Programme for Government 2019 to 2020

Chapter 3: Improving Outcomes Through Our Public Services

Improving outcomes and the wellbeing of the people of Scotland is central to Scotland's National Performance Framework and part of our commitment to achieving the UN Sustainable Development Goals.

Public services make a deep and lasting contribution to the wellbeing of our communities. It is our responsibility to deliver high quality, accessible and effective public services, underpinned by values of kindness, dignity, compassion, openness and transparency. This is central to shaping the kind of country that we want to be.

Healthy and active

Improvements in health, both physical and mental, are central to our wellbeing and success as a nation. This Government will continue to up the pace of improvement and change within Scotland's health and social care services and improve access to services.

We have established a clear set of priorities and key actions for government and for local health and care services. These focus on the delivery of better patient care, better health and better value for the people of Scotland, so that we live longer, healthier lives at home or in a homely setting.

To support this work, we continue to invest record levels in our NHS and community health services, spending £120 per person more on frontline health services than the UK average. We are attracting record numbers of staff to work in those services, helping us to build a strong health and social care workforce, who are supported and valued for what they do.

Mental health

In last year's Programme for Government, we set out comprehensive actions on mental health, with a particular focus on the needs of our children and young people. We recognised the need to support and treat people in the right place and at the right times, valuing both community and specialist mental health services.

There is no doubt that mental health is taken more seriously now than in the past but there is still much more to do. This year we continue to build on this foundation, as we develop services and support that can be accessed across all ages.

Investing in early years mental health

Although it is common to have periods of worry during pregnancy, for a significant number of women additional mental health support is needed. We know that the earlier that support is provided, the better for both mother and baby.

In February, we published recommendations to drive up standards of perinatal and infant mental healthcare, supported by a £50 million funding commitment. During 2019 and 2020, we will:

• support the third sector to deliver counselling and befriending services for women who might benefit from additional support in their community
• invest £825,000 to increase specialist staffing levels at the two current Mother and Baby Units at St John's Hospital in NHS Lothian and Leverndale Hospital in NHS Greater Glasgow and Clyde, enabling them to become centres of expertise
• support the development of a community perinatal mental health service across Scotland. Backed by £5 million of investment, this will focus on women with mild to moderate symptoms, allowing them to quickly access support from, for example, cognitive behavioural therapists and psychological therapists
• make £3 million available to support the establishment of integrated infant mental health hubs across Scotland. These will create a multi-agency model of infant mental health provision to meet the needs of families experiencing significant adversity, including infant developmental difficulties, parental substance misuse, domestic abuse and trauma

Improving support for children and young people

Last year we established the Children and Young People's Mental Health Taskforce to provide recommendations for improvements in provision for children and young people's mental health in Scotland.

In response to its initial recommendations, we invested an additional £4 million in Children and Adolescent Mental Health Services (CAMHS) to provide 80 new staff.

This year, working jointly with COSLA, we will take forward the Taskforce's concluding recommendations. We are establishing community wellbeing services across Scotland, focusing initially on children and young people from ages 5-24. This will be an open-access model and referrals can be made by those who work with and support children and young people. Crucially, children and young people will also be able to self-refer to the service. We will also scope out how this service can be made available in the future to people of all ages across Scotland.

We will continue to progress the actions we set out last year. The first tranche of the 350 additional counsellors across Scotland's secondary schools are in place this academic year – all will be in place by next September. Fifty additional school nurses will start training this year, with further tranches to follow until 250 are in training by 2022. We will implement the recommendations of the Personal and Social Education Review and embed whole-school approaches to supporting wellbeing by March 2021.

We have been supporting testing of the Distress Brief Intervention programme in Aberdeen, Inverness, Borders and Lanarkshire. Supported by funding of £7.9 million, the pilot projects are providing help to people aged 16 and over. Interim findings tell us that the programme is preventing suicidal behaviour and, as a consequence, is saving lives. By April 2020, we will review how the programme could be extended to those aged 15 and younger.

In addition, we will:

• develop our new 24/7 crisis support specifically for children and young people and their families. We will create a national service which links with police and emergency health services and introduce a text service so children and young people can text as well as phone to access help
• set out and embed clear national expectations on standards and specifications for CAMHS and other specialist services across Scotland to reduce rejected referrals
• work with NHS Boards to deliver the ambitious trajectories for waiting times improvements for CAMHS (and Psychological Therapies) set out in their Annual Operational Plans, supported by £15.5 million of funding this year
• take forward the recommendations of Her Majesty's Chief Inspector of Prisons for Scotland's independent review into the mental health services for young people in custody

Lifelong support for good mental health

To better support adult mental health services we will establish a new Adult Mental Health Collaborative so public services, the third sector and communities can work together to improve support to people suffering from mental ill health.

We have already committed to providing 800 additional mental health professionals in key settings such as Accident and Emergency, GP practices, custody and prisons by 2021-22. This will help to ensure that people have better access to mental health support at a time and place where they may need it the most. To date, over 260 staff have already been recruited and we are on track for recruitment to reach our target and deliver these vitally important roles.

Recognising the importance of working together across services, we will take forward the work of the National Distress Intervention Group to ensure that services from across our health, justice and social care system are brought together to focus on the needs of any person experiencing distress, particularly those with multiple, complex needs.

We will also:

• establish the Scottish Mental Health Policy and Research Forum to promote excellence in and improve the quality and quantity of mental health clinical research in Scotland
• enable the work of the independent reviews of the Mental Health Act and forensic mental health services so that the rights of individuals are protected

Last year saw the full national rollout of the Computerised Cognitive Behavioural Therapy service across all 14 territorial Health Boards and referral rates continue to rise. To further improve this service, we will develop self-referral access to online Cognitive Behavioural Therapy for anyone with mild to moderate depression and explore specifically how it can be used to support young people.

We will also:

• establish a Personality Disorder Managed Network to improve services, supporting a national roll out of patient self-management training
• invest £400,000 to develop improvements to early intervention psychosis services, ensuring that people suffering from psychosis anywhere in Scotland get timely access to effective care and treatment

We continue to take action to prevent suicide in Scotland. New mental health and suicide prevention workforce development resources have been produced for a range of settings, and we have asked all NHS Boards to include mental health and suicide prevention training as an essential element of local Workforce Development Plans. Last year, we established a National Suicide Prevention Leadership Group to help drive implementation of our Suicide Prevention Action Plan.

In the coming year, we will work with partners to:

• develop and promote best practice in local suicide prevention planning and learning reviews of suicides
• extend suicide prevention workforce development
• support implementation of measures to support those in crisis and for those who have been bereaved by suicide

Learning disabilities, neurodiversity and dementia

The vast majority of people with learning disabilities live in the community and play their full part in it. But they are faced with a range of barriers which we must address.

Through the Keys to Life Strategy – published in 2013 and recently refreshed – we have helped to change the lives of people with learning disabilities.

To support autistic people and their families, we have:

• developed a national anti-stigma campaign to improve how autistic people and their families are understood within their communities and launched a fund to remove barriers to employment for autistic people
• commissioned a National Autism Implementation Team to develop evidence-based improvements to reduce waits for diagnosis, improve autistic children's education experiences and increase access to employment
• worked in partnership with Education Scotland to update the online Autism Education Toolbox to improve teachers' knowledge of autism

Working with primary care teams and other partners in a number of areas, we will pilot health screening services specifically tailored to the needs of people with learning disabilities. We will also develop an online autism support service to help people live positively with autism while reducing demand for services through CAMHS, Psychological Therapies and other public services.

Scotland's Third National Dementia Strategy aims to deliver high quality, person-centred support for people with dementia, their families and carers from the point of diagnosis to the end of life. This year we have:

• supported local delivery of the national dementia post-diagnostic service
• piloted work to increase the accessibility of diagnosis and support in primary care settings
• funded two national dementia workforce programmes
• co-funded Alzheimer Scotland Dementia Nurse Consultants across NHS Boards
• supported a new reform agenda to modernise specialist NHS dementia care

In the coming year, we will:

• fund a new large-scale project to test integrated, intensive dementia home care
• establish Scotland's first national Brain Health Centre. This body will promote positive brain health as a way of reducing the risk of developing some dementias, linking with wider work to help encourage clinical research trial recruitment in Scotland as well as clinical research investment
• engage widely, including with service users and carers and statutory third sector and independent sector partners, to develop our fourth National Dementia Strategy, building on our internationally recognised action in areas such as rights-based care and post-diagnostic support

By the end of this year, we will publish Scotland's first ever National Action Plan on Neurological Conditions. It will set out how people with neurological conditions and their carers are involved in decisions about care and support, how we will improve the provision of coordinated health and social care and how we will build a sustainable neurological workforce for the future.

