Contextualising co-production and co-governance in the Scottish National Health Service

Scotland is a small nation with strong networks and a distinct political consensus over health policy direction. Since UK political devolution in 1999, Scotland has rejected marketization/competition in favour of mutual approaches to health and social care, based on collaboration between government, citizens and health care practitioners, and inter-organisationally within and beyond the NHS. Co-production recognises citizens as owners and partners, underpinned by statutory patient rights. Examples include managed clinical networks; mental health services; a national partnership programme with citizens by Government, statutory bodies and civil society organisations (CSOs) at individual, local and national levels; and a Scottish Co-Production Network. Co-governance engages CSOs in offering advice, support and material contributions to health and social care. Growing interest in deliberative methods within mini-publics to advise government, has led to a citizens' jury to discuss and make recommendations for the ideal form and processes for shared decision-making in health care. Complexity theory is invoked to combine various theoretical frameworks to provide a set of complementary insights and possible explanations for current emergent forms. While health care quality has improved, further research is required to evaluate co-production/co-governance against other systems. Nonetheless, both citizens and Government support it to promote fairness and social justice.