Care and wellbeing portfolio: newsletters

In this newsletter:

• welcome from Christine and Richard 
• recent examples of portfolio delivery
• NHS Scotland as an Anchor Institution
• digital dermatology
• using service redesign to support community provision 
• assessing progress – the dashboard
• useful links 

Welcome from Christine and Richard 

Our initial edition of the newsletter focused on introducing the care and wellbeing portfolio, in this second edition we are highlighting key areas of work across the portfolio and how progress across outcomes is being tracked and assessed.

Within the care and wellbeing portfolio the winter period has already seen lots of great engagement with key partners and stakeholders within government and beyond, which is helping us in shaping and delivering the work of the portfolio. This has included, the joint session with Health Board Chief Executives and Chairs on 27 March and discussions on our approach to prevention and portfolio progress at meetings of the Scottish Government’s Executive team in February and March.

We are also grateful to the Health and Social Care Alliance for hosting a care and wellbeing members’ event on the 1 March, which allowed us to further develop connections at portfolio and programme level with third sector member organisations.

Care and wellbeing is our key reform vehicle to improve population health, address inequalities and improve system sustainability. It includes work across government on the building blocks of health and wellbeing, and this focus was reflected in the new policy prospectus set out by the First Minister Humza Yousaf on 18 April. In Equality, Opportunity, Community: New Leadership – A Fresh Start, the prospectus sets out the vision for Scotland and the outcomes the government aims to achieve by 2026 to support three missions: Tackling poverty and protecting people from harm; A fair, green and growing economy; and Prioritising our public services.

The prospectus confirmed that the work of the health and social care portfolio would be aligned with our care and wellbeing approach, including:

• recovery and reform of our NHS services
• a sustainable health and social care system that ensures people get the right care, at the right time, and in the right place
• tackling inequality and reducing poverty, with a focus on preventing ill health and reducing health inequalities

We look forward to working with the new health and social care ministerial team in shaping and delivering this important work.

Key to all of our work is impacting change on the ground, and as key deliverables from the component parts of the portfolio firm up, we are including them in the respective planning and delivery guidance for different parts of the system.

Health board colleagues will be aware for example, the NHS Scotland Delivery Plan Guidance for NHS territorial boards issued on 28 February 2023 included board actions to progress deliverables in the place and wellbeing and preventative and proactive care programmes. More generally we are keen to see how Boards are planning to take forward the care and wellbeing portfolio’s mission locally through their medium-term plans due in July.

Beyond those formal touchpoints we are also keen to hear how health boards are progressing their contributions to the care and wellbeing portfolio and the good practice locally that we can highlight nationally. Please get in touch to tell us about that, and we hope that this newsletter, is helpful in setting out a flavour of the work underway and planned.

Recent examples of portfolio delivery

NHS Anchor Institutions

We introduced the ‘Anchors’ workstream within the place and wellbeing programme in the winter edition of the newsletter. By taking deliberate decisions to support disadvantaged local people, to procure goods and services locally where possible, and to ensure their assets are best used to the advantage of the local community, NHS boards and other bodies within the sector can function as anchor institutions and use their significant power to improve the lives of people in the communities they serve. 

Under the place and wellbeing programme, through the leadership of the Chief Executive of NHS Fife, work to support and enable all health and care to be effective and consistent Anchors is underway and following extensive engagement with NHS boards and various stakeholder groups, a workplan for the Anchors workstream is well developed and to be discussed at the Place and Wellbeing Programme Board. The workplan sets out a range of activities to meet the workstream’s overall aim of supporting NHS boards and others to be effective anchor institutions by aligning policy, removing barriers and enabling local activity in three key areas: procurement, land and assets and workforce.

Actions on procurement, and land and asset will be progressed through task and finish groups, with the Anchors Delivery Group having overall responsibility for delivery of the workplan.

For the workforce strand, the Anchors Workforce Strategic Group (chaired by David Miller, HR Director, NHS Fife) is responsible for leading on objectives around fair and equitable employment. Two subgroups have already been established under this group, with representation from each territorial NHS board. The Skills for Health and Social Care Group which is considering the use of apprenticeships and other access routes to NHS careers, and the Employability Leads Group which will provide a space for leads to raise issues, share good practice, and collaborate on the 
operationalisation of the workplan.

To complement the workplan, a communications strategy has been developed with the aim of inspiring further momentum and galvanizing action around anchors organisations, as well as fostering a shared understanding of the anchors concept across the health and social care sector.

