78.A number of witnesses stressed the importance of involving people with ‘lived experience’ of public services in conversations about how those services are used, and how they can be developed. David Knott, Director of the Office of Civil Society (OCS), which is part of the Department for Digital, Culture, Media and Sport, told us how a focus on ‘lived experience’ had helped the work of the OCS:
“It is actually going out and hearing the experience of real people who interact with services, particularly young people. Through various panels, we have brought young people into the heart of some decision-making. That is incredibly revealing, not only about what young people want but about their experiences of interacting with services.
79.This chapter describes how the voices of service users can support public services to integrate better, meet individuals’ needs, and tackle the inequalities of access to high-quality services facing some groups. Nathan Dick, Head of Policy at Revolving Doors, said that “so many of the people we talk to refer to someone who had lived the same sort of thing and was able to turn round and say, ‘We can do this differently. I’ve been there. We can change this’, and that has helped them to engage with services.” The National Council for Voluntary Organisations (NCVO) linked ‘lived experience’ with the successful delivery of services: “Organisations with deep roots in a community or … led by people with lived experience often pioneer approaches that build … strength and capacity, reaching those who are disengaged from ‘mainstream’ services.” Debra Baxter, a user of disabled people’s services, said that such an approach was cost-effective: “You can spend £1,000 on this, that and the other service, but the ideas that disabled people have themselves … cost less.”
80.Many witnesses advocated ‘co-production’—where the users of a service are involved in its design—as the best way to capture ‘lived experience’, “lock-in” reforms to public services, and ensure a cultural shift in public service provision towards more collaborative approaches.
‘Co-production’ is where providers work with service users as equal partners to design a new, or reform an existing, service or system for an agreed collective outcome. The approach is based on the principle that those who are affected by a service are best placed to help design it. ‘Co-production’ contrasts with a transaction-based method of service delivery in which people consume public services that are designed and delivered by providers.
81.We heard that ‘co-production’ should be embedded at every stage of the evaluation and reform of public services. Collective Voices said that ‘co-production’ should have been used to evaluate the initial public service response to COVID-19. It argued that greater consultation with service users “could have helped predict potential issues, such as a lack of female-specific accommodation” for rough sleepers during the first wave of the pandemic.
82.Asking users about their experiences of these innovations can help to embed the innovations that worked best. Revolving Doors contended that while service providers had reported benefits of the new methods of service delivery, it was important for providers to assess whether the changes had been “welcomed by people accessing these services”.
83.Using ‘co-production’ to design public services can help resolve the fundamental weaknesses of public services that the pandemic has exposed, thereby improving their resilience. Rosie Lewis of the Angelou Centre argued that involving BAME people in the design of services would have made services more responsive to minority communities’ needs in the years before the pandemic. And it would have helped to identify the health inequalities that have made BAME people disproportionately vulnerable to COVID-19. She believed that it was important to:
“Think about who is at the table, who is making the decisions and who holds the power. We have had decades of ‘delivery to’—delivery to communities rather than ‘co-production’ … It is not just about our response to people in need; it is about changing systems, and we need to do that together.”
84.The pandemic has shown that designing public services without consulting the people who use them embeds fundamental weaknesses such as inequalities of access. Users often have a better understanding of the outcomes that they would expect to see from public services, and involving user voice in service design increases the resilience of those services.
85.Local authorities and central Government should set out how they will support homelessness, mental health and addiction service providers to involve people with ‘lived experience’—and the voluntary organisations that advocate on their behalf—in the design and delivery of services.
86.‘Co-production’ can embed service delivery innovations of the kind that have developed since the pandemic began, and in a cost-effective manner. In its response to this report the Government should confirm how it will encourage ‘co-production’ in the commissioning of public services, and how it will measure the levels of involvement in service design by groups of service users such as disabled people and those from BAME backgrounds.
86 Written evidence from National Council for Voluntary Organisations (NCVO) ()
88 Written evidence from Healthwatch England (), , (David Isaac; Sarah Mann), Mental Health Foundation (), Locality (), Muslim Council of Britain () and Anna Fowlie, Scottish Council for Voluntary Organisations (SCVO) ()
89 Written evidence from Collective Voice ()
90 Written evidence from Revolving Doors () and Revolving Doors–supplementary written evidence ()