Health and Social Care Service Renewal Framework

4. Enabling Shifts Required

Rebalancing of Resources - Finance

In the 2025-26 Scottish Government Budget, funding of £21.7 billion was allocated to the Health and Social Care Portfolio with resource funding having more than doubled since 2006-07 in cash terms. However, growing demand means that our health and care services are having to stretch further than ever before. This Service Renewal Framework must enable us to make the very best use of the resources that are available to us to meet the needs of the population. In line with the principle of allocative/population value, the way we use these resources should be equitable and transparent, and distributed across the pathway of care, including prevention.

We will do this through the following measures:

• A continuous focus on efficiency and productivity and promoting clinical and operational excellence regardless of health setting. This will help us meet increases in demand more efficiently, reduce pressure on staff and facilities, and free up capacity to dedicate to health and care provision.
• Supporting more open, collaborative communication across statutory partners. This is critical to ensure widespread understanding across all partners of the pressures, cultures and drivers being experienced in different parts of the system, and opportunities to meaningfully shift resources.
• Maximising national collaboration for greater efficiency. We will make the most of opportunities to deliver services on a Once for Scotland^[42] basis – doing things once, nationally, rather than repeating across multiple organisations. This means building on the strengths of our National NHS Boards, ensuring they have the clear remit and authorising environment to lead and deliver on behalf of all NHS Boards. We also expect closer working between National Boards, with greater alignment of priorities, shared planning and, where appropriate, joint delivery of services. This collaborative approach will reduce duplication, improve consistency and make better use of national expertise and resources.
• Investing in digital, data and AI technologies to improve the delivery of services and enhance patient access and outcomes.
• Enacting a long-term shift in the balance of care by ensuring key resources (workforce, digital capital and training) and new investment proposals are focused on capacity building and service improvement in primary and community care. By building this capacity at a system level, with a focus on evidence, primary and community services will receive an increasing share of total health funding, ensuring our health and care system is adequately resourced to improve population health outcomes in the longer-term. We will monitor this balance as part of wider outcomes frameworks.
• Working with our NHS Chief Executives and accountable officers (i.e. Chief Officers) to understand and address barriers to re-focusing and rebalancing resources on preventative services and primary and community healthcare.
• Working collaboratively to further embed integration, including across integrated health and social care budgets. We will engage openly with our local populations and partners in the third and independent sector about the opportunities and challenges for reform.
• Prioritise long term strategic investment cases that align with this Framework, ensuring decisions on capital, workforce, infrastructure, etc. are drawn from robust population and planning data, are objective and are focused on and shaped around the health and social care system.

Outcomes, Quality and Impact: Renewed Systems Performance and Outcome Measures

No matter what setting, health and care must be high quality, effective, sustainable, and, as emphasised above, good value. Implementation of this SRF will contribute to increased effectiveness, quality and value for money within our health and social care services. This will happen not only through clear prioritisation, innovation and reform but through how we monitor performance and outcomes.

Understanding the performance, outcomes, and effectiveness of the health and social care system as it is now, and as it transforms, is critical. Our data, research and analysis must support delivery of the Major Changes set out in this Framework, ensuring not just that we are delivering on the actions identified, but that they are driving the change we need to see. To achieve this, our approach must be anchored in whole-system outcome frameworks, with updated performance metrics and clearly defined outcome measures for all parts of our system. To support implementation, an initial outcomes framework will be developed within the first year following publication of the SRF. This will translate the strategic priorities in this document into measurable outcomes that guide delivery, align efforts across the system, and enable transparent reporting on progress.

This work will build on the Health and Social Care Data Strategy which aims to get insights from data that allow us to improve services and inform policy; inform communities; monitor outcomes, experiences and access to services for different population groups; target interventions and support; and improve services and partnership working.

Performance, outcome, financial and experience data need be further developed, and data needs to be accessible and understandable to support improvement activity across the system. The principle of shifting of care into the community also requires a rebalancing of our funding, data and analysis towards primary care, community health and social care.

Going forward we will build on the work already undertaken to identify gaps in our data landscape and make improvements. This will include:

• Working with Local Authorities, NHS Boards and National Records for Scotland to better understand population need, including by determining how the changing burden of disease and demographic profile of the population will impact future service provision.
• Implementing the ‘Scottish Learning and Improvement Framework for Social Care Support and Community Health’ (SLIF) which been developed jointly by Scottish Government and COSLA, in partnership with key stakeholders and those with lived experience of care.
• Continuing work with National Services Scotland (NSS) and Public Health Scotland (PHS) to drive improvements in data, data gaps and administrative data, which includes exploring the automation of data collection, analysis and use of AI.
• Driving alignment between official statistics relating to performance and SRF priorities, following the outcome of the PHS statistics consultation
• Working with Research Data Scotland to continue to improve safe access to health and social care data for research and innovation. This includes expanding the availability of data which can be accessed via the Researcher Access Service, streamlining approvals processes for accessing data and continuing to engage the public on the safe use of data for research.
• Introducing secondary legislation, subject to the passing of the Care Reform (Scotland) Bill, that supports information sharing and the setting of information standards to help make better use of data to inform national and local insights, planning and developments.
• Developing a nationally coordinated approach to the capture and use of patient reported outcomes and experiences to drive improved services.
• Working to explore how we measure the preventative and early interventions undertaken in the health and social care system.

In addition to our work on performance and outcomes measures, we know research and innovation are essential to delivering safe, high quality and sustainable health care services. Embedding health research and innovation throughout the NHS, supporting our dedicated research and innovation professionals, and working in collaboration with the academic and life sciences sector are fundamental to transforming our NHS and bringing the benefits of scientific advances to the people of Scotland. We will continue to support and promote health research and innovation through maintaining the national research and innovation platforms within our NHS; continuing our support and fellowship offerings to future generations of research and innovation leaders; and by supporting the delivery of impactful research and innovation through grant funding and ensuring access to UK-wide funding opportunities.

