Health and social care reform - year 1 progress report: population health and service renewal frameworks

5. Progress against the Health and Social Care Vision

5.1 Prevention

Vision value: Health and care is preventative, supports self-care, and partners work together to create good health.

5.1.1 Progress to date

A central focus of reform has been to shift the system towards prevention and earlier intervention, recognising that avoidable illness and inequality drive long-term pressure on services.

5.1.2 Key achievements include:

• Delivery of preventative budgeting pilots across Scottish Government portfolios and nine NHS Boards, with findings published in June 2026 (see below Spotlight section for more information). Nine local authorities are currently participating in a similar pilot alongside other public sector bodies;
• Development of a Health Lens approach for a national impact assessment process to strengthen ‘Health in All Policies’;
• Increasing accountability for prevention by supporting NHS Boards to become Population Health Organisations, shifting their focus from a predominantly treatment-focused service to one that works collaboratively with partners to improve population health, prevent ill health and reduce inequalities, while delivering sustainable, value-based care. Boards are currently completing maturity assessments with action plans expected by the end of 2026;
• Progressing local partnership working on prevention through the Collaboration for Health Equity. Working with three pilot areas, this has developed from diagnostic work informed by small-area data analysis to identify local priorities for targeted implementation – all driven by a focus on improving the wider determinants of health to reduce inequalities and improve population health outcomes. All areas and localities explore key indicators and their trends through the Population Health Dashboard hosted on the Scottish Public Health Observatory's Online Profiles tool;
• Community Planning Partnerships remain critical mechanisms for delivering improvements locally and continue to play a central, coordinating role in taking forward preventative activity. A series of Deep Dives has been underway since spring 2026 with three Community Planning Partnerships (Angus, East Lothian & South Lanarkshire) to explore barriers to meeting their duties regarding community planning;
• Implementation of obesity medicines prescribing pathways across six NHS Boards;
• Delivery of early interventions at scale including the national launch of the Type 2 Diabetes Remission Programme, roll‑out and strong uptake of the Cardiovascular Disease Directed Enhanced Service (see below Spotlight section for more information), and expansion of pharmacogenetics testing following stroke as part of secondary prevention;
• Regulations that restrict the promotion of foods high in fat, sugar or salt, intended to make the healthy choice the easier choice and to support reducing overweight and obesity, were agreed by Parliament in late 2025 and come into force in October 2026;
• Publication of the Alcohol and Drugs Strategic Plan (March 2026), alongside continued action on tobacco, vapes and gambling harm with £7.9 million allocated in 2026/27 for a range of projects designed to address gambling addiction;
• The Scottish Parliament supported the Tobacco and Vapes Act, which gained Royal Assent in April 2026. This UK-wide public health legislation is a landmark step towards tackling the single biggest preventable cause of illness, with over 7,000 premature deaths each year; and
• Partnership work led by Public Health Scotland, NHS Boards, Health and Social Care Partnerships (HSCPs) and the Scottish Government is progressing implementation of Scotland’s 5‑year Vaccination and Immunisation Framework (2025–2030), focusing on improving uptake, reducing inequalities and preventing illness.

Together, these actions signal a shift towards prevention being embedded not only within services, but across policy, funding and regulation.

See Annex A for a fuller range of updates against relevant PHF and SRF commitments on prevention.

5.1.3 Spotlight: Preventative budgeting

Preventative budgeting is a central element of the Public Service Reform (PSR) Strategy and the Health and Social Care Reform Portfolio, with the PHF committing to the development of new approaches to resource allocation that support prevention across health and other public services. This approach reflects a strategic shift in how we allocate public resources, moving from reactive, crisis-driven spending to early intervention and long-term prevention. This shift is essential for improving outcomes, addressing the root causes of demand, and ensuring the long-term fiscal sustainability of Scotland’s public services.

The PSR Strategy recognises that real reform means addressing problems at their root. This means prevention must be at the heart of how we plan, budget and invest across the public sector. This work builds on the significant Budget investments addressing the drivers of health and wellbeing - £111 million on tackling child poverty, including increases to the Scottish Child Payment; an additional £40 million investment in sport and physical activity; and over £160 million to support the Alcohol and Drugs Strategic Plan published in March 2026.

In the past year, we have delivered preventative budgeting pilots across Scottish Government portfolios and with nine NHS Boards. Similar pilots are currently underway in nine local authorities. Findings from the Scottish Government and NHS pilots were published in a report in June 2026 and revised guidance and tools are now being used to inform a wider process to estimate preventative investment across the entire Scottish Budget. The aim is to complete a full tagging of the 2025-26 Scottish Budget later this year, with a view to integrating preventative investment reporting into the annual cycle by the end of 2026. An HSC Reform Preventative Investment Advisory Group has been established to build on the pilot outputs, explore how cross-cutting prevention issues are considered in funding decisions and generate insights on how preventative investment can be embedded more effectively.

5.1.4 Spotlight: Cardiovascular Disease

The Cardiovascular Disease (CVD) Risk Factor Programme was established by the Scottish Government to help prevent heart disease and improve both life expectancy and healthy life expectancy in Scotland.

