End of Commitment Report – Improving and increasing both service user / participant, and service delivery staff, in the development, design and improvement of health and care services in Scotland.

Name of Evaluator

Andy McDevitt

Email

[email protected]

Member Name

Scotland, United Kingdom

Action PlanAction plans are at the core of a government’s participation in OGP. They are the product of a co-creation process in which government and civil society jointly develop commitments to open governmen... Title

Action plan – Scotland, United Kingdom, 2021 – 2025

Commitment

Improving and increasing both service user/participant and service delivery staff in the development, design, and improvement of health and care services in Scotland.

Title

Improving and increasing both service user/participant and service delivery staff in the development, design, and improvement of health and care services in Scotland.

Action

As we remobilise the health service and begin to recover from the COVID-19 pandemic, person-centred healthcare, and ensuring that the voices of people who use healthcare services are heard, and can influence the design and delivery of services, is a priority for the Scottish Government and those who deliver services. Scottish Government will use the Open Government Principles and processes to develop actions that will support the aim of improving person-centred user design and participation in health and social care. This commitment will support developing better systems to involve people in the design and delivery of policy and services that meet their needs. The Scottish Approach to Service Design advises organisations on the importance of service users and delivery staff in the formation of multi-disciplinary design teams. The Scottish Government is committed to this approach, ensuring that work on the redesign and recovery of services post-pandemic will make it easier for people to participate in co-designing the services they need and use.The action will aim to embed the principles of co-design in health and social care policy-making. Co-design is an approach that involves everyone (e.g., employees, partners, customers, citizens, end users) in the design process to help ensure the end result meets the needs of those involved and is usable. We will seek to empower people to collaboratively design services, based on their lived experiences.

Problem

The current health and care system is not consistently person-centred. The development and design of health and social care services are not always co-designed. People are not engaged consistently, and when they are included, it is not always early enough in the policy-making process to fully influence work. People who are using/accessing health and social care systems are not always supported to be able to provide feedback or support development work based on their experiences and in an accessible way that meets their needs. People, parents, and/or carers are not always regarded and listened to as experts in their own lives or the lives of those they care for. They can be excluded from involvement under the current systems. There are currently few mechanisms for people, parents, and/or carers to be able to inform or establish the agenda in terms of health and social care development and design. Different sectors (national and local government, NHS, and third sector services) have different priorities, levels of funding, governance requirements, and levels of accountability, which can result in disjointed services. The current health and social care system often focuses on crisis and urgent care needs rather than prevention and early intervention. There can be a considerable difference between policy intentions and the delivery of services.

1.1 What was the overall level of progress in the commitment implementation at the time of this assessment?

substantial

Provide a brief explanation of your answer:

By February 2025, the NCS had engaged 2,097 people in co-design activities, including 39 seldom heard voices sessions. The GIRFE project completed co-design, producing prototypes tested with people with lived experience and added to a national toolkit. A co-design maturity matrix was being developed to help teams evaluate participation practice. As of June 2025, 561 individuals and 294 organisations were registered on NCS engagement platforms, with work underway to involve them in the new NCS Advisory Board. The TSC was formally established as civil society co-lead in 2024, replacing a haphazard earlier approach, though its late appointment limited its overall contribution. (See Final Report for full details and references)

1.2 Describe the main external or internal factors that impacted implementation of this commitment and how they were addressed (or not).

Notwithstanding the significant progress that was made in the co-design of the NCS, the overall impact was limited by the government’s decision to significantly reduce the scope of the proposed service. The original proposal for the NCS to take social care provision into a new national agency was dropped. Instead, the focus shifted to the creation of a national care service advisory board on a non-statutory basis, which aims to improve social care support services. In June 2025, the Scottish Government’s scaled-back care reforms was passed unanimously by the Scottish Parliament, with much removed from the original proposals, including the NCS as a service. According to civil society stakeholders, the collapse of the NCS led to deep mistrust from civil society, which had invested a great deal of time and effort in consultation.
At the operational level, the way the government is structured can act as a barrier to meaningful co-creation, with siloed teams posing a real challenge to cohesive policy-making. While policy teams are used to running consultations, deeper engagement and joint decision-making across teams is more alien to many. In this context, demonstrating that the design school model and participative approaches work is crucial.
At the same time, as with other commitments, limited resourcing in an increasingly restrictive fiscal environment has translated into pressures in the wider system. In order to address this, the health and social care team had to be conscious about framing co-design efforts as a means of upskilling, capacity buildingEnhancing the skills, abilities, and processes of public servants, civil society, and citizens is essential to achieving long-lasting results in opening government. Technical specifications: Set of ac..., and enabling teams to work together in order to build efficiencies. (See Final Report for full details and references)

