National outcomes and public health priorities

Someone said to me the other day that they were surprised the new public health priorities didn’t match the recently published refreshed National Outcomes.

I must admit to being a bit surprised, not least since earlier this year when asked about this at the Scottish Parliament Health and Sport Committee I had said I thought the then emerging but still draft priorities were very well aligned with the National Outcomes.

Since then I’ve had another look. Clearly these were two different exercises and for two different albeit related purposes. So what’s the difference and what’s the link?

Introduced in 2007 and refreshed most recently in 2018, the National Performance Framework (NPF) sets out in the Purpose and the National Outcomes a a vision for national wellbeing in Scotland across a range of economic, social and environmental factors. The NPF is a single framework to which all public services in Scotland are aligned. This latest refresh incorporates the UN Sustainable Development Goals.

The First Minister at its launch said “This new national performance framework includes 11 key outcomes that the whole of Scotland can get behind and has been developed in collaboration with other parties and all aspects of society, including public and private sectors, voluntary organisations, businesses and communities.”

We can see that this is a whole country approach to setting out a vision for a successful, thriving Scotland.

The expectation across all sectors is that organisations pay due attention to their contribution to achieving these national outcomes. And we see across a range of our national activities from employment and enterprise to justice and the environment; from early years and child care to manufacturing and regeneration, from education and learning to housing and sustainability, all of them developing their own sector outcomes and priorities aligned to the national outcomes. So for public health it’s important that we demonstrate the way in which our priorities contribute to our national outcomes.

In 2012, when NHS Health Scotland developed its five year strategy, A Fairer Healthier Scotland, we did just that. We looked at the national outcomes and set out our strategic priorities for improving the public’s health. That not only gave us real clarity in setting our objectives but helped us in our engagement with the other key players in public health right across public services and notably with local government and the third sector because they recognised the contribution to reducing inequalities and delivering Scotland’s National Outcomes.

The 2016 Health and Social Care Delivery Plan had three public health commitments, the first of which was to agree a new set of national public health priorities. This was to reflect the commitment to a whole system approach to public health with Public Health Scotland supporting a strengthened local public health delivery system. The launch of the new national public health priorities in June of this year recognised that “These public health priorities represent an important milestone. They represent agreement between the Scottish Government and Local Government about the importance of focusing our efforts to improve the health of the population. The priorities connect strongly to, and will help accelerate, our wider work and include local strategic planning and partnership activity; the refreshed National Performance Framework and related National Outcomes….”

And if we are to ensure these priorities really do contribute to the National Outcomes it will require us to address some of the other conclusions from the Review of Public Health published in 2016. We will need a strengthened public health leadership with a powerful and influential voice and a more systematic approach to developing our workforce. We will have addressed the fragmented nature of our national public health functions by bringing them together into Public Health Scotland and developed a stronger more effective relationship between our national and local public health systems.

Of course, as ever, the proof of the pudding will indeed be in the eating. The test will be whether these National Outcomes and our public health priorities really make a difference to population health in Scotland. To do that we need to engage actively with individuals, families and communities to deliver real improvements, especially for those who need them most. And that is why at the heart of our public health ambitions there must be an unerring focus and commitment to deliver these outcomes and priorities in a way that reduces inequalities in Scotland.