Helping people to live longer, healthier lives

Helping people to live healthier lives takes more than government action. The whole public sector, third sector organisations and people across Scotland have an important role to play in reducing health inequalities and improving healthy life expectancy. Health inequalities are a symptom of wider socio-economic inequalities which will inhibit our success as a country. We will continue to take action to close the gap.

As set out across this Programme for Government, tackling issues such as poverty and improving the quality of work are as important as reducing smoking rates and addressing obesity.

Work is well underway with COSLA and The Scottish branch of the Society of Local Authority Chief Executives and Senior Managers (SOLACE) to develop the new public health body, Public Health Scotland, which will launch next year. It will help to shape public health improvement across the whole of Scotland and enable us to make best use of Scotland's public health assets – data and intelligence and our public health professionals – in supporting local areas to create the right conditions for supporting health and wellbeing.

We have already started work to improve the range of weight management services for people being treated for, or who are at high risk of, type 2 diabetes. Backed by investment of £42 million, early adopters have been using this funding to redesign and deliver weight management services in line with the national guidelines. Learning from their experiences, all Health Boards have now received funding to help them develop plans for weight management services and these will begin to become available over the coming year, helping to achieve our ambition to halve childhood obesity by 2030.

We have consulted on restricting the promotion and marketing of food and drink high in fat, sugar or salt where they are sold to the public and will bring forward a Bill on Restricting Foods Promotions for introduction in next year's legislative programme.

Our Tobacco Action Plan focuses on addressing health inequalities and targeting smoking rates in the communities where people find it most difficult to quit. We have also banned tobacco in prisons. We will seek views on further restrictions on advertising of nicotine vapour products, to discourage non-smokers, children and young people from taking up vaping, and we will introduce a no-smoking perimeter around hospital buildings.

We continue to work with Scotland's Violence Reduction Unit and Medics Against Violence to expand the Navigator programme. This programme engages with people who have been affected by violence aiming to break the cycle of violence and ease the pressure that violence places on health, social care and justice services.

This year, we aim to extend the service, ensuring that people attending A&E with complex needs and chaotic lives are provided with the support they need to make positive changes in their lives. The Scottish Violence Reduction Unit is also exploring trialing this approach in community and justice settings such as custody suites, providing support to vulnerable people affected by trauma to make sure that they are able to access the services they need.

Tackling the harm associated with the use of illicit drugs and alcohol

This Government has taken radical steps to tackle alcohol misuse. Since the introduction of minimum unit pricing, alcohol sales have fallen to their lowest level since 1994.

This year, we will take further action to tackle the issues associated with use of illicit drugs and stop the rising number of drug deaths. We currently provide £53.8 million each year to Alcohol and Drug Partnerships, supplemented by £20 million annually following our 2017‑18 Programme for Government. But we need to go further.

We will now make an additional £20 million of funding available over two years. This frontline funding will include:

• providing funding to allow our new Drug Deaths Taskforce to support innovative projects, test new approaches and drive forward specific work to improve the quality of services
• establishing joint working protocols between alcohol and drug services and mental health services to improve access, assessment and outcomes from January 2020
• developing a national pathway for Opiate Substitute Therapy to make sure that it is effective across the country and help to reduce stigma
• establishing an Inclusive Scotland Fund to support a number of local areas to involve people with lived experience of severe, multiple disadvantage in developing whole system approaches to improve outcomes

We are doing everything we can in Scotland to save lives but the Misuse of Drugs Act 1971 remains reserved to the UK Government. Some steps we support, such as introducing medically supervised overdose prevention facilities, are not possible under the current arrangements.

The UK Government must recognise that we are facing a public health emergency in Scotland and they need to take the necessary steps to give Scotland the additional powers we need to help save lives.

We will:

• consult on drug law reform, setting out the changes we would want to make to the 1971 Act in the event that UK Government agrees to devolve the powers in the Act
• hold a summit in Glasgow to identify further steps to tackle this tragedy and ensure that the voices of those with experience of drugs and their families are heard

Alongside this work, we will take other action to tackle public health issues and health inequalities.

We will put in place a Women's Health Plan. In the coming year, it will take action to:

• ensure rapid and easily-accessible postnatal contraception
• improve access to abortion and contraception services for adolescents and young women
• improve services for women undergoing the menopause, including increasing the understanding and knowledge of women, families, healthcare professionals and employers
• reduce inequalities in health outcomes which affect women, such as endometriosis and antenatal care
• reduce inequalities in health outcomes for women's general health, including work on cardiac disease

Our Active Scotland work has increased support to Community Sports Hubs in our most deprived communities. We have also collaborated with partners to increase women's and girls' participation in sports and provided £1 million of funding for the Changing Lives Through Sport and Physical Activity Fund.

This year, we will create a new Community Sport Bond worth up to £5 million. We know that, for supporter and community groups, not having access to capital funds has been the main barrier to them being able to take ownership stakes in their local clubs when the opportunity has arisen. The Bond will empower communities and groups and strengthen local decision-making by giving groups the chance to acquire a share or control of their local sports club. To be eligible to apply for the Bond, groups must show clear community focus and support and, in particular, demonstrate how involvement in the running of their club would be used to support women and girls' participation in sports.

In addition, we will:

• work to eliminate Hepatitis C in Scotland by 2024, by increasing the number of people treated each year. By getting the message out that anyone who has ever been at risk should get tested and, if necessary, take a short course of medication, we will aim to eliminate this fatal virus six years earlier than expected by the World Health Organization
• enhance the current vitamins scheme in Scotland, providing free vitamin D for children and to breastfeeding mothers. The scheme launched in August for breastfeeding mothers and children under a year old and will expand to become available to all children under 3
• establish Precision Medicine Alliance Scotland to accelerate the development and implementation of precision medicine, focusing on conditions of major importance in Scotland, including diseases that disproportionately impact on those at risk of socio-economic disadvantage

We have passed legislation to introduce an opt-out system of organ and tissue donation – it will come into force in autumn next year and aims to increase the number of successful donations in Scotland, while ensuring that there are safeguards in place to respect a person's wishes. We will run a high profile awareness-raising campaign before the new system is introduced and on a regular basis thereafter so people know about the changes and understand what choices they have.

Integrated health and social care services

Improving our nation's health and wellbeing needs high quality and joined-up health and social care services – no matter whether those services are provided by the NHS, local government or the third and independent sectors.

Our work to integrate health and social care has changed the way key services are delivered, putting greater emphasis on supporting people in their own homes and communities and reducing the inappropriate use of hospitals and care homes.

There is evidence that our efforts are working. For example, there has been a reduction in unplanned overnight stays in hospital and many of our health and social care partnerships are making good progress in reducing their delays in hospital discharge, meaning many people are being cared for effectively at home, or in a homely setting, for longer.

We are also working with local partnerships to improve the planning of children's services and the positive impacts of this will be incorporated into our review of children's services guidance later this year.

But we want to go further. This year, the Scottish Government and COSLA are taking forward a series of actions to increase the pace and effectiveness of integration, based on the Review of Progress with Integration, published in February. This includes:

• developing new statutory guidance for community engagement and participation in the design and delivery of health and social care services
• developing a framework for community-based health and social care integrated services to help ensure that what works to improve outcomes in local community settings is shared and promoted across the whole system
• carrying out an audit of existing national leadership programmes and improving collaborative working with all health and social care partners, including the third and independent sectors
• empowering Integration Authorities to use all of the resources allocated to them in ways which work best for the people and communities they serve and to improve the understanding of accountabilities and responsibilities across the system
• improving strategic inspection by making sure it better reflects how different bodies need to work together to improve outcomes

Reforming social care

Social care support is an investment in Scotland's people, society and economy. One in 24 people of all ages in Scotland received social care support and services during 2017-18.

Social care is about helping people to participate in, and contribute to, society by supporting independent living and ensuring that their dignity and human rights are protected. We are committed to supporting people to stay at home or in a homely setting with maximum independence for as long as possible, with their support guided by their needs, priorities and choices.

We recognise the challenges in meeting the need for social care support in Scotland. We also know that self-directed support is not yet fully embedded as Scotland's approach to social care support. Together with partners, and guided by people who use social care support, we are taking actions to accelerate change.

