Co‐Production and Self‐Care: New Approaches to Managing Community Care Services for Older People¹

Abstract

A lack of management theory which is relevant to human service agencies, combined with a failure to recognise the very large contribution which older people make to their own care makes it difficult to deliver supportive services. Self care by elders is divided, in this preliminary classification, into new strategies for everyday living, the reallocation of time and the avoidance of risk. Managers who understand that service users are co-producers of care and recognise the need to manage the users, as well as their own staff and relations with other agencies, are more likely to be able to deliver good services. However the management of co-production is at present only theorised for the private sector where ethical issues are less pressing and users are customers. In future a greater understanding of co-production and the development of theory and practice which will combine the management of co-production with the empowerment of users will be essential.

Risk and adult social care: Identification, management and new policies. What does UK research evidence tell us?

“…In addition, the importance of psychological well-being has also been identified, especially with regard to older people retaining a degree of personal independence and control (see Wilson 1994, Clark et al 1996a,b, 1998. However, the importance of risk and damage to psychological well-being, especially service users' sense of emotional and social well-being that could arise from different professional practices seeking to manage risk appeared to be less well researched.…”

“…This was often a complex and lengthy process involving issues of personal choice and the desire to retain a degree of independence and control. Wilson (1994) showed that, for many older people, deciding 'what is risky?' and whether to take a risk was often a multi-dimensional process weighing up potential costs and benefits.…”

Facing Up to Underfunding: Equity and Retrenchment in Community Care

“…There are two aspects to this issue: outcomes and targeting. Outcome measurement is fraught with problems, not least because the co-produced nature of social care means that differences between individuals will powerfully affect outcomes and make it difficult to draw general lessons (Baldock 1997;Wilson 1994). The second aspect, which is the focus of this article, is the issue of targeting.…”

User co-production of public service delivery: Effects on trust

“…In other service sectors, however, the accessibility of users may be less difficult. For instance, one can easily compare parents who co-produce in child care and parents who do not (Vamstad, 2007); or compare elderly who assist in their own care with elderly who do not (Wilson, 1994). Also, the organizational staff in these sectors usually has less power than in the case of activation services.…”

“…However, this might lead to a selection effect: the inclusion of a particular group of users -those with high levels of motivation, often well-educated, native and healthy -whereas less-equipped citizens are excluded from co-produced service delivery. In the literature, however, co-production is praised for its possibility to 'empower' vulnerable citizens (Needham, 2009;Wilson, 1994). This leads to the first empirical, descriptive sub question what are the characteristics of users involved in co-production?…”