Vision for health and social care: Health Secretary speech

Health Secretary Neil Gray's opening speech to Scottish Parliament on 4 June 2024.

Thank you very much indeed Presiding Officer.

We have reached a critical point in our country’s health, we are seeing growing demand upon our health and social care services that needs addressed alongside an improvement in service performance.

The growing demand based on our poor population health which both reduces the wellbeing of Scotland and impacts on the sustainability of our services.

This Government is clear that the NHS in Scotland, and the values that underpin its work, is an institution of national pride.

And I also recognise the vital role of the social care system in supporting people to manage their health within their communities to live well.

The principles of a health service for everyone, owned by the people, and free at the point of delivery, are sacrosanct.

Let me be clear that any consideration of abandoning those fundamental values lies beyond a red line that we will not cross.

However, while those principles will not change, Scotland itself has changed.

The NHS was established 76 years ago to address the health challenges of its time.

Now, we live longer, medicines can do much more, technology has transformed the way we live, and our lifestyles have changed. And the treatment of people in hospitals when they are ill is only a small part of modern healthcare.

And while this Government is making progress in addressing the challenges of waiting lists, our health and social care services are hard pressed to meet service demand.

So today I seek to open a debate of openness, and in good faith, on how we can reform and improve our health services, and how we can collectively deliver a transformed system fit for the health challenges we face.

Presiding Officer, I am a pragmatist.

We have a clear vision for the direction of reform, which I will shortly outline, and a programme of improvements is already underway.

But I am willing also to consider fresh ideas. I am here today asking this Chamber to consider how together we can 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 which will guide our work.

This vision is one with which no one here could argue: a Scotland where people live longer, healthy and fulfilling lives.

This 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, with all of these 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 we can within our current arrangements, and in the medium term, we need to begin to transform how we work.

And 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, driving investment in prevention and early intervention.

Because our vision also reveals the complexity of the task before us: without improving our nation’s general health, no end of service improvements or 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.

This will be underpinned by the principles of accessibility, addressing health inequalities, maximising outcomes, and promoting innovation as well as value for money.

In urgent and unscheduled care, a lot has already been done, 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 patients receive personalised care.

We also need to look at the long-term reforms that are going to be required.

We are developing a Population Health Framework, taking a cross-government, cross-sector approach to improve the key building blocks of health.

We also must recognise the vital role of social care, and unpaid carers, supporting people to remain in their own homes for longer.

And this is a cross govt preventative approach.

We are supporting low income households, delivering the Scottish Child Payment, delivering Best Start Bright Futures to tackle child poverty, and expanding free school meals.

We will continue minimum unit pricing and to take forward radical action to reduce the harm caused by smoking.

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

Our service reforms must take a whole system approach, including social care and the planned National Care Service.

Primary Care, the crucial bedrock of the NHS and the key to driving sustainable, effective, good value for money healthcare, has a well-established collaborative programme of reform and improvement already underway.

Primary Care reform is focused around seeing the right person, in the right time, in the right place; and is key to realising a community first approach.

So improving access to primary care and shifting care to the community is and must be a key focus of reform.

This includes our NHS dental payment reform, free universal NHS-funded eye examinations, our NHS Pharmacy First service – signposting people with common conditions to local pharmacies for advice and treatment.

To support general practice, we have significantly expanded the primary care multi-disciplinary team workforce, with over 4,700 staff working in services including physiotherapy, pharmacy and phlebotomy.

We are supporting development of these teams through investment of £190m in the Primary Care Improvement Fund this year, as well as continuing to support practice learning time.

There are ongoing issues we need to continue to address.

People whose discharge from hospital is delayed are not receiving the best care that they need, and this can have significant consequences for them as well as the entire system.

We have already put in place the Delayed Discharge and Hospital Occupancy Action Plan to help create necessary capacity.

But we still need to improve the flow of patients through our hospitals and will work closely with all stakeholders to achieve this.

