Official Report 1065KB pdf
The next item of business is a statement by Neil Gray on delivering reform and renewal for health and social care.
15:01
Thank you, Presiding Officer, for the opportunity to update Parliament on the Scottish Government’s progress in advancing the health and social care reform programme, following the vision that I announced to Parliament last year and what was set out in the First Minister’s speech in January.
Today marks an important milestone in that journey. I am pleased to announce the publication of “Scotland’s Population Health Framework” and the “Health and Social Care Service Renewal Framework”, which are two vital components in delivering our shared vision for a healthier, fairer and more resilient Scotland. Together, the frameworks represent a significant step forward in shaping a future where people live longer, healthier and more fulfilling lives.
As the First Minister outlined earlier this year, we are taking bold and ambitious action to reform our health and care systems, delivering the transformation that the people of Scotland need and expect. Alongside the “NHS Scotland Operational Improvement Plan”, published in March, which is about improving service delivery now, the frameworks will drive forward public service reform in health and care, with a focus on prevention and on joined-up, efficient services. They provide clear direction on how we will plan and deliver services for the whole population over the next decade, while tackling the deep-rooted inequalities that continue to impact health and wellbeing across Scotland. As the First Minister set out just yesterday, they are part of an essential shift to a front-foot focus on prevention. They are public service reform in action in our health and care system.
The population health framework, which was co-developed with the Convention of Scottish Local Authorities, reflects our shared, long-term commitment to improving health and wellbeing across Scotland through a preventative, system-wide approach that addresses the broader drivers of health. Improving health and reducing inequality remains central to the Government’s ambition, yet we must face a hard truth: people in Scotland still experience vastly different health outcomes depending on where they live and the circumstances that they face. Too many people in our most deprived communities live shorter lives and spend more of those years in poor health. That cannot continue.
The core purpose of the population health framework is to improve life expectancy for everyone in Scotland and to reduce the unjust and avoidable gap between our most and least deprived communities. By shifting the focus from treating illness to preventing it, addressing the root causes of poor health and targeting our efforts where they are needed most, we can ensure lasting improvements for this generation and the next.
Most of what affects our health happens outside health and care settings; it happens in homes, in nurseries and schools, in workplaces, and in parks and green spaces—it happens in each and every one of our communities. That is why the framework contains 30 initial actions across these drivers of health: good early years, jobs, income and powerful communities.
The framework focuses on two early priorities: hardwiring prevention into our systems—how we plan, deliver, budget and account—and improving healthy weight. We know the toll on the health of our people from being overweight or living with obesity, and we know that that is preventable. The evidence tells us that tackling the environment is key. That is why one of the first actions of the population health framework will be to legislate to make the balance of foods that are available on promotion healthier and to restrict the location of less healthy foods in our supermarkets. That is what clinical leaders who treat our people have called for, and we will align with similar legislation in England and Wales, which is what our business leaders have called for.
This is the whole-system approach in action, delivering the decisive shift to prevention that the First Minister has called for. The approach follows the evidence; tackles the environment without blaming the individual; works with business and not against it; and involves all of us, across all our sectors and interests, working together.
As we move through the next decade, the framework will evolve and adapt to future challenges, meeting emerging needs and driving progress where it is needed most. Today, alongside the framework, we have published four sector summaries on the roles that the whole system plays in creating health. Developed by our business sector leaders, our community and voluntary sector leaders, our local government colleagues and national health service leaders, the summaries demonstrate the role that all sectors play in health and the opportunity that they all have to do more to improve health.
The business sector influences health through good employment with fair incomes, through the goods and services that it produces and by supporting thriving local economies. The NHS plays a central role in improving health, not only through the delivery of healthcare but as an anchor institution that works in partnership with local communities to improve the building blocks of health. Local government offers a critical leadership role and collaborates through local partnerships to deliver public services that strengthen health. The community and voluntary sector is uniquely situated to build trust, reach key population groups and support prevention through person-centred approaches, the delivery of critical services and the creation of community assets. That is the whole-system approach that public service reform requires, and we are grateful to our system leaders across all sectors for their work in developing the summaries.
