Jeane Freeman: striking the balance

As the Christie report argued, there is widespread agreement on the need for a shift to prevention in how we deliver our public services. Despite significant progress, including the integration of health and social care, the pace of change needs to accelerate.

Prevention is at the heart of the Scottish Government’s Vision for Health and Social Care. But, as a government, we need to maintain a balance between shifting our focus to delivering a system-wide redesign of our public services while not neglecting the challenges that are important in the here and now for patients, families and communities.

We need to recognise that to do both, we must avoid false choices between prevention and treatment, national and local and short and long-term interventions. We need to work towards redesigning a system that provides equal weighting towards waiting times and improving the public’s health. As Cabinet Secretary, my focus remains on striking that balance and delivering our ambition for health and social care that not only achieves the highest standards of care, but works effectively as a whole system endeavour to improve health and wellbeing in Scotland.

As a government, we are investing in redesigning services to improve access for patients. I am determined that waiting times for outpatient and inpatient appointments will be reduced. This government is absolutely committed to ensuring that all waiting-times standards and guarantees are met and that patients have confidence that they will receive swift and safe access to the range of NHS services that are clinically appropriate for them.

This is why I launched the Waiting Times Improvement Plan last October. The plan directs more than £850m of investment to substantially and sustainably improve waiting times in the face of rising demand. This investment will see phased and sustained improvement over the period to spring 2021, with the aim that no patient will wait more than the waiting-times standards and guarantees.

Annual operation plans (AOPs), introduced last year, set out how NHS boards will deliver expected levels of operational performance to provide the foundations for delivering the government’s priorities on waiting-times improvement; investment in mental health; and greater progress and pace in the integration of health and social care.

We will use these plans to monitor performance regularly to ensure NHS boards remain on track to deliver the agreed commitments in the Waiting Times Improvement Plan and the ultimate milestone in March 2021.

A&E performance in Scotland remains the best performing anywhere in the UK, despite facing increasing attendances from patients across Scotland. Work is underway across the health system to identify what can be done to manage this rise in attendances.

Increasing demand presents a challenge for staff. They are our biggest asset and the progress we make would not be achievable without the continuing commitment of staff who provide the best care for people, the length and breadth of the country.

I believe passionately in the NHS Scotland values of care and compassion, dignity and respect, openness, honesty, responsibility, quality and teamwork – and I know that staff across our NHS believe passionately in those values too.

The recent review on culture in NHS Highland by John Sturrock QC gives us the opportunity to consider organisational cultures more broadly to ensure what is and what isn’t acceptable behaviour is widely understood and enshrined across our NHS. With this in mind, I have written to all NHS Scotland boards asking them to reflect on the findings of the review and provide details of the actions their board has taken and plans to take in response to the recommendations.

I have also convened a working group to consider how we can deliver sustainable behavioural and attitudinal changes to leadership and management across NHS Scotland. The group, that has representation from amongst the collective leadership of NHS Scotland including chairs, chief executives, staff-side, the Royal Colleges and the professional and regulatory bodies, had its initial meeting on 31 July 2019 and the follow-up work has started.

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However well we perform as a health and social care system, we still face persistent and significant challenges around our health and wellbeing. The most recent analysis published by the National Records of Scotland shows a long-term improvement in life expectancy, however, in recent years, this progress has stalled. 

This isn’t unique to Scotland; trends in life expectancy show a similar trajectory across all constituent countries of the UK.

While people in Scotland can expect to spend a higher proportion of their lives in good health than in any other part of the UK, this varies across the country. Women living in the most affluent communities can expect to spend 23.0 more years in good health than those in the most deprived. For men, the difference is 22.5 years.

The Scottish Government has led efforts to tackle Scotland’s significant public health challenges, including major initiatives on alcohol, diet and healthy weight, physical activity, drugs and tobacco. However, it is self-evident that our approach to date has not yet delivered the sustained improvements in health outcomes we would wish to see.

The challenge is not just one for NHS Scotland, it impacts all our public services and undermines our ambitions to deliver sustainable economic growth. To reverse the downward trend in life expectancy, tackle persistent health inequalities and reduce the unsustainable demands on our public services, it will take a renewed, coordinated and committed effort across all levels of government – national and local – to put wellbeing at the heart of our ambition for Scotland. 

This is why the Scottish Government and COSLA have committed to reforming public health in Scotland. Public health reform will support a shift in our public services from one of managing increasing demand, to focusing on planning and delivering public services in a way that will prevent poor health and reduce demand on health and social care and other public sector bodies.

A focus on prevention and improving population health will be central to delivering our future vision for health and social care and the reform programme will establish a new national leadership body – Public Health Scotland – in April 2020 to work alongside and support our public services achieve this shift in focus. 

I recognise the scale of the challenge and the strong leadership required to deliver the systemic change needed to improve and protect the nation’s health, which is why I am delighted that Professor Jim McGoldrick has agreed to chair the new body.  Professor McGoldrick brings a wealth of experience that will be invaluable as Public Health Scotland begins its journey.

The new body will bring together existing national public health assets in health improvement, health protection and healthcare, underpinned by significant data and intelligence expertise to take advantage of Scotland’s inherent data capabilities.

It is in the innovative use of data and intelligence where we will be able to support our public services to make better decisions and target resources more efficiently, and on the areas where the biggest gains in health can be achieved.

Data will provide citizens with the information and power to make decisions about their own health and care and self-manage existing conditions more effectively. Data presents us with the opportunity to achieve a step change in the population’s health and deliver our future vision. Public Health Scotland will be at the forefront of this innovation.

The new body will be established consistent with the principles set out in the Christie Commission on the Future Delivery of Public Services and draw on fully integrated corporate functions delivered on a shared services model – this will enable the organisation to realise efficiencies and economies of scale to deliver enhanced service capabilities and support wider transformation. 

A decade on from Christie, Public Health Scotland will live and breathe these principles in how it functions and supports the wider system.

I am strongly of the view that where Public Health Scotland can add the greatest value will be in working alongside frontline services and communities to strengthen the focus on preventative spend.

Public health expertise will increasingly be more available to support local partnerships, communities and our public services make decisions that improve and protect population health and reduce health inequalities.

It is only by working collaboratively as a whole system that we will improve the health of the population and reduce demand on health and social care and other public services. This is right for the long-term sustainability of health and social care and will deliver long-term improvements in health and wellbeing for communities. 

Public Health Scotland will be uniquely accountable to both the Scottish Government and COSLA for providing the leadership and the support required – nationally and locally – to drive that collaboration and ensure a focus on prevention in everything we do.

Its long-term success will be judged against meeting Scotland’s public health challenges and how it works collaboratively with partners, communities and the wider system to achieve the shift to prevention in how we deliver our public services and improve health and wellbeing in Scotland.