions. Of course, public service professionals can often be frustrated by ‘non-compliance’ by users of services, but the answer must be to build new types of relationships rather than to neglect the role that users can play. Co-production – where staff and users work together in equal, reciprocal relationships – can help us to develop more effective, more preventative, and so more sustainable public services.

In health, we’ve shown how programmes can use the knowledge and experience of patients with long-term conditions to help others self-manage and prevent problems arising. We’ve seen examples of co-produced services delivering markedly improved outcomes, such as the HOPE service in Lincolnshire which ‘buddies’ patients with lung and respiratory conditions with a multidisciplinary professional team to design and deliver the programme. This award-winning service has some of the best patient outcomes nationally.

How could service users contribute to services in different, deeper ways? Scallywags is a parent-run nursery in Bethnal Green, East London. It was faced with service closure in 2005 due to changing regulations in child care. But rather than shutting down, Scallywags worked out a new framework to allow parents to be more involved in the nursery’s practice. There’s still a waiting list for places, and what’s brilliant is that Scallywags remains an affordable service. As a cooperative, with parents taking part in delivery, it costs just £2.50 per hour. Parents can afford to work, but can also join an instant community of peers and local residents.

As we argued last week on this blog, this isn’t to suggest that with state resources scaled back we can depend on voluntary time. Co-produced public services demand a very different role for state providers – and a different kind of support. Money savings come from designing better services that can harness the time and experience of service users and engage people in more effective ways.

Local Area Coordinators are a great way to illustrate this. LACs are state funded, public service professionals who are positioned within communities with direct relationships to service users. They work together with service users to really understand their needs and draw the right services around them. The approach started initially in the social care community, helping people with disabilities access a wider range of services – often more informal forms of provision than statutory services. This saved money as LACs were able to redirect demand away from expensive residential care, but it also improved the experience of services for their users and encouraged take-up and access.

How would services look different if they started from the users’ perspective? How would users want to engage in services, and what support would they need to do so? Assuming people can and want to be engaged could open up a whole number of ways to make services better. And that doesn’t just go for individual users, but communities too – more on that tomorrow.