NHS Recovery, Health and Social Care: FM letter to Cabinet Secretary

Dear Michael,  

Thank you for your commitment to the people of Scotland in your role as Cabinet Secretary for NHS Recovery, Health and Social Care. I look forward to continuing to work together to deliver real, tangible improvements in the lives of the people of Scotland.

 We, as a country, have faced incredible challenges over recent years. We are still recovering from the impact of the COVID pandemic. War continues in Europe, and the impact of Brexit and the cost of living crisis have combined to create some of the most challenging economic conditions in living memory. Brexit in particular has affected the social care workforce. Alongside this we face the twin crises of climate change and nature loss, which are global threats of existential proportions.

As a Government, we must be unapologetic about supporting those who need help the most. We will collectively deliver on the promises we have made in our Policy Prospectus and use the priorities it sets out to drive our decision-making, our accountability to parliament and our engagement with partners and the people of Scotland. This will mean that we will need to make tough decisions to ensure that every pound we spend and invest is targeted in such a way that it reaches those that need it most and delivers maximum value.

 Our aims as a Government  

To ensure we maintain a laser focus on delivery for the people of Scotland we have set out three critical and interdependent missions in our policy prospectus Equality, opportunity, community: New Leadership – a fresh start for the period between now and March 2026. These will be underpinned by our refreshed National Performance Framework and our shared policy priorities set out in the Bute House Agreement. These three outcomes are:

•  Tackling poverty and protecting people from harm. Continuing to tackle poverty in all its forms to improve the life chances of people across Scotland.
• A fair, green and growing economy Delivering a wellbeing economy through harnessing the skills and ingenuity of our people and seizing the economic and social opportunities from meeting our net zero targets.
• Prioritising our public services. Creating, investing in, and maintaining sustainable public services, to ensure the people of Scotland can access modern, effective, and timely services when they need to. 

These missions will define our work as a government. You and I have agreed an ambitious range of NHS Recovery, Health and Social Care outcomes that you will deliver over the next three years. We also have a collective responsibility across Cabinet to deliver all of the objectives we have set out in our policy prospectus to succeed in our missions.

Throughout all this, you should ensure you are contributing to Scotland's National Outcomes. Our National Outcomes describe our shared priorities, including the need to respect, protect and fulfil human rights and allow all in Scotland to live free from discrimination.

Having agreed this range of longer-term outcomes, I now ask you to consider what this looks like in terms of outcomes and delivery actions over the next year.

Objectives for your portfolio for 2023/24 

As Cabinet Secretary for NHS Recovery, Health and Social Care, the work of your portfolio is key to meeting these missions. The recovery and reform of our health and social care services will ensure the system becomes more effective, efficient and sustainable, and that the people of Scotland can get the right care, at the right time, and in the right place. I welcomed our recent discussion of the priorities for your portfolio for the remainder of this parliamentary term (listed in Annex A).

For this financial year we have agreed that you will deliver on the following outcomes:  

NHS recovery and waiting times

• Continue our relentless focus on reducing waiting times and NHS backlogs.
• Agree with each NHS Board 2023-24 activity trajectories and supporting plans which will be used to monitor performance and from July 2023 onwards monitor board performance weekly.
• Provide ongoing targeted improvement support for NHS Boards who require it from the Centre for Sustainable Delivery, to ensure that productivity enhancements - such as maximising regional working and reducing variation - are being deployed efficiently and effectively.
• Work with Boards to protect planned care, to match demand with available capacity across Scotland, and ensure that National Treatment Centres are fully operational.
• Identify challenges and actions required across NHS Boards from July 2023.
• National Treatment Centre in Forth Valley to open in September 2023, and NTC Golden Jubilee Phase 2 in December of 2023. Activity plans for additional procedures will be part year estimated at 1,040 in 2023/24, rising to over 4,000 in 2024/25.

• NTC Fife and NTC Highland to deliver 2,058 additional procedures in 2023/24. Golden Jubilee Phase I is planning to deliver 12,500 procedures in 2023/24 with additional ophthalmology activity due to commence in NTC Highland from autumn 2023. 