A reform of the adult social care support programme launched this year, led by the expertise and experience of people who use social care support and those who work in the sector. Its priorities include:

• a shared agreement on the purpose of adult social care support, with a focus on human rights
• ensuring social care support is centred on a person, how they want to live their life and what is important to them
• valuing and supporting social workers and social care workers and unpaid carers
• investment in social care support, and considering how it is paid for in the future

This year, we will:

• develop a future vision for a sustainable care home sector as part of the wider health and social care landscape
• work with health and social care partnerships, local authorities, providers and improvement organisations to make it easier to design and implement models of care which support the workforce to provide flexible, consistent care and support for people across care at home, care homes and other types of support
• continue to support the sector to develop a national framework agreement for both purchased and commissioned care and support services. This will increase consistency in the way in which support is commissioned, purchased and delivered across the country, and will strengthen the focus on person-centred and outcomes-focused practice
• support Social Work Scotland to work with local authorities and others to design and test a framework of practice for self-directed support across Scotland, including approaches to assessment and resource allocation. This will result in more consistent experiences, making it easier for supported people to move from one area of Scotland to another. Local flexibility will ensure authorities can work with their communities to develop systems that suit local strengths and needs, particularly in remote and rural areas

We will create a blueprint for the development of hospital at home services across Scotland, based on existing good practice in areas such as Lanarkshire and Fife. The blueprint will form part of the Framework for Community Health and Social Care Integrated Services, which is currently under development.

We implemented Frank's Law in April this year, supported by a £30 million investment. It means that anyone of any age who has been assessed as needing personal care has access to it, free of charge.

To make sure that the rights of Scotland's unpaid carers are secured, we have developed the Carers Act Implementation Plan, backed by an extra £10.5 million for local authorities this year.

We are investing a further £1 million this year to help carers centres build capacity and to fund local projects to develop and spread best practice for involving carers in decisions about hospital discharge. We will also launch a national marketing campaign to improve awareness of carers and their rights to support.

We are committed to ensuring our work always recognises the impacts on carers across different aspects of their lives such as employment, benefits and education. We will soon be consulting on our plans for a Carers Strategic Policy Statement and will announce final plans early next year.

We have consulted on proposals to reform the law on adults with incapacity. We want to make sure that people receive more support to make their own decisions and have better access to the care that they need. There are a number of sensitive areas that we continue to work on with stakeholders and, in the meantime, we will make improvements in training and support for those who work with adults with incapacity.

We will also provide updated guidance on power of attorney to help to make the law in this area more accessible and empower people to plan for the future.

Health and social care in prisons

We are working to improve how health and social care services are provided to people in prison and how these services can tackle health-related causes of offending such as drug and alcohol misuse.

We have established a new Scottish Prison Care Network and published a Prison Health Information Dashboard. This month, we will begin to test new approaches to delivering integrated social care which will improve the services provided to people in custody, helping them to rehabilitate and return to their communities when they are released. We will also publish a new Health and Social Care Strategy for Prisons over the coming year.

Providing the right healthcare and support when it is needed and at whatever stage of life

We are investing in a range of initiatives to improve primary care services, including increasing the number of GPs entering training, enhancing primary care teams with link workers, paramedics and pharmacists, investing in General Practice Nursing, providing support to retain GPs and setting a target to recruit 800 more GPs over 10 years. This investment will reach an additional £500 million a year by 2021-22 in primary care, of which £250 million will directly support General Practice.

Based on our new Scottish GP contract, all Integration Authorities now have locally-agreed Primary Care Improvement Plans. Plans for this year include local workforce planning, infrastructure development and patient engagement – work which will improve the primary care people receive in their communities. We are supporting GP practices via the GP Premises Sustainability Fund which we will increase from £30 million to £50 million this year.

Our £2.5 million Community Challenge Fund, encouraging people to take positive action to improve oral health, launched this summer. Work is underway to accredit General Dental Practitioners with the skills and equipment to see patients in care homes and early adopters began to operate this summer.

We continue to implement the recommendations from the Community Eyecare Services Review. A new Once-for-Scotland shared ophthalmology patient record will launch in the coming year, making sure patients are safely directed towards accredited community optometrists. This high quality community-based care will increase service capacity across Scotland which is particularly important as our population ages and demand on eyecare services increase.

We have strengthened the Chronic Medication Service, with over 750,000 patients now registered at their local pharmacy and community pharmacists providing care for people with stable long-term conditions. This year, the service, now called the 'Medicines: Care and Review Service', will continue to improve how pharmacists can provide personalised care.

NHS 24 is improving its services by introducing a new clinical supervision model which will increase the number of patients who receive the advice they need at the first point of contact, without needing to wait for a call back.

This year, we will test how to widen NHS 24's support to GP practices in-hours. Patients contacting their GP for a same-day appointment will have their symptoms triaged by NHS 24 to help make sure that they are directed to the most appropriate healthcare professional for their needs.

Out-of-hours services are under pressure. The National Out of Hours Oversight Group will continue to drive forward improvements and sustainability in out-of-hours care in the short, medium and longer term. An early action will be to provide grants to GP practices to deliver training in out-of-hours services.

We will provide new online learning modules for the health and social care workforce to help people who have lost their voice or have difficulty speaking. This will help staff to better identify people who may need or benefit from communication equipment and provide help to use that equipment.

Stroke: prevention, treatment and care

Over the past 10 years, the number of people in Scotland dying from stroke has decreased by 42%. This is significant progress but we want to strive for even better outcomes. In the coming year, we will develop a programme to improve stroke pathways and services, including prevention, treatment and care. We will:

• appoint a Specialty Adviser to the Chief Medical Officer on Stroke Care
• review and improve the current stroke care bundle to improve outcomes for patients
• collaborate across government on stroke prevention and raising awareness of the signs of stroke
• begin work to scope out and define what a progressive stroke unit looks like
• ensure that a national planning framework is in place for a high quality and clinically safe thrombectomy service

Of ultimate importance is making sure that primary care meets the needs of the communities it serves. We know that some groups of people face challenges accessing healthcare. To help, we have published new guidance on GP Practice registration which will make it easier for marginalised people to access healthcare and make that access more consistent across the country.

We know that there is no one-size-fits-all approach to primary healthcare. Our next phase of primary care reform will promote innovation and co-produced local solutions, with a focus on rural and deprived communities. But we want to know more about what communities need. We are considering the latest findings of the Health and Care Experience Survey and we will outline our plans in the coming months.

Access to services

Access to care at the right time is an essential part of improving Scotland's health and wellbeing. As well as making sure people have access to the services they need, all Health Boards will have plans in place by the end of this year to implement flexible visiting making it easier for patients to see their loved ones while in hospital.

Our Accident and Emergency services are the highest performing in the UK and have been for more than four years. We have opened new Major Trauma Centres in Aberdeen and Dundee and work is progressing towards the opening of Centres in Edinburgh and Glasgow. Our work to coordinate performance in how trauma is dealt with is also supported by the appointment of Trauma Co-ordinators in each region and the newly updated plan for managing Major Incidents with Mass Casualties. The new Trauma app will go live in the west of Scotland next August.

ScotSTAR (North) opened in April, helping patients involved in serious accidents and those in remote locations. Scotland now has full coverage by pre-hospital critical care teams – meaning patients across the country will be equally cared for in life-threatening situations.

We have been working to reduce unintentional harm which is estimated to cause around 500,000 A&E visits and one million GP appointments every year, including providing advice to families and supporting Child Safety Week.

Following the decision that the Royal Hospital for Children and Young People in Edinburgh was unable to open on time due to problems with ventilation systems, we have commissioned a review to identify the factors that led to the delay.

We have also instructed NHS National Services Scotland to review all current and recently completed major NHS capital projects to provide assurances that the required high standards have been met in their construction and renovation.

Patient safety is paramount – we will establish a national body with responsibility for the oversight of the design, construction and maintenance of major infrastructure developments within NHS Scotland. It is likely to involve a compliance function to ensure that construction and future maintenance is in line with statutory and other guidance.

We will set out specific plans for the Royal Hospital for Children and Young People following the reviews.

Tackling cancer

We continue our work to prevent cancer, detect it early and treat it effectively. Through our current cancer strategy, we have invested over £54 million to-date, including more than £4.5 million in key treatments and £500,000 in supporting work with children and young people with cancer. We have increased uptake in the new bowel cancer test and reduced the risk of cervical cancer due to the HPV vaccine.

