Co-production approaches to reducing health inequalities Catriona Ness NHS Tayside

Stress Lack of Direction Loss of Hope Learned Helplessness Health tends to decline in communities where levels of interaction are low and where people feel insecure (Smith Institute – 2008) Poverty and Health

Changing roles: Traditional service delivery model Planners specify what the services will look like, procure them and then monitor the services using targets Practitioners assess need, ration resources and deliver services to passive recipients Users and communities are defined by what they lack and receive care based on how needy they are perceived to be

Changing roles: Co-production model Planners, Practitioners, Users/Communities All three have a role in assessing needs, mapping assets, agreeing outcome targets, planning allocation of resources, designing and delivering services, monitoring and evaluating impact Professional and experiential knowledge are valued and combined, everyone’s capacity is developed. Minimises waste by developing solutions with users Can often reduce costs by focusing on person-led community- involved services, relieving pressure on expensive specialist services

“This is primarily a strategy for investing in community resilience, investing time and effort in promoting social capital and community enablement. We will primarily do this by offering social responses to social problems. In particular we will support co-production: helping people to plan services and to take back elements of services which do not need to be delivered by health professionals so that in total, services are co-produced by communities and the NHS. This promotes social capital - the importance of a connected and caring society - over institutions. In short we will ensure that our services promote more patient and community enablement, not more dependency on the NHS.” Health Equity Strategy “Communities in Control”

“The challenge is to work with communities, not to find out what they want and then provide it, but to enable them to take control and provide their own solutions. Communities need to be involved in the delivery of services, behaviour change initiatives and solutions, as well as in their design”. Health Equity Strategy “Communities in Control”

NHS Tayside Health Equity Strategy “Communities in Control” Contributing to Health Equity within a generation” NHS will utilise co-production as a means to build social capital Focus energy and resources on early years Focus greater effort on behavioural change Improve service access to areas of greatest need but ensure that this builds social capital not dependency Agree, with partners, measures of progress Build co-ordinated health intelligence

Local experience/examples include Dundee Healthy Living Initiative Healthy Communities Collaborative P&K - Older People/Teenage Pregnancy Healthy Happy Communities Angus - Focus on Alcohol - Young Families/Healthy Eating Time banking - Angus, Perth, Dundee Connecting Communities Equally Well -Social Prescribing

Changing the World One Baby at a Time Project Example: The Family Nurse Partnership (FNP)

To share talents and skills in a mutually beneficial way. To make a positive difference in the local area. To promote community spirit. To establish and strengthen neighbourliness. To build bridges across social groups. To build trust in the community. To share talents and skills in a mutually beneficial way. To make a positive difference in the local area. To promote community spirit. To establish and strengthen neighbourliness. To build bridges across social groups. To build trust in the community. Remit

P&K Healthy Communities Collaborative -Community-led Health Equal and reciprocal partnership comprising local people and professionals to effect changes in communities and improve health care and well-being

The Benefits of Co-Production to the Healthy Communities Initiative shares skills and workload builds community capacity promotes community led development reduces costs maximises efficiency

Leading by Example Cash4Communities Innovation Fund £2 million from Endowment Funds Community led initiatives Enhanced social capital Innovative Direct or indirect impact on wellbeing £1k to £100k awarded.

Enablers of Innovation & Opportunity Top level support, strategic ‘buy in’ but light touch Passionate, enthusiastic people good at communicating and inspiring Start with local people, develop trust & respect Agility and ability to work around bureaucratic obstacles

Challenges Culture Change our biggest challenge for NHS and throughout the public sector Time to build relationships –learn together, plan together, deliver together Short term funding –pilot-itis Courage-Public service leadership needs to learn to ‘let go’ and build co-production into existing services

Chaired jointly by NHS Tayside and Scottish Community Development Centre (SCDC), and funded by Joint Improvement Team Aims to be: -A locus for building on existing co-production activity -A space for learning, debate and development of ideas and approaches around co-production -A forum for practice exchange, and sharing of information and resources -And to supporting dialogue around emerging policy on delivering public services differently and advancing co-production approaches in Scotland Members’ meetings; learning events; national conference with JIT; website with publications, resources, networking forum Sign up now!

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