Co-production in health: A new settlement between citizens and the health system

Last night I re-read three inspiring articles about co-production.

They stopped me in my tracks as I realised, that with the enourmous financial and societal challenges and the fundamental shake up of the health system we are experiencing at the moment, comes a unique window of co-producing a brand new settlement between health systems and citizens which could mean a genuine and deep-rooted transformational change in our whole approach to health and beyond….

First developed by Elinor Ostrom in the 1970s and taken further through the timebanking movement, co-production is emerging from the ether across the country, particularly though not exclusively (e.g. see Cornwall County Council), in health.

From a health perspective the potential that co-production offers if taken up at scale is incredible. Co-production really is the ’emerging paradigm’, as the quote from Bovaird says in Dunston, R., et al (2009) ‘Co-production and Health System Reform- From Re-Imaging To Re-Making’.

To move from a traditional paternalistic approach where patients have ‘choice’ and  ‘voice’ to one where the conditions are created where citizens and consumers, services delivers and other stakeholders share equal and reciprocal rights and responsibilities in the design, delivery, commissioning and management of public services could be transformational both in processes and outcomes for the health system.

Key to the approach is the focus on relationships, dialogue and a shared understanding and ownership of the guiding principles, creating the right conditions for the right conversation.

NESTA articulate the cost benefit outcomes of potential really well in their publication Boyle, D. and Harris, M. (2009) The Challenge of Co-Production, NESTA:

•Delivering better outcomes:
•Preventing problems
•Bringing in more human resources
•Encouraging self-help and behaviour change
•Supporting better use of scarce resources:
•Growing social networks to support resilience
•Improving well-being

At Altogether Better ( we have experienced the potential of co-production through the (20,000 strong) community health champion model where individuals, communities, groups and local health systems have begun to achieve incredible transformational change in health outcomes and productivity within the system with evidence of all of the NESTA outcomes.

The Health Foundations’s publication, Realpe, A. and Wallace, L., (2010) What is Co-production?, Health Foundation, is an interesting exploration of the potential for co-production through consultations for people with long term conditions where good self-management is a key contributor for living well. It makes interesting reading for me  as a type 1 diabetic. I have personally experienced a move in the direction of co-production through the ‘DAFNE’ approach to diabetes (, the connection with co-production is that it creates the conditions for the patient to gain control and power over the management of their condition through building confidence, The outcomes for me were: much better HBA1C (blood sugar level control – which evidence shows reduces risks of complications and huge costs to the system), two healthy babies and generally a very healthy and happy lifestyle and it spurred me on to become a volunteer governor at the Foundation Trust who provided the training and support.

Another fabulous example of co-production happening right now is the Leeds Hubs (administered by CIHM)  where citizens, patients, services, academics and others have come up with a set of simple guiding principles:

•Start with listening
•Treat all people as assets
•Find out what we are ambitious for together
•Invest in the development of communities so they can be partners
•Value and make the most of expertise gained through experiences
•Do with not too – challenge them and us
•Professionals – ask how you can help people to help themselves
•Take time to get to know each other – build social networks

So if we understand that our health system cannot continue to operate as it stands and we cannot afford to deliver expectations and meet the demands of an ageing population with complex needs and competent consumers and we have a transformational solution which unlocks a (low cost) a previously untapped resource (citizens/consumers) and shares the rights and responsibilities as well as the power and control across many rather than few, surely it is time to scale up and systematise that solution?

Imagine the possibilities if this approach became integral to all planning, commissioning, delivery and management of health services from national to local. Surely, co-production in health really is a no brainer, isn’t it?

Four really useful articles for gaining a broad understanding of co-production in health



Nesta Catalogue

What is co-production


One thought on “Co-production in health: A new settlement between citizens and the health system

  1. Great piece Roz – the links to the resources are really helpful. Did you come across reference in your research to the need for professionals to be willing to give up power and control – and that in some cases this could mean reduction in the number of professionals employed?

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