Cancer

Achieve demonstrable improvement by April 2024, using the following measures:

• Cancer patients receive first cancer treatment within 31 days of decision to treat;
• Cancer patients receive first cancer treatment within 62 days of urgent suspicion of cancer referral.
• Increased access to the Single Point of Contact (SPoC) programme, which aims to ensure that all cancer patients have dedicated, person-centred support throughout their cancer pathway. The programme is currently being piloted at 12 NHS Boards and is supported by £1.5 million in 2023-24.
• All cancer patients having access to dedicated financial, emotional and practical support through the Transforming Cancer Care Programme. The programme is supported by £18 million of funding and works in partnership with MacMillan Cancer Support. 
• Building on existing partnerships with the third sector and the NHS to ensure everyone affected by cancer is aware of information and support services available and how to access them.

Workforce

• Align national recruitment and training strategies to improve trajectory, diversity and retention of health and adult social care workforce.
• Take forward the Ministerial Taskforce on Nursing and Midwifery, including a national conversation/listening project. 
• Implement the Agenda for Change review and revised pay bargaining processes across medical professions to improve pay structures and future pay negotiations.
• Implement action plan recommendations to improve leadership, wellbeing and diversity of the NHS workforce.
• Continue to work with HSCP’s, COSLA, Scottish Care and CCPS via regular troubleshooting sessions to ensure the £10.90 pay uplift is being processed in line with policy, and that Adult Social Care staff receive the 23/24 uplift.
• Ongoing development and support to evaluate viable options and timelines to deliver an uplift up to £12.00 per hour for Adult Social Care pay.
• Ongoing actions in support of development of the social care workforce, including an international recruitment programme to launch in summer 2023 and new national recruitment campaigns at key points in 2023 and 2024.
• Delivery of a further 100 funded medical students in 2023/24 as part of a commitment to increase places by 500.
• Maintain record fill rates in postgraduate medical training in 23/24.
• Monitor progress, spot emerging trends and support further policy measures – including turnover, absence and demographic trend data.

National Care Service and delayed discharge

• Subject to the agreement of Parliament, Stage 1 of the National Care Service Bill will continue to progress this year, and we will work towards completion of Stage 2 of the Bill by Easter 2024.
• Implement the actions contained within the delayed discharge and hospital occupancy plan in a comprehensive and sustained manner.
• Deliver actions to create the necessary capacity at times of surge, through effective winter planning and expanding Hospital at Home.

Primary and Community Care including GPs

• Provide continued investment in our primary care multi-disciplinary workforce to sustain General Practice and meet the needs of our communities, resulting in: better health outcomes, particularly for those living with complex needs or in disadvantaged areas; improved staff experience across all groups, allowing GPs to focus on their role as expert medical generalists; and reduced secondary care referrals, supporting community treatment.
• Support the continued development of Hospital at Home; aiming to increase capacity by up to 50% from 2022/23, by the end of March 2024.

• By March 2024, undertake analysis and testing of data provided by Health and Social Care Partnerships on the recurring resourcing requirements to support implementation of the MoU underpinning the GP contract.

• By March 2024, GP practices will have undertaken work to build inclusive patient engagement and community participation, enhanced skills for working with health inequalities and enabled proactive outreach and extended consultations with high-risk patients.
• Through the ‘Inclusion Health Action in General Practice’ Programme in Greater Glasgow & Clyde, deliver targeted support, using data and evidence, to our most vulnerable communities and by end 23/24 use lessons learned for sustained or increased investment and possible expansion to other areas, noting synergies with improved mental health and wellbeing support, to better assist people with complex needs.

Dentistry

• Showcase the payment reform model to the wider dental sector in the summer of 2023.
• By 31 October 2023, conclude the General Dental Service bridging payment ahead of full implementation of revised fee schedule from 1 November 2023.

Mental Health

• Publish a new Mental Health & Wellbeing Strategy and accompanying Delivery Plan by autumn 2023.

