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The challenge

Feedback from reports into integration of health and social care suggests that it is still at an early stage of development. Although integration has the potential to transform the experience of those requiring care the day to day experiences of people can be difficult to impact. The role of the Health and Social Care Academy is to help drive transformational change in Scotland’s health and social care system, led by people living with long term conditions, disabled people and unpaid carers. One of the ways the Academy does this is to inspire and share good practice and where there are gaps, support the development of new practice.  To consider what could be transformational across health and social care the Academy hosted a Think Tank that brought together a cross section of Scottish society including third and independent sector leaders; leaders from across the public sector (including the NHS, Scottish Government, Police Scotland, Scottish Fire and Rescue Service and academia); and people who use health and social care services. The output from that day resulted in the development of the ‘Five Provocations for the Future of Health and Social Care’: courageous leadership, nurturing transformation, emphasising humanity, target culture and ceding power. People responded with interest to these provocations and were keen to look at how they might translate into developing strategy and changing practice. Feedback from the health and social care sector was that support was needed with how to implement the Five Provocations.

The idea

As a result of this the Academy co-designed the ‘Unfold the Future’ toolkit to support people working in health and social care to think creatively and ambitiously about transformational change and improvement in their area. The Tool includes a workbook which unfolds six stages of transformation, from the present day to ten years from now, working through key questions and barriers that may be faced along the way. The questions are clearly tied to the Academy’s Five Provocations – emphasising humanity, nurturing transformation, target culture, courageous leadership and ceding power. The Toolkit is presented in an engaging and accessible format with room for writing alongside the questions. The Toolkit will be delivered by a facilitator using coaching and appreciative enquiry skills to build staff confidence in transformation and improvement plans and their own ability to lead and deliver change. By working through questions and barriers that may be faced in the short, medium and long term, the workbook supports the user to tolerate uncertainty and difficult conversations in order to achieve long-term strategic goals. The Toolkit is designed to help teams and individuals think about what the future should look like in their area, to challenge their own assumptions about transformation and provoke deeper thinking about what change is necessary to get there.


The tool was co-produced over the course of a year with a wide number of partners from across health and social care, including Healthcare Improvement Scotland and people and carers who use services. To identify potential demand the Academy carried out a feasibility study and reached out to six Health and Social Care Partnerships to schedule research discussions. The overall reception of the toolkit was very positive with the HSCP’s expressing the hope that the toolkit could address broad cultural issues (eg. Low staff confidence and interest in co-production) and specific organisational projects. 

Competitive analysis was undertaken to assess what already existed to support people with transformational change. This research discovered several programmes that overlap with the functionality and audience of Unfold the Future, however, there were no toolkits focussing on transformation or fully covering the Five Provocations – the unique selling points and key benefits of Unfold the Future. The conversations with HSCP’s revealed that they considered the Toolkit to be filling a substantial gap in the market for transformational and culture change, and believed there would be enthusiastic take up of the product in the sector, complementing the resources already provided. 

The funding will allow us to recruit a Project Manager to further refine the Toolkit, test out ideas and scale up delivery. This will allow targeted engagement with IJB’s and HSCP’s to let them know about the Toolkit and discuss how they could benefit from it. Co-designed facilitated sessions will be organised and delivered, followed up and evaluated. In depth research will be carried out into accreditation. 

Feedback will be solicited at the end of training sessions to allow for continual improvement of the toolkit. The Academy will also follow up with participants following the training to track and support the subsequent delivery of transformational change.

Benefits to the Q community

The Toolkit offers flexible options to all members of the Q community depending on needs and availability to support transformational change. Funding the initiative and sharing your feedback is an opportunity to shape the tool and ensure that it reaches as many people as possible.

The Academy uses the Five Provocations to enable transformational change and improvement. Particularly relevant to improvement is the need for courageous leadership. The Academy, in partnership with SSSC has been running a series of events aimed at creating a framework for how to be a courageous leader. This has involved illustrating examples of courageous leadership from across health and social care with people sharing examples and opinions; defining courageous leadership and looking at how we can enable courageous leadership. We would be delighted to share this learning and facilitate discussion with Q members using a variety of formats, including through peer learning, an improvement lab and  community of interest. 

How you can contribute

  • Help us identify who would be interested in using the Toolkit
  • Share your ideas to strengthen evaluation, measuring and sharing impact
  • Express an interest in opportunities for partnership working

Further information

Five-Provocations (PDF, 3MB)

Reviewer feedback

This is a great project because…

It's a good example of a more transformative approach to system change, building on progress made within Scotland that others across the UK will be keen to learn from. The toolkit format should help with thinking about sharing.

By the time of the event we encourage the project team to think more about…

Develop further the plans for sharing with the Q community.  More specifically what learning is this likely to generate and how can you engage with Q to help think about the best way to do this.  You may find thinking about how to share what you're doing will in turn help local implementation.


  1. Sarah, How can I get a look at the toolkit? Regards Tom

    1. Of course, can you email me at and I will send you a copy of the Toolkit?

      Thanks, Sarah

  2. I would be interested to investigate if the inclusion of some process maps, that is if they are not already included, would enhance your 'toolkit' and thereby increase its value and implementation process. If you think that this would be the case then please let me know. Regards Tom

    1. Hi Thomas

      Thank you for your comment, I would be keen to explore in more detail how process maps could add value to the Toolkit. Currently there is a focus on relational change and values and it would be great to discuss how a process map could support the implementation process.

