Care and wellbeing portfolio: newsletters

In this newsletter:

• latest updates on portfolio delivery - Waiting Well, Digital Telecare, GIRFE and primary care 
• cardiovascular disease as a new area of portfolio work 
• care and wellbeing dashboard – next steps 
• climate, health and care – interlinked risks, interlinked opportunities
• how can we embed health equity in our decision-making, and what do the public think about priorities for health? 
• upcoming event

Latest developments 

Since our last edition the First Minister has issued mandate letters to all Cabinet Secretaries highlighting how they will collectively deliver on the priorities set out in the Policy Prospectus . 

Within health and social care the letter sets out the SG’s commitment to planning for the future, including to: 

• continue with our recovery and renewal of the NHS and social care systems from the pandemic, including focusing on building a sustainable NHS and NCS fit for the future
• continue to drive recovery and reform of services through our strengthened delivery plan process with NHS boards, accelerate and scale service change work nationally
• set out a common approach for the reform of NHS to improve population health and system sustainability to meet the needs of our diverse population of Scotland
• reduce NHS greenhouse gas emissions and contribute to wider decarbonisation, develop a climate resilient health service and improve the impact of the NHS on the environment

The care and wellbeing portfolio will be a critical vehicle to bring coherence and accelerate our work on these longer-term reform priorities, and the Care and Wellbeing Portfolio Board will consider next steps at the end of October. 

The portfolio board met in July and agreed a workplan and governance for deliverables for 2023 and 2024 within the portfolio. This includes a proposal to take forward joint work with colleagues in DG Economy and PHS on health and work to focus on economic inactivity, due to long-term sickness and the impact this has on Scotland’s economy and population health. 

COSLA also led a discussion on the new deal with local government (the Verity House Agreement). This recognised the important milestone of the agreement as a moment to strengthen partnerships across government and the value of continuing engagement on shared priorities of tackling poverty, transforming our economy through a just transition to deliver net zero and, delivering sustainable, person-centred public services, which are key areas within CWP. The board agreed the importance of contributing to this throughout the portfolio to ensure progress on key CWP metrics, such as healthy life expectancy. The work will link directly with the Enabling Local Change Workstream within the Place and Wellbeing programme and work to define measurement through the care and wellbeing dashboard.

Updates on portfolio delivery 

The Preventative and Proactive Care (PPC) Programme has made substantive progress across its active workstreams with a new work strand being added.

Waiting Well 

The Waiting Well hub pages on NHS Inform have been created to support people waiting by access to better information to support them to proactively manage their health and wellbeing and to think about what matters to them and what health improvements they could make in the meantime. This piece of work is being led by the Waiting Well Public Information Subgroup supported by professionals and the third sector representatives. The site was developed with support from NHS24 content designers and input from various subject matter experts was sought to ensure reliability and accuracy of content. User research was conducted in order to maximise the use of the site. This is the first phase in the development of tools and guidance to support people who are waiting and will contribute to the portfolio’s mission and aims to better support Scotland’s citizens during set phases in their life and puts people at the heart of self-prevention and self-care during the waiting period. The hub is expected to golive in October 2023. 

A second subgroup in Waiting Well on ‘Health and Wellbeing Plans for People’ aims to create national principles and toolkit for local areas to provide a multiagency system of support to citizens. The group is also working with SG Planned Care team to provide Waiting Well input on the revised planned care guidance, with the guidance planned to be launched with the health boards at the end of September.

Digital PPC 

Substantial progress has been made in the digital workstream with the proposed programme plan for Proactive Telecare now being moved forward as integrated with the Shared Alarm Receiving Centre for Scotland. This provides an opportunity of trialling and embedding proactive telecare in a fully digital environment. PainChek work is underway across 10 care homes led by the Care Inspectorate; the work over the last couple of months has focussed on completing the test period for phase 1 and planning for phase 2. The Remote Health Pathways Connect Me: Hypertension programme is now live in 12 health boards with final two nearing completion; over 80,000 recruitments to date with noticeable monthly increase and transfer from legacy system to national platform. Other funding resources are being explored for Sub-Epidermal Moisture (SEM) Scanners in the community with interest from primary care.

Getting It Right For Everyone (GIRFE) 

The GIRFE pathfinders have completed their design school training and are now heading into sessions with people with lived experience. 

The eight pathfinder teams leading the GIRFE work - East Ayrshire, Fife, Orkney, Aberdeen City, Aberdeenshire, North Lanarkshire, Edinburgh, and Angus - have submitted approximately 140 personcentred journey maps during the discovery phase of the work. 

