Public service reform requires faster progress on digital transformation

One of the principal barriers to reform is the slow pace of digital transformation.

Workstreams such as the Digital Prescribing and Dispensing Pathway and the development of an integrated health and care record have the potential to transform the way services are delivered. However, progress remains too slow to support the scale of reform being sought.

An integrated digital health and care record, accessible to all relevant healthcare professionals and capable of being both read and updated by them, should be regarded as essential national infrastructure. Without interoperability and effective data-sharing across health and social care, much of the ambition contained within public service reform will be extremely difficult to achieve.

Multi-year investment in digital transformation should therefore become a central component of reform rather than a supporting activity.

Workforce reduction is not a reform strategy

The consultation asks whether an average reduction of 0.5 per cent per year in the public sector workforce is achievable.

We believe that framing reform primarily through workforce reduction risks overlooking the growing demand pressures the public sector faces. Public Health Scotland has projected a significant increase in the burden of ill health over the coming decades. In this context, simply reducing workforce numbers cannot be considered a reform strategy in itself.

The objective should instead be to improve productivity and outcomes through redesign.

Pharmacists, pharmacy technicians and wider pharmacy teams illustrate the opportunity available. Educational reforms mean that from August this year all newly registered pharmacists will qualify as prescribers on entry to practice. Combined with the expertise of pharmacy technicians and support staff, this creates opportunities to redesign patient pathways, improve access to care, optimise prescribing and support the introduction of increasingly sophisticated therapies, including personalised medicines.

When pharmacists are fully integrated into multidisciplinary and multi-agency teams, they can assume greater responsibility for prescribing, medicines optimisation, prevention and long-term condition management. This creates capacity elsewhere in the system while improving patient access and outcomes.

Frontline services must be defined more broadly

The Public Service Reform Strategy states that frontline services will be protected, yet there remains insufficient clarity about what constitutes a frontline role.

Within healthcare, pharmacists are often incorrectly viewed through the lens of medicines supply rather than clinical care. In reality, pharmacists working across community pharmacy, primary care, hospitals and specialist settings are frontline clinicians who deliver direct patient care every day.

Equally important are the functions that support safe and effective medicines use, including medicines governance, procurement, dispensing systems and prescribing analysis. These activities are sometimes categorised as back-office functions despite their direct impact on patient safety, quality of care and value for money.

A more sophisticated understanding of frontline services is required if reform is to avoid unintended consequences.

Prevention must be at the heart of reform

If public service reform is to succeed, it must be judged not simply on efficiencies achieved but on outcomes delivered.

For health and social care, those outcomes should include:

• Better patient outcomes
• Reduced health inequalities
• Improved access to care
• Safer use of medicines
• More integrated, person-centred services
• Reduced reliance on hospital-based care
• Improved workforce satisfaction and retention

The experience of Pharmacy First demonstrates the value of preventative investment. More than one-third of Scotland’s population uses the service each year through community pharmacies, providing early intervention and treatment for common clinical conditions closer to home. This approach reduces pressure on other parts of the NHS while improving accessibility for patients. Reform efforts should place greater emphasis on value-based services, supported by meaningful public involvement and strong government leadership. In a context of increasing demand and constrained resources, there is a need to prioritise activities that demonstrably improve outcomes and deliver value, enabling resources to be focused where they can have the greatest impact. The programme of work under Value Based Health & Care: Realistic Medicine is on example of this approach.

A broader vision for reform

Ultimately, Scotland’s reform agenda should be driven not by the pursuit of short-term efficiencies alone, but by a long-term vision of high-quality, integrated, preventative public services.

Pharmacists are among the most accessible healthcare professionals in the country and are increasingly qualified to provide advanced clinical care and prescribing services. Yet the system continues to underutilise their capabilities.

Real reform requires service redesign, workforce transformation and modern digital infrastructure. It requires breaking down professional and organisational boundaries. It requires a shift from treating illness to preventing it.

Most importantly, it requires meaningful engagement with those delivering services on the ground from the outset of the reform process.
We therefore encourage the Scottish Government, the Public Service Reform Committee and all stakeholders with an interest in public service reform to broaden the conversation beyond the current consultation framework and to actively consider how the full contribution of pharmacy and other underutilised professions can help deliver the sustainable, high-quality public services that Scotland needs.

Yours sincerely,

Catriona Sinclair FRCPharm
Chair, Scottish Pharmacy Advisory Council