Programme for Government 2021 to 2022

Chapter 1: A Caring Society

To set a new vision for health and social care, within the next 12 months we will:

Provide the first installment of a significant budget increase for frontline health services, and take forward our NHS Recovery Plan to increase capacity and address backlogs in treatment times.

Invest £8 million in a package of support to help health and social care staff to look after their own mental health and wellbeing.

Bring forward legislation to establish the new National Care Service.

Complete construction of National Treatment Centres in Fife, Forth Valley and Highlands – creating new and additional capacity for surgeries and procedures.

Provide the first £50 million of the planned £250 million increased investment to tackle the drugs death emergency – providing effective outreach services in every local authority and increasing both the availability of rehabilitation and aftercare services, and the number of people in treatment.

Provide £120 million for mental health service recovery, complete our commitment to recruit 800 additional mental health workers this year, and ensure community wellbeing services are available in every local authority.

Bring Free Personal Nursing Care rates in line with the National Care Home Contract and provide additional funding to enhance breaks for unpaid carers.

We will forever owe our health and social care services, and the extraordinary staff who kept them running in the toughest of years, our immense gratitude. Their selfless efforts and determination to provide care and comfort for those who needed it at a time of national emergency, while rapidly transforming ways of working, have been invaluable in our response to the pandemic so far.

As we emerge from the pandemic, we will strengthen and improve our health and social care system so that everyone gets the care they need, while recognising and repaying the efforts of staff given the toll the pandemic has had on them.

We will also rethink the ways in which care is provided – protecting the fundamental principle of providing free care at the point of need for everyone who requires it, while learning from the experience of the pandemic to ensure that care is delivered in a way, place and time that works best for people. That means reforms which start with people and places, rather than services. We will continue our work to promote healthy behaviours and lifestyles, and reduce health inequalities across the entire Scottish population.

A recovered and strengthened NHS

Whilst the rate of COVID‑19 hospital admissions has declined, there is no room for complacency: we must stay vigilant against transmission and new variants, and plan for pressures on the NHS to continue for some time.

The 2021‑22 Scottish Budget already takes health funding to over £16 billion. We will now go further, and increase investment in frontline health services by 20% over this Parliament. The next uplift will be applied through the 2022‑23 Scottish Budget, with frontline funding that directly supports patient services increasing by at least £2.5 billion by 2026‑27. We will pass on all frontline health and social care consequentials.

A hallmark of the pandemic was the shift in how people received care – pharmacists, GPs and other community services ensured people could still access high‑quality healthcare while reducing unnecessary trips to hospital.

Over this Parliament we will increase primary care funding by 25%, with half of all frontline health spend invested in community health services, to ensure this record investment provides more care for people in a place and in a way that meets their needs. We have also increased our Primary Care Fund from £195 million to £250 million in 2021‑22, which includes support for the new GP contract and for wider Primary Care reform. To ensure funding is distributed equitably across the country, we will review the NHS funding formula.

We will invest £10 billion over the next decade to replace and refurbish our health infrastructure to build the NHS for the future and ensure patients continue to access high quality care in world‑class facilities.

While the NHS remained open for essential services, many services had to be paused or reduced in scope and scale due to the pandemic. As a result many people are waiting longer for the care they need. The scale of that challenge is considerable and a significant and sustained remobilisation is needed to address that backlog.

Our NHS Scotland Recovery Plan, published within the Government's first 100 days, commits more than £1 billion of targeted investment for the recovery and renewal of our health service.

It outlines a range of reforms across primary and acute NHS services to help recover from the pandemic, and get everyone the treatment they need as quickly as possible.

In acute care we are increasing capacity for inpatients, day cases, outpatients and diagnostics. In primary care the focus is to restore more face‑to‑face treatment quickly and safely, while recognising that virtual services will continue to have a role to play.

