Investing in our National Health Service and tackling health inequalities

A photograph of the technology company Amiqus executive team

Key points:

  • Significant investment in our health services and workforce
  • Tackling health inequalities
  • Mental Health Strategy
  • Tackling Adult Social Care in Scotland

The Health and Sport portfolio is responsible for over £13 billion of resource spend annually, and we have continued our record investment in our NHS as part of the commitment to increase health funding by at least £2 billion over the lifetime of this Parliament. This spend includes significant investment in research and development, digital infrastructure and capital investment, all of which contribute to provision of apprenticeship opportunities, high quality employment and applications of new technology.

Delivery of high quality and timely healthcare is essential, and ensures that our workers are able to remain economically active through improving health and reducing health inequalities. We are taking significant steps to close health and economic inequalities, and we are exploring financial and regulatory measures which have a universal and preventative effect in tackling the burden of disease. Achieving the current target of 4% sickness absence would generate an additional 500,000 working days annually.

We are working to attract and retain talent from a diverse range of backgrounds. We believe our NHS would be better in every way, if our workforce is fully reflective of our communities. This employment is spread across the whole country, helping to sustain rural economies and generating local employment.

Investment in pay across the workforce is a key lever to attract and retain the skills required to deliver a sustainable service. This investment means that over 15% of the workforce are higher rate tax payers. We have awarded 147,000 NHS staff earning under £80,000 a minimum pay rise of 9% over the next three years and we will proceed with the implementation of a new contract for GPs.

It is important to harness the opportunities available to Scotland through investment in new healthcare facilities ensuring they continue to support innovation and research objectives. Scotland’s health and life sector is an important and growing component of the economy, creating highly skilled roles and new employment opportunities. New investment needs to ensure that it maximises the likelihood of match funding from the academic and private sector partners, for example, the continued development of the biomedical research park in Edinburgh and proposals for investment in digital health and analytics centres in Dundee and Glasgow.

Investment in healthcare infrastructure is also an opportunity for the NHS to take a leadership role in working with partners to maximise the leverage of all public sector investments in a place. This includes the repurposing or release of public sector land and assets for more beneficial economic or community activities, planning how the combined portfolio of partner assets can be reconfigured to better respond to community needs and aspirations, and the development of more accessible and shared facilities for better social and economic outcomes.

We will also deliver our new Parental Employability Support programmes to provide intensive support to low income parents through to 2022, backed by an investment of £12m. We will provide a £4m boost to our Parental Employability programmes (including Parental Employability Support Fund) to improve local connection between employability services and the expansion of funded early learning and childcare. This reduces childcare as a barrier to training, employment and career progression, as well as helping to support disabled parents to get quality jobs and stay in work. It will also help towards reducing the gender pay gap.

In addition to this we have developed our efforts in Neurological Care and Support in Scotland introducing a Framework for Action which was published late 2019. At least 10% of the Scottish population are estimated to be considered disabled as result of neuro conditions. We anticipate that an indirect outcome from this work maybe more people are able to continue in employment or take up employment as a result of the care and support they can access for their condition.

Along with See Me’s targeted work programme, NHS Health Scotland works with employers and employees to provide appropriate training to support workplace mental health and wellbeing through its Work Positive and Healthy Working Lives Programmes and in partnership with public and private sector employers, is developing a framework of key standards that will demonstrate how employers are supporting fair and healthy workplaces.

Evidence indicates that where people have the tools to manage their own health – including being supported to do so, through social prescribing – then their wellbeing may be improved. Training in first aid approaches for mental health should be as common as training in physical health first aid. There needs to be a strategic shift towards recovery models focused on assets, strengths and self- management; this is important to the design and provision of all services that have the potential to improve mental health and wellbeing – not only health services.

We will seek to use the reach and impact of sport – particularly football – to inspire people of all ages to stay active.

Being physically active is one of the very best things we can do for our physical and mental health, benefiting the economy by helping us to live healthy working lives, as well as by reducing pressure on healthcare services. Sport and physical activity help to prevent heart disease, strokes, diabetes, and a number of cancers; they plays an important part in helping us maintain a healthy weight; and reduce the risk of developing depression.

