This blog will consider three health-related strategy documents in turn: the Operational Improvement Plan (OIP), the Population Health Framework (PHF) and the Health and Social Care Service Renewal Framework (SRF). These were published by the Scottish Government in 2025. They have been declared by the Scottish Government and others as defining documents for the improvement of health and social care services over the next ten years. This blog also provides complementary examples which could be read alongside the SPICe blog on strategies, frameworks and plans: ‘When is a strategy a strategy (or not)? Navigating a complex landscape’ , which too considers definitions and the challenge such documents can present to supporting effective scrutiny.
The main focus of the three documents is prevention, with the aim to reduce demand, particularly unpredictable demand, on acute health services (delivered in hospitals), and to deliver care locally, in communities and at home, such that emergency admission to hospital is reduced. Ultimately, the wider goal is a healthier population, which is less susceptible to non-communicable diseases such as heart disease and type 2 diabetes. SPICe is currently reviewing work by the Scottish Government that is underway to track and measure preventive spend in health and social care.
Prevention
This blog is not discussing preventive spend, but going one step back in looking at how the strategic documents discuss prevention in the context of health (and social care). ‘Prevention’ requires some unpacking as a term, and can mean very different things to different people and to different professionals and services. The description in the paragraph above paints a somewhat negative, NHS-centric description, or a bio-medical approach to dealing with ill-health. A more social model of prevention is possibly harder to define because ‘being well’ is quite subjective and opinions will vary widely on what that means. (see also: Social_model_of_health_and_wellbeing_Systematic_review_Final.pdf). In social work practice, the comparison between the two could be characterised thus:
“The medical model can be seen as deficit-focused, concentrating on limitations and disorders. The social model, alternatively, adopts a strengths-based perspective, recognising the potential and resilience of individuals despite societal challenges.”
(source Social Work News)
There is also the classic, public health definition of the three tiers of prevention of ill health:
Three levels of prevention
source: Public Health Scotland
A more agnostic description is provided by the Scottish Health Equity Research Unit’s (SHERU) Prevention Watch website:
“By prevention, we are referring to public policy interventions that prevent poor outcomes in the future, as opposed to policy which intervenes to mitigate harms once they have already occurred or subsequently deals with the consequences.”
Unfortunately, the NHS and social care services are often conveyed as operating at the ‘secondary’ and ‘tertiary’ levels of prevention: dealing with the consequences of not intervening at a structural, cross-portfolio level, or earlier stage, before the need for treatment or support becomes essential or critical.
Three plans among many
Once you enter the warren of health and social care plans, visions, frameworks, working groups and strategies, it is difficult to know which burrow is the best to follow. However, it has become clear that these three documents are being presented as the driving documents to:
- ‘ensure the sustainability, efficiency, quality, and accessibility of health and social care services’ (SRF),
- ‘improving Scotland’s health and reducing health inequalities for the next decade’ (PHF) and setting out and defining
- ‘the Government’s approach to health and social care renewal’ (OIP)
Operational Improvement Plan (OIP)
The Operational Improvement Plan was the first to be published in March 2025, and is focused on the current and next financial years’ (2025 – 27) actions and operation, following a speech by the First Minister in January 2025 stating that:
(we must) “ensure a more accessible, more person-centred NHS we must reduce the immediate pressures across the NHS, shift the balance of care from acute services to the community, and use digital and technological innovation to improve access to care”.
The OIP overlaps with the NHS Recovery Plan 2021-26 and aligns with the final reporting on that. The most recent, and final, progress report was published in December 2024. The recovery referred to in that particular Plan is the recovery from the COVID-19 pandemic. There is read across from one Plan to the other, in terms of headings, but this is not so obvious in the detail. The OIP does not include the National Mission to tackle drug-related deaths, for example. The NHS Recovery Plan progress report is narrative, so it is hard to correlate any of the data, figures or funding between the two.
The OIP has four main chapters:
- Improving access to treatment
- Shifting the balance of care
- This chapter covers reducing pressure in hospitals by tackling delayed discharges and improving access to primary care services including pharmacy and dentistry.