Key actions include:

• Investing £29 million this year, to provide an additional 78,000 diagnostic procedures in 2021‑22 rising to 90,000 per year by 2025‑26.
• Increasing outpatient activity by 140,000 (10%) by 2025‑26 compared to pre‑pandemic activity levels of around 1.4 million appointments and procedures a year.
• Increasing inpatient and day case capacity to achieve an increase over pre‑pandemic levels of 27,500 procedures – a 10% increase – in 2022‑23 and an increase of 55,500 procedures per year – a 20% increase – by 2025‑26. We have also taken steps to introduce new capacity in 2021‑22, including new national capacity for 8,000 cataract procedures and 12,000 endoscopies.
• Providing £8 million this year to support the mental health and wellbeing of the health and social care workforce.

An extra £400 million investment will allow our National Treatment Centres to increase capacity – contributing to the delivery of 55,500 inpatient/day case procedures by creating capacity for more than 40,000 additional elective surgeries and procedures per year. Two additional Centres, in Cumbernauld and Ayrshire, will be added to existing plans with preparatory work, including development of business cases, beginning in this parliamentary year. We will accelerate recruitment of at least 1,500 more staff to support the Centres. The replacement of the Edinburgh Eye Pavilion will be progressed, with NHS Lothian preparing the Full Business Case, following the recent approval of the Outline Business Case. All of this work will deliver a national network of 10 specialist Centres across the country.

We will continue to support health research and innovation as a vital part of our recovery and our wider aims to improve the health of the population, investing in innovation at a local and national level. This is particularly important in supporting people living with the long‑term effects of COVID‑19 ("long COVID"). While most symptoms end within a few weeks, we know that some people experience new or persisting symptoms. We will ensure that those people receive quality care and support – from our NHS, social care or third sector – when they need it. We will publish the principles and commitments that underpin our care and support for long COVID in September 2021. We will build on our understanding of the longer term health impacts of COVID‑19 from research and lived experience, and ensure our approach continues to evolve and respond to evidence as it emerges. We will equip our NHS and care staff with up‑to‑date resources to help them support people with their recovery.

Over the coming years, through advances in research, medicine and diagnostics, there will be increasing demand for the genetic capacity and capabilities within NHS Scotland. Many of the new medicines being accepted by the Scottish Medicines Consortium require genetic tests. We will invest in the genetic labs and frontline genetics services required to embed genomics medicine into routine healthcare.

We have also established a new Centre for Sustainable Delivery to pioneer and deliver new, better and more sustainable ways of delivering services and improving access for patients. It will be key to supporting NHS recovery by reducing unnecessary demand for services, and also developing new pathways of care that are better for patients. This will include enhanced delivery of community services, transformation of hospital pharmacy services, reducing the variation in waiting times for planned and unplanned care, and improving overall patient experience. We will update the Recovery Plan to reflect that work as we review it each year.

Limiting the impact on cancer patients during the pandemic has been a top priority, with vital treatments continuing. The National Cancer Recovery Plan, backed by £114.5 million, is helping improve patients' experience of care, as well as supporting the roll out of innovative treatments to improve services. In July 2021, we provided £10 million for Health Boards to further recover and redesign cancer services and improve waiting times. We will retain the current cancer waiting time standards and review whether there is merit in additional targets.

We will publish a refreshed Framework for Effective Cancer Management in September 2021, that supports waiting times improvements and incorporate the new ways of managing services that have emerged as a result of COVID‑19.

We will develop a new vision for early diagnosis and optimal cancer pathways – starting with lung cancer – supported by an additional £20 million investment, over the life of this Parliament, for the Detect Cancer Early (DCE) Programme to improve early detection rates.

Within the Government's first 100 days, three Early Cancer Diagnostic Centres were established in Dumfries & Galloway, Fife, and Ayrshire & Arran. These enable GPs to refer patients with non‑specific symptoms suspicious of cancer onto a fast‑track diagnostic pathway, to get care and treatment quickly. We are committed to ensuring equitable access to an Early Diagnosis Centre for everyone across NHS Scotland who needs it, and will undertake an evaluation of the initial Centres after 12 months to help inform wider roll‑out.

We also recognise the impact of the pandemic on maternity, neonatal and IVF services for the women, families, and 70,000 newborn babies who have used them over the last 18 months. We will improve care for all pregnant women and newborn babies within the lifetime of this Parliament by delivering on the recommendations of The Best Start review of maternity and neonatal services. We will deliver our IVF guarantee of treatment within 12 months of referral, establish a dignified and compassionate miscarriage service by the end of 2023, and take forward the recommendations of the Independent Review into maternity services at Dr Gray's Hospital.

