Source: Scottish National Party
Thank you for joining me here this morning.
This is a room full of leaders, of decision makers, of people with a critical contribution to make to the future of Scottish society.
Your contribution, and your leadership are essential if the agenda I set out today is to become our nation’s reality.
The world is changing around us, at a pace and with an unpredictability that can leave us feeling anxious and unanchored, overwhelmed by the scale and complexity of the multiple challenges we face.
We all know from speaking to our friends and neighbours, our colleagues and families, that hope is a commodity in short supply.
Dark clouds dominate. There are many uncertainties. Which is why there is now – more than ever before – a need to set out a clear path forward.
Despite the anxieties, I remain convinced that we have in Scotland all that we need to successfully navigate this changing world.
But have no doubt, this changing world requires also a fundamental change in how we operate. The status quo – across almost every field of endeavour – is no longer sufficient, it no longer serves us well enough.
Public services first built in and for the 20th century must become rooted instead in the realities of the 21st. Our public realm reshaped; our nation renewed and reborn for this new age.
The Scotland I seek is modern and dynamic; it is an enterprising, compassionate, forward-looking nation that is well-placed to ride the waves of change rather than being buffeted by them, rather than being overwhelmed by them. A Scotland where tomorrow is better than today because, together, we have made it so.
It means public services too that are modern, accessible, flexible, responsive and seamless. Services capable of responding to life’s crises as well as to lives everyday. Services that are robust and creative in response to all the challenges – fiscal, climate, demographic – that are coming our way.
Today, therefore, I wish to do three things.
First, set out the central importance of technology as we renew Scotland’s public realm.
Second, highlight the various necessary elements of the roadmap as we move from where we are to where we need to be.
This is not about reinventing the wheel. We are not starting from a blank page. In the principles identified by the Christie Commission, and in our experience of this past decade and more – hard lessons learnt as a result of austerity, the Covid pandemic and its aftermath, inflation and energy shocks – we know what we need to do.
And third, and because the time for a step change in our approach is now, I will seek to engage you as active partners in this process of national renewal and rebirth.
Public sector, private sector, third sector. National, regional, local. The challenges are many, yes, but the opportunities are more. Working together, let’s be resolute in our belief that we’ve got the necessary knowledge and capacity to transform Scotland’s fortunes.
The task before us is difficult, but entirely achievable.
The challenges are complex, but the tools at our disposal are increasingly sophisticated.
I see firsthand, from my visits to all parts of the country, shining examples of partnership, innovation and success and I know that the first steps on the journey to better have already been taken.
Quite simply, I believe in Scotland and in our collective abilities.
Like you, I care deeply about this nation of ours. I see clearly her potential – the potential to be more modern in our approach and outlook.
But let me be clear, we are not going to be able to make the money we have available for public services match the demand for those services unless we ramp up our use of technology.
That requires a near complete digital refit of our public realm.
Above all, systems that are designed to serve the public first. In the NHS, making it easier to manage appointments, making it simpler to access test results, and providing new digital access points to tools designed to support us in healthier living.
Progress has been made – for example, I think of efforts around digital dermatology – but it is not extensive enough or rapid enough and that must intensify.
Scotland’s public sector should have a digital doorway that matches the very best in the commercial world.
That ambition will drive our actions ahead.
Also fundamental, are systems that make collaboration between public bodies easier. Systems that speak to each other instead of requiring clumsy work arounds. Systems that facilitate collaboration and joined up working rather than blocking them. We have been talking about this for too long, it is now time to make it happen.
And, of ever-increasing importance, technologies that enable ever more personalised public services.
I think of the work being done to deliver more targeted public health. That means linking technology, including AI, to local contexts, enabling more effective prediction of risk as well as earlier diagnosis. Technology, including cutting-edge use of genetics, to target interventions more effectively. It means ensuring we have targeted interventions too in communities that need extra support.