In the coming year, we will:

• work in close collaboration with NHS Boards to ensure cancer waiting times standards are met by spring 2021. We are supporting this with the Effective Cancer Management Framework and education sessions for staff to improve monitoring of patients with suspicion of cancer and make sure that cases are escalated cases effectively when required
• target our Detect Cancer Early social marketing campaigns to people who are most likely to present with later stage disease and less likely to participate in screening
• change national screening programmes where it is appropriate to ensure those in greatest need benefit fully
• begin work to pilot self-sampling for cervical screening at a national level
• further develop our approach to bowel and breast screening to enable us to better target areas of low uptake, particularly in our most deprived communities
• support the dissemination of clinically-refreshed Scottish Referral Guidelines for Suspected Cancer to support primary care clinicians to ensure those with symptoms suspicious of cancer are put on the right pathway at the right time
• invest an initial £2 million in technology to improve the detection of advanced prostate cancer

We are also committed to making sure our plans take account of the latest developments in cancer research, treatment and technology. This year, learning from our experiences to date, we will refresh our cancer strategy, making sure that we invest in the best services possible and deliver the best outcomes for people with cancer. We will develop defined and consistent diagnostic and treatment pathways for different types of cancer, including those which occur in small numbers.

As well as providing the best clinical care, we will invest £18 million in a partnership with Macmillan Cancer Support to make sure everyone at the point of a cancer diagnosis has contact with a link officer to talk about their specific needs and receive information and support tailored to them. Macmillan will also help people find financial, emotional and practical support that is right for them, meaning that patients and their families are looked after from diagnosis, through treatment and beyond.

Reducing waiting times

As part of our £850 million Waiting Times Improvement Plan, we are making £102 million available to Health Boards in 2019-20 to drive down the length of time patients wait for appointments and procedures, prioritising those who are waiting the longest. We will increase capacity in our health service, increase clinical effectiveness and efficiency and implement new models of care. By spring 2021:

• 95% of outpatients will wait less than 12 weeks to be seen
• 100% of inpatients/daycases will wait less than 12 weeks to be treated
• 95% of cancer patients will receive their first treatment within 62 days of an urgent suspicion of cancer referral

This year's investment will support more procedures such as cataract removal and hip and knee replacements, as well as increasing the number of outpatient and diagnostic appointments. It will also support work to increase capacity, including additional workforce, at the network of elective and diagnostic centres currently being created.

To provide longer-term capacity for elective procedures, construction has begun on the expansion of the Golden Jubilee Hospital. While that is underway, we have increased capacity in endoscopy, cardiology and ophthalmology by installing an interim mobile Cath Lab, increased general surgery activity, increased the number of additional cataract procedures and installed a second CT scanner.

We have brought forward the opening of an additional theatre in NHS Forth Valley, allowing more joint replacement operations to be undertaken. We have strengthened the management of patients with treatable pre-operative anaemia and trialed Active Clinical Referral Triage. In the coming year, construction work will also begin on elective centres in Grampian, Highland and Lothian.

This year, we will continue to deliver the Waiting Times Improvement Plan, working with partners to apply quality improvement expertise to help us to deliver sustainable improvements in waiting times whilst maintaining or improving the quality of care.

The power to drive improvement in performance often lies at hospital level. We want to empower hospital managers to make the kinds of changes we need to see to meet our ambition. We will develop a strategic plan setting out how we will strengthen responsibilities and capacity in hospital-level management to drive better performance and make sure that clinical judgement is better mainstreamed into hospital management decisions.

Digital technology can help to transform health services, making sure that they meet the needs of people across Scotland and are more accessible. Ensuring that people are involved in their design helps to overcome barriers to using online services as they arise.

The Attend Anywhere service is a web-based platform that gives patients the opportunity to video call their healthcare provider. In the past year, the Attend Anywhere Scale-up Challenge has seen increased usage and reports of significant savings in both patient and clinician travel and reducing travel-related emissions. It will now roll out to primary care and social care services so more services can be delivered closer to people's homes. We will also scale up the Blood Pressure service for remote diagnosis and management of hypertension.

This year, we will work with partners to trial new approaches to digital services, focusing on frailty, breathlessness and survivors of abuse, opening up services to those who may struggle to travel due to their condition using technology such as video consultations, telecare or home health monitoring.

Our workforce

All of us who have engaged with our health and social care services know that all those who work in these services make a huge difference to the lives of people and communities across Scotland.

We and our partners are taking forward a range of actions to strengthen the sector through the National Health and Social Care Workforce Plan.

Earlier this year, we launched a platform to improve the data, tools and methodologies available to help plan for the future. It will bring together, for the first time, a common evidence base that can be used by workforce planners and is already being used to identify workforce gaps and develop new staffing models.

This autumn, we will publish the results of an analysis undertaken to support recruitment and retention of staff.

To encourage more people to choose the sector for a career and encourage a diverse workforce, we will launch a national campaign early next year and we will launch an online careers resource this autumn to help improve career pathways. We will also work with national and local partners to take forward the recommendations set out in the Fair Work in Scotland's Social Care Sector 2019 report to improve fair work practices across the social care workforce.

We will continue to develop a positive working culture. This will include actively strengthening our policies and governance in relation to whistleblowing, bullying and harassment to make sure those who work in our NHS feel safe, protected at work and able to speak out. We will invest £138,000 to fund tailored mental health resources for our emergency responders.

We will improve consistency in employee experience and workforce practices with the aim of ensuring that NHS Scotland is a modern, consistent and exemplar employer.

We will launch a national recruitment campaign for nursing, midwifery, allied health professionals and healthcare scientists later this year and a campaign for social work and social care professionals in 2020.

We are on track to create around 2,600 new nursing and midwifery training places over this Parliament, with a student intake of over 4,000 this year – a 7.6% increase on last year – and the bursary for nursing and midwifery students will rise to £10,000 per year from 2020. In conjunction with local authorities, we will explore the potential to create new Modern Apprenticeship frameworks.

We have already announced an increase in medical undergraduate numbers. By 2021 medical school places will have increased by 190 over 2016 levels. To help ensure that Scotland has a world-class and sustainable medical workforce, we will fund an additional 105 foundation places for medical graduates by 2022. These will accommodate the first of the additional graduates and enable them to proceed to the next stage of their training in order to become qualified doctors. The new places will create a greater range of placements for trainee doctors, particularly in general practice and psychiatry and in remote or rural parts of Scotland. We will also develop proposals for a new medical school.

We have established the Scottish Global Health Co-ordination Unit which has a facilitating role in the co-ordination of health partnership work in NHS Scotland. Our unique approach to global citizenship builds on best practice and includes developing ethical and sustainable ways to donate surplus NHS equipment where it is needed most at home and overseas.

To make sure that our social workers are equipped to deliver for the people they work with, we will improve how newly-qualified social workers are supported. Based on the results of pilots due to conclude in summer next year, we will roll out a national approach to a supported year for newly qualified social workers to make sure that the training they receive during that first year of employment reflects the latest developments in policy and practice.

Growing up loved, safe and respected

As well as making sure our health service provides specialist support for those who need it, we must ensure all our children and young people have the opportunity to develop good health and wellbeing and get the best start in life. We are investing at every stage to ensure our children and young people grow up loved, safe and respected.

Getting it Right for Every Child is the approach we take to supporting families by making sure children and young people receive the right help, at the right time, from the right people. It is internationally renowned. By the end of this year, we will refresh our policy and guidance documents, updating our practice based on what we know works best for children.

Adverse Childhood Experiences (ACEs)

We continue work to address adverse childhood experiences (ACEs), including abuse, neglect and a range of difficult household and other experiences which negatively impact healthy development. We recognise the role that inequalities play and we are focused on tackling child poverty, addressing gender inequality and ensuring all children and young people can fulfil their rights.

We are committed to preventing ACEs and supporting children, young people and adults affected by childhood adversity and trauma. The evidence is clear that it is never too late to provide people with the help, kindness and compassion to address early life adversity.

In line with our four areas for action set out in last year's Programme for Government we are driving progress.

We have provided an additional 509 health visitors in Scotland, who are identifying and addressing needs early and improving outcomes for children and families.

We will continue to support our Family Nurse Partnership Programme this year. It provides intensive support to young mothers during pregnancy and for the first two years of a child's life. It has reached over 7,000 families since its inception and helped mothers to build the confidence and skills they need to provide the right support for their baby, and support their own mental health and confidence as well as housing, education and employment.

This year, we will develop Scottish standards for the Barnahus concept, forming a framework for a child-centred approach to delivering justice, care and recovery for children who have experienced trauma. We will publish draft standards for consultation at the end of this year and finalised standards in 2020.

We are helping children affected by parental imprisonment by continuing to support prison visitor centres, and the Scottish Prison Service has set out a five-year strategy to help those in prison and their families.

We have invested £1.35 million in the National Trauma Training Programme, enabling workers to recognise and respond to psychological trauma. Over 3,000 people across our public services, including police officers, nurses and social workers, have been trained to date, with training for a further 2,000 workers planned. We will expand the programme over the next two years, providing the opportunity for more frontline staff to receive training, such as those supporting Looked After Children and women receiving maternity care who have experienced sexual violence and abuse.