These journey maps, developed with people with lived experience, focused in on GIRFE’s five thematic areas: people in prisons; people in addiction services; people registered at deep end GP practices; families with multiple and/or complex needs; and young people in transition from GIRFEC to GIRFE, as well as older people and frailty. Cross-cutting insights have been drawn out and these national insights are represented in the diagram below. These insights have been split into three core themes of System, Practical, and Society, with a cross-cutting theme of ‘Cyclical Decline’ being evident. As well as being the foundation for the GIRFE work, these insights are being relayed to policy areas within SG, to support shared learning.

Pathfinder teams, using ‘how might we’ statements based on the insights, will be submitting their ideas and concepts back to SG in mid-October, with a further session set to take place in mid-November. The pathfinders will then begin the prototyping stage of the process. Partners will be brought in during this stage to act as testing sites for the prototypes, which will be developed by pathfinder teams in early 2024. 

Health and Social Care Partnerships (HSCPs) from across Scotland have been invited to take part in partner days in September, to find out more about GIRFE, their own readiness for GIRFE, and to consider becoming a GIRFE partner. GIRFE will impact all areas of health and social care in Scotland, forming the future practice model. The GIRFE team invites everyone working within the system, as well as SG, to consider how they will support the GIRFE approach over the coming months.

Primary care 

The rollout of the national Community Glaucoma Service (CGS) continues to progress well, with 313 letters issued to eligible patients in NHS GGC in August 2023. The roll-out in NHS Lanarkshire is expected to go live on or around 1 November 2023, followed by NHS Western Isles. In general practice, work continues with the expansion of multi-disciplinary teams in primary and community care, with future investment decisions made. 

Through Inclusion Health Action in General Practice (IHAGP), support has been enhanced for the most deprived communities in NHS GGC to tackle challenges associated with health inequalities for people who often have complex life circumstances and unmet needs. The payments support general practices to carry out activities which best meet the needs of the communities they serve. Finally, NHS 24 is working on preventative and proactive care as a specific workstream within its strategy; there was positive support for this at the recent Health and Social Care Management Board meeting.

Cardiovascular disease as a new area of work

The aim of the new CVD Workstream is to improve the identification and management of key clinical risk factors for cardiovascular disease with the aim of: 

• improving healthy life expectancy and life expectancy for all 
• increase our identification and management in those in our communities with the highest risk

A group have been working with the Chief Medical Officer on a draft workplan, built around a driver diagram and three emerging workstreams, which are: 

• information and awareness 
• transforming models of care 
• data and quality improvement 

The aim is to commence the groups and reporting of this workstream from November 2023. Whilst this will report in through the PPC programme to the care and wellbeing family, it is a cross-Health and Social Care Directorate endeavour with key contributions from population health, clinical priorities, primary care, professional teams.

Care and wellbeing dashboard next steps – integration with Scottish Public Health Observatory 

The care and wellbeing dashboard, developed in partnership with Public Health Scotland, was launched in June. The aim of the dashboard is to provide access to the latest evidence to understand progress, support improvement, drive local change and highlight where further action might be needed against relevant indicators mapped to the policy objectives of the Marmot review. 

Work is now underway, in collaboration with PHS analysts, to integrate the dashboard into the Scottish Public Health Observatory (ScotPHO) Online Profiles Tool. We are scoping out options on what this will look like as well as progressing work to create an early version of a care and wellbeing summary report drawing on care and wellbeing indicators already included in ScotPHO and hope to make this available by the end of October.

By bringing this into the ScotPHO this will: 

• provide a single repository of public health intelligence - ScotPHO profiles already include over 250 indicators 
• reach a wide existing user base of public health information - over 50,000 hits in 2020 and 2021 
• and provide a strong focus on health inequalities

In addition ScotPHO profiles provide information for different levels of geography and highlight variation through different display styles and options. 

To inform this work we would welcome feedback from all users, including those who may have previous experience of the ScotPHO online profile tool. 

• what sort of visualisations would be most useful to analyse information on the Care and Wellbeing indictors? 
• which levels of geography are most important to show and compare on the dashboard? 

Please contact the ScotPHO team phs.scotpho@phs.scot with any feedback.

Climate, health and care – interlinked risks, interlinked opportunities 

The end of September marked Scotland's Climate Week which is an annual event that encourages individuals, communities, organisations, and businesses to come together to show support for tackling the climate emergency.   

Human health and planetary health are inextricably linked. The World Health Organisation has described climate change as “the single biggest health threat facing humanity” and, the way we respond has been described as “the greatest global health opportunity of the 21st century”. Scotland’s Chief Medical Officer recently made climate and health one of the core themes of his annual report. 

This week Public Health Scotland announced their Climate Change and Sustainability Strategic Plan. This publication represents significant capacity building from Scotland’s public health agency and demonstrates the level of prioritisation being given to this key issue. It has been developed with colleagues from across climate change roles and was recognised by the Cabinet Secretary for Transport, Net Zero and Just Transition, Mairi McAllan who said: 

"Tackling the twin crises of climate change and nature loss is the collective fight of our lifetime, with huge implications for generations to come. From wildfires to flooding, it is affecting our lives right now in Scotland and across the world and the need for climate leadership could not be more urgent. 