Staffing and wellbeing

A modern and sustainable health service relies on a healthy and resilient workforce. We gave health and care staff our applause in the early months of the pandemic, but we owe them so much more – the pay rise this year will ensure they remain the best paid in the UK.

We have already implemented an average 4% pay raise for Agenda for Change staff, backdated to 1 December 2020. In August we implemented a 3% pay raise for NHS medical and dental staff, backdated to 1 April 2021. This recognises the exceptional year our NHS workers had and reflects the immense value we place on their continued hard work and dedication. This annual pay rise is in addition to the £500 Thank You Payment made to every health & social care worker in Scotland.

This year we are also providing an £8 million package to support the wellbeing of those working in health and social care, with £2 million targeted at social care and primary care, in recognition of their specific needs. Most immediately, we will support the ongoing development of a National Wellbeing Programme – including a dedicated hub and helpline – Workforce Specialist Service and psychological interventions and therapies, along with time and training for staff to support each other as teams, and practical support like rest spaces. This will seek to embed wellbeing into everyone's working lives, supported by compassionate leadership and a culture where wellbeing and mental health are seen as fundamentally important.

We will also take forward a range of actions to ensure we support the next generation of the workforce, including:

• Expanding medical school training places by at least 100 per year from 2021‑22, and doubling the number of funded widening access places to 120 per year.
• Establishing a review into the strategic requirements for Allied Health Professionals education, reporting by September 2022, to ensure the required skills mix and expansion to deliver Health and Social Care priorities.
• From September 2021, introducing a new Paramedic Students Bursary, providing eligible students with up to £10,000 per year.

Redesigning the system around the individual

The need to deliver services in new ways during COVID‑19 has demonstrated the range of alternatives available, in addition to traditional face‑to‑face care. Building on the desire of many to access care and support in new ways and underpinning our commitment to offer flexible access to care, we will scale up digital care.

While this will not be suitable for everyone, experience from the pandemic showed that it was a welcome option for many people, allowing them to get help without disrupting personal and work commitments, and reducing unnecessary travel. It also sits alongside our wider ambitions to make Scotland a digitally inclusive and connected country, including significant work to help get more people online through Connecting Scotland.

We will continue to increase the use of Near Me, the video consulting service, backed by £3.4 million a year. The service was rolled out to GP surgeries and community pharmacies in response to the pandemic and has now provided over 1 million consultations across all services. This year we will introduce it to social care services, including care homes and housing support, followed by wider public services including Social Security Scotland – ensuring its benefits are felt beyond health and care.

We will develop a safe and secure digital app that will support people to access information and services directly, self‑manage, and access and contribute to their own health and care information. It will be introduced by the end of this Parliament, following public consultation and engagement. We will also develop a digital prescription service freeing up capacity for healthcare professionals to see more patients and making it easier for patients to access their medicines quickly and safely. This will initially be between GP practices and community pharmacies, progressing to other areas, including Out of Hours services, NHS 24, hospitals for out‑patient and discharge prescribing, dentists, pharmacist prescribers, optometrists and community mobile prescribing.

Over this Parliament, we will continue the redesign of urgent care, helping the public access the right care in the right place at the right time. Even prior to the pandemic, attendances at A&E had been increasing substantially to a level where around 20% of people turning up would be more appropriately cared for in another setting. Every Health Board now has a hub to directly receive referrals from NHS 24, offering rapid access to a senior clinician and using telephone or video consultation where possible to minimise the need to attend A&E. Since June 2021, these have expanded to include children aged 18 months to 12 years. Where people are referred to A&E, this is scheduled – when possible – for a specific day and time, reducing unnecessary waits. Patients will be encouraged to contact their GP or community pharmacist as their first point of contact, keeping care as close to home as possible and avoiding unnecessary waits in A&E.

Prioritising mental health and wellbeing so everyone in Scotland can thrive as we recover

The impacts of the pandemic have been severe, in particular on those who were already experiencing inequalities, and as a result mental health services are facing increasing pressure. While we have significantly increased the support available, too many people are still waiting longer than we want for support.