People working in our schools have been supported with resources to increase their understanding of ACEs and how to take a trauma-informed approach in the classroom. This year, we will support the development of trauma training packages for all organisations who come into contact with victims of crime.

We are supporting community action to prevent and respond to childhood adversity and trauma, including the Families and Communities Fund for third sector organisations and investment from the Cashback for Communities programme.

Creating lasting change in our care system

It is our job, as a society, to love our most vulnerable children and give them the best start in life, doing everything we can to make sure they grow up surrounded by kindness, compassion and understanding. Listening to young people with care experience is essential to make sure that we continue to improve our care system and help young people achieve their full potential.

We have made the Permanence and Care Excellence programme available to every local authority in Scotland, helping to make sure more children find permanent placements sooner and are able to grow up in stable, loving homes.

Our Children Bill will strengthen duties to promote contact between siblings and our Family Justice Modernisation Strategy will include provisions in relation to placing siblings together.

From spring next year, new standards to improve experiences and outcomes for vulnerable young people in secure care will come into force. We also continue to invest in our looked-after children's education, providing £8 million of funding from the Scottish Attainment Challenge Fund again this year.

We will continue to work with COSLA to agree how best to take forward the recommendations of the National Review of Foster, Kinship and Adoption Care Allowances, with a view to implementation from April next year. This will improve consistency and transparency for looked-after children, their families and their carers across Scotland.

Our Advance Payment Scheme, set up to provide recognition and acknowledgement of historical child abuse in care in Scotland opened in April this year. A payment of £10,000 is available for eligible survivors who are terminally ill or over 70 years old, avoiding the need for these survivors to wait until legislation can be passed.

So far, over 75 payments have been made. We will continue to do everything possible to help survivors and their families by ensuring a simple application process and providing support to find sources of care records to make sure that no one is refused their application because of a lack of documentary evidence of having been in care.

We will take this important work forward, setting up a statutory redress scheme for anyone who has been a victim of historical child abuse whilst in care in Scotland beginning with introducing legislation in the coming year.

The Independent Care Review

The Independent Care Review is now in its third stage and will report its findings to us early next year. Care experienced young people have made clear, however, that we must not wait for the outcome of the Review's work before making changes to the care system.

We will:

• extend eligibility for free NHS dental care to care-experienced people between the ages of 18 and 26 to reduce the negative impacts that poor dental health can have on physical health, mental wellbeing and self‑confidence
• work with local government to make sure that care-experienced young people receiving a qualifying benefit are supported with discretionary housing payments from April next year, giving them greater choice in the housing options they have and more security in their tenancies
• launch our new Job Start Payment, ensuring that care leavers will get this help if they are receiving a qualifying benefit, without having had a period of unemployment
• remove the age 26 cap on the care-experienced student bursary in time for the start of the 2020-21 academic year. People with experience of care often do not feel ready to start further or higher education immediately after leaving school – we want to support them into either further or higher education at whatever point in life they feel they are ready, no matter what age they are
• extend entitlement to funded early learning and childcare provision to 2 year olds whose parents are care-experienced. For care-experienced people, becoming a parent can be more challenging than for others because they are less likely to have reliable family support around them. We will make sure that this entitlement is in place from August next year, the same time that we begin to deliver 1140 hours of funded provision for families across Scotland
• create a new statutory provision in favour of brothers and sisters who are taken into care being placed together where it is in their best interests

Protecting our children and vulnerable people

All children in Scotland have the right to be protected from abuse or neglect. We are ensuring that effective child protection procedures are in place wherever a child is experiencing or at risk of harm.

By summer next year, we will publish revised National Guidance for Child Protection in Scotland. Working with stakeholders, we will develop a new approach to reviewing significant protection cases and take forward a range of actions to prevent sexual offending involving children and young people.

We will publish a national dataset to support the planning and delivery of child protection services and work with our local authorities, health, education and justice sectors to make sure risk and harm are recognised and handled quickly and effectively.

We have introduced legislation to strengthen the protection of children and vulnerable people, while making the system of applying for criminal record checks more straightforward.

The Disclosure Bill makes the Protecting Vulnerable Groups scheme mandatory for anyone working with children or vulnerable people, such as sports coaches, and applying a renewable five-year membership rather than a lifetime membership. It will also end the automatic disclosure of all criminal offences committed as a young person, with decisions to be taken on a case-by-case basis.

The Bill will deliver a fairer regime which will provide the best possible protection for our most vulnerable people, and be simpler for employers and less invasive for the majority of users.

We will take action to improve the support and protection given to vulnerable adults at risk of harm. We will publish a three-year plan of improvement by spring next year, aiming to improve how assurance and inspection activities are undertaken, how legislation and policy make sure care is provided consistently and effectively and how data is best used to improve outcomes for adults at risk of harm.

Children's care and justice

We will invest a further £800,000 this year to strengthen Scotland's youth justice system, expanding our successful preventative partnership approach to youth crime.

We will implement the Age of Criminal Responsibility (Scotland) Act 2019 as quickly and as safely as possible. That means that, as of autumn this year, no child under the age of 12 at the time of an incident will be treated as an offender in the children's hearings system, or subsequently.

We have committed to better experiences and results for all by modernising the children's hearings system. We are supporting partners to introduce new digital technology approaches to transform children's participation in their hearings, making sure discussions and decisions are accessible to all children, and we are investing £700,000 in professionalising the support to unpaid children's panel volunteers.

In spring next year, we will introduce a national children's hearings advocacy scheme, backed by £1.5 million, to further reinforce children's rights and make sure the interests of each child is at the very heart of their hearing. We will also consult on enabling joint reporting to the Crown Office and the Scottish Children's Reporter Administration of all 16 and 17 year olds' offence cases.

The early years

Our work to make sure every child in Scotland gets the best start in life begins at the earliest stages. Our support to mothers during pregnancy is followed by the Baby Box containing the essentials newborns and their families need for the first few months.

Over 100,000 Baby Boxes have been received by families across the country, and they are helping to tackle inequality and improve health outcomes from the first few days of children's lives.

Early learning and childcare

Quality and nurturing early learning and childcare is the foundation from which every child can develop socially, emotionally and educationally, enabling them to reach their full potential.

From August next year our transformative expansion of early learning and childcare will begin. It will mean that all 3 and 4 year olds, and 2 year olds from disadvantaged communities, will receive 30 hours a week of funded childcare during the school year. They will also have the option to access a smaller number of hours per week all year round. This means that our children get the best possible start in life and will allow families the opportunity to explore more work and learning opportunities. It will save families up to £4,500 per child each year. Local authorities are working hard to deliver the new entitlement and we are providing them with the support that they need.

The expansion will benefit around 80,000 families across Scotland, with an additional annual investment of £567 million by 2021-22, bringing our total investment in early learning and childcare to almost £1 billion. It aims to support children's development and narrow the attainment gap; increase family resilience through improved health and wellbeing outcomes for parents and children; and allow more parents to be in work, training or education.

Parents and carers will have greater choice of high quality early learning and childcare providers, being able to access their child's entitlement from any provider across the public, private and third sectors (including childminders) which meets the National Standard, has a place available and is willing to enter a contract with their local authority.

The full expansion will be available from August next year but we have asked local authorities to prioritise more economically disadvantaged communities for any early provision, to ensure that those who will benefit the most will also benefit first.

The new National Standard includes daily access to outdoor play and learning, support from well-qualified and supported professionals and a free nutritious meal. To ensure that our workforce is treated fairly we are also providing the funding to enable all childcare workers delivering the funded hours to be paid at least the real Living Wage.

Over the next year, we will continue to support local authorities and other employers to recruit the workforce needed to deliver the expansion. Our national recruitment campaign is ongoing and we will continue to work with partners to make sure it reaches minority ethnic communities so that the new workforce is diverse and represents Scotland's communities.

We will continue to work with the Scottish Funding Council and Skills Development Scotland to create more capacity in our colleges and work-based learning sectors to train staff and increase the number of Modern Apprentices following an early learning and childcare pathway.

To ensure children access their early learning and childcare in suitable premises, we are on track to meet our target of 750 new, refurbished or extended nurseries as a result of the expansion programme.

To support outdoor learning, we will accelerate our forest kindergarten training programme to make it available in all regions of Scotland by summer 2020.

Out-of-school care

High quality out-of-school care gives children opportunities to play and socialise which benefits their attainment, learning and wellbeing. It also offers a way to tackle issues like food insecurity and gives parents and carers the chance to take up employment or study, or increase their working hours.

