Health and Social Care Service Renewal Framework

2. Impact of Service Renewal for People and the Workforce

Our key priority in implementing this Framework is to have a positive impact on people and on the workforce.

Impact for People

A shared aim of the Population Health Framework (PHF) and this Framework is to reduce health inequalities by ensuring that services are designed and delivered in ways that are inclusive, equitable, and responsive to the needs of all communities. This includes targeted support for those who face the greatest barriers to accessing care, whether due to geography, socio-economic status, disability, ethnicity, or other factors. Success in these Frameworks will result in people accessing care more quickly and on a more equitable basis.

People will experience more joined up, integrated care with a greater focus on prevention and early intervention. They will also be more in charge of how this care is delivered, participating in shared decision-making to make informed choices about the treatment and care that is right for them. The public will also inform the wider design and delivery of the reforms presented in this Framework.

In the future, more treatment and care will be available in local communities or, through better use of technology, including through supported care at home. Our acute hospitals will still play a vital role, but this means fewer people will need to go to hospital, unless it is for something that cannot be treated elsewhere, like major surgery or complex treatment and care. Thanks to new ways of working, including mobile healthcare teams and digital tools, treatments like intra-venous (IV) antibiotics can now be safely given at home or in nearby community clinics - whether you live in a town, a rural village, or an island. If someone does need to go into hospital, they will be supported to get home as soon as they are ready, with strong follow-up care and rehabilitation to help them recover well in familiar surroundings.

If someone needs to go to hospital, the type of hospital they attend will depend on the kind of care they need. Most routine treatments can be provided at a local hospital, close to home. But for more complex or specialist care, they might need to go to a hospital that is a bit further away to make sure they get the right support. This is already how many specialist services are delivered, ensuring people receive the best possible care from the most experienced teams. While this may mean some changes in how people access services, they can feel confident that their care will be delivered in the right place, by the right team, to give them the best possible outcome.

People’s ‘core front door’ in-person health services, such as their GP and community pharmacy, will have increased capacity and a strengthened role in the system. People can therefore expect greater access to these services when they need them. Furthermore, multi-disciplinary health and social care teams from hospital to home will work together to wrap around the person and their needs, removing the need for people to navigate multiple teams.

Defined core services and delivery models will ensure equitable access for people living in remote, rural, and island areas. Planning will reflect local needs and ensure consistency in service availability.

People will be offered the choice to access information and services digitally, where appropriate, in an inclusive manner. As our digital and data transformation becomes embedded, digital engagement with health and social care services will increase. This will include, for example, a growing proportion of interactions being via digital services where appropriate. This will include people being able to use their health and care record on their own phone, record their preferences, request checks, manage their condition, coordinate their appointments, access their prescriptions, see diagnostic results, access personalised preventative support and share information with their healthcare professional via our Digital Front Door service.

Those professionals supporting the person will have all the right digital access and information they need to do the best job. Digital and data technologies will enable significant change in our services with personalised and individual shared care plans being accessed and used by staff as the norm. Changes in artificial intelligence (AI), genomics, diagnostic testing and personalised medicine will further accelerate these changes with earlier and faster diagnosis of conditions. We will also aim to share data beyond the health and social care sector, supporting wider public sector reform (for example, to make sure people can easily access benefits they are entitled to).

Impact for the Workforce

The greatest asset of our health and social care system is our dedicated, diverse and highly skilled workforce. The changes that we need to make cannot happen without them. Positive working cultures and excellent staff wellbeing are crucial to the delivery of sustainable change. We want our health and social care services to be a working environment where everyone has the opportunity for an engaging and rewarding career, and where our teams are encouraged to break down boundaries, contribute ideas and drive innovative solutions to improve our health and social care system. As we take forward implementation of this Framework, we will work closely with the workforce and their supporting structures and representative bodies, including professional, regulatory and trade unions, to shape our approach.

As employers and contract holders with primary care providers, NHS Boards will work through their partnership structures and with partner employers to ensure that the workforce are ready for these changes and feel confident in their skills and ability to work in new ways.

We also recognise the invaluable role of the workforce that is employed through Local Government, the third sector, and independent care sector. All have distinct but vital roles in supporting people to live healthy, fulfilling lives. We will continue to work with partners to improve the experience of the workforce, including through progressing and embedding fair work principles across the health and social care sector.

Knowledge, skills and development will be considered to ensure that the current and future workforce are equipped for the new ways of working needed for the renewal of health and social care services.

Aligned with the People Principle (see Section 3), we want all of our workforce to work with people and patients as partners in their care, with people increasingly leading their own care plan. This requires a rebalancing of power, and a shift for how the workforce and people and patients work together. A larger proportion of the health workforce will work in community settings alongside existing community-based health and social care services. Our health, social work and social care workforce will more often work in multi-disciplinary teams, aiming to meet most care needs in the community, wherever possible and appropriate. Whole system education and training will be developed to support these changes, including developing awareness of the different roles which support people’s health and care across the system.

Our workforce will be deployed differently in the future to achieve improved outcomes for the people of Scotland. We will work with partners to strengthen workforce planning to deliver services that are planned and designed based on population needs, aligned with the Population principle. We will ensure the workforce is at the heart of this decision making and is consulted throughout planning. The workforce will continue to be able to make their career choices based on their individual aspirations and we will seek to facilitate choices to work in different settings and across geographic and service boundaries. This includes increasing the supply of affordable homes in our rural and island communities through our Rural and islands housing action plan, and the £25 million Rural Affordable Homes for Key Workers Fund, a five year initiative (2023-2028) to support Local Authorities and registered social landlords acquire suitable properties for key workers where there is identified need. We will continue to invest in our workforce as roles change, and ensure they have the skills and development opportunities in the future to carry out those roles.

The day-to-day experience of the workforce will improve through better use of digital systems to streamline support and reduce the administrative workload, freeing up capacity so staff can spend more time with individual patients and people. This will include making the most of digital care and treatment options. We will also focus on increasing the digital skills and leadership required, including in developing the specialist digital workforce and further enhancing the Digital and Data Capability Framework.

In all settings, our workforce will be supported to deliver Value Based Health and Care. Careful and kind care sits at the heart of delivering Value Based Health and Care, as set out in Chief Medical Officer annual reports.^[8]