We will invest in new and additional treatments and support, ensuring Health Boards redirect more of the funding we provide them, so that by the end of this Parliament 10% of all frontline NHS spend will go to mental health. We will also increase mental health spending by 25% over this Parliament. This funding will help shift the focus to prevention and early intervention, reducing demand and waiting times for clinical services, often at crisis point, by ensuring the right mental health support is available to people when they need it.

We will refresh and refocus our mental health commitments in 2022, including a review and refresh of the Mental Health Strategy 2017‑2027. We will also develop a long‑term mental health workforce plan in the first half of this Parliament, to ensure we have the right workforce to deliver these commitments.

By driving forward the actions set out in our Mental Health Transition and Recovery Plan, backed by £120 million in this financial year, we will:

• Provide up to £29 million for Health and Social Care Partnerships to complete recruitment of 800 additional mental health workers by the end of 2021‑22.
• Create transformational and lasting change by providing sufficient funding for around 320 additional staff in Child and Adolescent Mental Health Services (CAMHS) over the next 5 years, with the potential to increase capacity for CAMHS cases by over 10,000.
• Invest an additional £4 million to increase the capacity of NHS 24's Mental Health Hub, offering a compassionate response to those in distress or seeking support, 24 hours a day, 7 days a week.
• Launch a new website in spring 2022, offering tips and advice from mental health experts and people with lived experience of mental health issues. Users will be able to create personalised mental wellbeing plans and access moderated online peer support communities.
• Invest £328,000 to enable more than 300 key front‑line Police Scotland staff and around 200 Scottish Ambulance Service staff to refer people for Distress Brief Interventions, an effective and compassionate source of support.
• Provide additional funding for dementia post‑diagnostic support, to expand access to front‑line services and to strengthen wider support which benefits people with dementia and their families after a diagnosis.

GPs are usually the first port of call for people seeking professional support and treatment, and often become the main support for those people – when they may not be well enough equipped to respond to complex and varied needs. By 2026, every GP Practice will have access to a mental health and wellbeing service, funding 1,000 additional dedicated staff who can help grow community mental health resilience and direct social prescribing. Later this year, and on the basis of local plans submitted by Integration Authorities, we will fund the national implementation of these Mental Health in Primary Care teams.

The pandemic has also shown the possibilities for delivering quicker support through digital services, with 25% of psychological therapy referrals now going through such routes. Over the next year, we will begin work on an expanded Digital Mental Health Programme, that will increase self‑referral to online treatments, establish a Mental Health Innovation Hub and explore options for an online national psychology service.

While mental health can affect anyone, we recognise the particular risks for children and young people – particularly as the pandemic has constrained their social, educational and economic opportunities. Working with Health Boards, we will seek to ensure at least 1% of all frontline NHS spend goes on Children and Adolescent Mental Health Services by the end of this Parliament, and improve preventative and early intervention services. Around 200 community based mental health and wellbeing services have been funded in the past year to offer an alternative where specialist services are not appropriate. These will be established in all local authority areas this year, and we will double the budget for community based mental wellbeing services for children and young people to £30 million.

Sadly adverse and traumatic experiences also increased for many people during the pandemic, resulting in poorer physical and mental health. For some, pre‑existing trauma was exacerbated and access to support diminished. We have extended the National Trauma Training Programme for a further two years, to 2023, to facilitate a trauma‑informed workforce and services. An understanding of trauma will also inform the development of our forthcoming Mental Health Quality Standards, which we will publish during this Parliament. Working with COSLA, we have also initiated a Leadership Pledge of Support for Trauma Informed Practice, raising the standard of support across public and third sector organisations. Together, these will ensure that services and workforces recognise where people are affected by trauma and adverse childhood experiences, respond in ways that prevent further harm, and support people's recovery and life‑chances.

To protect the rights of those experiencing the most severe mental health issues – including those subject to the mental health, incapacity or adult support and protection legislation – the Scottish Government established the Barron Review of forensic mental health services, and the Scott Review of legislation. We will publish our response to the Barron Review later this year, and we are already working with partners to take forward its recommendations. We will take forward the Scott Review when it publishes in September 2022. We will use the outcome of these Reviews to create a world‑leading and human rights aligned mental health and incapacity legislative framework, and a forensic mental health system that delivers care and treatment for people who need it, when they need it, while protecting public safety.