Our draft framework for Out of School Care considers what more needs to be done to address the barriers many parents and carers face in accessing out of school care, as well as making sure children's voices are heard too. We will establish a public panel of parents, children and young people to provide ideas and feedback as we develop our plans further.

We already know that out-of-school care needs to be affordable, flexible and accessible and that there are barriers to low income families, so we are taking action now.

Over the coming year, we will invest £3 million in the Access to Childcare Fund as part of a range of measures to tackle child poverty. It will provide support to establish new projects delivering community-based childcare for low-income families. This will also provide opportunities for children within those communities to benefit from a range of activities before or after school or during the holidays. It will begin in April next year and run for two years.

Education – school and beyond

Our investment in education continues – in the last two years, there have been real terms increases in the amount of money spent on education by local authorities.

Over the last three years, teacher numbers have increased and we have ensured a fair pay deal for our teachers. Young people are achieving more qualifications and a record number are securing positive destinations after leaving full-time school education. Our universities are becoming more accessible – a greater proportion of students from the most deprived areas entered this year than ever before.

Closing the attainment gap

In the past year, we have continued our efforts to close the educational attainment gap, to make sure every child is able to achieve their potential no matter where they grow up.

We have continued to invest in the Scottish Attainment Challenge and Pupil Equity Fund with an investment of £182 million in 2019-20. This is part of a total of £750 million being made available between 2016 and 2021.

This year's funding will put money into the hands of headteachers to provide additional targeted support to help children and young people overcome barriers to achievement related to poverty.

We will extend funding for the Scottish Attainment Challenge at current levels for a further year into 2021-22. This gives vital clarity to schools and local authorities that this support will continue.

Regional Improvement Collaboratives have been set up to cover every local authority in Scotland. Over the past year, with our additional £5 million investment, the number of teachers involved has increased and a number of regional interventions have been designed which are improving attainment, supporting curriculum development and helping headteachers and others improve their leadership skills.

This year, we will take steps to identify the support required for a wider range of education practitioners such as school librarians and college lecturers.

Attainment improves when parents are involved in their children's learning. This year, the Scottish Attainment Challenge and Pupil Equity Funding have allowed schools and local authorities to increase the number of home-school link workers, resulting in improved attendance and behaviour, earlier resolution of issues, improved contact and engagement of parents and communities. This gives parents greater confidence and ability to get involved in their child's education. We will continue this work, providing schools and local authorities with an additional package of guidance and support by the end of this year.

Attainment at all levels has increased since 2009‑10 and the vast majority of headteachers report improvement in closing the poverty related gap in attainment or wellbeing. A further evaluation report on the impact of the funding will be published in spring 2020.

Additional support for learning

We need to make sure that our school system is tailored to every child, providing them with the support they need to reach their full potential.

This year, we have published guidance for local authorities on how to collect data about additional support for learning, helping us and local government to know what support is needed and where. Guidance on a presumption in favour of mainstream education was published to ensure the inclusion of children and young people who need additional support.

Based on research from Queen Margaret University, we have increased the capacity of professionals to provide additional support in the classroom through an online module for school staff and held an event to improve teachers' career pathways.

We will invest an additional £15 million in the coming year to improve the experiences of children who need additional support and their families. Working in partnership with local government, we will use this funding to secure additional frontline staff in this academic year.

Empowering schools

We have worked closely with leaders from across the education sector to empower schools, teachers and parents to make decisions about how best to run their schools for their pupils, removing the need for, and avoiding the delays associated with, taking a legislative route.

The Headteachers' Charter was published this year and we have provided draft guidance for school leaders on how headteachers can best use resources to make their own decisions about staffing, budgets, improvements and the curriculum in their schools.

Further support for headteachers will be made available this year, including a range of new and existing opportunities to enhance professional development and leadership skills.

To ensure teaching continues to be seen as a valuable career for young people and career changers, this year we will begin to deliver the recommendations of the Independent Panel on Career Pathways for Teachers.

We will also establish a Teacher Innovation Fund, providing opportunities for innovative teachers to apply for funding to help them access professional development. This will help to enhance the attractiveness of teaching as a career. Over the coming year, we will work with professional associations, local government and teaching unions to develop detailed criteria for the Fund.

Schools are further empowered when parents are involved and we have worked this year to improve the information available to parents. Information on the expansion of early learning and childcare has been made available so parents know what they are entitled to, and how to access the provision, and we have launched a parental involvement and engagement census so we can know which approaches to involving parents work best.

We will consult on amended statutory guidance for local authorities on how to ensure parents are involved in the lives of schools this autumn, publishing a final version by summer next year.

We have listened to the views of young people, setting up the Scottish Learner Panel last year. The Panel has already provided us with advice on inclusion and wellbeing, curriculum and learning and young people's participation in school life. The Panel will continue its work this year, making sure young people are a key part of shaping the future of our schools.

Healthier school meals

We are making changes that will improve our school food, help tackle childhood obesity and give our children the best start in life. We will be the first part of the UK to set maximum limits for consumption of red processed meat over the course of the school week, part of our new initiative to make school food healthier. By autumn next year, we will:

• increase the amount of fruit and vegetables served
• reduce the amount of sugar available throughout the school day
• encourage the use of fresh, local and sustainable produce

More than 360,000 school meals are served each day and, with these changes, we can make a significant impact on children's health, reduce inequality and help to protect our environment.

STEM (Science, Technology, Engineering and Maths)

Scotland is the only part of the UK where annual funding of up to £3 million helps science centres and festivals to support STEM learning, inspiring our next generation of scientists and making science accessible for around one million people every year.

Our work on the STEM education and training strategy continues, making sure that we have the skills to take advantage of the economic opportunities offered in this sector.

We have delivered 107 bursaries, with investment of over £2 million, to help people change careers and begin to teach STEM subjects. Colleges are leading the development of 13 regional STEM hubs to join up schools and colleges with universities, science centres and employers. Intakes for STEM secondary teacher training courses has increased.

Education Scotland is working with schools to tackle unconscious bias and gender stereotyping which leads to a gender imbalance in STEM. The Scottish Funding Council, in collaboration with colleges and other partners, is also working to tackle gender imbalances and reduce gender gaps in college courses. Skills Development Scotland is working with employers and training providers to address under representation in the workplace.

This year, we will:

• provide more bursaries for career changers to train as STEM teachers and provide £2 million of grants to support ongoing STEM professional learning in schools, early learning and community learning settings
• introduce new STEM Awards for early learning and childcare providers and schools to inspire and reward excellence in STEM and work with 80 early learning and community learning centres and schools to trial a new Young STEM leaders award to support young people to inspire each other to get involved in STEM
• launch our 2019 Women Returners Programme that will support women to re-enter the workplace following a career break across a variety of industrial sectors where women are under-represented, including the STEM sector

Learning for Sustainability

Learning for Sustainability is a cross-curricular approach to learning which allows young people to explore sustainability across a number of subjects.

It helps to develop a love of the natural world and a sense of environmental stewardship. It can provide the skills to tackle climate change by learning about greenhouse gases in the sciences, assessing impact on the natural landscape in geography, calculating carbon emissions in maths and monitoring climate change over time in history.

Learning for Sustainability can also influence changes in schools, prompting sustainable approaches to waste management, catering, travel, energy usage, design and build.

Our newly-published Action Plan strengthens references to Learning for Sustainability within curriculum guidance and the General Teaching Council for Scotland's Professional Standards.

Education Scotland will continue to develop a repository of advice, guidance and practice examples, helping to ensure that educators are confident in covering Learning for Sustainability and all learners receive their entitlement to this vital area of education.

We also continue to fund the Eco-Schools Scotland Programme which, in 25 years, has engaged with over 64,000 teachers and 843,000 young people and seen over 4,800 Green Flags awarded.

We will fund an expansion to Keep Scotland Beautiful' s Climate Ready Classrooms Programme which will see over 4,800 14‑17 year olds accredited as carbon literate between 2019 and 2021. This work will not only reaffirm the importance of Learning for Sustainability but crucially help to ensure efforts to address the global climate emergency continue for generations to come.

Learning in the community

Youth work has a significant impact on the life chances of Scotland's young people. In the coming year, we will develop and launch a new National Youth Work Strategy with young people and youth workers.

We will work with the newly-formed Adult Learning Strategic Forum for Scotland to develop an Adult Learning Strategy. The involvement of learners themselves and a range of community partners, such as universities, colleges, third sector organisations and local government, will help us develop the new strategy and it will launch in the coming year.