In tandem with the population health framework, the health and social care service renewal framework sets out a clear path to ensuring a sustainable, high-performing health and social care system that can meet the future demands and evolving needs of our population. It will ensure long-term financial sustainability, reduce health and care inequalities, further harness the benefits of digital technology and improve health outcomes for people in Scotland.
Five principles that will shape the future of care in Scotland are at the service renewal framework’s core. The first is prevention. The population health framework looks to prevent illness occurring in the first place; the service renewal framework builds on that, with a focus on early detection and supporting those living with long-term conditions.
The second principle is people. We will design care around individuals and not systems. People will be empowered to be more in charge of their care and more involved in the decisions about their support and treatment.
The third principle is community. By rebalancing our resources, it will be easier for people to access services and a broader range of treatments closer to home.
The fourth principle is population. We will plan services based on the needs of our populations and not according to administrative or geographical boundaries.
The fifth principle is digital. We will embrace technology to improve people’s access to modern, joined-up and efficient services. People will have the choice to access information and services digitally in an inclusive manner. That means that more treatment will be delivered safely closer to home, whether someone lives in a town, in a rural village or on an island. For example, our digital front door service will mean that you can manage your condition, co-ordinate your appointments and see your diagnostic results all from your own phone.
For our workforce, our effort to capitalise on digital innovation means having the right digital access and information that they need to do the best job possible. That will streamline support, reduce their administrative workload and free them up to spend more time with patients and people.
Digital systems and smarter ways of working are not just enhancements but essential enablers of reform. The ability to meet our health and social care reform objectives hinges on how effectively digital tools are deployed and making digital transformation a strategic imperative for sustainable, high-performing health and social care services. The transformation will be underpinned by strengthened governance, providing clear accountability, robust oversight and empowered leadership.
Through those principles and the major changes that we have set out in them, people will experience faster and fairer access to services; the workforce will have new opportunities to deliver care more effectively and efficiently; and we will create a system fit for the future.
As the First Minister highlighted yesterday during his visit to the Queen Elizabeth university hospital, the renewal of Scotland’s essential public services must be rooted in a long-term vision that prioritises prevention and early intervention. Both the population health framework and the service renewal framework place prevention at their core.
To support this transformation, we are bringing together existing national resources, which are currently spread across several national boards, into a single, co-ordinated body to be called NHS delivery. As part of that change, we will merge NHS National Services Scotland and NHS Education for Scotland. That will ensure that we are better equipped to deliver key priorities, including making progress on our digital ambitions. It will enable us to provide clear, streamlined support to local systems to deliver on once for Scotland services, both for NHS Scotland and, potentially, for the wider public sector.
We are not proposing structural changes for the Scottish Ambulance Service and NHS 24, but we expect them to work much more closely together, supported by enhanced joint planning and co-ordination, building on existing collaboration. That will support transformational improvements in urgent care, so that people can access timely, appropriate support wherever and whenever they need it.
I want to acknowledge the vital partnership with COSLA to develop both the frameworks. I call on partners across the Government, local authorities, the NHS, the third sector, business and communities to continue to work with us to deliver this ambition. We developed the frameworks together and I want to implement them together.
I spoke earlier about all of us, with all our interests, working together to improve health. That applies to members in this chamber, too. I know that all members want our people to enjoy good health and for our services to be modern, joined up and efficient. Together, through shared purpose and co-ordinated action, we can build a system that not only treats illness but helps people to live longer, healthier and more fulfilling lives.
The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for questions, after which we will move on to the next item of business. It would be helpful if members who wish to ask questions were to press their request-to-speak buttons.
I thank the cabinet secretary for early sight of his statement. Having read the statement, my overriding feeling is: what a breakthrough. Who would have thought that investing in preventative health and digital solutions would benefit the NHS and the health of our nation? Rarely have so many statements of the blindingly obvious been contained in a single Scottish Government publication.