Central to the mental health agenda is our vision for Scotland to be a place where suicide is preventable and prevented, and where help and support is available to anyone feeling suicidal, and to those who have lost a loved one. Over this Parliament, we will double funding for suicide prevention to £2.8 million per annum. This will ensure the right investment, policies and services are in place to underpin the new suicide prevention strategy – due to publish in 2022. This includes significantly expanding awareness‑raising and training on suicide prevention which will help workforces and communities respond to people who are at risk of suicide, including through programmes such as the Scottish Mental Health First Aid training and Ask Tell Respond programmes. In 2021, we will build on work underway by Public Health Scotland and NHS Education for Scotland to embed mental health training for staff in key public sector organisations.

Creating a person‑centred social care system, built on compassion, care and kindness

At the frontline of the pandemic, Scotland's carers provided quality care with compassion to some of our most vulnerable people during the toughest of times. The experience of our care staff and those living in social care settings was often heart breaking. Now is the time to rethink how we deliver care, and ensure consistently high‑quality services for everyone who needs them, their families and staff.

Over this Parliament, the Scottish Government will take forward the biggest reform of health and social care since the founding of the NHS, establishing a new National Care Service (NCS) – with the aim of treating people with dignity and respect at its heart. We will ensure that care is focused on the individual, fully addressing their human rights and understanding their needs, and properly recognises the value and insight of their experiences of living in care.

The NCS will also provide national accountability with strong and appropriate local input and ethical commissioning. It will support Fair Work commitments, not least by providing – for the first time ever – collective national negotiating for workers' terms and conditions. We will also ensure the service provides appropriate channels for workforce and trade union representation in its governance.

Our ambition is to bring the pay, terms and conditions of nursing staff working within the care sector in line with those in the NHS, and we will review options to achieve this. Until then, we have maintained our commitment to ensure staff delivering direct adult social care are paid at least the real living wage, with additional funding of £64.5 million this year. We will also work with CoSLA on the establishment of minimum standards for procurement decisions, with a requirement for ethical commissioning taking into account factors like fair work, including terms and conditions, and workforce and trade union recognition and representation.

We have already taken the immediate steps towards the creation of the National Care Service. In July we established a Social Covenant Group, made up of people with day‑to‑day experience, to set the values and principles that will guide decision making and oversight of the service. At the start of August – also within the Government's first 100 days – we launched a consultation on the establishment of the new service and will, by June 2022, introduce the legislation to enable its creation.

We will back our ambitions for social care with significant investment. While the exact costs of our reforms will depend on the ongoing consultation, and in turn legislation, as a minimum we will increase public investment in social care by 25% over this Parliament – providing over £800 million more by 2026‑27.

The establishment of the National Care Service will be a considerable undertaking, bringing momentous change. However, we will not wait for the service to come into being before taking forward some of the positive reforms we know our social care sector needs to continue to drive up standards and quality. We will develop options to remove charging for non‑residential care and, subject to consultation, bring Free Personal Nursing Care rates in line with the National Care Home Contract. We will also work with Health and Social Care Partnerships to identify actions to increase early intervention and prevention, rather than responding to critical need and crisis. We are working with the Scottish Social Services Council (SSSC) and NHS Education Scotland (NES) to develop a national induction programme for new entrants to Adult Social Care by the end of Spring 2022.

Throughout the pandemic, our overriding priority in care homes was to safeguard and protect staff and residents from infection – but at times, that meant that residents were cut off from their loved ones, causing anguish for many. We will strengthen residents' rights in adult residential settings and bring in 'Anne's Law' – giving nominated relatives or friends the same access rights to care homes as staff while following stringent infection control procedures, as called for by Care Home Relatives Scotland.

Tackling the drugs death emergency

Every single drugs death in Scotland is a tragedy – but more than that, it is a national disgrace. Our actions must be comprehensive – from providing the best start in life for every child, to ensuring the social safety net we have in place is a strong one. We want Scotland to be a fairer, more equal country, where the underlying causes of the drugs emergency are tackled at source. But we also need a concerted and radical public health approach to the crisis currently confronting us.

