Health and social care: national workforce strategy

Scotland's Health

Scotland's population is now at its highest level ever and the proportion of older people is steadily increasing. This latter demographic is reflected in our workforce population.

The fact that people are living longer is undoubtedly positive. Nonetheless, we will remain alert to addressing inequalities, noting that in some instances life expectancy has stalled. Tackling inequalities in health will remain central to our efforts as a country and in turn will impact on our workforce needs. We must respond to more complex health needs through new approaches. We must also recognise the economic and social roles that Health and Social Care providers and their workforces play in communities.

Further context includes:

• The next 20 years will see an ageing population, a continuing shift in the pattern of disease towards long-term conditions and growing numbers of older people with multiple conditions and complex needs and the impact of this on them and their immediate carers. There will be an increasing number of older family carers and older people within our workforce - many of whom will have their own health needs.
• The number of drug-related deaths has increased substantially over the last 20 years – there were 4.6 times as many deaths in 2020 compared with 2000.
• In 2020, adults in Scotland drank an average of 9.4 litres of alcohol per head which is 18.0 units per adult per week; whilst that's the lowest level in 26 years, it's still nearly 30% more than the low-risk guidelines of 14 units.
• In the 2020 Scottish Health Survey, 62% of adults in Scotland were overweight or obese. This figure has remained stable since 2008. The 2019^[1] Scottish Health Survey found that 30% of children in Scotland (age 2-15) are at risk of being overweight, approximately half of which are at risk of obesity.

Our population and indeed our workforce face inequalities across different protected characteristics and geographic and socio-economic groupings. This is coupled with continuing public health challenges including national priorities around diet and healthy weight, physical inactivity and harmful use of drugs, alcohol and other substances.

Our COVID Recovery Strategy^[2] sets out our vision and the actions we will take to address systemic inequalities made worse by COVID-19, to make progress towards a wellbeing economy and to accelerate inclusive person-centred public services.

It makes clear that all parts of Scotland's society must work together urgently, to recover from the pandemic. National and local government will work in partnership to deliver the joint leadership that is necessary for this effort, recognising the key leadership role councils play in their communities.

Wider factors affecting physical and mental health include housing, education, employment, social support, income, our communities, childhood experience and access to Health and Social Care services. We are seeking a shift from dealing with the consequences of poor health in acute settings to increasing preventative measures and early intervention. The challenges in making this shift must be addressed and resourced.

As the population gets older, the shift towards long-term, complex and multi-layered conditions will continue as will demands on our Health and Social Care services and workforce.

National approaches to supporting Health and Social Care needs must continue to be complemented by place-based action at local and community levels, including preventative action by councils, primary and community-based services, and others, across the course of individuals' lives.

Even before the pandemic, mental health problems had been increasing, particularly in women and girls. We must ensure that our workforce has the skills to support and care for a rights-based approach to mental health, and we recognise our workforce itself requires support and care.

The Impact of COVID-19 on Health and Social Care Services

The COVID-19 pandemic has had a profound impact on our health, economy and society, with damaging impacts on the way of life and wellbeing of people in Scotland. It has exacerbated health issues and inequalities, seen a rise in waiting times especially for elective surgery, and exhausted our workforce.

While steadily returning to pre-COVID-19 levels, the reality is that thousands of tests, treatments and operations have been, and continue to be, delayed and this is likely to have consequences for our workforce, such as an increase in demand for Social Care packages and potentially more complex Health and Social Care needs once these delays are addressed.

There is also likely to be an increase in care recipients who have multiple or complex needs whilst they await treatment or hospital admission.

Our Health and Social Care system has been under significant strain over the most pressured winter it has seen. It has been extremely challenging, not least because of the impact of the high level of COVID-19 cases and how this has translated to workforce availability.

There are long standing pressures across the Social Care system, in particular with regards to resourcing, attracting, recruiting and retaining staff, with national and local resilience efforts in place to address the immediate issues.

It is very likely that the combined impacts of the EU Exit and the pandemic have exacerbated existing staff shortages across Health and Social Care. Combined with a significant increase in demand for services, this has led to particular challenges in Social Care over recent months.

Over the winter, Social Care providers working with local and national government and trade unions agreed an approach to prioritise practical support for the sector, in recognition of its critical role to the whole landscape of Health and Social Care.

The huge efforts of all partners including workers, volunteers and carers are recognised and valued and must not be underestimated.

Nonetheless, there is currently substantial unmet need in the community which, in turn, is leading to pressure on carers and community services as well as bed-based care (including acute hospitals) as frail older people are admitted in the absence of other support. This has led to increased levels of delayed discharges and longer lengths of stay, adding to the demands on Health and Social Care services.

All this has also led to sustained additional pressure on unpaid carers, many of whom also work in Health and Social Care, with significant impacts on their own health and wellbeing.

We acknowledge that strategic action is needed both now and into the future to improve the sustainability of the Health and Social Care system.