A key aim is to reduce health inequalities by identifying and supporting people at higher risk, particularly those living in more deprived areas or less likely to access routine care.

In its first year, evaluation focused on how the Directed Enhanced Service (DES) was introduced and what early progress was made. This part of the programme received almost £10 million of funding and is a key NHS Scotland commitment. The DES encourages GP practices to reach patients who have not had recent checks for five main modifiable CVD risk factors, with a strong focus on those most at risk.

In the year to March 2026 over 122,000 patients were tested for cardiovascular disease risks, with more than 85,000 people clinically reviewed and given lifestyle advice as a result. More than 13,000 people were identified as being at increased risk and offered preventative treatment, nearly half of those at highest risk were living in the most deprived areas, and a further £10 million has been invested this year to expand the programme.

GP surveys, interviews with around 30 practices, case studies, and patient and third sector engagement are also being used to understand how the DES is working in practice. A full progress to date evaluation report will be published later in Autumn 2026, and its findings will help shape the future development and funding of the programme.

The Scottish Government is also working in partnership with Chest Heart and Stroke Scotland to deliver MOT-style Healthy Heart and Lung Checks in the community. These community lifestyle focused checks provide an additional support for prevention and early intervention, alongside the existing CVD Directed Enhanced Service.

5.2 Access

Vision value: Health and care is accessible, seamless and equitable.

5.2.1 Progress to date

To improve access focus has been on reducing unwarranted variation, improving equity and shifting care closer to home.

5.2.2 Key achievements include:

• The Primary Care and Community Route Map has been drafted and is currently being aligned with the Improving Flow Plan and the Community First Approach. Developed through extensive collaboration with partners across health and community care, the Route Map provides a strategic delivery plan for improving access, strengthening community-based services and supporting the shift of delivering health care closer to home, whilst focusing on prevention and early intervention. Publication is expected in Autumn 2026;
• Strengthened integration and planning through updated guidance for the Joint Strategic Needs Assessment and development of a national minimum dataset to improve understanding of current and future health and social care needs;
• Improved coordination across regions through the establishment of Scotland East and Scotland West sub-national planning structures for specified health services (see below Spotlight section for more information);
• Supported access through hospital redesign and increased investment to expand Hospital at Home with over 7,500 patients treated via the programme between February to April 2026;
• Progress is being made on GP digital telephony to ensure digital access does not widen inequalities;
• Improved digital access through the launch of MyCare.scot as a digital front door with early rollout to outpatient cohorts. Further work is underway to develop capabilities to enable earlier, more seamless and timelier engagement with social care and social work services;
• Exploring the use of Community Health Index (CHI) number and its potential as a common identifier across health, social work and social care services by taking forward the discovery phase of the CHI in Local Government programme. The programme is a collaboration between COSLA, the Digital Office for Local Government and Public Health Scotland;
• With the work underway on the Digital Health and Care Record, this has the potential to improve health and social care integration through more joined-up services, reducing duplication and the need for people to repeat information multiple times;
• Improving access to financial support through establishing a baseline of income maximisation pathway delivery within Maternity, Health Visiting and Family Nurse Partnership services; and
• Aligned to the SRF’s priorities on the redesign of hospitals, the Scottish Government have now delivered the Health and Care Improving Flow Plan, which will deliver one connected system providing simple routes to access care as quickly as possible. This means more efficient use of resources across Scotland, freeing up more time and capacity for treatment, and improving patient experience through more joined up care.

Together, these actions signal a shift towards improving access to health and care services as well as the factors that support the building blocks of health. See Annex A for a fuller range of updates against relevant PHF and SRF commitments on access to health and care.

5.2.3 Spotlight: Sub-national planning structures

A key principle of the SRF is population-based planning, whereby services are planned and delivered according to the demand and need for particular services and treatments across Scotland, rather than being constrained by organisational boundaries. This requires greater collaboration between NHS Boards and therefore the SRF committed to undertake a review of governance and decision-making for population-based planning.

Arising from this, the Scottish Government has now established new sub-national planning structures which bring NHS Boards together within two collaborative planning structures: Scotland East and Scotland West Strategic Planning and Delivery Committees. Building on existing collaborative working between NHS Boards, these arrangements ensure a coordinated approach to designing and delivering services across larger populations while retaining local accountability for service delivery. In the first year, they have focused on delivery of the key priorities of planned care waiting times (with a particular focus on orthopaedics), emergency healthcare services; a ‘Once for Scotland’ approach to business Systems and implementation of the MyCare.scot service.

During Year 1, Scotland East and Scotland West Strategic Planning and Delivery Committees became operational and are now leading on the planning and delivery of these priority areas, marking a substantial shift away from individual Board level planning to one which ensures that services are planned at a scale that supports consistency, safety and value. This provides a new mechanism for delivering health reform at scale and establishes a foundation for longer-term service redesign across the NHS.

5.2.4 Spotlight: Launch of MyCare.scot

MyCare.scot became available nationally in April 2026, marking a significant milestone in Scotland’s digital transformation journey. From June 2026, the service became available as a free downloadable app, providing people across Scotland with access to information about their medications, vaccination status, allergies and local health and care services through a single digital platform.