1.3 Was the commitment implemented as originally planned?

Most of the commitment milestones were implemented as planned

Provide a brief explanation of your answer:

The approach to civil society engagement under this commitment evolved significantly over the course of the action plan. Initially, the approach had been somewhat haphazard, with the Health and Social Care team within government selecting organisations based on their engagement in health service provision as stakeholder groups. According to interviewed civil society stakeholders, this did not prove successful as many of the individuals involved struggled to see the relevanceAccording to the OGP Articles of Governance, OGP commitments should include a clear open government lens. Specifically, they should advance at least one of the OGP values: transparency, citizen partic... of open government in their day-to-day lives. This limited the extent to which civil society was able to act as a critical friend to the co-design process. In recognition of these challenges, the civil society group engaging with the commitment was officially updated in 2024 to the Third Sector Health and Social Care Collaborative (TSC), a group of organisations that support the third sector’s contribution to the health and social care integration agenda. (See Final Report for full details and references)

2.1.1. – Did the government disclose more information; improve the quality of the information (new or existing); improve the value of the information; improve the channels to disclose or request information or improve accessibility to information?

Not Applicable

2.1.2. – Did the government create new opportunities to seek feedback from citizens/enable participation inform or influence decisions; improve existing channels or spaces to seek feedback from citizens/enable participation/ inform or influence decisions; create or improve capabilities in the government or the public aimed to improve how the government seeks feedback from citizens/enables participation/ or allows for the public to inform or influence decisions?

Yes

Degree of result:

Major

Explanation: In narrative form, what has been the impact on people or practice.

Both government and civil society stakeholders agreed that this commitment has achieved substantial results. Specifically, the commitment has made strong progress in developing approaches to person-centered co-design in two areas: (i) the proposed National Care Service (NCS); and (ii) the government’s Care and Wellbeing portfolio. However, the overall impact was limited by the government’s decision to significantly reduce the scope of the NCS. According to the government, the work undertaken as part of this commitment has represented an important shift in how co-design is applied – from an initial focus on service delivery to a broader focus on policy-making – with co-design approaches in health and social care now well embedded in government policy teams. Significantly, the design school model adopted under this commitment has brought policy teams, service delivery staff, the workforce, and people with lived experience together, with the explicit aim to collaborate on understanding problems, making sense of data and come up with ideas, which was not happening before. According to government stakeholders, just getting teams working on discrete policy areas to collaborate was, in and of itself, a powerful experience. According to the civil society co-lead for this commitment, there was great value in testing the co-design approach on the NCS development process given the critical importance and complexity of the health and social care sector and a very valuable and ambitious project to engage people with lived experience in the creation of a NCS. (See Final Report for full details and references)

2.1.3 Did the government create or improve channels, opportunities or capabilities to hold officials answerable to their actions?

Not Applicable

2.1.4 Other Results

Not Applicable

2.2 Did the commitment address the public policy problem that it intended to address as described in the action plan?

Yes

3. Provide at least one lesson or reflection relating to the implementation of this commitment. It can be the identification of key barriers to implementation, an unexpected help/hindrance, recommendations for future commitments, or if the commitment should be taken forward to the next action plan.

Notwithstanding the significant progress that the commitment made in co-design of the NCS, overall impact was limited by the government’s decision to significantly reduce the scope of the proposed service. The original proposal for the NCS to take social care provision into a new national agency was dropped. Instead, the focus shifted to the creation of a national care service advisory board on a non-statutory basis, which aims to improve social care support services. In June 2025, the Scottish Government’s scaled-back care reforms was passed unanimously by the Scottish Parliament, with much removed from the original proposals, including the NCS as a service. According to civil society stakeholders, the collapse of the NCS led to deep mistrust from civil society, who had invested a great deal of time and effort in consultation.
At the operational level, the way the government is structured can act as a barrier to meaningful co-creation, with siloed teams posing a real challenge to cohesive policy-making. While policy teams are used to running consultations, deeper engagement and joint decision-making across teams is more alien to many. In this context, demonstrating that the design school model and participative approaches work is crucial. At the same time, as with other commitments, limited resourcing in an increasingly restrictive fiscal environment has translated into pressures in the wider system. In order to address this, the health and social care team had to be conscious about framing co-design efforts as a means of upskilling, capacity building, and enabling teams to work together in order to build efficiencies. (See Final Report for full details and references)