In my first debate, on 7 June 2016, I championed preventative spend and investment in digital solutions. The then Cabinet Secretary for Health and Sport, Shona Robison, said:
“I am committed to taking forward our health and social care agenda in the context of public sector improvement and against the four pillars of public sector reform in our response to the Christie report”,
those being
“prevention; integration at a local level; workforce development; and a focus on performance, with outcomes-based targets.”—[Official Report, 7 June 2016; c 9.]
Scotland’s poor health record and low healthy life expectancy are no secret. In fact, the solutions have been in front of us for decades.
How will the cabinet secretary quantify preventative spent and measure success? Considering that the documents have apparently taken years to come together, when does he expect the changes in them to be achieved?
Finally, the much-trumpeted digital front door, commonly known as the NHS app and first announced in 2021, is expected to be providing limited services to dermatology patients in Lanarkshire by the end of the year. When does the cabinet secretary expect it to be able to do for patients in Scotland what it can already do for all the patients in the rest of the United Kingdom?
I thank Brian Whittle for what I think was his support for what we have set out in the documents. I recognise that there has to be a continued emphasis on prevention. With regard to what Ms Robison set out when she was in my role, significant steps have been made to move to a more preventative model, including the work that has been done on urgent care pathways and the hospital at home service, for example.
However, the statement is an acknowledgement that we need to do more. We need to go further and we need to go faster. On delivery, both of the documents set out the progress that we wish to make over the coming years, and I expect to see some elements of them delivered quickly. Some changes will be happening now, such as those that I announced in relation to foods that are high in fat, salt and sugar, and our proposed structural changes to some of our national boards.
On Brian Whittle’s question about the digital front door, he is correct. The initial pilot is happening in Lanarkshire at the end of this year and we expect to roll it out to the rest of Scotland in 2026.
This is simply tinkering around the edges. The Scottish National Party Government’s plan would simply merge two special boards rather than implement effective reform. It amounts to gesture politics that will not create an NHS in which systems work together and money follows the patient. Whatever the new board might be called, the hallmark of this Government will be its lack of delivery. If Neil Gray wants me to come up with ideas, he should tell John Swinney to call the election now and I will do the job for him.
I am not holding my breath over the promise of using an NHS app that has been used by NHS England since 2018 and that, although it was developed by a Glasgow headquartered company, has been ignored by the SNP. The SNP made a manifesto commitment to have an all-Scotland app, but we are to have a pilot in NHS Lanarkshire alone. That commitment has been broken but, cynically, it is now being reannounced.
The cabinet secretary rightly talks about prevention, but for the past 18 years the SNP Government has funded crisis rather than prevention. Audit Scotland has identified cuts of £560 million in social care—
Ms Baillie, please put your question to the cabinet secretary. You are over your time.
Of course. In this year alone, services are being cut to the bone—
No, Ms Baillie—we need questions.
Today’s statement amounts to little more than gaslighting the people of Scotland—
Ms Baillie, please put your question. You are well over your time.
—with announcements of measures that will never deliver—
Will you please put your question?
I am trying to.
You are over your time, Ms Baillie.
—coming from a Government that is running out of ideas and fast running out of time.
I do not know that there was a question there.
There was.
Cabinet secretary, please respond.
I am not convinced that there was a question there, Presiding Officer.
I am genuinely seeking to engage with members from across the Parliament on the contents of what we have put to them. The service renewal framework and the population health framework are about making generational shifts in the way in which we deliver our health and social care services by moving to a more preventative model, shifting the balance of care so that more services are delivered in our communities and ensuring that we intervene earlier and do not see an escalation in an individual’s poor health.
The digital front door will go further than the NHS app that is available elsewhere goes. It will be an integrated health and social care digital front door to ensure that there will be the element of co-ordination that Jackie Baillie asked for but is not being delivered elsewhere in the UK. I will be more than happy to work with her and other members to ensure that the vision for health and social care services that is set out in the documents is delivered.
I remind members who seek to ask questions to check that they have pressed their request-to-speak buttons.