Supporting pupils' next steps

We are committed to ensuring young people have the right advice and support to choose the career path that is right for them. To do that, we will continue to implement the recommendations of the Learner Journey Review. This year, our work includes:

• publishing a vision for our post-15 education system, rooted in the experience of learners, which shows the diversity of pathways through post-15 education and encourages all parts of the system to consider how best to support those different journeys
• delivering a national communications strategy to explain and promote the breadth of choices in the 15-24 learner journey

We will also build on the progress of the Developing the Young Workforce (DYW) programme, having delivered its headline target to reduce youth unemployment by 40% by 2021 – four years early. We will continue our work to establish effective partnerships between employers and education and maintain our commitment to the DYW employer-led regional groups.

Scotland's colleges enrolled over 300,000 students and employed nearly 11,000 full-time equivalent staff in 2017-18. Since 2007, we have invested over £810 million in new campuses and buildings, such as City of Glasgow College and Ayrshire College.

Work is ongoing across our colleges to improve the quality of the education offered to communities. This is guided by new quality improvement arrangements and refreshed professional standards. This is allowing colleges to target improvements for learners where they are most needed and work will continue this year to embed the approach across the college estate.

In response to Audit Scotland's report, we will work with the Scottish Funding Council to develop a medium-term estate strategy for the college sector. The strategy will help set priorities for investment, improve the student experience and support better outcomes, as well as setting out how the college estate will contribute to efforts to tackle climate change. We will publish our plans in summer next year.

It is our ambition that a child born today in one of Scotland's most deprived communities will, by the time he or she leaves school, have the same chance of entering university as a child born in one of our least deprived communities.

Our work on widening access has been ongoing since 2016. We introduced the bursary for care-experienced students in 2017 and made it equivalent to the real Living Wage in 2018.

The latest figures show our universities are becoming more accessible to students from deprived areas, with a greater number of these students entering higher education. By 2030, students from the 20% most deprived backgrounds should represent 20% of entrants to higher education.

Part of helping people to enter and remain in further and higher education is the support provided to them. The bursary for care-experienced students is now £8,100 per year, as recommended by the independent Review of Student Support, and Scottish universities will offer guaranteed places to students who, at any point in their lives, have been in care and meet the minimum access requirements for the course.

This academic year will see increased bursary support for eligible students in both further and higher education and the higher education bursary threshold has increased from £19,000 to £21,000, meaning more students are able to access the highest level of support. The maximum repayment period for student loans has been reduced from 35 years to 30 years and, from April 2021, the repayment threshold will rise to £25,000.

The support we provide is not only financial. We are working with key partners to develop an integrated approach to student wellbeing in higher and further education, from day one of a student's studies to the day they graduate or receive their qualification. Alongside the actions colleges and universities themselves can take, we are working to support improved local partnerships between colleges and universities, NHS Scotland, Health and Social Care Partnerships, local authorities and the third sector, to support student's mental health needs.

This complements our work to provide more than 80 counsellors in further and higher education over the next four years. Funding for this will be available in this academic year, allowing the recruitment of appropriately qualified and registered counsellors to begin.

Scotland's universities and research institutes conduct world-leading research, making science and research one of Scotland's key strengths. This year we are investing £285 million in supporting university research and knowledge exchange.

We want Scottish businesses and public services to reap the benefits of this investment, so we are continuing to support the translation of research into inclusive economic growth in our national and regional economies. We also want colleges to continue to engage closely with businesses to make sure that the skills they need are available.

Over the coming year, we will respond to the recommendations of two independent reports on how our universities and colleges could further improve their engagement with businesses – from supporting collaboration between universities, colleges and businesses, to improving business performance through innovation and upskilling and reskilling the workforce.

Scottish colleges and universities have strong international links and a growing network of alumni all over the world. We will develop an Alumni Action Plan to harness the power of alumni to promote Scotland as a destination of choice for study and business and strengthen our global economic connections.

Culture, heritage and creativity

Culture is central to our wellbeing and our social, economic and environmental prosperity and we are working hard to make sure that everyone now and in the future is able to benefit from the cultural and creative experiences Scotland has to offer. We will continue our commitment to ensure free access to Scotland's national museums and galleries.

Our strong investment in Scotland's culture and heritage infrastructure supports new and enriching experiences. Last year, the new V&A Museum of Design opened, heralding an exciting new chapter for Dundee and for the future of design and innovation in Scotland.

Culture should be central to regeneration and this year we will proudly support the Paisley Museum project and its aims to develop a world-class museum at the heart of Paisley's town centre. The museum will continue to build on the momentum from the V&A Museum in Dundee by profiling Paisley's own unique design story, central to Scotland's society, culture and economy.

This year, we continue to fund the redevelopment of the David Livingston Centre in Blantyre, the Burrell Collection in Glasgow and the new Great Tapestry of Scotland Visitor Centre in Galashiels, making art, history and heritage available across the country.

We will shortly publish a Culture Strategy for Scotland, following our national culture conversation and consultation, which received over 200 thoughtful responses. The strategy will highlight the intrinsic value and reach of culture and its transformational potential to contribute to individual, community and national wellbeing and prosperity.

Our libraries

Libraries do not just provide access to books – they play an essential role in our communities, improving attainment, supporting children and families in the early years, supporting digital inclusion and helping to tackle social isolation and loneliness.

Working with local authorities and the Scottish Library and Information Council, we will continue to support libraries through the Public Library Improvement Fund and working to make sure every child in Scotland is an active library member.

Major events and festivals

Sports, festivals and other events offer a chance for everyone in Scotland to participate in cultural activities, as well as giving us a chance to showcase ourselves to the world.

We will hold more world-class sporting events this year, welcoming the Solheim Cup, the biggest event in women's golf and one of the most prestigious in women's sport, to Gleneagles later this month.

In December, the European Short Course Swimming Championships will come to Glasgow and in June 2020 we will host a number of UEFA European Football Championship matches.

Hosting these events will enhance Scotland's reputation as a destination for major international events, promote Hampden as a leading venue and provide more opportunity for people in Scotland to experience world-class sport. We will introduce legislation to support the successful running of the Euro 2020 matches in Glasgow by prohibiting ticket touting and protecting commercial interests.

In the past year, we have won bids to host future editions of the Sprint World Orienteering Championships and the European Indoor Climbing Championships. The Island Games will be held in Orkney in 2023.

In 2023, we will host the inaugural Cycling World Championships, combining the world championships of 13 cycling disciplines and holding them concurrently in venues across Scotland. Welcoming another innovative event to Scotland confirms our position as a world leader in hosting bold new events. The World Championships will also be used as a catalyst to drive behavioural change in Scotland. It will provide a platform for wider benefits, such as those associated with active travel, healthier lifestyles and activity-based tourism. Our longer-term vision is that Scotland will truly become a Cycling Nation.

Scotland's festivals enhance our reputation as a welcoming, inclusive and creative country and contribute greatly to our culture, tourism and economy.

Since 2008 we have invested £25 million in the Scottish Government EXPO Fund to support our renowned Edinburgh festivals and we have expanded it to include Celtic Connections and Glasgow International. EXPO will continue to support leading projects which promote Scotland's creativity.

We will continue to fund Scotland's Winter Festivals. This includes our National Events programme which aims to engage up to 275,000 people at around 15 events across the country to celebrate St Andrew's Day, Hogmanay and Burns' Night.

In particular, we will build upon the success of the multi-cultural celebration of Scotland's Winter Festivals and the first edition of St Andrew's Fair Saturday in 2018, drawing upon our unique and diverse cultural heritage to showcase Scotland's values of fairness, kindness, inclusivity and internationalism on the world stage.

Last year's celebrations involved 26 cities and towns across 17 local authorities in Scotland, generating £38,682 to support 56 social causes. People from all over Scotland and the world experienced our vibrant culture.

This year's ambitious programme, to be held on 30 November, will show the value of cultural events beyond economic impact, boosting social inclusion, fairness and community engagement and showcase our collective values of fairness, inclusion and diversity.

Our national events strategy, Scotland: The Perfect Stage, launched in 2015 and runs until 2025. Now at the mid-point, this year we will review the strategy to ensure it continues to reflect our ambitions and priorities for Scotland's position on the global events stage.

This year, we will invest £150,000 as part of the International Creative Ambition Programme to strengthen Scotland's cultural links around the world. Supporting young artists to perform at major cultural gatherings will help them to build international connections, sharing cultural experiences, knowledge, skills and experiences to shape our understanding of the world.

Our National Performing Companies are the pride of Scotland and we will continue to support their significant contribution both at home and internationally as they showcase their talents on the world stage.

The Youth Music Initiative will continue its excellent work in supporting young musicians and ensure that our young people have the opportunity to experience music tuition by the time they leave primary school.

