Improving public services and NHS renewal: First Minister's speech - 27 January 2025

Good morning. And thank you very for joining me here today.

I had the opportunity earlier on today to tour the Scottish National Blood Transfusion Service’s Jack Copland Centre. 

The centre is a great example of the NHS at its best. with the latest technology being used to meet the transfusion needs of patients all across Scotland.

The Transfusion Service is also home to ground-breaking research related to blood and donor tissues and cells, as well as trialling new advanced therapies.

So what happens there both provides care and improves it, and there is an important metaphor for us and what I am going to talk about today.

I am looking forward also, after this speech, to learning more about the exciting work going on here at the National Robotarium.

My appetite has been whetted by an article written last month by the Robotarium’s Business Development Manager, Lisa Farrell, on the potential for robotics to modernise our health service.

Lisa highlighted cases here in Scotland – such as automated porters and robotic pharmacy assistants – where this modernisation is already happening and taking place within the National Health Service. 

She spoke of the potential for robotics to ease the pressure on our workforces.

To give staff more time to devote to the aspects of care that do require a human touch.

And she pointed out that achieving the full potential of such innovations requires coordinated action and strategic investment.

I couldn’t agree more.

It is against the background of the research and innovation that goes on at these two centres that I want to speak to you about the most cherished of our public services, the National Health Service.

The NHS is stitched into the very fabric of our nation.

It is part of who we are, in terms not only of the care it provides at every stage of our lives, and the lives of those we love, but also because every single family in Scotland will have someone, or know someone, who works in the National Health Service, who devotes their life to this service.

Like all of us, the National Health Service is personal for me – I see first-hand all that it does, and has done, for my own family.

In the last years of my beloved Mother’s life, I saw such care and attentiveness in the community and in hospital care.

My wife would not have the capacity and capability she has in dealing with MS, had it not been for the outstanding care and insight of the National Health Service alongside, might I say, her absolutely personal determination to stay strong.

I would not have had such joy in my life at the birth of my three children without the National Health Service. 

It is personal for all of us.

That is why we care about it so much.

That is why we want to see it thriving once again.

We all know the tremendous pressures our NHS has been under in recent years.

We see a service still reeling from the strain of a global pandemic – a pandemic that revealed the NHS’s many strengths but also exposed its underlying weaknesses. 

Weaknesses made worse by a decade and a half of austerity, and by the body blow of inflation that has meant – as we know from our own family finances – the available money delivers less.

It is a service still beset by backlogs and delayed discharges, and struggling to meet the increasing needs of an ageing population.

The challenges are great, of that I have no doubt. But I know also that our NHS is fundamentally resilient, fundamentally robust.

I witnessed both these realities earlier this month when I spent a Saturday evening visiting the emergency department at the Royal Infirmary of Edinburgh.

In the midst of both winter pressures and a particularly challenging flu season, I saw patients who waited too long to be seen, but also staff who went above and beyond.

I saw an NHS that in the face of the storm kept on standing, kept on delivering.

There are some who oppose the NHS model, who believe that the answer to our health challenges is a privatisation of care. They want us to believe that the health service is beyond saving, that it is on the point of collapse.

But that is simply not true.

There are challenges.

Some services are struggling.

Periods of real crisis as we have seen in recent weeks as flu cases spiked.

The impact of these issues on too many patients is real.

But, as I will set out today, there is nothing wrong with the National Health Service that can’t be fixed by what is right with the National Health Service.

What is right with the National Health Service includes the thousands of health and care staff who are doing phenomenal things under enormous pressure. 

People who, time and again, display resilience, selflessness and grit, who truly go above and beyond.

It includes innovations, such as the Rapid Cancer Diagnostic Service, a new pathway that delivers significant reductions in the time from referral to diagnosis, opening the door also to faster treatment.

It includes national public health initiatives like the HPV vaccination programme, which has resulted in no cases of cervical cancer in young women who have been fully vaccinated.

A remarkable, utterly remarkable, life-saving achievement.

And it includes cutting-edge research, multiple projects, looking into the ways AI can transform diagnosis and treatment in the years to come.

The foundations on which we will build NHS recovery and renewal are strong.

Under this Government, the NHS will always remain in the hands of the public and free at the point of use. That is non-negotiable.

The question then becomes how do we do better?

How do we ensure our health service is not just the best in these isles but the best it can possibly be?

The answer to that question is not a simple one. There is no ‘magic bullet’.

Rather, it involves progress across multiple fronts, a balancing of sometimes competing demands and interests.

It will require choices and action by central government, yes, but that must be delivered in partnership with others – local government, the third sector, patient groups, and health and social care workers at all levels.

It must deliver reform that is fundamentally patient-centred but do so through a health and social care system that becomes an ever more interconnected whole.

I have said before that my approach as First Minister is to seek the right solutions, not merely the quick ones. 

I favour consensus building and collaboration over diktats from on high. For the future success of our NHS this is not only the right approach, but also the necessary approach.

We will only succeed on this path of reform and renewal if we walk it together.

