We need a different approach to the delivery of public services
Some might argue that those words underplay the scale of the deficit. Whatever the truth, it is unarguable that nowhere is the gap between ambition and progress more acutely felt than in relation to health inequalities.
In its 2023 report, Leave No One Behind, the Health Foundation asserted that the persistence of health inequalities in Scotland over the previous decade was related to three underlying factors – the accumulation of severe multiple disadvantage, a stagnation in living standards and, tellingly, the fragility of public services in the wake of austerity.
It is welcome therefore that the Health and Social Care Service Renewal Framework and the Population Health Framework were also published as the recess approached. While the former is concerned with health and social care delivery, the latter recognises that progress on improving health and reducing inequalities requires action beyond those services.
In doing so it echoes Leave No One Behind's focus on the socio-economic determinants of health – income, housing, education, employment. While early health interventions matter, it is prevention which will determine whether Scotland can reverse the tide of worsening health inequalities – among the worst in western Europe – over the next decade.
But in their response to the Population Health Framework, analysts at the Scottish Health Equity Research Unit, funded by the Health Foundation, have questioned how far its specific actions reach beyond health and social care.
While welcoming the framework's focus on prevention, they point out that actions in crucial areas such as housing are more limited. They call for a broader range of cross-government actions, clearer implementation plans and robust monitoring and evaluation.
However, they also recognise that the Public Services Reform Strategy shines a light on the very things which need to happen to ensure intention is met with action – clearer leadership, greater accountability and, critically, budget processes that enable the long overdue shift to preventative spend.
Despite fiscal challenges, funding can and must be reshaped to support a different approach to the delivery of hard-pressed public services. Campbell Christie died just four months after his landmark report was published. For those living in Scotland's most deprived communities, where the gap in healthy life expectancy compared to those in the least deprived reaches 25 years, the changes he called for cannot come a moment too soon.
Chris Creegan is Director of the Health Foundation's Improving Health and Reducing Inequalities in Scotland Programme
Agenda is a column for outside contributors. Contact: agenda@theherald.co.uk
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