The creative economy

As well as being critical to wellbeing, culture plays an important part in our economy with creative industries employing around 77,000 people in Scotland.

Our screen sector is particularly vibrant. Public service broadcasters are increasing their presence in Scotland, with the new BBC Scotland channel and Channel 4's plans to open a creative hub in Glasgow by the end of this year.

Screen Scotland leads the growth of the screen sector through funding and support for film and television production, specialist staff and investment in skills, festivals, audiences and education.

Since Screen Scotland launched last summer, £4.9 million has been allocated to projects through the new Broadcast Content Fund, helping Scottish companies to grow and reach their ambitions in this sector. Over the past year, Screen Scotland has increased funding to a total of £2 million a year to attract inward investment to bring major productions to Scotland and we continue to work together to stimulate conditions for studio and infrastructure growth across Scotland. We will continue our work to support the creative industries.

Celebrating our heritage

We will continue to support and invest in the Gaelic and Scots languages, recognising them as an important part of our heritage and promoting the learning, speaking and use of these languages.

MG ALBA continues to produce high quality Gaelic programmes, working with a range of independent producers, making important contributions in media, arts, training, international co-productions, Gaelic learning and strengthening the economy in areas of low population.

Increased attendance at Fèisean, Royal National Mòd and Ceòlas show our work to increase the profile of Gaelic at home and abroad is successful.

As part of our support for the Scots language, the Scottish Government will ensure its Scots language policy and Action Plan is revised and relaunched this year. We have also worked with Creative Scotland on the forthcoming Scots Awards and Scots Language conference to mark the UNESCO year of indigenous languages in 2019.

We want to see more young people speaking and using Gaelic and our support for Gaelic extends to promoting the growth of Gaelic education at all levels. Funding will be maintained this year to continue our support to local authorities to provide delivery of Gaelic medium education from nursery provision to adult learning.

We are working with Bòrd na Gàidhlig to update their early years strategy to make sure that our expansion of early learning and childcare provision also supports parents who would like their children to learn in the medium of Gaelic.

There is growing demand from parents for Gaelic medium education and we are working with local authorities across Scotland on new Gaelic schools or units. The Govan Annex in Glasgow opened last month and work begins shortly on the Darroch Annex in Edinburgh, due to open in August next year.

As well as investing in physical Gaelic medium education infrastructure, we are also developing and expanding e-Sgoil which is now operating in 21 local authorities and supporting schools with the delivery of 25 subjects including Gaelic subjects.

Our historic environment

2020 marks the 700th anniversary of the 'signing' of the 1320 Declaration of Arbroath, considered by many as the first steps towards democracy as we know it today. With the support of the Scottish Government, National Records of Scotland and National Museum of Scotland are partnering to enable this rarely seen but iconic document to be on public display in Edinburgh from 27 March to 26 April 2020. Historic Environment Scotland (HES) are also planning activities to mark the anniversary alongside the Arbroath 2020 festival, a six month long programme of related cultural and creative activity, launching in April 2020.

Our historic environment tells the story of our past and helps to shape our future. Last year, heritage tourism at HES sites contributed £620 million to Scotland's economy – HES welcomed over 5 million visitors to historic sites and supported more than 128,000 free education visits.

As well as helping more people to access sites, HES has now made more than half-a-million archival items available online, widening access to our history and heritage.

In 2018-19, HES invested £14.5 million in grants and launched the Historic Skills Investment Plan in partnership with Skills Development Scotland to address skills challenges and opportunities in the sector.

Its traditional skills programme is encouraging a greater understanding of traditional building materials and skills and it has increased the number of apprentices developing the skills needed to conserve and manage the historic environment into the future.

This year, HES will:

• implement an updated Climate Change and Environmental Action Plan to protect our historic properties
• work with Community Planning Partnerships to promote the role of the historic environment in place-making activities
• increase the contribution historic properties make to their local economies
• use the historic environment to support education and learning, ensuring that it is accessible to a diverse audience

Cultural and historical environment bodies, including HES, National Records of Scotland and National Library of Scotland, are also increasingly making archival material available on line and widening access to our history and heritage, with millions of items now accessible from anywhere around the world.

Funding our public services

These investments in our public services would not be possible without our approach to taxation. We have taken an approach to make tax fairer and more progressive to raise the additional revenue we need to protect our public services, tackle the effects of UK Government austerity and safeguard those on lower incomes.

Our approach to income tax means that the majority of people in Scotland pay less tax than elsewhere in the UK and those who can afford it pay proportionately more. Our reforms to residential Land and Building Transaction Tax (LBTT) mean that more than 80% of taxpayers have paid less tax compared to Stamp Duty Land Tax or no tax at all and our LBTT first-time buyer relief has helped over 10,000 buyers in the past year.

Our non-residential LBTT has the most competitive rates and bands in the UK for all commercial transactions, ensuring that Scotland is an attractive location for those wishing to buy or lease business premises.

We have introduced legislation to improve our non-domestic rates system to help businesses grow, encourage long-term investment and reflect changing marketplaces.

Our Non-Domestic Rates Bill sets out the move to a three-year valuation cycle as well as how we will ensure a level playing field by reforming a number of reliefs and tackling known avoidance measures. We will also devolve empty property relief to local authorities in time for the next revaluation in April 2022.

We supported amendments to the Transport Bill at stage two which will provide local authorities with the discretionary power to apply a workplace parking levy. As well as helping local authorities to address local transport needs, it is a tool that could be used to help achieve our ambitions to tackle climate change.

We will shortly begin a consultation on the principles of a locally-determined transient visitor levy, prior to introducing legislation next year. This will give local authorities the power to choose to apply a levy if appropriate for their local circumstances, providing a means of responding to some of the local pressures tourism may bring whilst also allowing local tourism offers to be enhanced.

We will also continue to hold talks with other parties to identify a replacement for Council Tax that could be supported by the Scottish Parliament. Should cross-party agreement be reached, we will prepare the necessary legislation to implement the reforms agreed before the end of the next Parliament.

We are taking a path for tax that works for Scotland. Had we followed UK Government's approach to income tax, analysis shows we would have £500 million less to spend this year on improving the quality of life of people across Scotland.

Investing in our workforce

Essential to making sure our public services are fit-for-purpose and deliver for the people of Scotland is a strong workforce.

This year, we continued our commitment to implement a progressive pay policy across public bodies where Scottish Ministers' pay policy applies. Multi-year pay awards have also been agreed, providing added certainty for many of the 470,000 people in our wider public sector workforces, including police officers, those working in our NHS, local government and those teaching in our schools and colleges.

This continuing recognition of the important contribution of our hard-working public sector employees also maintains our commitment to the real Living Wage, helps to reduce overall income inequality and provides a direct boost to household incomes.

This year we will continue to focus on ensuring our public sector pay policy strengthens public services, supports our public sector workforce and is affordable. We will announce our detailed plans later this year in the context of the Scottish Budget.

Working across the public sector

Our commitment to improving the lives of people across Scotland is rooted in the quality and strength of our partnerships and relationships with all those who shape and deliver, high quality public services.

Over the coming year, we will build on our collective achievements and reinforce the critical partnerships between national and local government, the third sector and the many public sector bodies that all have a part to play in improving the wellbeing of our people and communities.

These partnerships are crucial as we continue our work to:

• improve health and deliver better social care
• build inclusive, empowered and resilient communities
• improve skills and educational outcomes
• deliver Fair Work
• tackle poverty
• transform local democracy and accountability
• continue to prepare for the risks of EU Exit
• take action to respond to the global climate emergency

Open government

Scotland works with over 90 other governments across the world to improve the openness and transparency of what we do and improve citizen participation in our work.

Our second Open Government action plan, co‑created with third-sector organisations and people across Scotland, was published this year. It will run to 2020 and has a broader scope than before, including local government, scrutiny bodies and regulators.

This work will make sure that those driving reform of our public services and those delivering them have the skills, tools and ways of working with people across Scotland so that they can see, understand and influence the decisions that affect them.

We have brought forward legislation to extend coverage of freedom of information to registered social landlords and their subsidiaries from November this year and we are consulting on further extension in autumn 2019.

We have made significant improvements in how we respond to Freedom of Information Requests. Our performance is holding steady, but we are just short of the 95% target and aim to make further improvements this year.

Wellbeing governments

We hosted the Wellbeing Governments Group in Edinburgh this year. Working with Iceland and New Zealand, the other founding members, we will share expertise and transferable policy practice to help us drive improvements in wellbeing through our economic approach.

We will hold further events in the coming year, including hosting an international business-led summit to promote best practice on how business can help us work towards a wellbeing economy through sustainable growth, inclusion and protecting our environment.