Strengthen prevention and lifelong support (2026 Manifesto)

Strengthen prevention

• Ensure policy intent on prevention is implemented.
• Protect and increase investment in the Community Links Worker approach.
• Commit to maintaining the Self Management Fund and the innovative projects it supports.

The need for greater investment in preventing health inequalities is widely recognised, particularly as healthy life expectancy falls and Scotland’s population continues to age. However, progress on delivering that investment has been slow. Whilst there will always be a need for acute, emergency services, preventing people from needing these in the first place is better for their own wellbeing as well as more cost effective. Crucially, preventative approaches must go beyond primary prevention of incidence. Secondary and tertiary prevention through early intervention and ongoing management is essential to ensure that people with long term conditions are not forgotten.

A significant shift is needed to ensure that welcome policy intent on prevention is implemented, taking a whole system and cross-sector collaborative approach. A wide range of preventative work is being successfully delivered by the third sector across primary, secondary and tertiary levels, but this is not always recognised and requires sustainable, sufficient resources to continue. Furthermore, prevention is complex and cannot be achieved by the public sector alone. The next Scottish Government must ensure that the policy intent on prevention is implemented through sufficient financial investment and implementation plans, including in the third sector, and commitment to fully involve people, communities and the third sector in equal decision making.

One highly successful secondary prevention initiative is the provision of Community Links Workers (CLWs), particularly in Deep End GP practices. Through a social prescribing approach CLWs help to address the wider determinants of health and reduce pressure on GPs, who may be a natural point of contact but are not necessarily equipped to help. However, despite the proven success of this approach, funding can be unacceptably insecure and has repeatedly come under threat. The next Scottish Government must commit to protecting existing Community Link Worker provision, and to increase investment to ensure long term stability and wider availability.

Many successful examples of third sector tertiary preventative approaches are also seen through the Self Management Fund, which the ALLIANCE has administered on behalf of the Scottish Government since 2009. The fund has distributed money to hundreds of projects that reduce barriers to accessing health and social care services and enhance people’s ability to self manage. Through supported self management people can improve their quality of life, prevent or slow progression and improve management of flareups. The next Scottish Government must commit to continued provision of the Self Management Fund, supporting future rounds of innovative self management projects.

Deliver effective and lifetime support for long term conditions

• Ensure that any overarching framework complements rather than replaces condition-specific action.
• Invest in greater support for people with long term conditions.
• Develop a supportive approach to health and work.

The most recent Scottish Health Survey estimated that 39% of adults in Scotland live with a limiting long term condition. This proportion is expected to continue rising due to the overall ageing of the Scottish population. Everyone has the human right to health, and it is vital that people with long term conditions can fully realise this right. It is therefore essential to ensure there is timely, accessible, effective support to live with and manage long term conditions. Quality support can also help more people to thrive and remain at work or volunteering.

As the current Scottish Government develops a broad-based Long Term Conditions Framework, it is important to get the balance right. Not all conditions are, or can be, covered by a dedicated plan and experiences such as pain and fatigue are widely shared, so there are some benefits in a cross-cutting approach. However, existing condition-specific work has led to demonstrable improvements in people’s experiences and outcomes which is important to maintain. The next Scottish Government must ensure that any overarching Long Term Conditions Framework complements rather than fully replaces condition-specific plans and actions which work successfully.

The success of a new Long Term Conditions Framework will rely in part on the level of investment in support for people with long term conditions. Primary and secondary care pathways need to be improved, with wider access to community support for accompanying issues like mental health and chronic pain, as well as supported self management and peer support networks. The next Scottish Government must provide sufficient invest in support for people with long term conditions, including via nationally administered grant funding for effective third sector services.

Disabled people and people with long term conditions should not face unnecessary barriers to work. Without adequate understanding and support, however, people who would otherwise prefer to keep working may be forced to stop. In addition, where employers fail to make adequate adjustments for their workforce, otherwise manageable conditions can be exacerbated, leading to more working days lost to ill health. The next Scottish Government must ensure that their Fair Work agenda incorporates support for disabled people and people with long term conditions to participate equally in the workforce, with clear guidance for and obligations on employers.

A reenergised approach to mental health

• Develop rights based mental health and incapacity law by implementing the recommendations of the Scottish Mental Health Law Review.
• Invest in mental health services, including renewed funding for the Communities Mental Health and Wellbeing Fund.
• Roll out the Living Well: Emotional Support Matters approach to support the mental health and wellbeing of people with long term conditions and the third sector organisations that work for and with them.

Awareness of the need to support everyone’s mental health has never been greater, but the gap between rhetoric and action remains significant. Scotland’s legislative mental health and incapacity framework is not fit for purpose, fails to fully respect human rights, and requires urgent modernisation. Despite increased demand for services, investment in mental health as a proportion of frontline NHS expenditure has hardly changed over this term of parliament, meaning the current target of 10% of frontline NHS expenditure may be missed.

In 2022 the Scottish Mental Health Law Review published their final report, setting out a wide range of recommendations for a human rights based approach to mental health. This included strengthening supported decision making, reducing coercion, and improved interactions with the criminal justice system. The next Scottish Government must implement the recommendations of the Scottish Mental Health Law Review, and progress work to amend the Adults with Incapacity Act, to develop a human rights based legal framework that is fit for the future. It must also act on the earlier recommendations of the Rome Review by removing autism and learning disability from the definition of “mental disorder.”

The clear need for greater investment in mental health services is recognised via the existing expenditure target. However, even if achieved, that target should not be seen as an endpoint, nor should expenditure be limited to frontline NHS services. Investment through the Communities Mental Health and Wellbeing Fund has supported a variety of community mental health initiatives, including third sector services. The next Scottish Government must deliver investment in frontline mental health support beyond the existing 10% target, whilst supporting community and third sector services including through renewing funding for the Communities Mental Health and Wellbeing Fund.

In partnership with the Mental Health Foundation, the ALLIANCE delivered the “Living Well: Emotional Support Matters” programme. This supported third sector long term condition organisations to embed mental health across their work in response to the Covid-19 related rise in mental ill-health. Evaluation was highly positive, finding increased capacity, skills and confidence; emerging organisational culture change; and improvements in mental health and wellbeing. The programme generated £3.7 million in health and wellbeing impacts, a funding to impact ratio of £1:£8.60, whilst generating an estimated £0.2 million in cost savings. The next Scottish Government must commit to supporting a wider roll out of the proven Living Well: Emotional Support Matters approach as part of their investment in mental health support.