I have heard from constituents who are British Sign Language users who have been assessed for a care support package but cannot access it due to a lack of BSL-trained support workers. I know that they are keen to hear the outcome of the inquiry that the Equalities, Human Rights and Civil Justice Committee is currently holding. Can the cabinet secretary provide any reassurance to BSL users that health services are aware of gaps in provision and are focusing on closing those gaps?
A shared aim of the population health framework and the service renewal framework is to reduce health inequalities by ensuring that services are designed and delivered in ways that are inclusive, equitable and responsive to the needs of all communities.
The Government’s BSL national plan, which was published in 2023, represents our on-going commitment to making Scotland the best place in the world for BSL users to live in. Equal access, opportunity, representation and inclusion are key components of our plan, which apply across areas such as education, health, justice and culture. Through the national plan’s implementation advisory group, we will work with key partners who represent deaf and deafblind communities to ensure that we are held accountable for the actions in the plan and to draw on their experience to strengthen delivery, including in the areas that Emma Roddick has asked about.
Annie Wells is joining us remotely.
The Government says that it wants to prioritise community-based preventative care but, right now, Glasgow’s Huntington’s disease specialist service is facing closure. It consists of front-line professionals who prevent hospital admissions and support families in crisis. Will the cabinet secretary act to protect those essential services before more vulnerable families are left behind?
I recognise the issue that Annie Wells has posed and the seriousness with which the proposed closure will be regarded by the community in Glasgow that receives support with Huntington’s disease. We are working on the two documents in collaboration with the Convention of Scottish Local Authorities, in recognition of the fact that, in many ways, local authorities are our delivery agents in such settings, along with our health and social care partnerships.
We have invested in an increased level of support for our local authority partners, which should also mean an increased level of support for our health and social care partnerships, but I recognise that, at the moment, people still need to make difficult decisions.
The two documents set out the frameworks for how we can shift the balance of care and how we can shift where resource goes to support those more interventionist actions and early intervention priorities, such as the one that Annie Wells sets out. If she wants to write to me with the details, I will be more than happy to see what can be done in the short term.
The landscape of general practice in Scotland has changed significantly in recent years, with rising numbers of people living longer and with more than one condition. What reform opportunities are being considered to enable general practitioners to offer a greater specialist response, meeting the needs of population groups across areas such as cardiac and frailty?
Audrey Nicoll is absolutely right that general practice will play an ever more important role in the delivery of our services. For us to shift the balance of care and for our constituents to receive services within the community that they call home, we will be required to support general practice to play that role in a sustainable way.
A further £10.5 million has been invested this year to expand targeted interventions by GP practices on cardiovascular disease and frailty prevention. As part of that investment, we have already agreed an enhanced service with the British Medical Association that will increase the number of proactive interventions to prevent cardiovascular disease from having a significant impact on patients’ long-term health outlook.
By spring next year, we will offer a frailty enhanced service to general practices, enabling each GP practice to identify a frailty lead, which will help to drive improvements in frailty care through training, data optimisation and cross-sector collaboration.
I welcome the publication of the long-overdue population health framework and the Government’s response to the high in fat, sugar or salt consultation, which has just been published in the past few minutes, although we were promised it at the start of this year. Those things are critical to improving health and reducing inequalities.
However, I fear that the Government’s actions fall short of its ambition. When does the Government intend to publish its impact assessment on food and drink that is high in fat, sugar or salt? If the Government is truly committed to delivering improvements to health and reducing inequalities, it will need to ensure that regulations are brought forward, otherwise it will just be the usual piecemeal approach to public health intervention.
I have a number of things to say. First, I appreciate Carol Mochan’s welcome of the documents. We have a lot of shared endeavour in relation to what they can achieve and in recognising their importance in supporting and enhancing health and social care services.
We will be setting out our regulations on foods that are high in fat, salt and sugar later this year, and I would expect the publications that Carol Mochan has asked for to be a part of that. Carol Mochan stressed the need for ambition. The regulations will match what is happening in England and Wales already, so that there is consistency across these islands. However, I recognise that there is more for us to do in supporting people to have healthy, active lifestyles and in tackling obesity. That is what the population health framework is all about, and we are trying to enable people to deliver on it.
