Programme for Government 2023 to 2024

Cabinet Secretary for NHS Recovery, Health and Social Care

Michael Matheson MSP

The recovery and reform of Scotland’s National Health Service is crucial to ensuring that we deliver sustainable services which provide the people of Scotland with the right care, at the right time and in the right place.

Backed by targeted investment, including our £1 billion NHS Recovery Plan, we are making significant progress. The range of reforms across primary and acute services will not only help speed the recovery from the pandemic, but they will also reduce unnecessary demand for services and develop new pathways of care that are better for patients as we face the health challenges of the coming years.

Through this plan, we are working to reduce waiting lists, with a continuing focus on the longest waits. We have seen a significant reduction in the longest waits since targets were announced last July, with over 80% of new outpatient specialities now having fewer than ten patients waiting more than two years.

Our £1.8 million investment in a new national digital dermatology programme is speeding up treatment, and we have formally opened the third National Treatment Centre (NTC) located in NHS Highland. Our investment of a further £3.6 million in Hospital at Home provides acute-level care at home and avoids hospital admissions, supporting more than 11,000 people in the last year.

We continue to improve cancer care, from prevention and diagnosis through to treatment. We expanded Rapid Cancer Diagnostic Services to NHS Lanarkshire and NHS Borders, and nearly 1,000 people have been seen by this service – with 12% of those being diagnosed with cancer. We have also published a new ten-year Cancer Strategy and associated three-year action plan – underpinned by an understanding of what matters to the individual.

We are working towards the introduction of a National Care Service so that everyone has access to consistently high quality social care, whenever they need it. Getting this right will remove barriers, tackle inequalities and allow people to flourish by living independent lives in communities of their choice. It will also ease pressure on our NHS and continue the integration of community health and social care support.

With COSLA, we have given initial support to a national framework for social care and social work support, which would see Scottish Ministers, local authorities and NHS Boards share accountability. People have already begun to share their views through our national engagement events. In line with our shared commitment to improve social care, we will explore with Local Government and agree an approach to ending all non-residential social care support charges within the lifetime of this Parliament.

Our commitment to health and care staff is unwavering. Agenda for Change NHS staff will benefit from the largest overall investment in pay in a single year and a deal that includes improved terms and conditions, such as bringing forward a 36-hour working week. This

£568 million deal will ensure staff remain the best paid anywhere in the UK. Junior doctors have also accepted their single biggest pay rise since devolution and we will now embark on a journey of contract and pay bargaining reform with them. We will also implement the NHS dental payment reform model, which has been developed with the sector, by 1 November 2023.

Uniquely within the UK, there has been no industrial action in the health service in Scotland because the Scottish Government has faced up to a series of challenging negotiations over pay and conditions. We are grateful to unions for their continued engagement and both patients and staff have benefitted from our collective determination to reach fair agreements.

The launch of an international recruitment pilot will support the social care workforce. We are also taking ongoing action to hire an additional 800 nurses, midwives and allied health professionals from overseas, backed by £8 million of funding. Since March 2022, we have increased the number of professionals working in primary care multi-disciplinary teams by 518 to 4,731, meaning that the average practice now has access to more than five additional professionals.

We will utilise scientific and technological innovation to provide new diagnostic tools, improve patient flow and create new therapeutic options through our accelerated national innovation adoption pathway. This will embed realistic and value-based medicine, putting patients at the centre of decision making. We have also invested £20 million in surgical robots, boosting hospital capacity and delivering less invasive procedures for patients.

Underpinning support for our health and care systems is a commitment to improve the health of our nation, from supporting infant and maternal health and keeping The Promise, to promoting healthier active lifestyles, preventing ill health, and reducing health inequalities and poverty. To realise these ambitions, we will continue to work in collaboration with a range of partners across Scottish society, including our crucial third sector and business allies.

Our Women’s Health Plan sets out actions, including the appointment of our first Women’s Health Champion, to address health inequalities and improve health outcomes for women throughout their lives.

We also remain committed to increasing overall physical activity through investment in sport and active travel, as physical activity is vital to the wellbeing of the nation.

We awarded £15 million to grassroots and community-based projects supporting people affected by problem substance use, including residential rehabilitation, addiction support services and programmes working with children and families. We also provided an additional £30 million for community-based mental health support and published the Mental Health and Wellbeing Strategy, which sets out our vision of a Scotland in which everyone achieves the best mental health and wellbeing possible. We are continuing to fund around 320 additional staff in Children and Adolescent Mental Health Services (CAMHS) over the next five years, with the potential to increase capacity for CAMHS cases by over 10,000. Local authorities have also confirmed that access to counselling services through secondary schools is in place for all school pupils aged 10 and above in Scotland. We have also published a strategy to improve the quality of life for those living with dementia, their families and carers.

The National Green Theatres Programme ensures we continue to cut high emissions and waste generated in surgery while maintaining patient safety and quality of care.

The actions set out here, led by the establishment of a National Care Service and our commitment to enhancing primary care, not only tackle the issues we face now, but the ones we may face in the future. They are key steps in achieving our wider objective to reform and renew our health and social care services for decades to come.

We will not shy away from taking the difficult and necessary decisions to improve Scotland’s public health.

Delivering in the year ahead

In the coming year, I will take forward the following critical activity.