We have established a national mission to reduce harm, promote recovery and tackle the increase in drug‑related deaths. We will invest an additional £250 million over the lifetime of this Parliament – £50 million a year – to get more people into life‑saving and life‑changing treatment, which is right for them and offered when they ask, in all parts of Scotland. This will increase capacity and make it easier for people to access service, as well as improving services – including aftercare for those returning to communities. We will provide milestones to show how this investment increases sustainable capacity across the 5 years. This also includes a £100 million investment in residential rehabilitation over the life of this Parliament.

We will connect the emergency work that saves lives with the work being done to improve lives in: keeping the Promise that every child grows up loved, safe and respected; addressing childhood trauma; mental health; housing and homelessness; poverty and inequality; education and prevention; and improvements in the justice system. Central to making these links is the inclusion of alcohol and drug services in a new National Care Service. The NCS consultation includes questions about alcohol and drug services and national commissioning of services to achieve consistency across Scotland. This along with forthcoming legislation on Human Rights, will help us make people's rights a reality, and help us implement change and improvement for them.

This year, we invested a further £14.4 million in front‑line services to get more people into treatment, and introduced new treatments such as long‑acting buprenorphine as an alternative to methadone. This includes £4 million of dedicated support for implementing the new Medication Assisted Treatment (MAT) standards, which give people a wider choice of treatment or recovery and include same‑day treatment. We also provided an extra £13.3 million for Alcohol and Drugs Partnerships, with specific funding to support children and families and to increase the capacity and use of residential rehabilitation.

Health and Social Care Partnerships will fully implement the 10 new MAT standards by April 2022, which includes better integration of addictions and mental health services with primary care. As part of this, we will ensure funding provides effective outreach services in every local authority, making treatment and support available to people who need it, when they need it, based on what will work for them. For 2022, we will introduce a new target for getting more people into treatment.

The five year funding cycle we have already introduced for third sector and grassroots organisations builds sustainability and allows for longer‑term interventions which will save lives. The guarantee of £18 million in the first year will enable long‑term investment and includes:

• £5 million Local Support Fund to increase capacity in community and third sector organisations
• £5 million Improvement Fund to improve outreach services, treatment, rehabilitation and aftercare, with dedicated support for women in response to rising numbers of drug deaths among women
• £3 million Families and Children Fund to support children, young people and families affected by drug use
• £5 million Recovery Fund for additional residential rehabilitation capacity

The scale of the drugs death emergency requires us to use every lever at our disposal. There is strong evidence from other countries that safe consumption facilities can help prevent fatal overdoses, and encourage people who use drugs to access longer‑term help. We will explore every legal avenue in an attempt to establish medically supervised safe consumption facilities, and are working with local authorities to identify more areas in Scotland where we can introduce heroin‑assisted treatment services, building on the positive example of Glasgow. We are investing £400,000 this year to help Glasgow expand its existing service and to support other cities consider the introduction of similar services.

The national mission has people at its heart and particularly those with lived experience. This year we will set up a National Collaborative to bring together these voices to help shape services for the future. We will work with those with lived experience to tackle the stigma which often stops people reaching out for support and run a national campaign on the issue towards the end of this year.

This is an all‑Scotland and all‑Government mission, overseen by an Implementation Group of Ministers, service leads and people with lived experience.

Prevention and promoting active, healthy lifestyles

We will prioritise services that improve the physical and mental health and wellbeing of the entire Scottish population while reducing health inequalities. The reality of Scotland's comparatively poor health is avoidable disease and suffering – particularly for those living in our most deprived communities.Increases in life expectancy have stalled since 2012 – and for some in our most deprived communities, it has decreased.

We will continue to lead the way with bold population‑wide approaches to reduce the significant disproportionate harms of tobacco, alcohol and unhealthy diets, and to inspire healthy behaviours and lifestyles.

Smoking remains the primary preventable cause of ill‑health and premature death in Scotland. Successful previous work has reduced the overall numbers of people smoking, however our rates are persistently high amongst more disadvantaged groups. We will develop a renewed action plan, which will identify further interventions needed in order to achieve the ambition for a tobacco‑free generation by 2034.

