Constraining co-creation? An ethnographic study of Healthwatch organizations in England

While the potential benefits of co-production and co-creation are widely vaunted, the degree to which they precipitate innovative change in systems varies, and influences on their impact demand greater attention. We present an ethnographic study of organizations intended to foster co-creation in English health and social care. Comparing five cases, we find demonstrable activity and some tangible impacts. At the same time, the positioning of these organizations as collaborative insiders in local governance systems constrained the publics and issues that were prioritized in co-creative activities. Our findings highlight the significance of discursive forms of meta-governance in delimiting the scope of co-creation.