That is why the Cabinet Secretary for Health and I meet regularly with staff in all parts of the National Health Service.

It is why we have been engaging with health boards, local government, Health and Social Care Partnerships, the Scottish Ambulance Service, Public Health Scotland, and NHS 24.

We have listened carefully, also, to patients and their families, to all those who depend on the NHS for lifesaving, life-enhancing care.

We have been told all that is going well and all that must be better.

We have heard the advice from those with direct, frontline experience. And that has helped us develop a clear understanding of where the challenges are, and what changes are needed.

It is this kind of open, collaborative approach, with a focus on solutions, on the right answers over the easy ones, that has led to the actions I am setting out today.

It is a set of actions with clear outcomes – tangible improvements that we can and will deliver.

Tangible improvements to make people’s experience of the NHS in Scotland better than it is today.

Actions made possible by the record funding we are delivering to the NHS frontline.

Actions that will address the immediate issues in our health service – those problems of access that I know cause so much frustration, and indeed for some, unnecessary pain.

Actions that set out a new course so we can safeguard the NHS for the long-term.

Over the coming weeks, the Government will set out for Parliament what the different elements of our approach will mean in practice.

And we will be reminding Members of Parliament as we do that, that the delivery of this stronger NHS depends on the safe progress of the draft Budget currently being considered by Parliament.

The actions we will take to deliver a more accessible, more person-centred NHS have three clear purposes:

First, to reduce the immediate pressures across the NHS.

Second, to shift the balance of care from acute services to the community.

Third, to use innovation – digital and technological – to improve access to care.

Together, these will address the problems that right now, every day weigh down our National Health Service.

They will begin to deliver the long-term, systemic improvement that is needed to ensure our health service is sustainable for the future. 

And they will make it easier for people across Scotland to live healthier lives, helping us to build a future in which health is practiced in homes and communities as much as it is practiced in surgeries and hospitals.

So let’s talk first about those immediate problems, the crises facing too many parts of our National Health Service. 

The first and most important thing on many people’s minds is how long it can take to access services.

Delays in access, with waiting times that are too long, and delays in discharge, because appropriate at home or in community care is not available.

The two, of course, are fundamentally connected.

Last year, I referred to delayed discharge as the canary in the coal mine of our National Health Service. I think of waiting times in much the same way.

Both these delays tell us that the flow of people through the health system is not happening as it should.

Put more simply, people are not getting the right care in the right place, at the right time.

That is not acceptable to me.

It is not acceptable to my Government, because it can lead to people getting sicker as they wait, and it can mean they can take longer to recover.

It adds substantially to the stress they and their loved ones experience.

It creates greater strain across the system, leading to more delays elsewhere, poorer outcomes for others and still further stress on services.

It is the very definition of a vicious circle, and it has to come to an end. 

So, today, we commit to a substantial increase in capacity in order to significantly reduce people’s waits.

The changes we propose – including an enhanced regional delivery model, alongside increased levels of activity in our National Treatment Centres – will deliver over 150,000 extra appointments and procedures – in hospitals, in communities – in the coming year.

That includes 10,000 extra procedures through smarter working in the National Treatment Centres.

Other sites – including Gartnavel, Inverclyde, Stracathro, Perth Royal Infirmary and Queen Margaret Hospital – will deliver 9,500 extra cataract procedures.

As well as 2,500 extra orthopaedic appointments and procedures – operations such as hip or knee replacements.

In this way, we will create centres of excellence, places of expertise and specialisation, where we will be better placed to capitalise on the technological innovation and the potential of AI.

And we will cut our waiting lists.

Cancer referrals, gynaecology, ophthalmology, orthopaedics, and radiology – all benefiting from this new investment.

Centres able to deliver more care, more quickly and more efficiently than traditional, smaller, more fragmented facilities – with transport support provided for those who need it.

And, to ensure that they do, we will put in place clear milestones and targets for those specialities that add the most to our waiting lists.

Our second focus will see more and better care delivered in the community.

I spoke earlier about the importance of people receiving the right care at the right time, in the right setting.

That right setting will always be the least intensive setting appropriate to the person’s needs.

Sometimes that appropriate setting is in hospital. More often, it is not. 

So to strengthen and renew our NHS, we will shift more care into communities and into homes.

As much as possible, people who do not need to be in hospital will not go to hospital, protecting those acute services for those who absolutely need them.

This new approach will mean changing the way we deliver acute services.

By this summer, we will have specialised staff in frailty teams, at the front door of every A&E department in Scotland.

This will mean that frail patients, often older patients with complex needs, will bypass our busy A&Es, in order to receive the specialist care and support they need, whether in hospital or back at home.

It will mean better care for these most vulnerable patients while reducing the pressure on our A&Es. 

Our actions will also improve the NHS’s capacity to treat people at home.

Our Hospital at Home initiative, which allows hospital-levels of care in a person’s home, will be expanded to at least 2,000 beds by the end of 2026.

