Healthcare Reform: Stakeholder Advisory Group minutes: March 2025

Attendees and apologies

• Neil Gray MSP, Cabinet Secretary for Health and Social Care
• Caroline Lamb, Chief Executive NHS Scotland/DG Health and Social Care 
• Brian Moore (NHS State Hospitals Board for Scotland)
• Benjamin Hannan (NHS FIFE)
• Julie Mosgrove (Optometry Scotland) 
• Lee Knifton (Mental Health Foundation)
• Eileen Mckenna (RCN)
• Rachael King (NHS Orkney)
• Sengupta, Soumen (South Lanarkshire University Health and Social Care Partnership)
• McLaughlin, Matt (UNISON)
• Marriott, Craig (NHS Lothian)
• Emma Currer (The Royal College of Midwives)
• Mark MacGregor (NHS GOLDEN JUBILEE)
• Rachel Cackett (CCPS)
• Iain Kennedy (BMA)
• Lucy Mulvagh (Alliance)
• Sharon Hilton-Christie (NSS)
• Matt Barclay (Community Pharmacy Scotland)
• Cameron, Heather (Scottish Directors of Allied Health Professions)
• Marriott, Craig (NHS Lothian)
• Eddie Follan (COSLA)
• Jennifer Champion (NHS Forth Valley)
• Chris Provan (Royal College of General Practitioners)
• Lorraine Cowie (NHS Highland)
• Sharon Wiener-Ogilvie (NHS Fife)
• Roisin Kavanagh (AA Pharmacy/ NHS Ayrshire and Arran)
• Iain Morrison (BMA)
• George Crooks (Digital Health and Care Innovation Centre)
• Kenryck Lloyd-Jones (CSP)
• Fraser, Eddie (SOLACE)
• Paul Johnston (Public Health Scotland)
• Susan Webb (NHS Grampian)
• Robbie Pearson (NHS Healthcare Improvement Scotland)
• Meghan McEwen (NHS Orkney)
• Kirstin Dickson (AA Transformation and Sustainability)
• O'Connell, James (Unite)
• Margot McBride (Allied Health Professions Federation Scotland)
• Jann Gardner (NHS Greater Glasgow and Clyde)

Items and actions

Welcome and update on reform - Neil Gray MSP, Cabinet Secretary for Health and Social Care and Caroline Lamb, Chief Executive NHS Scotland/DG Health and Social Care

The Director General welcomed members to the third Stakeholder Advisory Group (StAG). 

The Cabinet Secretary:

• highlighted recent service improvements
• noted the passage of the budget which enables funding to be deployed to improving flow and address waiting times, and emphasized that delivering improvement in outcomes enabled through the health budget is his number one priority
• noted his thanks to HSC workforce who are working to improve performance and support change to ensure a sustainable health and social care system
• highlighted that to support short, medium and longer term reform, the Scottish Government is publishing three products around reform and renewal, which were being discussed at today’s meeting

Update on Operational Improvement Plan - Douglas McLaren, Deputy Chief Operating Officer NHS Scotland

An Operational Improvement Plan is expected to be published in March and provides more detail to the renewal plans that were outlined in January. 

The Operational Improvement Plan focusing on the next 12-18 months will cover:

• improving access (incl. improving waiting times and reducing delayed discharges)
• shifting the balance of care (incl. Hospital at Home, frailty and standardising good practice)
• digital and technological innovation
• prevention

The plan aims to look at how we deliver extra appointments and procedures, address backlogs of waits and have different models of working, for example increasing capacity, regional and national working, diagnostics and clearing CAMHS backlogs. To shift the balance of care, actions and initiatives are being undertaken such as a focus upon improving access to GPs and other primary and community care clinicians, Hospital at Home, frailty services, delivering new eye condition services during 2025, expanding NHS Scotland Pharmacy First Service, targeted investment in dentistry and utilising collaborative engagement for longer-term transformation.

Key to reform will be a focus on proactive prevention (e.g. CVD) and on driving digital and technological innovation e.g. digital dermatology pathway and health and social care app. 

