Page 11 - WCEN Dr Rochelle Burgess evaluation report\ Baloon

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Introductionn
Introduction
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, 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) and 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 (Entwistle, 2009). 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, (refs), there remains a need to evaluate the everyday realities of achieving coproduced
services, and the impact this has on the wider health care landscape.

Since 2001, WCEN has built a programme of coproduction programmes that draw on investments and
engagements with a wide range of actors within the health economy – including statutory bodies, and
voluntary and community-based organisations. In principle, the WCEN coproduction model seeks to
tackle socio-cultural inequalities through a process of engaging communities as experts and leaders
in their own rights alongside statutory partners, as part of a process of using communities as platforms
for the delivery of locally relevant services. Given the paucity of evidence on the lived realities of
coproduced services (ref), the overarching aim of the evaluation was to develop an understanding of
the WECN coproduction network. By examining the process of “coproduction”, the evaluation sought
to understand the network’s ability to provide alternative mechanisms for service design and delivery
in communities, in line with the following aims:

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