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Burgess, Rochelle Ann and Choudary, Natasha (2017) Coproduction from theory to practice: Wandsworth Community Empowerment Network: an evaluation report. Project Report. Wandsworth Community Empowerment Network (WCEN), London.
The following evaluation report presents findings from a multi-site ethnography of the Wandsworth Community Empowerment Network (WCEN). Development of a theoretical model highlighted that the WCEN approach was theoretically innovative through its development of a preparatory stage prior to coproduction activities. This initial phase is cognisant of the importance of shifting power relationships, developing trust within and across groups in the network, and committing to engaging in these supportive processes over time. This key phase led to a series of specific outcomes for both communities and statutory partners, who worked collectively to coproduce health services in Wandsworth. Findings highlighted that the WCEN model resulted in significant shifts at four key levels: identities, ideas, practices and individuals. Evidence demonstrated that identities of communities have shifted, because of a process of empowerment, which shaped the way communities participated in ventures with one another and with statutory agencies. Statutory agencies views of communities shifted, viewing them as meaningful partners, autonomous actors, with important assets to contribute to mutual engagements. This fed into shifts in the conceptualisation of coproduction. The nature of practices of engagements between statutory and community groups shifted. These changes included the development of safe-spaces, which shifted engagement between statutory agencies and communities within environments for mutual learning and a tangible space to redress imbalances of power.
Barriers to systems change included risk adversity within statutory agencies, primarily around financial risk. However, some evidence suggested that risk adversity might be linked to issues of shifting power to communities. Other barriers included professional values such as a view of the individualisation of health and views of coproduction, that only value nominal participation from communities. Findings also suggested that redistribution of financial resources would help to solidify small systems change currently achieved within the WCEN network. Risks to the future development of the network linked to dangers around scaling-up work before capacity had been built, the need to foster community resilience to shifts in wider political priorities and reforms. The risk of losing organisational identity was also noted as formalisation of the network could affect the qualities of passion and commitments that underpin current engagements. Lastly, concerns were raised around the likelihood of coproduction being positioned solely as a cost-savings activity, which would therefore limit its ability to result in meaningful changes within communities that could lead to a reduction of inequalities. The report concludes with recommendations in three key areas to sustain progress and to build on current strengths in systematic ways. First, there is a need to streamline focus in programmatic areas, in order to avoid burn out of already over-committed, albeit passionate individuals. Secondly, WCEN should work towards distributing leadership across the network. This would even out capacity in community sites that are less developed, and bolster the capacity of well-established sites for the delivery of services. This is critical in supporting future expansion in relation to new coproduction projects. Thirdly, the report suggests WCEN should commit resources to develop mechanisms of accountability within the network. Specifically, efforts should be made to establish a framework of monitoring and evaluation of health improvements and patient outcomes linked to coproduced interventions. The formal health economy in the United Kingdom (UK) is currently facing a series of challenges in maintaining high quality service delivery amidst a climate of restructuring and cost savings.
Statutory bodies including the NHS, Public Health England, and related social care organisations have been called on to reconceptualise models of care in response to increasing levels of austerity and mounting burdens on the health sector. The NHS five year forward view (NHS, 2015) articulates the need for more integrated approaches to treatment, situating community engagement at the heart of a process to tackling health inequalities. In doing so, it conceptualises the ‘community’ as a critical resource and ‘partner’ in reducing strains on the health sector, increasing availability of locally relevant care and access to prevention services (NHS, 2015).
This positive view of patient and community involvement has a long legacy within the NHS, albeit under slightly different formulations. Arguments for patient centred care, patient engagement and increased patient ownership, are all united by the premise that individuals should be supported in taking a more active role in their treatment and achievement of well-being (Laverack, 2007). Ideas of patient involvement are taken a step further under the remit of community participation and empowerment discourses, which are driven by arguments espousing the importance of attention to wider dimensions of community life, including access to power, recognition and resources in empowering people to take ownership in their lives (Laverack, 2013, Rifkin, 2012). Within both perspectives, working with communities are viewed as a means to widen the parameters of care, to engage with social determinants of health and to positively change the shape of contemporary health services in the UK (Public Health England, 2015). Coproduction of health care services stands at the intersection of these two fields. As argued by Batalden and colleagues (2015) Coproduction approaches highlight the value of partnerships at multiple levels that is in line with a more complex view of service user-provider relationship to include more complex dynamics of partnerships, power and resources. Co-commissioning, co-design, co-delivery (which includes co-managing and co-performing), in addition to co-assessment and evaluation of services are positioned as the pillars of coproduction approaches (Loeffler, Powere, Bovaird, Hine-Hughes, 2013). It is hoped that through increasing the presence of multi-level partnerships embodied by coproduction, increased attention to the lived experiences of patients, families, and health professionals can be achieved. Beyond this, coproduction discourages the oversimplification of partnerships that are often associated with ‘patient engagement’ and ‘patient centred’ approaches (Bovaird, 2007). It also creates a platform to acknowledge the importance of addressing power dynamics and social realities between groups engaged in coproduction, alongside efforts to promote change for individuals, systems, and wider communities. Despite growing evidence of the value of coproduction approaches within public policy settings, (Batalden et al., 2015) there remains a need to evaluate the everyday realities of achieving coproduced services, and the impact this has on the wider health care landscape.
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