Scotland's Population Health Framework

Equitable Health and Care

Foster a health and social care system that delivers equity, prevention and early intervention.

Beyond the social, economic and environmental factors described, health and care services play an essential role in promoting, protecting, maintaining and restoring health and wellbeing.

Health and Social Care Partnerships bring health and social care together into a single, joined-up system that provides holistic, person-led care and support, with a focus on anticipatory and preventative care. Central to the local delivery of prevention and early intervention activities are the voluntary sector, community-based organisations, carers (paid and unpaid), social care services, social workers and primary and community care. Improved proactive and preventative management of long-term conditions by these broad, expert teams play a vital role in enabling people to live longer, healthier and more fulfilling lives.

When people do not, or cannot, access timely and appropriate care and support, this is likely to lead to poorer health outcomes and inequalities and can require more extensive and costly treatments. The COVID-19 pandemic reinforced and exacerbated existing inequalities within our communities, particularly among groups with worse health outcomes prior to the pandemic.

The pandemic also demonstrated the impact infectious diseases continue to have on the health of our population. Strong and effective health protection, including pandemic preparedness, is a critical part of our efforts to improve and protect Scotland’s health.

Building Upon Existing Action

Actions within this driver build upon existing action already being progressed under the following, non-exhaustive, list of policies and strategies:’

• Mental Health and Wellbeing Strategy
• Value-Based Health and Care
• Getting it Right for Everyone
• Scotland’s 5-year Vaccination and Immunisation Framework and Delivery Plan
• Sexual Health and Blood Borne Virus Action Plan
• Health Screening: Equity in Screening Strategy 2023 to 2026
• Women’s Health Plan
• Scottish Allied Health Professions Public Health Strategic Framework Implementation Plan: 2022 to 2027
• Digital Health and Care Strategy
• Primary Care Reform Programme
• General Practice Healthcare Inequalities Programme
• Oral Health Improvement Programmes
• Dementia Strategy for Scotland
• Health and Social Care: National Workforce Strategy
• NHS Scotland Climate Emergency and Sustainability Strategy

The Health and Social Care Service Renewal Framework focuses on the delivery of health and care in Scotland, including primary and community care, social care and hospital-based services. This driver seeks to connect the two Frameworks, ensuring a joined up approach to health and social care reform and renewal, acknowledging the role social, primary and community care play in prevention, early intervention, support and treatment.

Conditions for Change

A strong health and care system not only treats illness but also works to prevent disease and promote, protect and maintain health. Ensuring equitable access to population level prevention, early detection services, care and treatment is fundamental to improving health and wellbeing. This is in addition to the key role the system plays in improving the wider determinants of health across all the drivers and their interconnections.

We will continue to embed value-based health and care and Realistic Medicine principles to deliver better outcomes and experiences for people through the equitable, sustainable, appropriate and transparent use of available resources.

Appropriate support delivered by a sustainable social care, primary care and community care system is vital, to ensuring people receive personalised care at the right time and place and are supported to live independently in their communities. These services have frequent encounters across our population, build trusting relationships and have potential to deliver more preventative action. We recognise unpaid carers as an essential part of the social care system, enabling people they care for to get the most out of life, and we will continue to work to ensure carers have the right support in place to continue caring.

To provide a healthcare system that is truly equitable for all we must address the causes of low engagement in healthcare, including ‘missingness’ - the repeated tendency not to take up appointments or offers of care such that it has a negative impact on the person and potentially leads to adverse health outcomes - and healthcare inequalities to support the people and communities who need it most.

We will continue to address the barriers and inequalities that exist in vaccination and screening uptake to maximise our prevention and early intervention efforts. To improve vaccine uptake, we must address negative perceptions leading to hesitancy; and other barriers. Finding disease earlier through screening will lead to better outcomes for people and reduce the future burden on services.

Given the continued threat of infectious disease to Scotland’s population health, we must continue to work collaboratively across local, national and international partners through our health protection services to ensure the population is protected from infectious and environmental hazards.

Realising our wider aim must also ensure the promotion of good sexual health and wellbeing. This will be achieved through ensuring high quality, innovative sexual health and blood borne virus (BBV) prevention, care and support is available to those who need it.

In the medium to long-term our aim is to:

• ensure good quality and person-led health and social care services are accessible and inclusive to all
• improve efficiency and sustainability of services through enhanced and improved proactive prevention and early detection
• mobilise the health workforce to make every contact count
• increase confidence in and accessible approaches to increase the uptake of universal vaccinations and screening
• set targets for elimination of cervical cancer, HBV, HCV and HIV transmission

Building for Our Future

Over the next two years we will progress the following actions with our partners:

Healthcare Inequalities

Develop a Healthcare Inequalities Action Plan.

This will include:

• addressing ‘missingness’ in health services supporting physical and mental health
• ensuring the routine collection, analysis, reporting and use of healthcare inequalities data by key variables including SIMD, gender, age, disability, race and ethnicity to enable better accountability
• embedding equity across the CVD prevention programme and learning from the new Enhanced Service on CVD prevention in General Practice
• building on the Proportionate Universalism approach taken with Childsmile - providing universal services to everyone, but with a greater focus on those with the most significant needs - to consider the application of this approach more widely
• developing the General Practice Healthcare Inequalities Programme to reduce barriers to accessing care
• developing practical guidance on equitable care to support a systemic focus on health equity that reduces missingness and digital exclusion, particularly for inclusion health groups
• supporting health inequalities training and education for health, social care and social work professionals
• addressing stigma and discrimination and racialised health inequalities

Vaccination and Immunisation

Deliver the actions of the Scottish Vaccination and Immunisation Programme (SVIP) 5 Year Framework and Delivery Plan (2025-2030).

This will include:

• building on the programme’s work to increase confidence and uptake, especially in under-served communities
• responding to Joint Committee on Vaccination and Immunisation (JCVI) advice regarding changes to current vaccination programmes and the introduction of new vaccination programmes
• developing Standards for vaccination services, with indicators to assess for the improvement of these services

Screening

Innovate and improve screening and early detection of disease.

This will include:

• piloting a lung screening programme in Scotland’s most deprived areas
• developing a new screening strategy
• publishing a further three-year Screening Equity Plan, supporting our vision of equity in access for all eligible people, across the full screening pathway
• implementing Breast Screening Modernisation recommendations
• responding to the Cervical Cancer Elimination Expert Group’s advice which will set out recommendations and timelines required to achieve elimination in Scotland covering: vaccination, screening and cancer treatment services

Health Protection

Support better health protection in Scotland.

This will include:

• establishing a Scottish Pandemic Sciences Partnership
• investing in surveillance tools and capability to ensure we have the surveillance and data needed to: manage disease outbreaks; monitor and respond to the public health effects of climate change; and prepare for future pandemics
• strengthening high consequence infectious diseases (HCID) pathways for assessment and management of suspected cases in secondary care

Sexual Health and Blood Borne Virus

Progress delivery of improvements to sexual health and wellbeing.

This will include:

• progressing actions to improve access to effective contraception
• progressing action to support the elimination of Hepatitis C by 2025 and HIV transmission by 2030
• delivering the Sexual Health and Blood Borne Virus Action Plan and HIV Transmission Elimination Delivery Plan