Professor Anna Dominiczak, our Chief Scientist for health, tells me that we have a generational opportunity to put Scotland at the forefront of deployment of precision medicine – an approach to healthcare that tailor’s medical treatment to the individual characteristics of each patient. It means a move away from a one-size-fits-all model, helping us ensure the right treatment at the right time for each patient.
Over this coming decade, taking a more precise and personalised approach to medicine can, and I believe will, revolutionise healthcare. It means bringing together AI, data analysis, genetics and wearable devices. It will be the cornerstone of a more personalised, efficient and cost-effective NHS moving forward. It is at the heart of my vision for more person-centred health services.
The foundations for this new approach are already in place, but it is now time to up the pace.
That is why I have asked my Ministers Richard Lochhead and Ivan McKee, to take the lead as we make this vision a reality, so that we can bring the transformational technologies of tomorrow, many of which are being developed right here in Scotland, into day-to-day use in Scotland’s NHS.
Technology deployed in a way that empowers individuals and communities, that enables our public sector to integrate better, makes it more efficient, and most important of all, facilitates the essential shift to a front-foot focus on prevention as the best means of saving the public purse in the long term.
Those of you with a keen ear and a long memory will recognise those four elements – empowerment, integration, efficiency and prevention – as the four principles of the Christie Commission.
It was 15 years ago, when I was Cabinet Secretary for Finance in the first SNP administration, that I asked the late Dr Campbell Christie to lead a Commission on the Future Delivery of Public Services.
We launched the commission because we could see even then, in the immediate aftermath of the financial crisis and with the advent of austerity, and with climate and demographic challenges already to the fore, the necessity of moving to a more outcomes focused approach.
The Christie approach has delivered key successes.
The creation of a single Scottish Police service has led to over £200m in savings over legacy arrangements, while crime has continued to fall to near record low levels.
Working at City Region level has enabled co-ordinated investment in economic development, transport and growth.
And the partnership between local and central government that delivered the rapid expansion of early learning and childcare for all 3- and 4-year-olds and many 2-year-olds – a £1 billion a year investment in giving younger Scots the best possible start in life – offers an example of early intervention at its very best. We are already seeing the fruits of this choice, this investment, and will undoubtedly see more in the decades to come.
However, the needs of this age mean we have to intensify our efforts to make the progress we require.
That is because the headwinds have been strong. The global pandemic put unprecedented and prolonged strain on our public services. The challenges have become greater.
Brexit and a shift in immigration policy has made it more difficult to recruit the public sector staff that we need.
The post-Ukraine invasion inflation spike means that our money buys less than it used to.
Our aging population is already resulting in greater demands on public services.
The sum total of this is an environment in which, despite increased investment, and the valiant efforts of dedicated public sector staff, our public services strain at the seams.
As austerity squeezed budgets and Covid increased demand, we – quite understandably – prioritised those most in need.
This focus on the urgent consigned others to frustratingly long waits.
Too often, it reinforced silos, as limited budgets were gripped ever more tightly.
The result, a short-term win – it balances a budget – but it leaves long-term pressures to make services sustainable.
Because those we do not support today are in greater need tomorrow.
And when we address that greater need, we do so at the expense of the next person. And when their need grows, we address it at the expense of the next person. On and on.
Across the public sector, we are effectively balancing this year’s budget just to chart a course to balance in next year’s. And the same story the year after, and again, on and on.
It is all a vicious cycle. It is unsustainable. And I intend to sort it.
That requires, right now, a clear, collective commitment to the paradigm shift in public service delivery that we started with Christie in 2011.
I have given them in shorthand already, but here are the Christie principles in full:
- Reform must aim to empower individuals and communities receiving public services by involving them in the design and delivery of the services they use.
- Public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve.
- We must prioritise expenditure on public services which prevent negative outcomes from arising.
- And our whole system of public services – public, third and private sectors – must become more efficient by reducing duplication and sharing services wherever possible.
Each of these principles is connected, each informs and shapes the other, each is essential if our project of renewal is to deliver the change that people quite rightly expect.
A new way of working and thinking is demanded from my government.
