While Scottish Government is responsible for the strategic direction of the NHS, territorial Health Boards are responsible for delivering services in their areas, and providing appropriate community spaces for midwives and allied health professionals.

Community-based maternity services should have access to appropriate accommodation to provide face to face appointments. ‘The Best Start: a Five Year forward Plan for maternity and neonatal care’ outlines the expectation that Boards provide routine care and maternity services through Community Hubs.

We are also supporting development of primary care multi-disciplinary teams (MDT), including allied health professionals, with investment of £190 million in 2023-24 through the Primary Care Improvement Fund.

Integrated Authorities must work closely with local communities and other stakeholders to ensure that Primary Care Improvement Plans address specific local challenges and population need.

While making significant progress in these reforms, we recognise that implementation gaps remain, including around accommodation barriers.

We are now also introducing an additional ‘phased investment programme’ working with a small number of areas to demonstrate what a model MDT can look like in practice. The findings from this programme will build understanding of the national context for further implementation and inform future long-term Scottish Government investment.

A Flow Navigation Centre has been established in every mainland Health Board as part of the Redesign of Urgent Care Programme. They provide expert clinical advice, referrals to alternative services and, when necessary, schedule appointments at A&E. They play a key role in ensuring patients receive the ‘Right Care, in the Right Place’ by diverting patients to more appropriate pathways of care and reducing unplanned attendances to A&E departments.

The RUC Programme was introduced during the Covid-19 pandemic (December 2020), impacting on the comparability of statistics. However, in the 12 months to October 2023, A&E attendances where down by more than 11 percentage points compared to 2019 levels. Whilst we do not have comprehensive data available, we understand through discussions with Health Boards that the reduction in attendance is in part due to Flow Navigation Centre’s.

In order to realise the full potential of Flow Navigation Centres, the Centre for Sustainable Delivery (CfSD) have established a Flow Navigation Specialty Delivery Group to drive the development and delivery of high quality Flow Navigation services across Scotland. The group brings together key stakeholders to establish the optimal Flow Navigation Model and reduce unwarranted variation. Developing and capturing the relevant data to measure the impact of this work and to understand and evidence outcomes is part of the SDG workplan which is being taken forward over the next year.

The Scottish Government has commissioned the Centre for Sustainable Delivery (CfSD) to improve Community Urgent Care (CUC) pathways as part of the wider Urgent and Unscheduled Care Programme. In addition to validated nationally collected data from Public Health Scotland, an Unscheduled Care Improvement Dashboard is in creation which will consist of ‘data for improvement’ collected manually by each Health Board Area, which supports tracking of locally held data to reflect the impact of improvement activity, creating visibility of progress.

Work is also underway through an external partner to evaluate the Redesign of Urgent Care pathway through NHS 24 111 service which launched in 2020 and provides access to local Flow Navigation Centres and virtual A&E teams.This evaluation will assess impact on a range of measures, including patient and staff experience and assess what other outcomes are impacted by the service.

• The Scottish Government has commissioned the Centre for Sustainable Delivery (CfSD) to improve Community Urgent Care (CUC) pathways as part of the wider Urgent and Unscheduled Care Programme.
• In addition to validated nationally collected data from Public Health Scotland, an Unscheduled Care Improvement Dashboard is in creation which will consist of ‘data for improvement’ collected manually by each Health Board Area, which supports tracking of locally held data to reflect the impact of improvement activity, creating visibility of progress.
• Work is also underway through an external partner to evaluate the Redesign of Urgent Care pathway through NHS 24 111 service which launched in 2020 and provides access to local Flow Navigation Centres and virtual A&E teams. This evaluation will assess impact on a range of measures, including patient and staff experience and assess what other outcomes are impacted by the service.

Scottish Government officials met with NHS Scotland Board Chief Executives on 12 December where they discussed agency nurse staffing as one of their priority actions. This follows detailed engagement with Boards regarding the arrangements currently in place for contracting agency staffing, the outputs of which are being used to inform targeted improvement activity in this area.

