The role of co-creation in delivering integrated health and social care

Mechanisms of Improvement

The perspectives of service managers/planners regarding how co-production and co-creation is understood, implemented and sustained as part of                                                  improvement programme delivery within the health and social care context in                            Scotland: A qualitative study

What we know

Co-creation and co-production have become recognised by public and third sector bodies in Scotland as a vehicle to improve services and achieve positive outcomes, more effectively1, 2, 3, 4.    These ideas have been part of the Scottish Government’s public sector reform agenda linked to the National Performance Framework.

Although service managers/planners have been tasked with delivering improvements in health and social care, it is not clear how co-production and co-creation is understood and enacted by those undertaking integration and improvement programmes in Scotland.  Little is known about how service planners undertake co-production and co-creation5 in Scotland’s health and social care services.

Given the policy centrality of co-production for improving public services, this research provides a timely evidence and policy review, which identifies how perspectives relating to co-creation and co-production are articulated and promoted.

Interviews with key stakeholders, provide insights into how co-production and co-creation can be implemented and sustained, from the perspective of those tasked with undertaking, supporting and delivering co-production practices. The interviews also highland detailed and nuanced reflections regarding leading change based on the ideas of co-creation and co-production within the existing Scottish policy system in the health and social care area.

    1.  Evaluation Support Scotland (2017). ‘Evidencing genuine co-production in the third sector’, (Accessed 21st February 2018).
     2.  Alliance Scotland (2018), ‘Our co-production team review activities over 2017 for our annual report’,  (Accessed 21st February 2018).
     3.  Healthcare Improvement Scotland (2018),’Who we are’,  (Accessed 21st February 2018)
     4.  Scottish Co-production Network (2018), ‘Background’  (Accessed 21st February 2018)

Project aim

To examine how service managers/planners understand, implement and sustain co-production and co-creation as part of improvement programme delivery within the health and social care organisations across Scotland.

What this research explored   

The aim of this study is to inform policy-makers and practitioners about how co-production and co-creation is (and can be) implemented at scale and the potential for sustainable impact in service improvements in health and social care.

More broadly, the project seeks to enhance the evidence-base of the implementation of co-production and co-creation as part of public sector reform agendas.

The research questions that underpin this study are:

  1. What are the perceived impacts of co-production and co-creation on service improvements?
  1. How do service managers/planners evidence the effectiveness of co-production and co-creation?
  1. What are the facilitators and barriers to sustaining co-production and co-creation in improvement programmes in Scotland?
  1. How does the social, policy and political context shape the sustainability of co-production co-creation in health and social care in Scotland?

The study was designed in two parts; the first to capture current evidence from review studies and policy documents.  These evidence narratives were complimented by the second element of the project – a series of qualitative interviews capturing lived-experiences of implementing and promoting co-production and co-creation practices.

What this study adds

What is clear from this research is that there is value attached to the idea of undertaking co-productive work amongst those leading health and social care in the Scottish public sector (i.e. Chief Officers and those within key public sector national agencies).

The qualitative findings provide a whole-system summary of how these approaches are understood, operationalised and sustained.  It demonstrates positive examples, the benefits of these approaches and emphasises the skillset and leadership qualities required to undertake and promote co-production.

The study illuminates the how sustaining co-creation and co-production at a partnership level with health and social care areas requires the space for innovation to take place but this needs to be supported, in terms of capacity building, by national government, particularly in terms of unlocking support for embedding evaluation within the system. In short the report shows how localism and empowerment has key benefits but that this needs to be strategically supported and led, otherwise national agencies risk operating a cross-purposes.  Overall, the report elucidates how system-based challenges can impede organisational capacities for implementing and sustaining co-production and co-creation practices.

Moreover, this study informs policymakers and practitioners about the available evidence about co-production and co-creation and summarises the issues, practice and complexities around how to undertake such an improvement agenda.

The Report’s rapid evidence review presents a summary of published findings and policy narratives; providing the wider contextual background to the practices of co-production and co-creation.

Given that one of the clear conclusions from both the evidence review and qualitative data, is that the term co-production is far more recognised than co-creation.  It suggests that that there would be benefit from withdrawing the term ‘co-creation’ from policy narratives, reducing the confusion around terminologies, enabling a clear system-wide focus on ‘meaningful and sustained co-production’.

Benefits and impact

  • Inform service planners across health and social care areas in Scotland about lived occupational experiences of co-creation in the planning, design and integration of services across partnerships to support an evidence-based approach to co-production.
  • Transferable lessons – best practice approaches to co-production.
  • Inform national policy-makers of the approaches, opportunities, successes and challenges of contemporary public sector reform in a multi-level policy system within the context of the health and social care integration agenda.
  • Develop greater understanding about the pivotal role of service professionals in co-productive practices. Addressing a gap within improvement science and policy implementation literature.


    This project was led by Professor John Connolly, Professor in Public Policy at the University of West of Scotland. with the project also included researchers from the Scottish Improvement Science Collaborating Centre. The project advisory group was made up of multiple stakeholders including Healthcare Improvement Scotland, Alliance Scotland, Health Scotland, and representatives from health and social care areas across Scotland.

    For more information please contact SISCC (

    Related Publications:

    How co-production and co-creation is understood, implemented and sustained as part of improvement programme delivery within the health and social care context in Scotland (2020)



    Health and Social Care Alliance Scotland

    Healthcare Improvement Scotland

    Public Health Scotland

    Scottish Government – Health and Social Care Integration