Health and Social Care Service Renewal Framework

Executive Summary

The Health and Social Care Service Renewal Framework (SRF) will help us achieve our vision for health and social care - a ‘Scotland where people live longer, healthier, and more fulfilling lives’. It comes at a time of significant financial challenges for health and social care, and at a time when we expect demand for services to continue to increase, driven in part by Scotland’s changing demography.^[2]

This Framework provides a high-level guide for change, to ensure the sustainability, efficiency, quality, and accessibility of health and social care services in Scotland. Importantly, the SRF builds on the Operational Improvement Plan (OIP) and Population Health Framework (PHF). The SRF sustains and builds on the immediate improvements set out in the OIP, and it maximises the contribution health and social care services can make to improve population health as described in the PHF.

What the Service Renewal Framework means for people

Implementing the changes set out in this Framework will bring significant, positive improvements to how people in Scotland experience health and social care. Over the next ten years, people can expect faster and fairer access to care, with a particular focus on reducing long waits for planned treatment. By expanding capacity in primary and community healthcare, the SRF will help ensure that more people receive the right care, in the right place, at the right time.

Care will be more ‘people-led’, with greater emphasis on choice and control. Timely access will be more firmly embedded across care and support services. People will be empowered to be more in charge of their care, and they will be supported to manage their self-care. More ‘specialist’ clinical care, such as optometry, will be available in local settings, helping to reduce pressure on hospitals and shorten waiting times for more complex care. People will also have improved digital access to information about their own health and care, be able to record information that matters to them, and be able to use digital tools to manage how they interact with the services they use (such as booking appointments). This will further streamline their care journey and reduce some of the frustrations we know people have around how their care is coordinated.

What the Service Renewal Framework means for the workforce

For the workforce, the transformation outlined in this Framework will bring new opportunities to deliver care more effectively and efficiently. Staff will be supported to work in more collaborative, flexible ways across territorial and organisational boundaries. It will mean working more with people as partners in their care and having improved access to information about the people they support. Staff and their representatives will play a key role in shaping and developing services and to support individuals to manage their own care, which in turn will reduce demand on acute services.

Our NHS Boards and Integration Authorities will be empowered and held accountable for collaborating on planning and delivering services within the principles of this Framework. That will mean planning at a national, sub-national^[3] and local level, working closely with the Scottish Government, partners in Local Government, wider stakeholders and service providers to make change. This work will be progressed by optimising the use of data and drawing on the evidence of what improves outcomes for people. The Framework will also promote an environment in which health and social care system leaders will be authorised and supported to help create the changes necessary to realise our vision.

Principles and Changes

This Framework sets out five key principles for renewal:

1. Prevention Principle: Prevention across the continuum of care

2. People Principle: Care designed around people rather than the ‘system’ or ‘services’

3. Community Principle: More care in the community rather than a hospital-focused model

4. Population Principle: Population planning, rather than along boundaries

5. Digital Principle: Reflecting societal expectations and system needs

These principles provide an evidence-based and value-driven foundation from which to plan, make decisions, and deliver change.

The Framework also sets out major areas for change, which will deliver on the intentions behind these principles so that they become a reality. These include:

• Enhancing services that prevent disease, enable early detection and effectively manage long-term conditions.
• Delivering health and social care that is people-led and ‘Value Based’.^[4]
• Strengthening integration across the system.
• Improving access to services and treatments in the community.
• Redesigning our hospitals as we deliver more care within communities.
• Delivering services which are accessible through digital technologies, with people and our workforce able to access and make use of the right information.

To support service renewal, we will need to adapt how we use our resources. Our focus will remain on enhancing efficiency and productivity, applying the Once for Scotland approach—an ethos of national consistency in policy and practice that ensures services are designed and delivered in a unified, streamlined way across the country. This helps avoid duplication, reduce variation, and maximise value across people, finances, and infrastructure. Improving access to services and treatments in communities will also mean using those resources differently, with more of them deployed over time in primary care and community settings.

We acknowledge Audit Scotland’s recent report on governance of NHS Scotland and will continue to build robust and clear governance arrangements to support the scale of reform required. We are committed to ensuring that NHS Scotland remains sustainable, accountable, and fit for the future. This Framework is a central part of our response to the challenges highlighted in the report.

We will work collaboratively with system leaders to progress the development of national, sub-national and local population plans, which will reflect the Population principle set out in this Framework.^[5] We will maximise the use of existing mechanisms such as Community Planning Partnerships to drive collaborative leadership and planning. We will review current accountability frameworks to ensure transparent, effective governance and decision-making. This will lead to more responsive services, better use of resources, and improved outcomes for people. In doing so, we will deliver care that is safer, fairer and more aligned with people’s needs.

We will develop performance management systems with an increasing focus on outcomes, place^[6], and person-centred and whole system views.

Recognising the mixed market of providers for health and social care, we will also work with partners across the public, third and independent sectors to strengthen strategic, financial and workforce planning. This is to ensure the workforce is shaped to deliver services that are planned and designed in accordance with this Framework.

A Phased Approach to Delivering Long-term Change

This Framework sets out a long-term strategic intent to renew health and social care services, supported by a series of milestones structured around a ‘three horizon’ model. These horizons provide a roadmap for achieving the Year 10 objectives.

We have identified a set of specific, realistic actions for the first five years, with a particular focus on Year 1, where detailed planning has already been completed. These early actions lay the groundwork for transformation and allow us to make tangible progress.

For the period beyond Year 5, we have not yet defined detailed actions. This is deliberate. Further changes will be shaped by:

• Evidence of progress made in the early years,
• Ongoing engagement with delivery partners, and
• Evolving population needs and system pressures.

This approach ensures the Framework remains flexible, evidence-informed, and responsive, while keeping a clear focus on long-term outcomes we aim to achieve by Year 10.