Alcohol‑related harm is also one of the most pressing public health challenges that we face in Scotland. On average Scottish adults drink around 18 units of alcohol per week, 30% more than the 14 unit weekly limit. We will drive forward our Alcohol Framework, which contains 20 actions to reduce alcohol‑related harms and embeds the World Health Organization's focus on tackling the affordability, availability and attractiveness of alcohol.

Specific actions include evaluating our world‑leading minimum unit pricing policy, improving alcohol labelling and consulting on potential alcohol advertising restrictions during 2022, to protect children and young people. We will also continue to strengthen alcohol treatment and support services, with implementation of UK‑wide clinical guidelines, improved staff training, and work to address complex needs.

COVID‑19 shone a light on the strength of local communities in understanding and responding quickly to local needs. We will support people and communities, strengthening existing work with partner organisations that help people to manage their own health conditions and promote active living.

For some people, the pandemic served as encouragement to take up new physical activities, but for others the emotional toll and changes in routine meant exercise became less frequent. We will double investment in sport and active living to £100 million a year by the end of the Parliament ensuring more people can enjoy active lives as we recover, improving physical, mental and social health. In addition to raising physical activity levels, this will allow us to rebuild capacity and resilience in the sector following closures during the pandemic.

We will work with sportscotland and partners to understand how best to increase investment in physical activity and sport, while ensuring we address inequality of access. We will work with sportscotland and partners to ensure that investment is equal: engaging with the media and sector partners to significantly improve and increase the visibility of women's sports, athletes and participants, through the creation of a Scottish sport media summit which will improve content and increase coverage across all media platforms. More participation and visibility of girls and women in sport is a priority.

We will also focus on improving the health of our young people, aiming to halve childhood obesity by 2030 and significantly reduce diet‑related health inequalities, by taking forward the actions in our Diet and Healthy Weight Delivery Plan. We will evaluate 3 pilots of whole systems approaches to improving diet and healthy weight services, to scale up and implement best practice across all Health Boards. £650,000 has also been made available this year to help Health Boards and local partners, support services which encourage and reinforce good nutrition, healthy eating habits and physical activity for children under five and their families.

Over the coming year, we will also work with sportscotland on the next steps to ensure that Active Schools programmes are free for all children and young people by the end of this Parliament, providing them with more opportunities to take part in sport before, during and after school.

In this Parliament we will introduce a Public Health Bill that includes restrictions on unhealthier food and drink promotions and in September we will publish an Out of Home Action Plan to help people make informed, healthier food choices when eating out or ordering in.

Making services accessible to all

The record levels of funding we will provide for primary care will protect free eye examinations and free prescriptions. It will also enable us to abolish all NHS dentistry charges over the course of the Parliament, having already abolished charges for young people aged under 26 in our first 100 days.

We will also expand the positive work done by the NHS Pharmacy First service – backed by £7.5 million investment in 2021‑22, rising to £10 million by 2022‑23 – which enables community pharmacies to help people with more minor ailments and common clinical conditions; offering advice, treatment or referral to other healthcare teams if required. We will also legislate to allow other healthcare staff to undertake vaccinations without being under the direction and control of a medical practitioner. This will reduce the pressure in General Practice and also improve the availability of all vaccines by increasing the bank of staff who can vaccinate.

We will support NHS Audiologists to work in a general practice and community settings, building on two pilots in NHS Tayside and NHS Ayrshire and Arran, freeing up capacity in acute settings. We will deliver a national community‑based service for people with low vision, transferring services from hospitals to settings closer to people. A small scale service will be available from April 2023, and rolled out across all Health Board areas by 2026.

We agree with the Right to Rehab Coalition that no one should be excluded from support that helps them understand their condition, how to improve it and, most importantly, how to manage it. We are implementing our recovery and rehabilitation framework, which will ensure that by the end of 2025 all adults who require rehabilitation will have timely access to the right services, in the right place. We will work with Health Boards and Integration Joint Boards to eliminate referral and criteria based routes to rehabilitation and move towards "request for assistance" models that ensure no one is excluded from accessing support. We are also working with health, social care, third sector and leisure trusts to ensure there are good quality, easily accessible community based rehabilitation resources available across all sectors.