- Improving access to health and social care services through digital and technological innovation
- The focus here is on the ‘Digital Front Door’ app, to give everyone access to communications about appointments etc. Other technologies are also referred to which are intended to increase efficiency and access.
- Prevention – working with people to prevent illness and more proactively meet their needs
- This is perhaps the most interesting, yet the most muddled of the chapters, and doesn’t sit so well with the others. However, the OIP did precede the publication of the Population Health Framework. While the introduction references the whole of government, public, private voluntary sectors, a long-term approach and primary prevention, the following sections can only be read under the headings of tertiary or, at best, secondary prevention, not primary (structural) prevention approaches and focus required across government portfolios.
Taken overall, the OIP collects together a series of existing initiatives, mostly specific, nested under a set of chapter headings.
The other two reports being considered here were both published on 17 June 2025.
Health and Social care service renewal framework 2025-2035(SRF)
The SRF is badged as a ten-year plan, published jointly by the Scottish Government and COSLA (Convention of Scottish Local Authorities). It has four key chapters:
- Impact of service renewal for people and the workforce
- Service renewal framework
- Enabling shifts required
- Delivering change
There are also five principles for renewal:
“1. Prevention Principle: Prevention across the continuum of care
2. People Principle: Care designed around people rather than the ‘system’ or ‘services’
3. Community Principle: More care in the community rather than a hospital-focused model
4. Population Principle: Population planning, rather than along health board boundaries
5. Digital Principle: Reflecting societal expectations and system needs”
This is a ‘high-level guide for change’, and states that it builds on the OIP and the PHF. It appears to take the detail from the OIP, of existing initiatives, and anticipates that the SRF will sustain and build on any improvements coming from those initiatives. The use in the introduction of words and phrases like ‘will bring’, ‘will be more’, ‘will be available’ suggests a determination of certainty, a willing into reality, for the measures described, which can’t be guaranteed by the existence of the SRF alone.
“The SRF sets out the framework within which our system and service leaders, and staff, alongside the wider population, will plan services for the future, building on what we already know works well…”
…”The Framework also sets out major areas for change, which will deliver on the intentions behind these principles so that they become a reality. These include:
• Enhancing services that prevent disease, enable early detection and effectively manage long-term conditions.
• Delivering health and social care that is people-led and ‘Value Based’.
• Strengthening integration across the system.
• Improving access to services and treatments in the community”
• Redesigning our hospitals as we deliver more care within communities.
• Delivering services which are accessible through digital technologies, with people and our workforce able to access and make use of the right information.”
None of this is new, and is very similar to an overall shift from acute to community based care that this (and other) governments have sought to realise for years if not decades.
This long-standing intention can be seen in Better Health, Better Care, the Action Plan published by the Scottish Government in 2007. What is notable is the disappearance, over the years since its publication, of the primacy of addressing health inequality, and actions which are referred to, but not focused on, in the PHF that will tackle the root causes of poor health. In the SRF, the discussion on prevention circles around healthy weight, mental wellbeing support and managing long-term conditions. These discussions describe mainly secondary prevention approaches.
The body of the SRF cites a number of examples of innovation under the different principles. The Health, Social Care and Sport Committee has frequently heard about such innovation and their success, but has often queried why replication, rolling out and sustainability of these initiatives is so challenging.
That said, the SRF sets out the key steps to delivering change (pp9 – 11), with most detail in the first five years, and the desired outcomes for years 6-10 of the Framework.
Members also often ask in Committee about the existence of baseline data from which progress and success can be measured or observed. There does not appear to be a solid set of baseline data in the OIP or the SRF. The Scottish Government is currently looking at how the data gaps in respect of measuring preventive spend can be addressed.