The current route to becoming a midwife is to attain a degree in midwifery, however there is a shortened programme available to existing adult nurses who can dual-qualify in 20 months via Edinburgh Napier University. Higher Education Institutions (HEIs) are autonomous bodies responsible for the attraction and recruitment of their own students. Each institution has their own advertising and recruitment strategy which will include visiting schools, attending careers fairs and promoting the range of opportunities via their social media channels. HEIs also recruit to their Nursing and Midwifery Council approved programmes against their own entry requirements and will encourage and support prospective students in how to achieve the required standards.

Additionally, the attraction and retention of people into nursing and midwifery is a key part of the remit of the Nursing and Midwifery Taskforce. This work is ongoing and the Taskforce will recommend a workplan of actions to support longer-term workforce sustainability within nursing and midwifery next year.

As part of our work to develop a sustainable healthcare workforce, we continue to look for opportunities to increase levels of student attraction to healthcare professions. Careers in NHS Scotland are promoted on the NHS Education Scotland NHS careers website, designed to promote opportunities to school leavers, those in education and those looking to change careers. This site can be accessed at NHSScotland Careers .

The current route to becoming a podiatrist registered with HCPC is to attain a degree in podiatry and, as such, higher education institutions (HEIs) are autonomous bodies responsible for the attraction and recruitment of their own students. Each institution has their own advertising and recruitment strategy which will include visiting schools, attending careers fairs and promoting the range of opportunities via their social media channels. HEIs also recruit to their approved programmes against their own entry requirements and will encourage and support prospective students in how to achieve the required standards.

Additionally, the Allied Health Professions (AHP) Education and Workforce Policy Review examined workforce and education issues and recommendations included promotion of allied health professional careers and aligning strategies to market a career as an allied health professional. An advisory group has been established to oversee the effective implementation of these recommendations.

The Nursing and Midwifery Taskforce, which brings together representatives from a broad range of stakeholders, including the RCN, RCM, and academia, focuses on retention as one of its five key themes. Retention, including the retention of nursing graduates, is currently being assessed with recommended action as indicated by its findings due in the coming year.

Our approach to planning and delivering health and care services needs to change to enable the step-change we need in our services. Our Policy Prospectus and Programme for Government is explicitly clear that reform is required and sets out initial actions we are taking.

Work is already underway to progress reforms to ensure long term sustainability, reduction of health inequalities, deliver services closer to home, further harness the benefits of digital technology, and the improvement of population health outcomes in Scotland. We engage frequently with health boards, the public, health and social care staff and other key stakeholders across a range of issues to develop our thinking.

The Deputy First Minister announced in her statement on the budget on 19th December that the Government will be taking forward a National Conversation on the future of the NHS. The Deputy First Minister set out the principles of public ownership of our NHS and ensuring services are available free at the point of need.

The Cabinet Secretary will set out in more detail in the new year how the Government will progress this work.

This will be a collaborative process across the health and social care system, alongside stakeholder and citizen engagement as a core principle. The Scottish Government will continue to build on engagement already in place with services, clinicians, professionals, service-users and citizens in 2024 to collectively build our long-term planning for health and social care in Scotland.

As this commitment relates to activity currently underway and due to be completed by the end of this financial year, this data will therefore not be available until after the end of the 2023-24 accounting period. Activity will include participants in NHS Get Started and Get Into programmes as well as Achieve educational events.

The NHS Scotland Academy (NHSSA) provides training opportunities across five programme areas: National Workforce Programmes; National Endoscopy Training Programmes (NETP); National Perioperative Training Programmes; National Imaging Training Programmes; NHS Scotland Youth Academy and the NHSSA Skills & Simulation Centre. Within these programme areas, NHSSA facilitates over 30 training courses. More information, including a full list of courses, can be found on the NHSSA website - www.nhsscotlandacademy.co.uk/education-and-training

In the last 12 months, NHSSA has provided additional training opportunities for 5,918 new and existing staff.

The learning modules “Preparing for work in Health and Social Care in Scotland”, designed to support incoming staff, have been completed by 3,941 learners in the last 12 months.

In financial year 2022-23, NHSSA was provided with £3.5m in funding.