• By the third quarter of 2023, produce the trajectories for when all Boards are expected to meet the CAMHS waiting times standard.
• Continue to expand the Mental Health and Wellbeing Fund to provide early interventions and other non-clinical supports in communities across Scotland, which benefitted over 1400 grassroots projects in 22/23 alone, with a further £15 million of funding to be allocated in 23/24.
• Ensure that the Distress Brief Intervention programme will be available in all areas by March 2024.

Population Health

• Support the Minister for Alcohol and Drugs Policy to implement the National Mission on drugs, in particular:

• Develop the establishment of a Safer Drug Consumption Facility, through engagement with the UK Government, the Lord Advocate, Police Scotland and Glasgow Health and Social Care Partnership. If the response to the proposal from the Lord Advocate is positive, move to the next phase with Glasgow Health and Social Care Partnership, including local consultation, funding and establishing a facility.
• Implement the Medication Assisted Treatment standards by the end of 2023 in addition to supporting residential rehab referrals, developing further capacity and co-producing service standards for young people.

• Publish a report on the effect of Minimum Unit Pricing during the first five years of its operation in September 2023, alongside a consultation on the future of Minimum Unit Pricing. This evaluation will support Parliament to decide on the continuation of Minimum Unit Pricing, and preferred price, by April 2024. 
• Undertake a review of alcohol marketing consultation and publish responses by end 2023. Publish a refreshed Tobacco Action Plan in autumn 2023; which will include further action on nicotine vapour products.
• Publish the Smoking Cessation Review in summer 2023.

• Prepare and publish an updated Active Scotland Delivery Plan including a review of the Active Scotland Outcomes Framework by the end of 2023.
• Commission Sportscotland's full facilities estate review of all active infrastructure in Scotland by March 2024.

Safe Access Zones for Abortion Services

• Work closely with Gillian Mackay MSP to support her proposed Member’s Bill to establish safe access zones outside healthcare premises that provide abortion services.

Planning for the future

• 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.

A number of commitments that support the achievement of these outcomes have been identified as part of the priorities set out in our policy prospectus. These will not be the only areas of work to contribute, but are some of the key levers we have to deliver the outcomes set out above. I expect impact and improvement to be key considerations as you deliver these priorities and I expect you to bring forward suggestions for where we may achieve better outcomes if you think there are additional or alternative options. I would also like you to consider the opportunity for public service reform within your portfolio and the efficiency of the institutions and public bodies you have responsibility for to deliver better outcomes for Scotland.  

Responsibility for financial sustainability

 As we take action together to carefully manage the Scottish Budget to deliver these priorities, you must work within your portfolio to drive efficiency and reform, and identify measures that can be taken to create additional flexibility within the wider Budget and deliver a balanced outturn against agreed envelopes.

We must prioritise, to ensure that we use our finite resources in the most effective way. That prioritisation work is significant, but it will also be demanding, and will require us to make hard decisions. I know you will be guided by our commitment to support those who need the most help and prioritise resources to the policies and programmes which make the biggest difference to our three core missions.  

Collaborative working with partners

It is important to recognise this work cannot be achieved in isolation. It requires collaboration with key partners: Health Boards, Local Government, business (including small businesses), trade unions, communities and third sector partners, among others.  I believe, as I know you do, that the participation of, and collaboration with, these key partners is essential. I ask you to continue to ensure you listen to their ideas, their views, and their lived experience, take into account potential impacts – as well as benefits - on them and put them at the centre of our work. 

You will also work closely with our colleagues and partners in the Scottish Green Party, to ensure a continued, positive and productive relationship via the Bute House Agreement. 

 Our Policy Prospectus set out our commitment to resetting important relationships. As well as resetting the relationship with business, our commitment to resetting the relationship with local authorities and working collaboratively with Local Government is central to the delivery of many of the things we have committed to achieve. I ask you to work with your colleagues to support the Deputy First Minister in building on the constructive progress already made in developing our relationship with Local Government. I would also particularly encourage you to work closely with the business community to ensure that policies and how they are delivered takes account of potential impacts on businesses and considers opportunities for businesses, especially small businesses, to benefit from our policies and spend.