The impact for people and the workforce is envisaged to mean that care will be more ‘people-led’. The language has shifted from ‘person-centred’ care, and, along with the rhetoric of ‘realistic medicine’, the move is to support people to manage more self-care, and opening up capacity in community and primary health. This is connected to the introduction of digital tools, the ‘digital front door’, allowing people to access relevant information on appointments etc., the reasoning being that more people will be able to manage and monitor their own health and conditions better.
For staff, the suggestion is about autonomy to work more collaboratively and to play a role in developing services in the community (to reduce demand on acute services).
“The Framework will also promote an environment in which health and social care system leaders will be authorised and supported to help create the changes necessary to realise our vision.”
Social Work Scotland responded to the publication, arguing that community care intentions are presented in a way that supports the NHS, rather than that community-based care is a preferable approach to care and prevention in its own right:
“While the ambition to improve the sustainability, efficiency, and quality of Scotland’s health and care system is welcome, the Framework overwhelmingly prioritises the NHS and continues to marginalise the essential contributions of social work and social care.”
Scotland’s Population Health Framework 2025 – 2035 (PHF)
Along with the SRF, the PHF is another joint Scottish Government-COSLA (Convention of Scottish Local Authorities)publication, with a foreword written by the First Minister, John Swinney MSP and the President of COSLA, Councillor Shona Morrison. An Evidence Paper was also published to accompany the PHF.
According to the King’s Fund, population health is an approach to improving the health of an entire population, without increasing health inequalities. It requires attention and application from all policy areas, communities and public bodies.
This is the third of the documents, and it is possible to see how they are interconnected while also having a distinct purpose. The stated aim of the PHF:
“is two-fold – to improve Scottish life expectancy whilst reducing the life expectancy gap between the most deprived 20% of local areas and the national average by 2035. The Framework is based on five key interconnected prevention drivers of health and wellbeing:
• Prevention Focused System
• Social and Economic Factors
• Places and Communities
• Enabling Healthy Living
• Equitable Access to Health and Care
The Framework sets out initial actions across these drivers. It also identifies two initial evidence-based priorities – embedding prevention in our systems and improving healthy weight.”
The PHF uses the King’s Fund Population Health Pillars and Institute of Health Equity’s eight Marmot principles.
So, in this document we do see a focus on a slightly more holistic approach, with acknowledgement of social and economic factors that influence health outcomes, but not the commercial factors that might influence health outcomes. The ‘Initial Actions’ in the Framework, are mostly focused on health policy. However, under a ‘prevention focused system’, we see the aim to address health inequalities across portfolios, and a ‘Health in all policies’ approach.
It will be interesting to follow the implementation of the PHF actions, particularly Priority 1 – ‘embedding prevention in our systems’. It sits oddly beside ‘Improving healthy weight’ (Priority 2) because the demands and challenges of the former are potentially of a much greater magnitude than the actions described in the Framework to address diet.
For Priority 1, the focus will be on the Place Principle and place-based working approaches. But, despite the narrative around underlying determinants and a prevention-focused system, the approach for this priority still has a focus on health and social care budgets and policy.
So, there could be a danger that the broader aim for a prevention-focused system (depending which ‘system’ is being referred to) could be lost in the noise and energy of these initial, health focused priorities. Whether that system is health and social care, or all public services and the economy is not made clear in the PHF.
It reads, in the round as if the some of the drivers of population health have become lost and population health potential has become somewhat conflated with public health priorities. However, with reducing healthy life expectancy, persistent inequalities and an average lower life expectancy in Scotland of two years compared with the rest of the UK, perhaps this is unsurprising.
The Scottish Health Equity Research Unit’s (SHERU) response to the Population Health Framework highlights that it requires further clarification:
“we are calling for the new framework to be accompanied by concrete cross-government actions, clearer implementation plans and a monitoring and evaluation framework.”
Time will tell what impetus this trio of documents will have on preventive actions and approaches, and whether coherent preventive systems emerge across public services. It will also be interesting to see what will happen in the efforts to achieve “reform and renewal” of the NHS and social care sector, in the coming parliamentary session through this work.
Anne Jepson, Senior Researcher, Health and Social Care, SPICe