Scots identify health and social care “reality gap”, new research shows

New research finds people are ready for honest conversations about how to bridge the “reality gap” of health and social care reform.

Public frustrations over the growing “reality gap” between the ambitions for health and social care and their everyday experiences have been highlighted in a major new deliberative report released today (Thursday, 29 October). 

At a time when health inequalities are widening and the issue of health remains the public’s second highest priority (1), those using essential services say the fragmented, complex NHS and social care system must be reformed.  

And the new research shows the Scottish public is prepared to put hard choices and trade-offs under the microscope to ensure a better system centred around people and prevention. 

Scotland’s health and social care sector’s membership organisation, the Health and Social Care Alliance Scotland (the ALLIANCE) (2), commissioned the research from leading research company, the Diffley Partnership. 

The ALLIANCE wanted to better understand people’s views on health and social care, what matters most to them, and their appetite for change. 

The new deliberative research ‘A real, grown up conversation’ is being launched today (Thursday, 29 October) at an event organised by the ALLIANCE, chaired by Derek Feeley, and attended by the Diffley Partnership, policy makers, people with lived experience, and representatives from public bodies and the third sector. 

The research brought together members of the public over a series of sessions exploring health and social care in Scotland and found that people become increasingly supportive of reform when given time, information and space, even if that meant difficult choices had to be made.  

Participants views started off focussing on personal frustrations, for example, waiting lists and access to services, but over time moved to a deeper understanding of system-change, the need for long term reform, prevention and investment. 

The study also revealed that while discussions often began with concerns over NHS services, that participants increasingly recognised the importance of social care in prevention and the intrinsic link to the NHS. 

The need to bridge the gap between Scotland’s vision for health and social care, and lived experience, was a clear conclusion in the Diffley Partnership’s analysis of the findings.  

The report stated: 

• Participants explicitly asked for cross party agreement and ownership to stop health becoming a “political football”. 

• While there are “multiple strategies and frameworks” for services there remains a “patchwork” system where on the ground experiences are highly localised and inconsistent. 

• A “weak translation of lived experience” and that while person centred care is a policy objective it’s often “absent in practice”, with participants noting most failure in access and continuity of care, and accountability for the quality of care received.  

Professor Derek Feeley, who will chair today’s event, was Chief Executive of the NHS Scotland, and the Scottish Government’s Director General for Health and Social Care.  

Feeley, who also led the independent review of Adult Social Care in Scotland, said lived experience needed to be central to legitimate change. 

“People are often portrayed as resistant to change but this research suggests they are willing to engage with complex questions about the future of health and social care,” he said. 

“The challenge facing Scotland is not deciding whether we need reform or not – but cross-party and system-wide commitment to implementation. We need a clear sense of what we are trying to achieve, the changes required to get there, and how we measure whether those changes are making a difference. 

“People are ready to be part of that journey. Change can’t be done behind closed doors, where the most powerful voices are the only ones heard. It needs to be done in the open, with transparency and with people’s experiences central to bridging the gap between vision and reality.” 

Sara Redmond, Chief Officer, Health and Social Care Alliance Scotland (the ALLIANCE) said:  

“For years we’ve been told that people won’t accept difficult conversations about health and social care reform. This research shows the opposite.  

“When people are trusted with information and involved in decision making, they are thoughtful and considered about the challenges we face and the change that is needed. 

“But they also see the reality gap between the ambitions set out for health and social care, or ways the system is meant to work, that are far from what they or family members experience. 

“Bridging that reality gap means moving from reform that is done to people and instead trusting the public to help create a system that is better, bolder and future-proof.” 

Mark Diffley, Founder and Director of Diffley Partnership, said: 

“What strikes us, from this project, and our other polling and focus groups on this topic, is the Scottish population want to experience tangible improvements and are concerned about the ongoing challenge of health inequalities. They place such importance on health and social care delivery for their present quality of life, and Scotland’s future. 

“Our deliberative research participants welcomed ‘grown-up conversations’ on public sector reform. They are very capable of coming to informed views on choices, trade-offs and prioritisation of spend.” 

The Health and Social Care Alliance Scotland (the ALLIANCE) is the national third sector membership organisation for the health and social care sector, representing over 3,500 members. 

The ALLIANCE wanted to better understand people’s views on health and social care, what matters most to them, and their appetite for change. To do this, the ALLIANCE commissioned Diffley Partnership to deliver a deliberative research project; a method of research that involves engaging participants in meaningful discussion, weighing up evidence, and considering different views. 

Notes to editors:

1. The Health and Social Care Alliance Scotland (the ALLIANCE) is the national third sector membership organisation for the health and social care sector. We bring together over 3,500 people and organisations dedicated to achieving our vision of a Scotland where everyone has a strong voice and enjoys the right to live well, with dignity and respect. Our members are essential in creating a society in which we all can thrive, and we believe that by working together, our voice is stronger.
2. The Diffley Partnership research commission ran from September 2025 – July 2026, with sessions running from November 2025 – March 2026. A panel of 40 residents in Scotland was selected to represent a range of demographic, geographic, and attitudinal factors.
3. Understanding Scotland Report Wave 20

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