The Active Scotland Outcomes Framework sets out our ambitions for a more active Scotland which is underpinned by a commitment to equality. sportscotland’s new strategy, “Sport for Life”, operationalises this ambition by encouraging communities to come together and engage positively through sport. The Scottish Government continues to invest heavily in sport and has increased the sportscotland budget to £32.65 million for 2019-20.

Adult social care in Scotland is facing significant challenges. These include rising demand and increasingly complex care needs. Our Programme for Government recognises that social care support is a key investment in Scotland’s people, society and economy. For thousands of people across Scotland, social care support is vital for being able to live independently and participate in the community. For many, that means being able to access volunteering, education and employment opportunities on the same basis as everyone else. Social services are also a significant employer in Scotland. They provide over 200,000 jobs, which is almost 8% of Scotland’s total workforce.

Adult social care alone is estimated to contribute £3.4 billion in terms of Gross Value Added (GVA) to the Scottish economy (this includes direct, indirect and induced impact).1

In addition to the paid social care workforce, there are an estimated 700,000 to 800,000 people in Scotland doing unpaid care. Around 29,000 of these are under the age of 18. There are more people caring full time for relatives or friends than staff working in either social care or the NHS. Unpaid carers make a huge contribution to the people they care for, their communities and to Scotland. It is estimated that unpaid care in Scotland is estimated to be worth £10.8 billion a year – roughly equivalent of the cost of a second NHS.

Around 270,000 people in Scotland combine work and unpaid care. This represents around 1 in 8 of the workforce. Balancing unpaid care with employment can be a tricky juggling act. 59% of carers are women and women are more likely to be carers than men throughout the working years. With gender stereotypes surrounding caring, women feel more pressured to undertake caring roles. The impact of women reducing hours, not taking or applying for promotions, or leaving the labour market altogether in order to provide unpaid care, contributes towards Scotland’s gender pay gap.

In 2019/20, we have increased our investment in social care support and integration of health and social care to more than £700 million. This is an increase of 29% – up from £550 million in 2018/19.

This includes investment in carer support under the Carers Act, which has established a system of carers’ rights designed to listen to carers; improve consistency of support; and prevent problems – helping sustain caring relationships and protect carers’ health and wellbeing.

In recognition of the challenges in social care, but also of the innovative work that is being taken forward already across Scotland to start to address them, we are working with COSLA, people who use social care support, carers, and the social services sector to take forward a national programme to support local reform of adult social care. This is focused on supporting best practice across all of Scotland and systems that are sustainable and demonstrate quality support focused on people and their personal outcomes.

The priorities of the reform programme include:

  • social care support that 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;
  • a sustainable future for care homes;
  • equity of experience and expectations across Scotland; and
  • investment in social care support, and looking at how it is paid for in the future.

The workforce is central in taking forward the priorities of the reform programme. We are clear that attracting and retaining the right people, developing them in their roles and raising the status of the sector as a valued workforce is key to delivering this.

We have committed to working 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 are also taking action under the National Health and Social Care Workforce Plan to address recruitment and retention issues and improve workforce planning in the sector. This includes a national campaign to promote recruitment to the sector which will launch early in 2020.

Supporting carers to stay in or enter work brings vital benefits to carers, employers and the economy. We are working to raise awareness amongst employers of issues facing staff who balance work and caring. We are funding and promoting the Carer Positive accreditation scheme to recognise those employers who put in place flexible and supportive working practices for people juggling work with unpaid care. There are now over 416,000 people across Scotland working for Carer Positive accredited organisations committed to helping their staff who are juggling work and caring.

Scotland is also one of only two countries in the UK (Northern Ireland being the other) that has maintained a specific national fund to support independent living for people with complex disabilities. The £47.2 million Independent Living Fund (ILF) supports over 2000 disabled people with high support needs in Scotland to live in their communities and lead independent lives. This can readily include support in employment, education, relationships both personal and social, and in achieving as active a life as other citizens would generally experience.

We recently also opened a Transition Fund which provides an additional £5 million of support for young disabled people. The aim of the Transition Fund is to support young people with the changes they face after leaving school or children’s social care services, to try new activities and experiences that enhance their independence and confidence, and to continue spending time with other people.

Key resources:

NHS Scotland

Scottish Government: Digital Health Care Strategy

1 The Economic Value of the Adult Social Care sector – Scotland (Final report), June 2018. Accessed at The Economic Value of the Adult Social Care sector - Scotland on 21 November 2019.