The launch of MyCare.scot delivers the first iteration of the SRF’s Digital Front Door ambition, taken forward jointly by Scottish Government and COSLA, in partnership with support from Public Services Delivery Scotland and Local Government Digital Office. It represents an important step towards more person-led, digitally enabled health and social care services. By providing easier access to trusted health and care information, the service aims to improve people’s experience of accessing support, help individuals take a more active role in managing their health and wellbeing, and make it easier to navigate health and care services.

MyCare.scot forms the foundation of a future integrated digital health and care service. Future enhancements will progressively introduce additional functionality, including appointments, digital communications, prescription services and greater integration with health, social work and social care services. This will support a more joined-up and personalised experience for people accessing services across Scotland.

The service is a key component of wider health and social care reform, supporting the shift towards digital-first services where appropriate, improving access to information and helping people exercise greater choice and control over their own care. Alongside wider investment in digital inclusion, digital infrastructure and the development of a Digital Health and Care Record, MyCare.scot helps establish the basis for a more connected, responsive and person-led health and care system.

5.3 Quality

Vision value: Health and care is high quality, effective, sustainable and good value.

5.3.1 Progress to date

Quality improvements have focused on strengthening system reliability, safety and long‑term sustainability.

5.3.2 Key achievements include:

• Integration of quality services through the establishment of Public Services Delivery (PSD) Scotland, bringing together two high performing organisations and providing services using a ‘Once for Scotland’ approach (see below Spotlight section for more information);
• Strengthening collaborative planning through establishing Scotland East and Scotland West sub-national planning structures supporting more coordinated service design and delivery (as noted in 5.2 Access achievements);
• Evidence based planning through delivery and progression of clinical Strategic Needs Assessments across several priority services, including vascular care and diagnostics and development of early Target Operating Models;
• Improving health protection and prevention of avoidable harm through the establishment of the Scottish Pandemic Sciences Partnership, strengthening national capability to respond to emerging infectious threats and continued delivery of vaccination and screening programmes; and
• Improving quality through digital innovation with significant progress transitioning to digital healthcare.

Together, these actions signal a shift towards integration of services to improve the coordination of delivery. See Annex A for a fuller range of updates against relevant PHF and SRF commitments on the quality of health and care.

5.3.3 Spotlight: Establishment of Public Services Delivery (PSD) Scotland

Public Services Delivery Scotland (PSD Scotland), originally proposed as ‘NHS Delivery’ in the SRF, was established on 1 April 2026 as a new national organisation bringing together NHS Education for Scotland (NES) and NHS National Services Scotland (NSS) into a single national organisation. This delivered the SRF commitment to create a single national delivery organisation, supporting a more consistent ‘Once for Scotland’ approach to delivering national services and support across health and social care.

The creation of PSD Scotland represents one of the most significant organisational reforms delivered through the SRF. By bringing together workforce planning and development, education, digital services, national infrastructure, procurement and improvement functions within a single organisation, PSD Scotland provides a clearer line of accountability and greater opportunities for collaboration, consistency and service improvement.

Karen Reid, formerly Chief Executive of NES, was appointed as the first Chief Executive of PSD Scotland, providing leadership for the new organisation as it begins its next phase of delivery and transformation. More than 3,000 staff transferred into the new organisation as part of a complex transition programme. Throughout the process, continuity of critical national services and support functions was maintained, ensuring minimal disruption across the health and care system.

A key strength of the programme was the collaborative approach taken across Scottish Government, NSS, NES, staff representatives and subject matter experts from a wide range of professional disciplines. This partnership approach helped ensure legislative, workforce, digital, financial and operational requirements were managed in a coordinated way, providing a stable foundation for the new organisation.

PSD Scotland will play a key role in supporting wider health and social care reform through national leadership of workforce development, digital transformation and service improvement. Establishing the organisation creates a strong platform for future reform, innovation and modernisation, helping partners work more effectively together to improve outcomes for people across Scotland.

5.4 Person-led

Vision value: Health and care is responsive, respects individual needs and delivers outcomes that matter to people.

5.4.1 Progress to date

Reform has increasingly focused on people’s rights, experience and voice.

5.4.2 Key achievements include:

• Strengthening the public’s understanding and awareness of their rights and entitlements through the publication of the National Care Service Charter of Rights in March 2026. Co-designed with more than 700 people, the Charter provides accessible information about existing rights and supports more informed, rights-based decision making;
• Embedding person-led approaches through continued development of Getting It Right For Everyone (GIRFE) and Team Around the Person, expansion of social prescribing and community-based wellbeing approaches as well as publishing a measurement framework for the Value Based Health and Care Action Plan in March 2026; and
• Supporting choice and participation through digital inclusion by delivering a national digital inclusion programme, supporting access to digital health and care service, and ongoing development of MyCare.scot.

Together, these actions signal a shift towards supporting people’s rights and embedding person-led approaches. See Annex A for a fuller range of updates against relevant PHF and SRF commitments on person-led care.