Citizens' Assembly of Scotland - Doing Politics Differently report: Scottish Government response

6. Health and wellbeing

"a strong focus on prioritising mental health, improving health promotion, on NHS governance, increasing the wages for healthcare staff and a focus on community health"

'Doing Politics Differently'

Summary of recommendations

Recommendations 43 – 49 are themed as 'Health and wellbeing'. These proposals have a strong focus on the NHS, including: staff pay; governance, continued public ownership and operation of the NHS; the need for community health care hubs; and also for greater mental health care provision.

Recovery from the pandemic provides the context for the government's plans on health, well-being and social care. The NHS Scotland Recovery Plan^[98] commits to more than £1 billion of targeted investment for the recovery and renewal of the health service. The Programme for Government sets out further plans for investment in the NHS – increasing by 20% over this Parliament^[99] – and the establishment of a National Care Service, the biggest reform of health and social care since the founding of the NHS.^[100]

Within the overall plans for recovery and strengthening health and care services, there are measures to delivering priorities identified by the Assembly. These include:

• on NHS pay (recommendation 44) within a week of the recent election, the Scottish Government implemented a 4% pay raise for Agenda for Change staff, backdated to December 2020; there was also a 3% increase for NHS medical and dental staff, in recognition of their efforts during the pandemic, backdated to April 2021^[101]
• on community healthcare hubs (recommendation 47) half of annual frontline spending will be invested in community health services by the end of this Parliament^[102]
• on health promotion and information on services (recommendations 43) to redesign the system around the individual, a refreshed digital health and care strategy will be published soon where digital care will be scaled up and a safe and secure digital app will be developed to support people to access information and services directly;^[103] the government also plans a range of measures for promoting wellbeing and active, healthy lifestyles, such as reducing smoking and alcohol consumption, and encouraging sport and active living^[104]

On mental health care (recommendation 49) the government has set out plans for the recovery and development of mental health services^[105] and has worked to support the mental wellbeing of the people of Scotland throughout the pandemic through the Clear Your Head campaign.^[106] A range of activity to deliver these plans is being supported by an additional £120 million Mental Health Recovery and Renewal Fund. This includes a new £15 million Communities Mental Health and Wellbeing Fund,^[107] which was launched in October to support adult community-based initiatives across Scotland which promote good mental health for all, early intervention for those in distress and tackle the impact of social isolation, loneliness and the mental health inequalities made worse by the pandemic. The government recognises the value added to policy and service design by incorporating the views and experiences of people who have lived and living experience of using services, as well as their families and carers. Opportunities for this kind of positive participation are built into work on mental health including through the development of a national lived experience panel.

The Assembly also made three recommendations on the management and public perception of the NHS:

• people are informed of how much the NHS costs at an individual level to build a sense of value and respect (recommendation 45)
• there is a higher proportion of medically trained staff and community members of management boards (recommendation 46)
• there is transparency about private companies' involvement in the NHS "to overcome the challenges of creeping privatisation" (recommendation 48)

In line with the recommendations of the Assembly, Scotland's Health Boards already comprise a mix of Executive and Non-Executive members, with Executive members appointed because of their professional expertise. This includes, for example, the medical and nurse director, both of whom are professionally qualified members of staff. Health Boards need to be representative of the communities they serve, and the people of Scotland, and this is the role of Non-Executive Members, ordinary members of the public who are appointed following a recruitment process regulated by the Commissioner for Ethical Standards in Scotland. Similarly, the Scottish Government remains absolutely committed to a publicly owned and operated NHS. However, there are no plans to produce individual level indications of the cost of the NHS as these would depend on the use made of the service by people according to their individual needs. The health service is intended to provide the health care required by people, free at the point of delivery, whatever these are and whatever their circumstances.

These recommendations of the Assembly, especially those on privatisation and rewards for its staff, demonstrate again the value placed on the NHS by the people of Scotland, a value reinforced by its efforts during the pandemic. There is always a need for improvement and development, but the government shares the Assembly's view of the crucial role the NHS plays in Scotland's society.