Piloting an Approach to Identifying Preventative Spend in the Scottish Budget

Annex A – Health and Social Care Portfolio Pilot (Excluding Health Boards)

Introduction

As part of the preventative budgeting pilot programme, a pilot study was developed with the Health and Social Care (H&SC) portfolio to understand how prevention features in spending across the portfolio. In this Annex we cover H&SC Portfolio excluding Health Boards as these are treated separately through a bespoke pilot programme run with participating Health Boards (discussed in Annex C).

Approach

The pilot was designed to cover a sub-set of Level 4 budget lines in the H&SC Portfolio that cover a mix of different types of spend types (preventative and non-preventative) and different levels of prevention (if preventative). Lines were selected for inclusion that met these criteria.

The final scope included 18 Level 4 budget lines (excluding NHS National and Territorial Boards), which is approximately 22% of the total number of level 4 lines in the H&SC portfolio (81). These 18 budget lines accounted for around £2.6bn of planned resource spend, around 62% of the total H&SC portfolio spend (excluding NHS National and Territorial Boards). The lines included in the pilot are shown in Figure 14.

• General Medical Services
• Primary Care Reform and Delivery
• Tribunals and Appeals
• General Medical Services - Other
• Immunisations
• Tobacco Control
• Active Healthy Lives
• AHP and HCS Training and Development
• District Nurses
• Paramedics Bursaries
• Pre-reg Nursing and Midwifery Training
• General Dental Services
• Community Eye Care
• Mental Health and Wellbeing
• Mental Health Services
• Mental Health Complex Care
• Mental Health Other Services
• Bursaries (Nursing and Midwifery)
  

The Level 4 Budget lines included in the pilot varied significantly in terms of value, and scope of activities covered within each line. In some cases, a simple tag was applied to the Level 4 Budget line (e.g. tribunals and appeals, paramedics bursaries, immunisations). For some of the larger H&SC lines, we used additional budget information or additional data to apportion activity. This approach was used for lines such as General Medical Services, General Dental Services, Community Eyecare, Mental Health Services, AHP and HCS Training and Development, Pre-reg Nursing and Midwifery Training, Bursary (Nursing and Midwifery).

Figure 15 sets out examples of different activities classified as per our definitions of prevention.

Classification: Examples

Primary Prevention

• Vaccinations
• Active health lives activity – e.g. grants for walking, participation in sport, etc
• Information to raise awareness of Autism (Different Minds)
• Programmes to tackle mental health stigma
• Preventative dental advice (incl Childsmile)

Secondary Prevention

• Childhood obesity reduction
• Screening services
• Improving mental health of people in prisons
• Mental health work for people at risk of homelessness
• Dental screening and preventative treatment
• Primary Eye Examinations

Tertiary Prevention

• Primary care enhanced services (e.g. link workers)
• Autism post-diagnostic support
• Future pathways for those experiencing neglect
• Veterans clinical mental health services

Enabling

• Tobacco and NVP register
• Funding for advocacy organisations (e.g. obesity action scotland)
• Autism toolbox hosting and maintenance
• Mental health complex care quality standards
• Monitoring/ evaluation specific to preventative activity
• Pre-reg, nursing and midwifery training (preventative roles/ activities)

Acute/ responsive/ Treatment

• GP response activity
• Unscheduled eyecare appointments
• Redeeming vouchers for glasses
• Dental treatment
• District nurses
• NHS 24 mental health hub
• Emergency dental treatments

Other

• General H&SC portfolio policy and analytical activity
• General GP training (non-preventative roles/ activities)
• Development/ publication of strategies / law

Results

This section sets out the results from the budget tagging exercise for the Level 4 budget lines that were covered by the H&SC pilot.

Note these results should be taken as preliminaryand could change between the pilot phase and the final estimates planned for Summer 2026 . Caution should also be taken when drawing broader conclusions and comparing against other portfolios, given the exercise only covers a sub-set of the budget. The final aggregate results for the full portfolio (planned Summer 2026) may look significantly different from the sample of pilot lines.

Preventative spend

The pilot study found that around 20% of the planned 2025/26 spending covered by the pilots can be defined as preventative spend (£507m) (Figure 16). Around 52% of planned spending within the Health and Social Care Portfolio (excl NHS Boards) was acute/ responsive/ treatment (£1,351m), 26% other/ general service (£682m) and 2% enabling (£46m).

Level of prevention

Of the preventative spend recorded, the majority of planned spend was classified as primary prevention (Figure 17). Around 22% of the total planned preventative spend was spent on primary prevention (£111m). Secondary spend accounted for 46% of total preventative spend (£233m). Tertiary accounted for 32% was primary prevention (£163m).