Improving Lives Through Delivering for Scotland: Health Secretary opening speech

Presiding Officer,

The First Minister has introduced the Programme for Government to this Parliament and to the nation.

Fundamental to this is the delivery of a significant reform of our public services.

Let me be clear. These are vital services to the people of Scotland that require partnership and are delivered by an exceptional workforce. We absolutely value their work, and all who work in them.

But it is time for change Presiding Officer.  

It is time to look with clear eyes and open minds at the shape and size of our public sector.

We must ask: is it in the right kind of shape for the challenges that this country faces now and in the future?

Do our systems fit around people? Or are we expecting people to fit into systems?

Because public services designed for the 20th century must be ready for the realities of the 21st century.

That is why over the course of this Parliament, we will rewire the Scottish state.

Public Service Reform will be at the very heart of delivery in this administration.

And this is not about marginal change.

It is about working with communities, those who rely on services, the workforce and trade unions to reimagine the state.

A state that is more joined up, more efficient and is more focused on prevention as early as possible.

And in this, people of Scotland must come first, not the systems, not habits, assumptions nor institutions.

Indeed, these public services reforms will be the biggest reform in this country since the Scottish Parliament was reconvened in 1999.

But as Nye Bevan, the founder of our beloved NHS said, there are also many dangers to staying in the middle of the road.

So why do we need change? Let us be frank. 

If all of us in this Chamber were to sit down and design a modern, efficient and responsive Scottish public sector on a blank sheet of paper, it would not look like this.

There are 134 public bodies in Scotland.

In health and social care, there are 14 health boards, seven special health boards, 31 Integration Joint Boards, 31 Health and Social Care Partnerships and 84 accountable officers.

Multiple layers of decision-making that remove services further and further away from the people in need on the ground.

This complex and cluttered landscape that members of our public need to navigate demonstrates why we need to simplify how decisions are made and who makes them, reducing unnecessary complication and confusing duplication and addressing the inconsistency and variability of how services are provided.

The simplification of decisions, governance and planning does not mean centralisation of service delivery.

Our reforms are about putting people and their care at the heart of our services, wherever you may live. 

The intention is that local services remain local wherever that is the best way to meet the needs of communities.

Our reforms must ensure that no matter where you live in Scotland you can access the same high-quality care.

This is an issue I have seen first-hand during the summer as I visited Dr Gray’s in Moray and also in time I spend with staff and citizens in Kirkwall.

Our vision is of a Scotland where citizens enjoy excellent public services, delivered to meet their individual needs, regardless of geography.

And we want the staff providing those services to feel valued and empowered to make a real difference to people’s lives.

Public Sector Reform will be led by our health and social care services.

In the reformed structures we want to see, health reform is the first stake in the ground.

Since the foundation of the NHS 80 years ago, both the demands we create and our expectations of the health services have changed.

These are led by demographic changes – we have an ageing population. People are living longer with more complex health conditions.

And we still have areas of deprivation across our country where health outcomes are poorer.

So there is rising demand, changing expectations, and rising costs.

And unless we radically shift course in our delivery of health and social care services, they will not be in the best position to respond to the needs of our people

Reforming the NHS is future-proofing it for future generations to come.

The first step on this journey of reform is simplifying the structure of the NHS.

We will replace the current territorial Health Boards with two Strategic Health Boards: east and west.

This will reduce unnecessary duplication and make responsibility much clearer.

Beyond Territorial Boards, we will also build on already planned reforms to further reduce the number of special Health Boards.

Simplifying the structures gives us a platform to allow people to access the care they need quickly, safely, and with dignity.

We’ll do this alongside continued investment in local community services like GP walk-in centres and Hospital at Home, digital transformation led by our MyCare app, and redesigned services to ensure people receive the right care in the right place at the right time.

An example of this will be how we deliver a new National Plan for Orthopaedics, where simpler structures will increase access to elective procedures and eradicate long waits. 

People should not have to wait longer for an operation or procedure because of where they live - if there is capacity in our system then that must be used.

By streamlining structures in this way, we'll empower our senior leaders to make decisions that benefit patients faster and in a more dynamic way. 

As I mentioned, we are committed to empowering communities.

We will enable bespoke solutions for our islands, including the implementation of Single Authority Models where that is desired, local governance arrangements to enable decision-making to be better tailored to the needs of the place.

But let there be no mistake - this Government is absolutely committed to the founding principles of the NHS.

An SNP Government will always be clear: our NHS will never be for sale. To safeguard its future, we must do more than reform structures.

That is why the Programme for Government focuses on prevention, supporting people to live longer, healthier lives and reducing demand on our NHS.

So we must continue to make the shift from reacting to illness, to preventing it.

We already have well-established strategies and frameworks for this.

And we will continue to embed prevention across government and public services - with investment in programmes that prevent illness and detect diseases earlier, including vaccination and screening.

This is why we’re working with Chest, Heart and Stroke Scotland to deliver new heart and lung ‘MOTs’. And we will strengthen action on healthy weight, physical activity and the wider drivers of health.

Work is progressing on helping people access practical help before health problems escalate, including in our vital fight against Scotland's drugs deaths emergency. 

But prevention cannot be delivered by the NHS alone. It requires coordinated action across government - working in partnership with local government, businesses, and the community and voluntary sector.

These preventative measures should be more integrated with the services that treat people closer to home, avoiding the need for acute hospital care.

We have already made significant progress to increase activity and bring down long waits for operations and procedures.

Our new Health and Care Improving Flow Plan will see us create one connected system with simpler routes to care.

It will declutter the landscape, ensuring we more effectively ‘plan’ for unplanned care, improve the flow of patients through hospital and tackle delayed discharge.

We want people to spend less time waiting and more time receiving care.

This is our new contract with the public - making clear what the public should expect, in return for accessing care in the right place.

Now I do not wish to re-open the old wounds this Parliament felt during the debates surrounding the National Care Service.

However social care must be central to our reforms.

It is vital if we are to make any headway in reducing delayed discharges and ensuring people are cared for closer to home.

Our vision is clear: people should be able to live healthy, independent and fulfilling lives, connected to their families, friends and communities for as long as possible.

That is why we will use the next three months to reach agreement with local government on the next phase of social care reform.

Together, I hope that we can develop a model that delivers fairer and more consistent services. Above all, our approach will be shaped by the voices of those with lived experience.

Thousands of people who access, deliver and support care have shared their experience and insights with us in recent years. Their message has been consistent: services must be easier to navigate and should be person-centred and joined up.  

Our aim is to meet those goals.

I urge local government to work hand in hand with us to design an approach that works for the people that we were all elected to serve.

That offer also extends to Members across this Chamber. I have already had some early discussions with the Greens, Labour and Tories about their views on public service reform, but my door will very much be open to those parties and to the Liberal Democrats too.

It is important that Members voices help shape the future of how our services are delivered.

Presiding Officer, this Government will always look to find and create common ground in our pursuit of a better Scotland – based on fairness, compassion, and inclusion.

Let me reassure the Chamber that we will work closely with staff and trade unions from the outset of this process, drawing on their expertise, leadership, skills and capabilities required to design and deliver better services for people and communities.

Government does not have a monopoly on good ideas.

So we invite leaders across local government, public bodies, trades unions, and delivery partners to join us now in shaping a clear vision for the future.

We make the most progress when we work together.

Public Service Reform I think we all know cannot be deferred. But the people of Scotland must be at the heart of this reform process.

They are, after all, why we are here. And it is with this in mind that we take forward this work to improve the lives of all who live in Scotland. Thank you.