My question is in a similar vein, with regard to high-fat, high-sugar and high-salt foods. The cabinet secretary will be aware of the work of Henry Dimbleby, Dr Tim Spector and Dr Chris Van Tulleken on ultra-high-processed foods and ultra-processed foods that are high in fat, sugar and salt, and their connection to poorer health, as well as of my interest in the subject. Will the cabinet secretary say a bit more about the actions that will be taken regarding the promotion of healthier foods and the restriction of less healthy foods in our supermarkets?
I recognise Emma Harper’s long-standing interest in this area and the work that she has done, as well as the work of the Health, Social Care and Sport Committee, which she sits on, to advance things in that area.
The regulations later this year will provide the full details, but at the centre of those regulations, we will set out where products can be located, how they can be promoted and to whom. As I said to Carol Mochan, we will also be aligning ourselves with the regulations that are in place in England and Wales, to ensure that there is consistency across these isles for those who are selling such products.
The documents land in the context of significant cuts to existing prevention services around the country. Through constituents in Glasgow alone, we learn of cuts to the Glasgow psychological trauma service, the Huntington’s disease specialist services, adult mental health services, Flourish house, the falls prevention programme, counselling at the Sandyford sexual health service, and breastfeeding support from the National Childbirth Trust. Does the cabinet secretary acknowledge that we are already losing successful prevention services as a result of how integration joint board decisions are being made? That will have a human and financial cost in the future. Does he acknowledge that the way that the IJB makes those decisions is democratically unaccountable and needs to change?
I recognise, as I did in my answer to Annie Wells, the fact that we have delivery agents with whom we need to work to make sure that decisions that are taken locally reflect the national policy direction that is set out in the documents. I also recognise that we need to continue to support local areas, as we are doing—our local authority partners received a record funding settlement, as did our health boards, this year; those are the funders of our health and social care partnerships.
I recognise that decisions are to be taken locally, but, in some of the areas that Patrick Harvie set out, they are not in keeping with what I have set out in relation to the population health or service renewal frameworks, or directed towards preventative areas of spending. That is why I will continue to work with local decision makers, as we have done in the development of the product through COSLA, to ensure that the importance of prevention is recognised.
Strategies and recovery plans such as these come and go, but the health and social care sector is still on its knees. Nowhere is that crisis more acute than in our remote, rural and island communities. However, the renewal document suggests that those communities will have to wait until year 9 before they can expect care that meets quality standards. All the while, mums will have to drive 100 miles down the A9, care homes in the Highlands will continue to close and care visits will be cut short because of travel time. Does the cabinet secretary really expect those communities to be happy to wait until 2034 for the care that we all expect now?
That is not what we have set out. We expect the framework to inform decision making from now on. The decision-making process that the service renewal framework and the population health framework set out is about taking those considerations into account. We will continue to work with our boards—including those that represent rural and island communities—to ensure that service parity is available.
I was born and brought up in an island community; I know what it is like to travel to receive services; I therefore recognise that, for some, travel will inevitably be needed. I want to ensure that that is done equitably, fairly and supportively, so that there will be a better situation for island communities such as the one that I am from, and for the communities that colleagues across parties represent—and a better system for the people of Scotland.
For a number of years, social care recruitment has been a challenge in the east of East Lothian—in particular, for the rural villages near Dunbar, Haddington and North Berwick. To build on care at home, what strategies will be in place to address the issue of the social care worker shortage in rural areas and villages such as Innerwick, Gifford and Gullane, in my constituency?
Clearly, we are aware of the challenges of recruiting staff in rural and island communities. Changing demographics and increased needs serve only to add to those challenges. The population health framework and the service renewal framework set out the key areas of reform and the principles that we will work to that will reduce pressures, increase opportunity, improve integration and transform how services are experienced by the workforce and those whom it supports.