The Place and Wellbeing Programme team will also be liaising with NHS boards over the coming months to discuss what they would find helpful to progress the ask in the recently issued ‘NHS Scotland Delivery Plan Guidance’ to support them to develop an Anchors Strategic Plan that outlines their governance, partnership and benchmarking arrangements. 

For more information contact Úna Bartley at pawsecretariat@gov.scot. 

Digital dermatology

Through the Care and Wellbeing portfolio, the Scottish Government created the Accelerated National Innovation Adoption (ANIA) pathway and established an Innovation Design Authority (IDA). Together they are providing a once for Scotland approach to the identification, assessment and accelerated adoption of innovative technologies within NHS Scotland. 

We are already seeing several initial innovations coming through ANIA for the IDA to consider, including Closed Loop Systems for type 1 diabetic patients, Digital theatre scheduling, a Digital Diabetes Remission Programme and Digital Dermatology.

For example, the digital dermatology innovation is an example of secondary prevention in action. Increasing image acquisition in primary care and subsequent digital triage by a dermatology consultant, could significantly reduce pressure on secondary care and improve waiting times for diagnosis and treatment, improving outcomes.

An estimated 36% of referrals across Scotland currently include a digital image. If this was increased to 90% through the development of a national image capture, transfer and triage process, we estimate that this could deliver a 50% reduction in demand for outpatient appointments and allow some patients to be directly scheduled for surgery. 

Following national procurement, deployment to 25% of boards with the lowest use of digital images/longest waits will start Oct 2023. Full national deployment to over 900 GP practices and 14 Boards will be completed over 2025.

By reducing waiting times and enabling earlier clinical triage, this innovation will also increase the likelihood of earlier diagnosis, particularly for skin cancers, making it less likely that they would be diagnosed at the point when they have become difficult to successfully treat.

Using Service Redesign to Support Community Provision 

Through the work of the Preventative and Proactive Care Programme (PPC), service redesign to better support the needs of people with glaucoma is now at the point of delivery. It represents a practical real-world example of shifting the balance of care from acute provision to community provision. 

Patients with glaucoma are traditionally managed in the hospital setting by a consultant ophthalmologist. Under a new NHS Community Glaucoma Service (CGS), lower risk patients will be managed in the community by accredited community optometrists. This will free up hospital capacity to help reduce hospital waiting lists and will deliver care closer to the patient’s home. 

The first patients have been registered under the CGS in NHS Greater Glasgow and Clyde, and then the service will be rolled out in other NHS boards. At full rollout, an estimated 20,000 patients in Scotland will be registered under the service. Marking the launch at Munro Optometrists, one of the first practices to offer the service, 

Public Health Minister Jenni Minto said:

“Scotland is regarded as a world leader in community eye care service provision. We are the only country in the UK to provide free universal NHS-funded eye examinations, and our investment in community optometry services has helped reduce the burden on GPs and secondary care services. I am very pleased to celebrate the launch of this new flagship NHS Community Glaucoma Service in Glasgow and look forward to seeing more patients across the country benefiting from the rollout.”

Launch of NHS Community Glaucoma Service

Shifting the balance of care from acute to community services will mean improvements to the experience of people who can receive the care they need locally. It will free up capacity within the hospital eye service to ensure more timely treatment is available to those patients who require a consultant ophthalmology led service.

Assessing progress – the dashboard

Work is underway in partnership with Public Health Scotland (PHS) to develop a dashboard for the portfolio, building on the prototype dashboard developed for the Scottish Government’s COVID Recovery Strategy and including indicators mapped to the policy objectives of the Marmot Review. The dashboard is intended to provide access to the latest evidence to:

• understand progress against each indicator at national and local level and assess if outcomes are improving
• support improvement and drive local change by delivery partners, including health boards and community planning partners
• highlight where further action might be needed

The plan is for data to be disaggregated by health board and local authority level, and by equalities groups, where available. 

Developing the dashboard will include targeted engagement with a range of potential dashboard users including health boards and local government to understand their needs, how they might interact with the data and identify priority areas for improvement. There will also be work to develop case study examples of how dashboard data is being used to support improvement and drive local change and showcase successful prevention in action.

Useful links

Care and Wellbeing Portfolio Board minutes.

Previous editions of this newsletter 

Care and Wellbeing Portfolio newsletter - December 2022.

Get in touch

Please get in touch with the team if you would like to find out more about the care and wellbeing portfolio NSS.CareAndWellbeing@nhs.scot.