Without the need for any new bricks and mortar, the effective capacity of every single hospital in Scotland will be expanded.

Taken together, it is action that will ease acute pressures, reduce delays, cost less to our NHS, and most importantly, help people get better more quickly, more comfortably.

Quality care for thousands of Scots delivered not simply close to home, but at home.

Of course, we cannot simply shift services out of acute settings. We also need to build capacity in our primary care and community health settings. 

With this in mind, the Government has been listening carefully to the views of Scotland’s GPs. 

They have described the multiple contributions general practice can make as we shift to more community-focused care. They have argued that GPs must be given the resources they need to fulfil that role.

We have listened, and we have been persuaded.

As a result, our plan will ensure that a greater proportion of new NHS funding goes to primary and community care. 

GPs and services in the community will have the resources they need to play a greater role in our health system.

This increased investment will result in GP services that are easier for people to access.

That is important in terms of people’s confidence in the health service – indeed, difficulties making GP appointments top the list of issues that people often raise with me.

But equally, it will make it more likely that health issues are picked up quickly and dealt with earlier.

For there is no better way to deal with illness than to prevent it.

Addressing conditions early and intervening to prevent diseases from progressing, prevents manageable conditions from becoming serious ones.

It is good for patients and of vital importance for the future sustainability of our National Health Service.

That is why our plan also includes £10.5 million to build GP capacity to intervene earlier and prevent illnesses, such as cardiovascular disease.

But this is not only an issue of money. We must also innovate and identify new ways of working.

For example, I want to see the NHS Scotland Pharmacy First Service expand so that community pharmacies can treat a greater number of clinical conditions and prevent the need for a GP visit in the first place.

The third part of our approach is innovation to improve access to, and delivery of, care.

Better use of data will ensure that more operating theatres are working at maximum capacity, with best practice approaches, approaches shown to increase productivity by 20%, rolled out across the country.

Using existing capacity, more operations will be delivered – enabling us to also deliver shorter waiting times.

The latest innovations in genetic testing will be harnessed to enable better targeting of medications in cases ranging from recent stroke patients to new-born infants with bacterial infections.

Smarter care, better care.

Building on the already successful model of digital support for mental health – a service that saw 74,000 referrals in 2023-24 – we will offer support in additional areas including dermatology and the management of long-term conditions.

This type of care, because it is not dependent on physical attendance, at a specific time, in a specific place, is more flexible.

It means care can be made to fit better into the lives of those who use the services.

Again, smarter care, and better care.

And, as a much-needed addition to improve patients’ interaction with the NHS, there will be a Scottish health and social care app.

This ‘Digital Front Door’ will begin rollout from the end of this year, starting in Lanarkshire, and, over time, it will become an ever more central, ever more important access and management point for care in Scotland. 

This is the third in a series of speeches I have delivered in recent weeks.

In each I have spoken about the importance of identifying clear goals, clear direction to national policy.

If we have a clear sense of the direction we wish to travel, the levels of success we wish to achieve, and if we can unite behind these goals, then genuine progress becomes all the more possible.

Protecting, strengthening, renewing our National Health Service – that is a goal I think we can all get behind.

A real focus of common purpose.

If we care about Scotland’s NHS – and we all clearly do – then let’s commit ourselves to doing what it takes to get our NHS thriving once again.

That requires action from me, as First Minister, from my Health Secretary Neil Gray, and from my Government. We can offer the leadership and direction – as the measures outlined today seek to do.

With Parliament, I can marshal the necessary resources to turn plans into reality, and believe you me I will.

From those with management and leadership responsibilities within the NHS it asks for creativity, passion, innovation.

For a renewed focus on what works, for a commitment to sharing best practice, and an effort to serve and support those staff most directly on the frontline.

For all our hardworking staff delivering care it asks, I am afraid, for yet more laps of the track.

We see all that you do, all the responsibility that you carry.

In so many ways, NHS renewal and recovery will be delivered by you, but it must also work for you.

And for all of us who depend on the NHS and the wider healthcare system at those moments of greatest vulnerability and need in our lives, it asks something of us too.

It means accessing care at the most appropriate level.

Last year, there were more than 1.5 million attendances at A&E. We know that many of those would have been better dealt with in another health setting. It is something that can change and, let us be honest, must change.

And preventing ill-health is not only about early access to health services; it is also about doing all we can to live healthier, more active lives.

Have no doubt, a healthier Scotland – and that means healthier Scots – is an important component, a necessary component, of a stronger, more sustainable National Health Service.

Our National Health Service is there when we need it.

It is there when we come into this world.

It is there when we are ill or hurt.

It is there when we become parents and grandparents.

And it is there at the end.

No other public institution supports us with so much care through life’s biggest moments. We must support it in return.

The approach I set out today charts our course to do that.

It addresses both the challenges and the opportunities. It sets the NHS on a path of modernisation and renewal.

In doing so, it ensures that this cherished institution, that has been around for all of our lives, will be around for many more to come.

And of the greatest importance to me – it will thrive in the years ahead.