Collaborative working across Cabinet

It is your responsibility to engage, timeously and appropriately, with your Cabinet colleagues and their junior Ministers as we seek to deliver on these objectives. In addition to those objectives laid out above, you are also expected and required to work on cross-cutting government objectives, which will contribute to our priority outcomes. These include, but are not limited to, the transition to Net Zero; work to meet our child poverty targets; Keeping The Promise; and the incorporation of human rights treaties into Scots law, as far as possible within devolved competence.  I know you will also continue to work closely with the Minister for Independence to provide the people of Scotland the information they need to make an informed choice about whether Scotland should become an independent country. 

In considering what issues to bring to Cabinet, I want you to prioritise those issues which most clearly support the delivery of our three core missions and therefore most significantly engage the collective responsibility of this Government.  This will ensure that Cabinet is focused on long term delivery, on the most critical issues of policy and on what matters most to the people of Scotland[1]. 

Cabinet Sub-Committees and Ministerial Working Groups also play a key role in ensuring leadership and accountability of cross cutting issues to support delivery of our three core missions.  They are critical for providing a space for oversight on delivery of our commitments thereby helping us to maintain our outcomes focus.  I expect all members of the Cabinet Sub-Committees to play a proactive role in them, recognising that there will be a number of challenging decisions to be taken by the Cabinet Sub-Committees in the coming months.  

Planning and accountability for delivery

I ask that you ensure that thorough, evidence-based and financially assessed delivery plans are in place for these commitments, to support the ongoing and effective monitoring of progress and impact. This plan should contain baseline performance measures for each commitment and highlight which commitments you are prioritising for early implementation, alongside related timelines, dependencies and assumptions. It will be my expectation that this articulates your agreed programme for the year ahead, with outcomes which represent best value for money for the resources you have at your disposal and that they demonstrate your balanced portfolio budget. This will in turn allow the Deputy First Minister and I to ensure all portfolios deliver within our overall budget the prioritised set of outcomes we are seeking.

I have asked the Deputy First Minister to consider these plans from all portfolios and to join me in six monthly discussions with you on progress against out agreed objectives. The Deputy First Minister will be in touch separately with you around reporting arrangements as part of her role in co-ordinating cross government delivery.

I look forward to working with you to deliver on our shared ambitions for Scotland.  

Yours sincerely, 

First Minister 

NHS Recovery, Health and Social Care policy portfolio outcomes to be achieved by 2026, as set out in Equality, opportunity, community: New leadership – a fresh start

• Reduce NHS waiting times year on year.

• Reduce drug deaths and supported the establishment of a safer drug consumption facility.
• Deliver year on year reductions in waiting lists with new National Treatment Centres (NTCs) in NHS Highland, NHS Forth Valley, NHS Golden Jubilee and further NTCs in development.
• Improve cancer outcomes through better prevention and diagnostics, including expanded Rapid Cancer Diagnostic Services in Lanarkshire and Borders by June 2023.
• Modernise Agenda for Change to deliver improvements in workforce planning, attraction, training, employment and wellbeing, progressing towards a sustainable, skilled health and care workforce, with attractive career choices, where all are respected and valued for the work they do.
• Improve outcomes for people in primary, community, and social care, through enhanced integrated multi-disciplinary teams, with better digital tools including access to personal health information.
• Sustain our investment in general practice through the Primary Care Improvement Fund and invested more in practices servicing disadvantaged areas.
• Sustain and improve equitable national access to NHS dentistry.
• Deliver the National Care Service legislation, subject to the agreement of parliament, to tackle consistency of provision and improvements in health and social care to significantly reduce delayed discharges, in partnership with Local Government, to improve social care across Scotland.
•  Increase adult social care pay to help reduce the workforce challenges our care sector is facing.
• Improve mental health and wellbeing support in a wide range of settings with reduced waiting times for Child & Adolescent Mental Health Services (CAMHS) and distress and ongoing implementation of our suicide prevention strategy.
• Take decisive preventative action to reduce alcohol harm, including reviewing minimum unit pricing, and ensured smoking rates remain on track to make Scotland tobacco-free by 2034.
• Continue to increase physical activity through investment in sport and active travel.
• Ensure the introduction of safe access zones for premises providing abortion services.