The connections between tackling the climate crisis and improving public health are clear. We welcome the role that Public Health Scotland is playing in this area and look forward to working with them as they deliver on the vital goals of this strategy". 

Climate is a key priority of the care and wellbeing portfolio and over the past year we have been focused on working across government to join up transformational change agendas and to build capacity. 

This is ensuring that health and care interests are considered within climate change policy and, importantly, that we challenge ourselves to consider the climate in our own policy development. We are inputting into, and will continue working with, Scottish Government plans to:

• achieve net zero emissions 
• adapt to a changing climate 
• achieve these through a just transition 

It was just over a year ago that the NHS Scotland Climate Emergency and Sustainability Strategy was launched. Recent developments include: 

• iHS Scotland won the Sustainable Healthcare Project of the Year 2023 at the inaugural European Sustainable Healthcare Awards. The winning project, Green Anaesthesia Scotland, reduces the environmental impact of medical gases across healthcare services
• the National Green Theatre Programme has been launched to reduce the carbon footprint of theatres across NHS Scotland and enable more sustainable care. 
• a technical briefing was issued to health boards in August on Entonox®. The challenge for NHS Scotland is to minimise the environmental and occupational health risks of Entonox® while continuing to utilise this analgesic agent without compromising patient care
• the propellant in metered dose inhalers used for the treatment of asthma and COPD are powerful greenhouse gases. A respiratory prescribing consultation has been launched and is open for responses until 31 October. Recommendations contained within the guide can assist to reduce the environmental impact of respiratory prescribing

If you have ideas you would like to discuss, please contact steven.carter@gov.scot in the first instance.

Healthcare prioritisation and inequalities

How can we embed health equity in our decision-making, and what do the public think about priorities for health? 

To support the care and wellbeing portfolio’s aims, a team of researchers in Scottish Government Health and Social Care Analysis have reviewed the literature on healthcare prioritisation and inequalities. As part of that broad piece of work, this piece highlights findings on implementing health equity as a system goal, alongside eliciting the public’s views. 

There were many common themes that contributed to the success of implementing health equity approaches:

• the need for clarity about what is to be prioritised, and how this prioritisation is to take place
• knowledge around the prioritisation process itself and its potential effects, particularly from an equalities perspective 
• the need for all levels of organisations to be involved as opposed to trying to implement prioritisation top-down or bottom-up

Potential challenges for implementation included: 

• the complexity of the health care system
• lack of resources
• gaps in knowledge in the evidence base for choosing between projects and around the use of prioritisation tools themselves
• the need to ensure processes are robust and transparent

The values of the people involved in decision-making are also key. One study (Smith et al., 2018) explored the perceptions of senior public health leaders in Canada. While health equity was a core value, they were more comfortable when implementation and prioritisation were associated with addressing inequities of access to care and material determinants of health, compared to a focus on political issues, power imbalances or systemic disadvantage. 

Transparency and trust have been identified as key to successfully implementing changes to prioritisation by building public trust, with a lack of transparency associated with scepticism among those needing to implement changes (Marks et al. 2013). Transparency can aid public understanding of decisions (such as NICE publishing).

Given the complexity of health inequalities, a range of methods have been used to understand how the public would make these trade-offs. This kind of information can help inform or legitimise choices. We found three papers using:

• citizens juries 
• the Q methodology (a mixed methods approach) 
• discrete choice experiments (a specialised survey) 

The citizens juries approach is useful to understand a range of views, how these change with further expert evidence, and how consensus is formed. The Q method is most useful in generating clusters of views to see which aspects of a problem different groups see as more important. Lastly, discrete choice experiments are useful in generating the quantitative data to estimate how people make trade-offs between different attributes in a problem.

These surveys found that the public does prefer prevention when it is targeted at younger people, and treatments where the disease is less related to the recipient’s lifestyle. It has also shown that whereas some experts believe determinants of health are largely social, there is a consistent view in some parts of the public that health is a personal responsibility. 

This article presents summary results from a longer literature review held by HSCA. Please get in touch with Alastair.Irvine@gov.scot for further information.

Upcoming events PPC 

Autumn event, 24 October 2023

Since launching last autumn, the programme has been progressing on some key workstreams, with new areas of work also being added. This event will cover an update on what is new in PPC workstreams since the launch event on 26 October 2022. The event is open to colleagues who are leading and delivering health and social care services across Scotland and third sector organisations. 

Useful links

Care and Wellbeing Portfolio Board minutes.

Previous editions of this newsletter 

• December 2022
• May 2023 

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.