Hansard

There are areas that we should develop in the details of the service delivery that we can achieve, such as the one that Pam Duncan-Glancy mentions. That is why I want the debate: so that we can take forward the ideas that we think can help on prevention, improve our population health and improve our public health measures.

I am willing to consider fresh ideas. I am here today asking the Parliament to consider how we can work together to seize the opportunity to reform health and social care for present and future generations. I have already outlined to my Cabinet colleagues an overarching vision that will guide our work. I believe that no one here could argue with a vision of a Scotland where people live longer, healthy and fulfilling lives.

That vision is supported by four key areas of work: improving population health; a focus on prevention and early intervention; providing quality services; and maximising access. All those areas are underpinned by giving due consideration to the people at the heart of those services.

In the short term, we must ensure that our services are delivered in the best way that we can within our current arrangements. In the medium term, we need to begin to transform how we work. We must keep our eyes on the horizon because, in the longer term, we also need to fundamentally change how we think about the delivery of health and care by driving investment in prevention and early intervention.

Our vision also reveals the complexity of the task that is before us. If we do not improve our nation’s general health, no service improvements, clinical strategies or refined operating models will be able to make us a healthier nation in the long run. That is why prevention is key. We want to shift the balance of care closer to people’s homes and drive a proactive approach of early intervention and prevention. That will be underpinned by the principles of accessibility, addressing health inequalities, maximising outcomes and promoting innovation, as well as value for money.

A lot has already been done in urgent and unscheduled care, working with the Scottish Ambulance Service, NHS 24 and through the creation of flow navigation centres, to manage demand. Our continued investment in hospital at home will help to increase the provision of acute care at home and ensure that patients receive personalised care.

We also need to look at the long-term reforms that will be required. We are developing a population health framework, taking a cross-Government and cross-sector approach to improving the key building blocks of health.

We must also recognise the vital role of social care and unpaid carers in supporting people to remain in their own homes for longer. That is a cross-Government preventative approach. We are supporting low-income households, delivering the Scottish child payment, delivering the “Best Start, Bright Futures” plan to tackle child poverty and expanding free school meals. We will continue minimum unit pricing and take radical action to reduce the harm that is caused by smoking.

I am also clear that, as a nation, we all need to take personal responsibility and do what we can to mind our own health by paying due attention to nutrition, our mental health and exercise, whatever form it may take.

Our service reforms must take a whole-system approach, including social care and the planned national care service. Primary care, which is the crucial bedrock of the NHS and the key to driving sustainable, effective and good value-for-money healthcare, has a well-established collaborative programme of reform and improvement already under way. Primary care reform is focused on seeing the right person at the right time in the right place and is key to realising a community-first approach. Improving access to primary care and shifting care to the community is and must be a key focus of reform. That includes our NHS dental payment reform, free universal NHS-funded eye examinations, our NHS pharmacy first service and signposting people who have common conditions to local pharmacies for advice and treatment.

To support general practice, we have significantly expanded the primary care multidisciplinary team workforce, with more than 4,700 staff working in services including physiotherapy, pharmacy and phlebotomy. We are supporting development of those teams through investment of £190 million in the primary care improvement fund this year, as well as continuing to support practice learning time.

There are on-going issues that we need to continue to address. People whose discharge from hospital is delayed are not receiving the best care that they need, and that can have significant consequences for them as well as for the entire system. We have already put in place the delayed discharge and hospital occupancy action plan to help to create the necessary capacity, but we still need to improve the flow of patients through our hospitals, and we will work closely with all stakeholders to achieve that.

In 2021, the independent review of adult social care showed the clear need for change and recommended the reform of social care in Scotland and the strengthening of national accountability for social care support. The National Care Service (Scotland) Bill, which will ensure greater transparency in the delivery of community health and social care, improve standards, strengthen the role of the workforce and provide better support for unpaid carers, is the biggest public sector reform since devolution.

We will put people at the heart of reform, ending the inconsistencies in care provision across Scotland, ensuring that those who need it have access to consistently high-quality care and support and embedding fair work principles for our workforce.

Reform is also taking place within our mental health services, which we will continue investing in. We will shortly publish the delivery plan for the new mental health and capacity reform programme, which will be the first important step in making sure that the law, our policies and our practices will ensure that anyone who requires support is treated fairly and with dignity. That is just one aspect of our work to improve mental health support at all levels and we will continue working closely with the Convention of Scottish Local Authorities, health boards and other partners to implement the delivery plans that we published last year.

Our valued healthcare workforce is a key part of our vision for reform. In addition to the on-going implementation of agenda for change, we are working with the British Medical Association on reform of junior doctors’ contracts and have launched a ministerial task force on nursing and midwifery, with a remit that covers attraction, education and training, retention and staff wellbeing.