To provide the very highest standards of care right up to the end of life, we will ensure that everyone who needs it can access seamless, timely and high‑quality palliative care. Over the coming year, we will develop and publish a new national strategy for palliative and end of life care that takes a whole system, public health approach. And we will ensure provision of high‑quality child palliative care, regardless of location, supported by sustainable funding of at least £7 million per year through Children's Hospices Across Scotland.

To secure safe, high‑quality and cost‑effective medicines, we will create a new NHS National Pharmaceutical Agency by 2025, with preparatory work beginning this year. This could include expanding manufacturing capabilities for both generic medicines and medicines that are specially manufactured to meet the needs of individual patients, and supporting investment in research and development to bring new medicines and jobs to Scotland.

To ensure the voices of people using health services are heard, and their concerns acted upon, we will establish a Patient Safety Commissioner. They will work with, and support, healthcare providers and other relevant bodies to improve the processes and systems they have in place for receiving and acting on patient feedback; support patients to raise issues or concerns about the treatment or care they have received; and act as an advocate for patients. A consultation on this closed in May 2021, and we will now analyse responses before bringing forward legislation.

We will also ensure that our islands and rural areas are not left behind as we work to improve health services by creating a centre of excellence for rural and remote medicine and social care, with scoping work starting this year.

Tackling inequality

Health inequalities impact on every aspect of too many people's lives. But those inequalities – where they stem from, and the outcomes they have – should not be accepted, and need not be preordained.

The last 18 months have put inequalities across society in the spotlight. Like the rest of the world Scotland's health inequalities have been highlighted and exacerbated by the pandemic. The disproportionate harm caused to minority ethnic groups, people living in greatest deprivation, people with obesity, diabetes and respiratory disease has highlighted vulnerabilities and widened existing inequalities.

We will pursue equity with a fresh focus on minority ethnic groups by implementing the recommendations from the Expert Reference Group on Covid‑19 and Ethnicity to improve collection and use of ethnicity data within Health & Social Care.

Women and girls face particular health inequalities, resulting in differing levels of care and poorer outcomes. Within its first 100 days, the Scottish Government has published a new Women's Health Plan to improve outcomes and services for women and girls, with immediate actions this year. A detailed implementation plan will be developed this year, with progress reported through Implementation Reports from 2022. From Autumn 2021, we will introduce 'bridging contraception', as the first step in expanding community pharmacies' role in supporting women's health. This will allow community pharmacies to prescribe longer‑term contraceptive options, alongside emergency contraception. We will also support any local authority who wants to establish byelaws to create protest‑free buffer zones outside clinics that provide abortion services.

We know that some women have been failed when they have presented with the pain and suffering of mesh‑related complications in our health services. In our first 100 days, we introduced a Bill to reimburse those who have paid to undergo private mesh removal surgery. Contracts have also been awarded for private removal surgery outwith Scotland, for those who feel unable to be treated in Scotland, with surgery, travel and associated costs covered.

NHS Gender Identity Services have seen increased demand, leading to longer waiting times. To improve access and delivery over the next three years we will centrally fund Gender Identity Service improvements until late 2024. A plan for transformation of these services will be also developed and published by late 2021, and implemented in 2022‑2024. This work will include the voices of those with lived experience throughout.

Learning lessons from the pandemic

The pandemic required an unprecedented response from local and national government, and a wide range of partners. At every step, decisions had to be taken quickly to save lives, reduce the spread of the virus, and protect our health and care services. In making those decisions, we have always been guided by clinical and scientific advice – but we have dealt with an unknown virus and constantly evolving situation. There must be a full and proper opportunity to learn lessons for the future. Within our first 100 days, the Scottish Government has taken steps towards the establishment of an independent public inquiry into the response to the pandemic, inviting views on the draft aims and principles of an inquiry. The Inquiry will be statutory and judge-led and we will establish it by the end of this year.

Also within our first 100 days, we have established a Standing Committee on Pandemics – an expert group of leading scientists and medical specialists who will advise the Scottish Government on preparing for the threat of future pandemics. It met for the first time in August.