Scotland's Population Health Framework

Prevention Focused System

Strengthen collective accountability for population health outcomes and inequalities.

Realising our aim requires a whole system response in which prevention is embedded across all parts of government and all sectors. Renewed focus and new capabilities are required to ensure the wide adoption of a more prevention focused approach.

A whole system approach is not one thing. It’s not a group or forum, or a step-by-step process. It’s the way that things are done. It is how all partners work together nationally and locally to identify collective actions. It is about how evidence and learning is captured and shared, how policies are developed and implemented, services planned and delivered; and how people are supported to live longer, healthier and more fulfilling lives.

The Scottish Government, local government, NHS, Health and Social Care Partnerships, voluntary and community organisations, the business sector, academic community and local communities all have diverse roles to play and contributions to make, which need to be undertaken in partnership. Cross-sector collaboration remains essential to fully embedding prevention across the system and builds upon the lessons learned from our response to the COVID-19 pandemic.

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:

• National Performance Framework
• Verity House Agreement
• Public Service Reform
• National Population Strategy
• Fairer Future Partnerships
• Mental Health and Wellbeing Strategy
• Children and Young People (Scotland)Act 2014
• Community Empowerment (Scotland)Act 2015

Conditions for Change

We will work with all partners and sectors to maximise their contributions to our shared vision through defined outcomes and a commitment to preventative investment. We will encourage partners to share power and resources with other partners and across communities, accept joint accountability for outcomes and commit to delivery in this way.

Fundamental to our wider health and care service reform and renewal, and to the delivery of the Framework, is a shift in how the NHS sees itself. The NHS in Scotland is about prevention – not just treatment. As an anchor institution it has significant impact on the building blocks of health through employment, commissioning and purchasing, and creative use of its land and assets. It is a population health organisation that works collaboratively with local government to deliver integrated health and social care with an emphasis on anticipatory and preventative care. Community planning with local partners is vital to preventing ill health and inequalities and delivering value-based, sustainable health and care. This includes supporting the health and social care workforce to realise their role in prevention and the delivery of the priorities and actions within the Framework.

Mechanisms which embed health and inequalities considerations across all levels of government and sectors will ensure decision-makers are empowered to prioritise prevention and upstream investment. We will build upon and strengthen established place-based working and health in all policies approaches by improving the consideration of health and health equity outcomes across existing impact assessment activity.

Central to collaborative working locally are Community Planning Partnerships (CPPs). The Verity House Agreement^[13] recognises CPPs as a critical mechanism for the alignment of local resource, focused on prevention and early intervention, and delivering our shared priorities. Realising the full potential of CPPs requires all partners that can contribute to community planning to play their part. This includes the meaningful involvement of the community and voluntary sector as an equal partner.

A key enabler for our work going forward is ensuring digital and innovation opportunities are considered, maximised and integrated across our programmes and services. Innovations, including digital population health interventions, can provide a range of benefits for population health, including promoting positive health behaviours and supporting self-management.

We must also establish robust monitoring and evaluation mechanisms to track our progress and contributions to our aim. Ongoing research will offer us clear insights, data and evidence to support and track progress. This includes trialling new approaches to place-based working through the Collaboration for Health Equity in Scotland (CHES) to accelerate action to improve health equity and share insights and expertise by learning from Marmot Places^[14] in Scotland.

By embedding continuous learning and adaptation within the Framework, Scotland can respond effectively to emerging challenges and ensure policies and interventions remain responsive and fit for purpose.

Building for Our Future

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

Preventative Investment

Develop new approaches to resource allocation that support prevention.

This will include:

• developing, trialling and implementing new resource allocation approaches and tools in health and social care that prioritise prevention and upstream investment
• working with Health Board Directors of Finance and Directors of Public Health to explore models of finance that can identify and support investment in preventative action

Accountability

Improve whole system accountability for primary prevention.

This will include:

• strengthening primary prevention in NHS Board Planning and wider system planning and prioritisation
• balancing performance metrics across systems to include more upstream data
• reforming the National Performance Framework to support the development of a stronger more impactful framework for Scotland

Health in All Policies

Develop and implement a ‘health lens approach’ to impact assessment.

This will include:

• collaborating with local, regional and national partners to strengthen support mechanisms that integrate the building blocks of health and equity into decision-making across all sectors
• maximising the benefits and minimising negative impacts on physical and mental health throughout the decision-making process
• ensuring that national level impact assessments include health considerations that are rigorously evaluated during policy development

Community Planning

Strengthen collective leadership and shared accountability to improve local outcomes and address inequalities through a refreshed focus on the role of Community Planning Partnerships.

This will include:

• expecting local partners to use the Population Health Framework priorities and actions to inform the development and delivery of their Local Outcome Improvement Plans (LOIPs) and Locality Plans
• encouraging commitment from all local partners to provide the resources required to deliver agreed plans
• ensuring meaningful representation and participation by local community and voluntary sector organisations in community planning and sharing good practice
• working with existing mechanisms such as the Community Planning Improvement Board and the Scottish Community Planning Network to strengthen collaborative leadership and share learning to drive improvement

Collaboration for Health Equity in Scotland

Introduce Marmot Places in Scotland.

This will include:

• working with PHS and the Institute of Health Equity to support three areas to develop a local, whole system approach to address the wider determinants of health
• establishing a national learning system to share insights and integrate learning from the three Marmot Places
• identifying recommendations for national as well as local policy to accelerate action and drive improvements in health equity

Digital Population Health

Ensure digital opportunities are maximised and integrated across programmes of work to improve productivity and service user outcomes, the prevention of ill health – both physical and mental – and system sustainability.

This will include:

• embedding digital inclusion approaches which promote digital choice and reduce the risk of deepening inequalities
• empowering people to have greater flexibility and control over their health and care through digitally enabled access to information, resources, treatment and services

Research and Innovation

Support research and innovation that improves the prevention of ill health.

This will include:

• continuing to transform our approach to innovation across health and social care by building new partnerships between local and national government, the NHS, academia and industry
• building prevention research capability through the Scottish Prevention Hub
• progressing research-proven innovations in prevention and early intervention through the Accelerated National Innovation Adoption (ANIA) pathway

Evaluation and Learning

Develop a comprehensive evaluation and monitoring approach to measure the impact and value of the Population Health Framework.

This will include:

• gathering evidence to assess how the Framework is supporting a shift towards prevention
• communicating the accompanying Population Health Dashboard to support local use of outcome indicators on the determinants of health