Coordinated Planning and Delivery

Population Level Strategic Needs assessment

To plan and deliver effectively, the Health and Social Care system requires strategic needs assessment across the range of areas that will impact service provision in the short, medium and long term. This marks a significant shift from traditional service-based planning to a population level model that considers the full spectrum of health and wellbeing needs—now and into the future. It will enable a more proactive, preventative, and equitable approach to service design and resource allocation.

There is already excellent work in place on the Burden of Disease and related products and further development is planned. This must now be applied and further developed at a national, sub national, Community Planning Partnership (CPP), Integration Authority and locality level to enable a firmly evidence-based approach to planning in the immediate, medium and long term. This will be a single source of truth available to all, allowing the public to see how the system plans to meet need.

Planning and delivery

Planning and delivery will be nationally coordinated but locally led. The Population Principle in this Framework prioritises planning for our population’s needs at a national, sub-national and local level, above organisational interest and beyond the constraints of organisational boundaries. It seeks to deliver Value Based Health and Care, and it recognises that greater central vision is needed to make that behaviour and philosophy a reality in the NHS.

In recognition of the need to work differently and more collaboratively across the NHS, a revised Scottish Government governance structure has been introduced to support the DG Health and Social Care and Chief Executive NHS Scotland. The NHS Scotland Executive Group (NHSEG) is a key lever to deliver transformation at a national level. The group will make decisions and recommendations on what should be delivered at a national or sub-national level across relevant Health Boards. The Executive Group is supported by a sub structure, which includes the NHS Scotland Planning and Delivery Board and Strategic Planning Board, who have a role in providing leadership and oversight of population level planning.

We will continue to work collaboratively between Scottish Government and COSLA through our joint governance structures, including the Collaborative Response and Assurance Group, to support and drive forward local improvement through use of whole system data.

NHS Boards, Integration Authorities, Local Authorities, and wider delivery partners will collaborate to ensure planning and delivery is responsive to the needs of their communities and has local ownership. Community Planning Partnerships and Local Outcome Improvement Plans will play a vital role in aligning this local planning with national priorities. Planning structures will also reflect the priority given to primary care and community health, working with independent contractors through groups such as the Primary and Community Health Steering Group and embedding a shift toward preventative, community-based care.

These priorities mirror and are intended to drive forward the ambitions set out within the Public Bodies (Joint Working) (Scotland) Act 2014 and the Community Empowerment (Scotland) Act 2015. Both pieces of legislation clearly emphasised the need to shift the balance towards integrated, preventative community care.

We will significantly transform the capability of our National NHS Boards by the creation of a new single body called ‘NHS Delivery’. That new body will bring together the existing functions of NHS National Services Scotland and NHS Education for Scotland, and will allow us to review and consolidate other cross-cutting delivery functions. This will provide a single point of accountability and delivery for a wide range of support, training and digital services to the Health and Care system in Scotland and will underpin the concept of Once for Scotland services across the public sector. The Scottish Ambulance Service and NHS 24 will be tasked to develop a complementary Collaboration Plan to enable transformational improvement in the delivery of urgent care services.

In addition, we acknowledge Audit Scotland’s report and continue to build robust and clear governance arrangements to support the scale of reform required across NHS Scotland. 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:

• Clarify Governance Structures: Building on the existing blueprint for good governance, we will look across the range of duties and guidance that is in place for Boards and work with them to ensure that those legal duties and relevant guidance are fully met in our work on reform.
• Strengthen the governance of NHS Boards: We are updating guidance to more explicitly align board governance with the demands of service reform. This will include clearer expectations for performance oversight, risk management, and collaborative leadership.
• Support Collaborative Planning: The Service Renewal Framework introduces a more integrated NHS planning model that encourages NHS Boards to work together and with wider public service partners. This will help deliver more consistent and equitable healthcare across Scotland.
• Ensure Strategic Alignment: The Framework has been designed to ensure that governance improvements are embedded within a broader vision for transformation.
• Significantly transform the capability of our National NHS Boards by the creation of a new single body called ‘NHS Delivery’.

We recognise that reform is challenging, but it is essential. We are working closely with NHS Boards and stakeholders to implement these changes effectively and transparently.

Recognising the central role of primary care and community health within the NHS and across the wider system, we will strengthen their integration into whole-system planning and governance. This includes drawing on the expertise of existing mechanisms such as the Primary and Community Health Steering Group and the Mental Health and Wellbeing Strategic Leadership Board.^[43]

All planning must be complementary and demonstrate meaningful partnership working across NHS Boards, Integration Authorities, Local Authorities, and other key stakeholders. This includes the third and independent sectors, whose contributions are essential to delivering holistic, person-centred care.

Single Authority Models are an opportunity to explore the role of alternative local governance arrangements in delivering service renewal, with a particular focus on health and social care. We are working with three geographies (Argyll and Bute, Orkney and the Western Isles) to develop local decision-making arrangements which can best respond to the unique challenges faced by these communities.

This document does not change any responsibilities on NHS Boards, Local Authorities or Integration Authorities regarding their planning and delivery responsibilities as set out in the Primary Medical Services (Scotland) Act 2004, The National Health Service (Scotland) Act 1978 and the Public Bodies (Joint Working) (Scotland) Act 2014. Our approach, with its emphasis on collaboration at a national, sub-national and local level, driven by population needs, complements these legislative frameworks and will help to strengthen the role of clinicians and care professionals, along with the third and independent sectors, in planning and delivery of services.