What will not help us to attract and retain our workforce are the United Kingdom Government’s damaging policies on our social care staff. In that regard, I encourage it to think again.
Forced to deliver a £30 million budget cut, NHS Dumfries and Galloway is seeing a systematic dismantling of local health services. Cottage hospitals are being closed, maternity services are being shut, there is no hospice provision, and care home beds are in critically short supply, yet this Government claims that it wants to deliver on five principles of reform.
How does the closure of maternity services and cottage hospitals align with the second principle of people—designing care around individuals and empowering them to make their care decisions? How does it support the third principle of community—bringing services closer to home—when expectant mothers are forced to travel miles for basic care? How does it reflect the fourth principle of population—planning services based on local needs—when the needs of rural families in Galloway are being entirely ignored?
Is it not the case that this Government’s rhetoric on reform is completely at odds with lived experience—
Mr Carson, that is quite long—I think that the cabinet secretary has the gist of the three questions.
I well recognise the issues that Mr Carson raises. I engaged on them with his constituents when I was at the Dumfries and Galloway board annual review last year and when I met trade union colleagues in his area. I have also had meetings with him to discuss those matters.
The thread that runs through all that he has set out is patient safety. We rely on clinicians to advise us on ensuring that services remain safe. I recognise that a balance always needs to be struck between needing to travel and ensuring safe and timely access to services.
As I said, I am from an island community, so I recognise the need to travel for services and what that means, and the burden that it can have on individuals and their families. We want to make sure that such decisions are always taken in a proportionate manner that reflects the needs of those communities.
Three more members have requested to ask a question. I will take all three, but I need one brief question from each member and a brief answer.
I remind members of my entry in the register of members’ interests—I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
As the cabinet secretary outlined in his statement, we know that taking preventative action at any point of a person’s health or care needs can make a significant difference. Will he advise how Scottish Government investment is helping to expand targeted interventions across Scotland, particularly for cardiovascular disease and frailty prevention, and how the population health framework will complement those initiatives?
We have launched the cardiovascular disease risk factors programme to improve CVD outcomes, with an aim of reducing avoidable CVD deaths by 20 per cent in 20 years. We have established a new GP enhanced service from 2025-2026 to support 100,000 patients who are at risk of developing CVD. We will also bring forward funding for a frailty enhanced service. We are investing £4.5 million over three years to tackle type 2 diabetes.
The population health framework is a cross-Government, whole-society approach to creating health. We are using the totality of public expenditure and hard-wiring prevention into our systems—through planning, delivery, budgets and accountability—to reduce the demand that such issues can cause in our system.
The cabinet secretary has spoken about preventative spend. Does he agree that GPs can play a crucial role? I recently met Dr Robert Lockhart from Elgin, whom I think the cabinet secretary met on Friday. He discussed what they can do locally and nationally with more funding.
What percentage of the health budget is currently spent on general practice? What percentage does the cabinet secretary believe it should be to allow our GPs to deliver more?
I did, indeed, meet Dr Lockhart on Friday, and I was very pleased to do so. We had an informative discussion, including with the community council, which Mr Lochhead also took part in. The areas that relate to the latter part of Douglas Ross’s question are currently matters of discussion and negotiation with the British Medical Association. We are discussing how we can continue to support general practice and its sustainability, and how it can deliver more in our communities, as both Dr Lockhart and I want to see.
In his statement, the cabinet secretary talked about local government supporting health inequalities. Accessing information is critical, and having effective digital tools is vital. Partnership working and frameworks must be the goal, but how can they be achieved without major reforms taking place?
If Mr Stewart is asking me about reform within local government, that is not for today. However, the Convention of Scottish Local Authorities provided collaborative support for the two documents that have been published, so we are seeing a willingness on its part to engage and recognise the role that its members play as delivery agents for our national policy ambitions.
This is a shared endeavour of ambition; we want to see a step change and generational shift in the way that we deliver services and in the balance of care. I am confident that COSLA will continue to support us in that endeavour.
That concludes the ministerial statement.
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