That shift is already underway with a sharpening of focus in the Programme for Government, with clear priorities then shaping also the decisions we make in the budget process.
It is why we are reforming the National Performance Framework so that it enables the sort of cross-cutting, outcomes focused decisions that we need, while also reshaping the delivery structures within government.
It requires a change also in the way we work with you and the way you work with each other.
We must stop thinking only of our silos and the services we provide. We must look at the whole person and the whole system.
Fundamentally, we must shift our approach to one that focuses on value – the amount of impact we achieve for our investment.
And that value must be the greatest overall value – not to an individual service. It must be the greatest overall value to the person and to the wider system.
Some of this can be done by making better use of the services we have.
By better and earlier identification of who needs help.
By making access easier and services more coordinated and seamless – tailored to people’s needs rather than to the system’s.
And that is why I began today by focusing on the central role of technology in the delivery of our aims.
But technology, while necessary, is on its own not enough.
Equally, if we are to find value on the scale we need, marginal improvements in efficiency or effectiveness will not be sufficient.
Quite simply, we cannot continue waiting until people have suffered, until the damage is done, and the problem has already cost us much to remedy, to at last do something about it.
We must treat prevention and early intervention, not as luxuries we cannot afford, but as essentials our services can’t do without.
Of course, when it comes to prevention and early intervention, most people think of health. And for good reason; health, given its scope and scale, and its budget dominance, is a key arena for this.
Eighty percent of what affects our health happens outside a health and care setting. It happens in homes and schools, in workplaces and green spaces. It happens in communities.
So when we think of our health, we can’t think only of treatment and services. We will never be successful only thinking of 20% of the things that make a difference.
That is why, tomorrow, in partnership with COSLA, we take an important step towards supporting the other 80%: We publish Scotland’s 10-year Population Health Framework.
This Framework will set into motion system-wide action designed to increase life expectancy and reduce health inequalities across the Scottish population.
Just as much, it seeks to set into motion a cultural shift moving beyond the medical model of treatment in favour of a community-wide approach to improving and sustaining the population’s health and wellbeing.
But this move to prevention and maximising value is not only about our approach to health. We must radically rethink how we design, develop and deliver all our public services.
Fundamentally, we must stop thinking in terms of expenditure and start thinking in terms of investment.
We invest in preventative services today because we know we will benefit from them tomorrow. And so will the people we are investing in.
They will benefit when they stay out of poverty.
When they stay out of the criminal justice system.
When they go further in school.
When their air is cleaner, and their spaces are greener.
And when they live longer, healthier, wealthier and happier lives.
Scotland has form with this kind of investment in prevention. We have been doing it for many years from high profile initiatives like the smoking ban or minimum unit pricing to the significant anti-poverty interventions like the Scottish Child Payment.
And, let’s be very clear about this: prevention is not some vague policy speak only relevant to rooms full of professionals such as this.
Prevention is the hard-nosed financial principle behind the decisions we have taken on the Winter Fuel Payment.
When the UK Labour Government decided to take the payment off millions of pensioners, I was appalled. Most people were.
I was appalled at the immorality.
But I was also appalled at the financial shortsightedness it represented.
The Winter Fuel Payment kept some of the most vulnerable in society warm in winter.
It was always the right thing to do but it was also the smart thing to do.
Smart because it kept people out of hospital, in their own home. It kept them warm and well.
And then it was gone. To be quite blunt about it, I don’t believe cutting this winter lifeline was ever going to save a penny.
Because making millions of pensioners poorer makes them also colder and makes them also sicker.
And that in turn puts up the bill for our social services and our NHS.
It is an almost textbook definition of a false economy.
Keeping the Winter Fuel Payment looks after our pensioners, but it also looks after our NHS.
That is the sharp financial reality of the prevention principle in action. It is one of the reasons we were so quick to step in to protect pensioners in Scotland as best we could from Labour’s wrong decision.
And now they have seen the error of their ways, my government will once again do right by Scotland’s pensioners.