Comments from the wider group included: 

• the focus on clearing CAMHS waiting times this year was welcomed
• important that a value based health and care approach is taken – it was noted that this will be included as part of the longer term improvement plan
• it was highlighted that psychology professions can also support a whole systems approach to shifting the balance of care, and a values based care focus, for those with physical or mental health issues, as part of an MDT approach 
• better access to General Practice is required. Investment is needed to boost capacity and improve access. A well-supported General Practice, delivering care close to home using relationship based, continuous care can support most of the out-patient journey and the wider preventative agenda
• it was observed that across the three products the OIP is focused more towards NHS than social care. It was highlighted by the Cabinet Secretary that there is a significant amount of work around flow of system that has direct relevance to social care
• there were concerns around expectations on staff and associated support and the lack of assessment of potential workforce impacts of actions – there is a need to deliver the plan in collaboration with workforce
• importance of utilising innovation and shifting the balance of care to be transformative

HSC Service Renewal Framework (SRF) - Karen Duffy, Delivery Director

Explained that the SRF will set the strategic intent for health and social care. The vision sets out what we want the future to look like and the major changes we will need to drive transformation. The SRF is intended to give a clear vision and high level intent for service reform in the coming decades. It will set the scene and early priorities for those changes – three, five, and ten years ahead. Key questions to be covered in the SRF will include how we plan to deliver acute services differently so make the best use of our resource and do more in the community. The SRF will build on the National Clinical Strategy (2016) and build on work undertaken around the National Care Service (NCS). 

A set of 5 reform principles are being developed – population planned first, community first, people first, digital first, prevention first. It was highlighted that there would be opportunities for stakeholders to contribute to the content of the document. A first draft will be brought to STAG members for the next meeting in April. 

The conversation was opened to the group and the following points were discussed:

• in general there was support with the five principles outlined
• there were questions around ‘community first’ principle phrasing and how we ensure that there would be transformational change to health and social care in Scotland, enabled by resourcing shifts
• need greater explicit reference to equality and rights – these need to be mainstreamed and embedded throughout. Focusing on a social contract to realise people's rights through our health and social care system would really help lever change
• important to monitor and track progress towards achieving ambitions in the plan
• there is a solid foundation (Clinical Strategy and NCS) which this plan can build on to ensure an integrated approach is embedded
•  a value based approach to the planning and delivery of health and care will lead us to optimise the health of the population from available resource and prioritise activity work within budget
• welcome the re-focus on prevention and community approaches - AHPs have a pivotal role in this area, but financial pressures are preventing this shift from happening
• the evidence points to needing this framework. The principles have huge resonance but consensus is needed on the long term approach and how we ensure collectively that it happens - question whether there is merit in taking longer to deliver framework and seeking cross party support
• regional approach to delivery of secondary care services can support aspirations to get acute services working differently and release resources to the community but there is a need to consider how can this be further supported 
• given the intense pressures on waiting lists and on NHS budgets it will be important to understand the cross government contribution, recognising the wide range of factors that build and maintain good health
• the views of those with lived experience, including unpaid carers, is vital so we can maximise benefits for the public (and staff) in a challenging fiscal climate
•  we need better data collection which means improved IT and infrastructure if we are going to evaluate changes. Currently the system is driven by what we measure in secondary care
•  one innovative approach would be to apply an equality and human rights budgeting approach - this wouldn't require more money, but would facilitate taking a rights based approach (transparent, fair, participative) to how revenue is raised, allocated and spent
• the way in which we educate our health professionals - we need to look at more efficient ways of delivering undergraduate programmes to produce practitioners who develop advanced practice skills and introduce a range of skill mix to support our advance practitioners and clinical services giving our support workers career opportunities
•  maternity services need to have joined up thinking also - we are continuing to see medicalised births and centralised care in obstetric units and need the investment in midwives to keep women out of hospital whenever appropriate 
•  use new technologies e.g. AI and assistive technologies to speed up results and easier access to data management systems

Update on Population Health Framework - John Nicholson, Deputy Director for Population Health and Improvement

Introduced the Population Health Framework. Explained that taking a longer term approach to health can help mitigate challenges. The framework is needed to tackle the long-term trends – improvements in population health have stalled and Scotland’s health is worsening. We also know the forecast burden of disease is to increase by 21% over the next 20 years. The purpose of the framework is to accelerate the improvement and recovery of population health in Scotland through a coherent long-term framework of whole system primary preventative action. It has been co-developed with COSLA, PHS and Scottish Directors of Public Health. Work began last year with content development – workshops, evidence sessions and an engagement document have been used to engage with stakeholders to date. The engagement process ran throughout the autumn across sectors. Publication will not be the end of the approach and further engagement will continue as appropriate. Content is being finalised with key partners. The intention remains to provide a published document in spring 2025. 

Next steps and closing remarks

The Cabinet Secretary highlighted the challenges facing the system and that the fiscal reality and inflation has impacted our ability to respond to service challenges. Whilst there is no immediate financial solution, we need to look now at how we deliver services differently and to a high quality - there are already positive examples where that is happening. Reform is necessary and the unique perspectives being offered by this forum are key. He thanked everyone for their contributions. The Director-General thanked the group for the good discussion and noted that there was not disagreement on the principles of reform but that the challenge for us all is how we make it happen, with the challenging fiscal environment and an already stretched workforce- a focus is needed on identifying the conditions to progress our reform ambitions.