Health and Care Improving Flow Plan 2026 - 2031

4. Why Change is Needed

Scotland's health and care services are a source of national pride. Every day, staff, carers, volunteers, communities and partner organisations provide compassionate, high-quality support to people across the country. However, the environment in which services operate is changing rapidly, and reform is essential to ensure they can continue to meet your needs in the future.

Changing Needs and Growing Demand

Scotland's population is ageing, and more people are living longer with multiple long-term conditions, frailty, mental health needs and increasingly complex care requirements. As demand grows, people need help from an increasing range of services in their lives. At the same time, you rightly expect care that is timely, coordinated and centred around your needs.

Yet too often services are organised around organisations rather than people. This can result in delays, fragmented care, repeated assessments and you moving between different parts of the system before you receive the support you need.

A Different Model of Care

Hospitals will always play a vital role in responding to life-threatening emergencies, treating serious illness and complex conditions, but they cannot meet rising demand on their own. Many people can safely receive care closer to home, in their communities, or through digital services. For older people, those living with long-term conditions, complex needs or frailty, this often leads to better outcomes and a better experience of care.

Reform is therefore about creating a more connected system that supports you earlier, prevents avoidable crises and ensures care is delivered in the right place, at the right time.

Pressures on the Current System

The need for change can be seen across the health and care system today:

• People are waiting too long for urgent and unscheduled care.
• Emergency Departments and ambulance services are under significant pressure.
• Hospitals often operate at very high occupancy levels.
• Too many people remain in hospital after they are clinically ready to leave.
• Staff spend valuable time managing system pressures rather than providing direct care.
• Access, experience and outcomes can vary according to people's circumstances and where they live.

These challenges affect patients, families, carers and staff every day and the current way of delivering care is not sustainable without reform.

Building a Sustainable Future

Health and social care services also face significant financial, workforce and operational pressures. Meeting future demand will require a greater focus on prevention, early intervention, community-based support, digital innovation and new models of care that help you access support sooner and in the right place.

Across Scotland, examples such as Hospital at Home services, integrated community teams and improved discharge planning are already demonstrating that better, more person-centred care is possible. We must now work to make these improvements available consistently across the country.

Improving flow is about creating a health and care system that is easier to access, better connected, more equitable and sustainable, and capable of delivering high-quality care for future generations.

Whole-System Collaboration

Improving flow cannot be achieved solely through changes within hospitals but requires a whole-system response that supports you earlier, closer to your home and in more appropriate settings.

We recognise that transforming urgent and unscheduled care will require sustained collaboration across health, social care, local government, emergency services, the third sector, independent providers, professional bodies, staff representatives and people who use services.

We will therefore continue to engage widely with stakeholders as we implement this Plan, using evidence, learning and lived experience to further develop our approach. Through this ongoing partnership, we will refine and strengthen our plans, ensuring that future actions reflect your needs, the needs of our staff and of our communities, while supporting the delivery of a more sustainable, person-centred and responsive urgent and unscheduled care system.