Scotland’s NHS: Citizen Participation and Mutuality in Scottish Health Policy

Abstract

In Chapter 1 I introduced the subject of participation in healthcare in international contexts. Throughout this book I work with empirical material from the Scottish NHS as a case study of how participation has been attempted in practice, across one health system. This is not because Scotland is an outlier, taking a particularly radical, effective (or indeed, ineffective) approach to the challenges of ‘doing’ participation. It is partly a function of the unusual breadth of empirical data I accumulated (working alone, or with colleagues) in Scotland between 2009 and 2014, ranging from interviews with ‘ordinary’ citizens and frontline staff to senior civil servants and managers. However, it is also an intellectual choice, because in the 15 years since devolution, the Scottish health system had been in an unusual state of flux, in which the path dependency which shapes so much of day-to-day policy in most health systems (Greener, 2002) was, if not negated, at least called into question. As successive administrations have sought to define a way forward for the NHS in Scotland (and in the case of the Scottish National Party administrations from 2007 onwards, to define a way forward which breaks with the past and current status quo elsewhere in the UK) an eclectic and at times downright contradictory set of policy tools as evolved.