In 2021 the Independent Review of Adult Social Care showed the clear need for change, recommending a reform of social care in Scotland and strengthening national accountability for social care support.

The National Care Service 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.

People are at the heart of this reform – ending the inconsistency of care provision across Scotland, ensuring those who need it have access to consistently high-quality care and support and instilling Fair Work principles for our workforce.

Reform is also taking place within our mental health services, which we will continue to invest in, and will shortly see the publication of the Delivery Plan for the new Mental Health and Capacity Reform Programme.

This is the first important step in ensuring that the law, and our policies and practices ensure that anyone who requires support is treated fairly and with dignity.

This is just one aspect of our work to improve mental health support at all levels and we will continue to work closely with COLSA, health boards and other partners to implement the delivery plans we published last year.

Our valued healthcare workforce is of course a key part to our vision for reform.

In addition to the ongoing implementation of Agenda for Change, we are working with the BMA on junior doctor contract reform, and we have launched the Ministerial Taskforce on Nursing and Midwifery, which covers attraction, education and training, retention and staff wellbeing.

The Health and Care (Staffing) (Scotland) Act 2019, introduced in April, is the first comprehensive, multi-disciplinary, workforce planning legislation in Scotland – the most comprehensive of its kind in the UK.

And we have recognised the vital role of the social care workforce, with a pay uplift to £12 per hour for adult social care workers in commissioned services.

Alongside that support for the workforce wellbeing productivity into service, our reforms can and must be accelerated and enriched by the transformative potential of scientific innovation.

Last week, the Deputy First Minister and I co-chaired a roundtable on game-changing technologies.

The event brought together key leaders from the life science industry as well as academics, the NHS and Government, to discuss advances in science and technology that can transform lives and the implementation of service.

Medical research is moving faster than ever, and new preventative technologies are supporting people to better manage their own health better and prevent and mitigate disease.

Wearable devices are helping people to take ownership over their own health, while new diagnostic and screening methods can support the NHS identify and treat disease before symptoms appear.

There is a huge future potential in personalised and precision medicine and gene therapies as well as robotic surgery.

So we will proceed with a new partnership based between Government, the NHS, our academic institutions, and the life sciences industry, focused on seizing opportunities to empower patients, liberate clinicians, drive efficiencies, and prevent ill health.

And I am pleased today to announce that five Scottish institutions – the Universities of Aberdeen, Edinburgh, St Andrews and Strathclyde, as well as Public Health Scotland, have been awarded £1 million of funding each through the Chief Scientist Office to conduct major research programmes into areas of population health in Scotland.

The five programmes awarded funding have the potential to make a significant impact.

So Presiding Officer, I am aware there are voices in this Chamber who have already called for structural change but I think the urgency of the change required and the focus must be on the transformation of services
services within the current structures and maximising current assets.

So I will work to implement an NHS Scotland approach, to harness greater levels of collaboration in our health boards and partners, resulting in better value, quality, and outcomes for patients and staff.

And that will be led through a government-led national engagement which we must make sure we are fully committed to the series of engagement which will inform our plans, led through a person-centred approach but obviously making sure we utilise the incredible work of our workforce.

We have established a Primary and Community Health Steering Group, bringing together a range of stakeholders partners.

And an Expert Reference Group will be convened this autumn, providing independent input, advice and an additional independent international perspective.

A Stakeholder Advisory Group will also bring together a cross-section of professional associations, COSLA, the ALLIANCE, regulators and others in service delivery. I look forward to hearing directly from them to translate the vision into delivery across the system.

We will also listen to all voices and by the end of the year, I hope to have brought them to bear on the actions we take.

In conclusion, Presiding Officer, there is no more important issue to a nation than the health of its people.

I am not looking to publish another strategy. Our work is already being guided by multiple plans, notably the National Clinical Strategy of 2016.

Our task now centres on listening, and delivery.

So I am pleased and privileged to open this debate today and welcome all contributions and move the motion in my name.


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