NHS Recovery

• Continue to work with our NHS in its efforts to tackle waiting lists and protect planned care, including providing significant additional capacity in endoscopies, orthopaedics and general surgery by opening the new National Treatment Centre (NTC) in Forth Valley and the second phase of the NHS Golden Jubilee NTC by the end of 2023.
• Agree with NHS Boards their 2023-24 activity trajectories and plans and provide ongoing support from the Centre for Sustainable Delivery to improve productivity and efficiency, delivering better outcomes for patients.
• Improve consistency of provision and deliver improvements in health and social care to significantly reduce delayed discharge and hospital occupancy.
• Continue to expand Hospital at Home and other out of hospital pathways to reduce occupancy levels and improve flow for both unscheduled and planned care.

Supporting the NHS and social care workforce

• Commit to provide the necessary funding in the next Budget to increase the pay of social care workers in the PVI sectors in a direct care role – and those working in the PVI sector to deliver funded early learning and childcare – to at least £12 per hour, an increase that could be worth up to £2,000 per year for those on full-time contracts.
• Improve workforce planning, practice and culture with a focus on collaborative, compassionate leadership, wellbeing and equality to deliver a more sustainable and skilled workforce, supported by the commencement of the Health and Care (Staffing) (Scotland) Act 2019, and take forward the recommendations from the Nursing and Midwifery Taskforce.
• Implement the Agenda for Change review and
• revised pay bargaining processes for junior doctors to improve pay structures and future pay negotiations.

Investing in primary and community care

• Improve access to GP services through further expansion to multi-disciplinary teams, which will deliver more appointments with a wider range of healthcare professionals, and embed access principles for patients and practices to ensure services meet local needs.
• Establish the Expert Medical Generalist GP role and future career pathway with professional bodies.
• Progress the National Centre for Remote and Rural Health and Care, expected to launch in October 2023, to improve primary and community services.
• Deliver targeted support to practices serving the most disadvantaged communities in NHS Greater Glasgow and Clyde and work with local areas to ensure vital specialist services such as Community Link Workers can respond to local needs.

Improving cancer outcomes

• Improve cancer outcomes by April 2024 through implementation of our new Cancer Strategy, using the following key metrics: cancer patients receive their first cancer treatment within 31 days of decision to treat, and cancer patients receive their first cancer treatment within 62 days of urgent suspicion of cancer referral.

National Care Service

• Deliver the National Care Service legislation, subject to the agreement of Parliament, to ensure consistency of provision and improvements in social care, social work and community health support, working in partnership with people who access and deliver services, trade unions, Local Government and the third sector.
• Continue funding the voluntary sector Short Breaks Fund ahead of including a right to short breaks for carers in the National Care Service Bill.

Independent Living Fund

• Reopen the Independent Living Fund on a phased basis, with an initial £9 million in 2024-25 to enable up to 1,000 additional disabled people with the most complex needs to access the support they need and deserve to live independent lives.

Population health

• Continue to embed Medication Assisted Treatment standards, increase access to residential rehabilitation, develop a protocol for co-occurring mental health conditions and substance use, and co-produce alcohol and drug service standards for young people.
• Support proposals to establish a Safer Drug Consumption Facility and continue to advocate for evidence-based drug law reform to enhance our efforts to reduce deaths and improve lives.
• Support the development of a Charter of Rights for people who use drugs, to increase accountability, monitoring and challenge in the context of the forthcoming Human Rights Bill.
• Publish a report on five years of Minimum Unit Pricing in September 2023 alongside a consultation on its future, both in terms of price and the continuation of the scheme, and undertake a review of the alcohol marketing consultation, publishing responses by the end of 2023.
• Publish a refreshed Tobacco Action Plan in autumn 2023 which outlines decisive action to remain on track to make Scotland tobacco-free by 2034.
• Take action to reduce vaping among non-smokers and young people and to tackle the environmental impact of single-use vapes, including consulting on a proposal to ban their sale and other appropriate measures.

Sport

• Convene a working group, including representatives from COSLA, sportscotland and sporting and community organisations, to explore how community access to facilities, such as schools, can be maximised and enhanced, and identify areas of best practice across the country.

Mental health

• Publish the new Mental Health & Wellbeing Delivery Plan and accompanying Workforce Action Plan in the autumn and commission Health Boards to produce trajectories for when they expect to meet the CAMHS waiting times standard.
• Establish a new Mental Health and Capacity Reform Programme to begin the process of updating and modernising our mental health and capacity legislation to enhance the protection of people’s rights.
• Consult on a Learning Disability, Autism and Neurodiversity Bill by the end of 2023, which will aim to ensure that the rights of neurodivergent people, including autistic people and people with learning disabilities, are respected, protected and championed.

Abortion services

• Work closely with Gillian Mackay MSP to deliver her Member’s Bill for safe access zones, and subsequently undertake a review of abortion law to identify potential proposals, by the end of this parliamentary term, for reforms to ensure that abortion services are first and foremost a healthcare matter.

Miscarriage care and support

• Improve miscarriage care so women do not wait until a third miscarriage to receive tailored support, including access to progesterone prescriptions and separate spaces in hospitals within maternity wards for people who suffer a miscarriage, and launch a Certificate and Memorial Book of Pregnancy and Baby Loss Prior to 24 Weeks.
• Work to ensure people who experience miscarriage or stillbirth receive three days of paid leave, implementing this across the public sector and calling on the UK Government to make the necessary changes to employment law to make this available for everyone.

Gender identity healthcare

• Continue work to improve gender identity healthcare, to tackle waiting times and adopt a human rights based, person-centred and multidisciplinary approach to improving this healthcare provision.