      Thanks again


  3. Guest

    Sara Redmond 3 years, 5 months ago

    Hi Sarah, I think this is such an important toolkit and programme of work that is treading new ground and will add to the methodologies that currently exist to support quality improvement.  Creating transformational change means attending to the everyday - embedding new working practices and a renewed culture that involves different roles for all of us, whether we are accessing or delivering support and services.  One of the things that we often come hear in our work to support the implementation the Self Management Strategy in Scotland is the often unseen power dynamic that plays out in interactions and can make the types of conversations Hilda refers to as a real challenge. How do we create the conditions to empower everyone to reach their potential and to be innovative?  We would be keen to support this work as it progresses.

  4. I am pleased to support the idea and encourage further development of the potential that exists for this resource to assist people to consider key dimensions of organisational effectiveness and cross-organisational collaboration.

  5. Guest

    Jason Leitch 3 years, 6 months ago

    This is an excellent proposal. I have followed the development, implementation and scale-up of this work since its inception. It is innovative, person-centred and practical. This small investment would help with further spread and development.

    1. Hi Jason


      I agree it has so many areas where it can be applied, but we do need this small amount of funding to help the Academy to further develop it and share with others to adopt and adapt. Can you please tick the 'You support this idea' box at the top of the page as the more visible supporters the idea has the greater chance it may have of success and I am keen such an excellent toolkit has the chance of being taken to the next level. Thank you Hilda

  6. Hi Sarah


    You are very welcome and I think the toolkit has amazing possibilities, delighted to be able to partner with you on it and anything practical I can do for now, please let me know

  7. Hi Sarah

    I think this is an excellent idea on so many levels. Often in quality improvement staff can feel under pressure to 'do something else', that their current workload and demand is already too much and here is something else to have to deal with. There can also be a fear of repercussions of the ''new thing'' which has to be taken on board if it isn't done to order etc. However, policies and procedures on their own are just pieces of paper, its the people who implement them which enables real transformational change to happen.

    The Five Provocations create a safe place for staff to be able to recognise frustrations they may have are legitimate, while also providing a safe environment for moving on from this frustration to remind themselves why they came into the job and what really matters, which is people. With this renewed motivation to make a difference, staff then actively look for new ways of doing things and embrace improvement as they feel an ownership of the change.

    I see this used in many settings, within health and social care staff to support the new integrated ways of working and refocus on why the decision was made to do this, so people have a better experience.

    Within Communities which can be geographic or other, where people want to see the quality of services they receive improve and where agencies want to do more work around co production and design but aren't sure how to go about it in a structured way which will have meaningful outcomes for all concerned

    For partners who are seeking new ways of building connections and understanding each other to begin to work across non traditional boundaries and have the courageous conversations needed for real transformational change to happen e.g. GP's finding new ways to build connections with Third Sector and Community Services so feel more confident to signpost people they see to 'non statutory' supports

    For other partners within the Q Community as this toolkit has had a lot of work put into it already, it has followed excellent design principles and none of us have time to reinvent the wheel, we have something which can support so many other Q pieces of work as it is a starting point, getting people on board, once people are on board energy then goes into improvement.

    This fits with work we are doing around primary care transformation and COPE would be happy to be a partner in taking this idea forwards as we believe we need to invest more in bringing people on board any new changes, otherwise, energy which nowadays is a scare resource is wasted in people trying to maintain the status quo as they don't see the need or reason for change or just feel too tired. We cannot emphasise strongly enough the pressures and stress many health and social care workers are experiencing at the moment, if we want people to come on board new change they need to have their capacity built to do this and this toolkit has real potential in so may ways.

    There is also ways it can be adopted and adapted for use in other ways e.g. supporting self management conversations between people and their carers and health and social care professionals.

    You also touch on leadership and true leadership is essential for real trans-formative change to happen, BUT, to do this people need to think what True leadership involves. We were fortunate recently to be one of the mentors for Nurses on a leadership course, following everyone's placement, the students fed back the qualities they saw in others which they viewed as leadership these were:
    Importance of relationships
    Flexibility but consistent,
    Anyone can do it!
    Leading by example
    Grab every opportunity!
    You are never alone
    Practice development
    Many leadership styles
    Actions speak louder than words
    Being visible and approachable
    Developing a shared vision
    Being innovative
    Self-caring and creating a team culture of loving kindness
    Being and having a critical friend to/with others
    Value other people’s opinions/experience
    Inspire others
    Being dedicated
    Being humble
    Creating a person-centered workplace
    Allowing room for growth of self and others
    Admit mistakes

    The questions they then asked were:
    How do we create the conditions to empower team members to reach their potential and to be innovative?
    How do we motivate other team members who are counting down to retirement?
    How can we seek further opportunities?
    How do we keep up momentum?
    How can we ensure we are what our new teams need but still retain a sense of self?
    How do we maintain our vision in times of challenge?
    How do we facilitate a shared vision of change?
    How can we apply this learning in our practice?
    How can we share our learning and vision of the re-focused role with senior management?
    The Five provocations toolkit could be adopted and adapted as a way of thinking through these questions to come up with a strategy and plan to move forwards.

    We think there are many ways this toolkit could and should be used and would be happy to be partners in any work going forwards, its a great piece of work already and we need to get it out there, adapted to suit different groups and visible which I think the funding would support


    Let me know how I can help


    1. Hilda,

      Thank you very much for taking the time to comment in so much details, for your support of the idea and for offering to partner with us. We would be delighted to have you as a partner. This will allow the Toolkit to widen its reach and specifically to support co-production and communities. It can be a way of giving people a voice, empowering them to play a role in the improvement process and build confidence. The Toolkit recognises peoples assets and skills and builds upon these in creating change.

      Your role in mentoring nurses on the leadership course sounds like a wonderful opportunity. Thank you for sharing the themes and questions, they are all very thought provoking. It would be fantastic to use the Toolkit to support this group of Future Leaders, which is something the Academy has previously worked on and very keen to support.

      Thanks again


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