Page 10 - WCEN Dr Rochelle Burgess evaluation report\ Baloon

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.

10