Leadership Board: Second meeting - Prioritisation Paper

Mental Health and Wellbeing Strategy Delivery Plan and Workforce Action Plan - Prioritisation of Commitments

Background

In the Mental Health and Wellbeing Strategy Delivery Plan and Workforce Action Plan, we noted that:

• they would be reviewed and refreshed after 18 months;
• actions in the Delivery Plan will not just be limited to each plan’s lifespan;
• actions in the Workforce Action Plan would be phased given the emerging evidence and evolving landscape;
• future refreshes may carry over actions, while introducing new commitments as appropriate, and closing off actions that have been successfully delivered.

This context is intended to ensure that the Plans remain focused on the most appropriate and deliverable actions to support progress towards the Strategy’s ambitions. As the first anniversary of the publication of the Delivery Plan and Workforce Action Plan has passed, Scottish Government and COSLA officials have begun the process of reflection, prioritisation, and future planning.

As we seek to undertake this work, wider circumstances must be taken into account. In-year fiscal reductions to the Scottish Government’s budget were announced in September 2024, reducing the overall mental health budget for 2024-25 by £18.8m (decreasing from £290m to £271.2m).

The impact of these in-year cuts has been reflected in the progress reports to the Board. Where actions are not currently progressing as originally planned, funding and capacity have been primary causal factors.

Local Government also faces an extremely difficult fiscal settlement, creating widespread challenges for service provision, including in response to the social determinants of mental health and wellbeing. This has the potential to increase demand for mental health support and put extra pressure on delivery partners across the system.

The 2025-26 budget will follow the standard Parliamentary budget approval process from December 2024 (draft budget presented to parliament) to February 2025 (stage 3 approval). There will be some clarity on the budget available for Mental Health and Wellbeing as the budget process unfolds. However, we would currently expect fiscal challenges to continue in future financial years, with a possibility that in-year reductions might be required again in Financial Year 2025/26. Additionally, there is still some uncertainty on the impact of the UK budget, and the level of the Barnett consequentials that the Scottish Government will receive.

Date of refreshed publications

Given the context outlined above, it is currently uncertain whether it is feasible to publish refreshed Delivery Plan and Workforce Action Plans in early 2025. A key consideration is that future iterations of the Plans should be informed by the Financial Framework section of the Strategy (Chapter 13). Ongoing fiscal uncertainty may mean that it is unlikely to be possible to finalise fully costed commitments in early 2025.

Despite this challenging context, thorough work on the prioritisation of actions in the Delivery Plan and Workforce Action Plan is still required now so that the Scottish Government, COSLA, and all partners, are prepared for whatever the outcome of the 2025-26 budget process is. The refreshed Plans will then follow when the context allows for certainty about the deliverability of the contents in full, with Leadership Board being kept fully apprised.

This prioritisation work will allow space for reflection on whether any ongoing work should be continued, amended, expanded or discontinued. This will also provide an opportunity to identify where we have further policy options if future budget allocations allow.

Timeline

The current objective is to agree a prioritised set of commitments in June 2025. A decision will be made closer to that time on whether the outputs from the prioritisation exercise are published in future Plans, or published as part of a progress report in summer 2025.

Draft principles for prioritisation exercise

To support this prioritisation, a set of underpinning principles have been drafted. These principles would help to ensure transparency, equity and appropriate engagement throughout the prioritisation exercise. They are included here for discussion and support by the Board -

1. There should be better alignment between future Mental Health and Wellbeing Delivery Plans and Workforce Action Plans.

2. There should be more alignment with cross-portfolio work, seeking to capitalise on ongoing work in other areas that can contribute to the Strategy’s Vision and Outcomes.

3. There should be fewer commitments, with a focus on quality rather than quantity. The focus should be on actions which will deliver the greatest impact.

4. A set of consistent criteria should be used to inform decisions on prioritisation. These include an assessment of impact, deliverability, sustainability, affordability, and equalities and human rights.

5. Consultation with stakeholders should be proportionate, including using the networks available through the Executive Group and Leadership Board.

We would appreciate thoughts from Board members over the coming weeks and months on the above points. Early thinking would be welcome at the December meeting to be followed up with future discussions.

Scheduling of work

A phased approach to the prioritisation exercise over the coming months is summarised below for consideration. There are several pieces of work that are already underway to support this exercise and these will be supplemented where necessary, to create a suite of options for consideration.

Phase 1: Understanding the current context

• Create a factual summary of where we currently are, including actions that are due to conclude by April 2025 and actions that are currently timetabled to continue into 2025/26. This work will be mostly informed by the latest round of progress reporting, and will be supplemented by work with lead policy teams to understand the status of actions as of April 2025.

Phase 2a: Policy gap analysis for the Delivery Plan

• Undertake an exploratory policy gap analysis, including an assessment of:

1. Any new, innovative or emerging policy options that we are not currently committed to;

2. Examples of work that has been stopped or deferred as a result of budgetary reductions, and;

3. Examples of good practice that we are already taking forward, but where we could go further.

• We think it would be helpful to initially undertake this exercise independently of the current fiscal context, in order to maximise creative thinking around potential future policy options.
• Outputs from the SG and COSLA will be brought together to create a full set of options, which can then be assessed against the budgetary situation in 2025/26.

Phase 2b: Policy analysis and practical steps to focus actions in future refreshes of Workforce Action Plan

1. Set out examples of where work has been delivered or stopped or requires a longer timeframe for completion i.e. workforce and equality data.

2. Monitor, and where necessary, implement new or emerging actions from priority areas of work i.e. MH Nursing Review, Psychiatry Working Group and Education and Training Advisory Group.

3. Explore the benefits and implications of aligning future refreshes of the Delivery Plan and Workforce Action Plan.

Phase 3: Develop a priority “scoring” tool

• As outlined in the set of principles above, agreement is sought that a ‘criteria tool’ should be developed and utilised when taking decisions about what commitments should be prioritised.
• A tool would bring consistency and a robust process to how commitments are prioritised in future refreshes of the Delivery Plan and Workforce Action Plan. An example ‘scoring tool’ is included in Annex A for discussion by the Board.

Phase 4: Engagement on options for the Delivery Plan and Workforce Action Plan

• Test the emerging thinking with key governance groups and stakeholders.
• Take suggested options for priorities to the Executive Group, Leadership Board and associated advisory groups.
• Identify if further engagement is required through these networks.
• Identify next steps based on resourcing decisions.

Phase 5: Outcomes and Drafting TBC, pending further discussion by the Leadership Board

Annex A

Refer to the PDF version to view the Example Prioritisation Scoring Tool.