Public Involvement and Engagement in Health and Social Care in Scotland – A Decade of Change: Real Progress or Just New Terminologies?

Introduction

Over the past decade, Scotland has made significant efforts to strengthen public involvement and engagement within health and social care. Through successive legislations, frameworks, and integration initiatives, the Scottish Government has attempted to give communities a real voice in shaping the design, development, and delivery of services.

From the creation of Health Care Partnerships (HCPs), later evolved into Health and Social Care Partnerships (HSCPs) under the Public Bodies (Joint Working) (Scotland) Act 2014- to the Community Empowerment (Scotland) Act 2015, the intent has been clear: empower communities and bring decision-making closer to the people.

At the local level, Public Partnership Forums (PPFs) were established to facilitate community input into service planning, supported by the Scottish Health Council (SHC), which later became part of Healthcare Improvement Scotland (HIS). HIS continues to play a key role through initiatives such as The Quality Framework for Community Engagement and Participation, providing a structure for assessing and improving engagement across NHS Boards and HSCPs.

Complementing these are critical legislations like the Equality Act 2010 and the Patient Rights (Scotland) Act 2011, all of which collectively provide a robust foundation for public participation.

Have We Achieved Real and Inclusive Involvement?

Despite the existence of this extensive policy architecture, the question remains:

“After ten years, do we truly have real, inclusive, and evidence-based public involvement, from the process of service design to delivery or, have we only changed the terminology?”

Reports from Public Health Scotland and the Scottish Government outline activity and progress in community participation. However, data specifically measuring the depth, quality, and inclusivity of public involvement particularly at the service design level remains limited.

There is growing concern that participation from hard-to-reach communities, those from lower socio-economic backgrounds and minority ethnic groups remains disproportionately low. As highlighted by the Glasgow Centre for Population Health (GCPH), racialised health inequalities are deeply influenced by structural racism, unequal access to resources, and systemic disadvantages.

In short, while legislative intent is strong, implementation often falls short of achieving real inclusivity.

The Importance of Real, Inclusive, and Evidenced Engagement

From over 15 years of experience in public health and community engagement in Scotland, I have seen firsthand that genuine public involvement, particularly among disadvantaged and minority groups is complex and resource intensive.

For engagement to be meaningful, we must ensure that participation is not tokenistic but embedded within the structures, culture, and processes of service design and delivery. Communities must not only be consulted but also see tangible evidence of how their input shapes outcomes.

A Three-Pronged Approach to Strengthening Public Involvement

To move from intent to impact, I propose a three-pronged approach, ensuring that each component reinforces the others:

1. Embed Public Involvement in Staff Development (via HR):

   • Integrate public involvement principles into staff induction and continuous professional development.

   • Create organisational cultures where engagement is seen as everyone’s responsibility, not an add-on.

2. Make Public Involvement a Mandatory Step in Service Design/Redesign:

   • Require public involvement at the inception stage of all new or redesigned services, with accountability held by service leads.

   • Accept that meaningful engagement may take time and occasionally delay service development, but such delays reflect democratic and ethical practice.

3. Ensure Consistency and Incentivisation:

   • Establish consistent mechanisms for engagement across NHS Boards and HSCPs.

   • Consider non-monetary incentives to sustain public participation, such as recognition, feedback, or any other method of incentivising as suitable locally, and visible impact of community input to avoid reliance on the “usual suspects.”

Diagrammatic Representation: The Interlinked Model of Public Involvement.

Conclusion

Meaningful public involvement in health and social care is not achieved through frameworks or policies alone, it requires culture change, accountability, and shared ownership.

Scotland’s legislative landscape provides a strong foundation, but to realise its promise, implementation must go deeper. By embedding engagement into workforce development, mandating it within service design, and sustaining it through consistent, incentivised participation, we can move beyond changing terminologies to achieving real and inclusive transformation.