Open Government action plan 2021 to 2025 - commitment 2: health and social care

Commitment overview

Commitment 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.

Timeframe

October 2021 to September 2025

Lead implementing directorate

Directorate for Healthcare Quality and Improvement, DG Health and Social Care

Civil society stakeholders

• Open Government Partnership
• Scottish Community Development Centre
• Community Justice Scotland /Shelter / Families Outside
• Safe Families for Children
• Barnardo's Scotland
• Cancer Support Scotland
• The Pain Association Scotland
• Parkinsons UK
• Centrestage (Arts)

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 which 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 delivery of services

Status Quo

The Scottish Government is taking a proactive approach to hear from and involve people and communities in aspects of the planning, delivery and continuous improvement of services, for example:

• we support NHS Boards to engage with the independent website Care Opinion, where people can share their stories of care in Scotland, good or bad, and engage in constructive dialogue about how services could be improved
• we fund the 'Our Voice' Citizens' Panel, which enables the voices of people to be heard including how to make communication between services and those that use them more inclusive
• the Scottish Care Experience Survey Programme provides information on the quality of health and care services from the perspective of those using them
• the Scottish Government is developing Community Engagement Guidance, recognising the important role that people have in shaping their local services
• the Independent Review of Adult Care in Scotland stated "we have a duty to co-produce our new system with the people who it is designed to support, both individually and collectively"
• in Scotland's Open Government Action Plan 2018-20 a Participation Framework was created to enable and embed a strong culture and practice of participation across government

We will build on all of the above work, drawing on lessons from each of piece of work to better embed co-production with people in priority work in health and social care.

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. 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 which 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.

Initial milestones

(Milestones will be updated accordingly)

To identify the necessary skills and experience required by a person centred design team to drive forward our action plan. Recruit, induct and train the above individuals

• hire and on-board a person centred design team. Start August 2021 – end January 2022
• develop the programme plan to ensure that the person centred user design work is built into the programme management structure of all work around the re-design and remobilisation of service post-pandemic. Start August 2021 – end February 2022

To identify the necessary skills and experience required by a person centred design team to drive forward our action plan. Recruit, induct and train the above individuals

• to establish a civil society group to work with Scottish Government officials over the period of the action plan to review work that is undertaken, feedback on progress and ensure actions are progressed as intended in winter 2021/2022. We will work with partners to agree the group’s terms of reference and continue to keep the group up to date on developments and changes as the design work taking place across the Health and Social Care Programmes progresses
• review relevant good practice that has already been undertaken on this subject to learn lessons from existing and previous work

To develop a programme of work that systematically embeds good practice and the principles of co-design across the re-design of services and work, to support recovery from the pandemic in health and social care. The Principles of co-design that will guide service design across health and care service work are as follows:

• we listen to what people have told us is the problem before we start designing a solution
• we design service journeys around people and not around how our health and care services are currently set-up
• we understand that people may enter at any stage of the journey and move between different services – and so we commit to coherence and consistency across our work
• we use inclusive and accessible design methods to allow people to participate fully and meaningfully
• health and care services should be co-designed with those who rely on them and those who deliver them. Health and care services will put the needs, rights and preferences of those who use the services at the heart of their decision making
• the work will focus on services being re-designed or strands of work related to recovery from the pandemic with the wider public sector, to ensure we are driving towards whole services that make sense to people and solve whole problems for them

To ensure future work can be progressed more widely, we will draw out learnings both in health and social care and across wider Scottish Government

• test and embed good practice in a local or small scale environment to test the developed approach on a different scale
• review and apply changes to our work as it progresses based on learning and feedback

How the commitment will contribute to solving the problem described above

The commitment will ensure Scottish Government has tested and effective processes for involving people in the co-design of health and care services. Previous work to review existing literature on this topic evidenced the importance of involving communities as equal and reciprocal partners in effecting change. It also highlights the importance of the evaluation of work being participatory. In embedding these principles we will design services that meet the needs of people accessing and working within them.

Working with people to co-design services should help ensure people can access the services that they need to access at the right time. It should reduce barriers to people accessing health and care provision. By designing services that work for the people using them and those working in them they should be more efficient, hopefully reducing costs and time. This will also provide a blue print that can be used in wider policy making.

Open Government Partnership value this commitment is relevant to

• civic participation
• public accountability