I am very happy to confirm that no pensioner in Scotland will receive less than they would under the new UK scheme.
Details will be set out in due course but my Government, the Scottish Government, will always seek what is best for Scotland’s pensioners.
That is one particularly prominent example of the prevention principle in action, but it happens also in ways big and small across Scotland today.
To take one example, Glasgow Health and Social Care Partnership decided to invest in holistic, intensive family support for looked after and accommodated children in the care system.
It meant early crisis intervention when needed, but also a more compassionate and child-centred approach – the result, the number of children in formal care has more than halved between 2016 and today.
At the same time, savings of nearly £30 million have been achieved, as well as £70 million in cost avoidance.
Imagine the possibilities if we make gains like these across the public sector: significantly improved outcomes delivering also significantly reduced costs.
I am aware of the challenges. People have developed specialisms. There is attachment to ways of doing things developed through years of training, dedication and hard work.
Sacrifice is often required and that is asking a lot of people, especially if there is no clear vision of what better means.
Structures designed for the world we have known make it almost impossible to bring together data or budgets for the new world that is emerging. Our ways of understanding need don’t match with what we measure or how we fund.
Existing systems of accountability and governance are no longer fit for purpose.
These are real problems, absolutely, and up to now they have hamstrung change. But no more. These barriers must be navigated, and any blockages removed.
Once again, I include national government in this. I am talking as much to my Ministers and officials as I am to you.
I offer you this guarantee. I have made it clear within government that we must be enablers of change.
That includes a willingness to change the way we manage budgets and move money around the system.
To change how and where we make decisions, how we empower and hold our leaders and staff accountable.
As First Minister, have no doubt, I will provide leadership to drive this forward. And my government will provide coordination, share learning so that change can happen at pace. And if you see a blockage that we are creating, a barrier that we are building. If our actions don’t match our words, you must let me know.
On Thursday, and as an important next step in this work, we will publish Scotland’s Public Service Reform strategy – a new approach developed with the input of the councils, public bodies, third sector organisations and business who attended our Public Service Reform Summit earlier this year.
It will update Christie for this new decade and set out a vision and a plan to renew Scotland’s public services sector – a path towards greater focus on value and sustainability, on shifting care away from acute crisis response towards seamless community support, prevention and early intervention.
Our Medium Term Financial Strategy, which we will publish next week, will define an approach to managing the public finances that will align with and enable this work.
Strategies are necessary but never on their own enough. Getting delivery right on the ground is way more important than getting the words right on a page.
That is why next week I will also bring together a delivery-focused group of senior leaders across local government, the health service, the third sector and the wider public sector, to drive forward our approach to Whole Family Support.
As the name implies, Whole Family Support looks at the whole person and the whole family. It proactively offers tailored support where they need it, regardless of what that support might look like.
No one is pushed from pillar to post. It does not require numerous referrals, repeated forms or questions. Support and care reach the family as one, big public service.
No one – and no need – falls through the cracks because there aren’t any. Instead, families work with someone who knows their names, their children’s names, their struggles and their strengths.
This means issues are addressed as quickly and effectively as possible, in the way that is just right for that particular family.
And that quick, effective care reduces the need for more costly interventions down the line.
In this way, Whole Family Support makes the most of our collective assets and expertise.
It trusts people, communities and frontline workers to know what is needed, and it aligns our shared resources and processes behind that.
It is Christie put into practice as we commit ourselves on this path of renewal.
I want you to leave today with a clear sense of my ambition and my commitment to this national project of renewal.
I want you to feel enthused, but more importantly empowered. This will only happen if we, if you, make it happen.
People often tell me that they feel as though they do not have permission to deliver the change in their organisation that they know is needed. Well today, let’s give each other that permission.
This is a moment for change. All around us we hear the demand for better. But the solution is not to rip things up or pull things down, but to build on the strong foundations that we are blessed with.
It is a time when we can come together and choose to renew our nation.
It is a time when we can make Scotland the modern, dynamic, forward-looking nation we know it can be.