New Report - Prevention Under Pressure
In 2025, Scottish Government published three major strategies for health, social care and public service reform: the Population Health Framework 2025-2035; the Public Service Reform Strategy; and the Health and Social Care Service Renewal Framework. The first two highlight prevention and joined up working as key means of improving health and reducing inequality, while the third emphasises the vital role of community-led services in meeting Scotland’s health and social care needs, particularly in terms of prevention.
This framing, of community-led services as central to the achievement of Scotland’s health and social care goals, is welcome recognition of the substantial part that the sector plays in enhancing health and wellbeing in Scotland. However, it comes at a time when services have endured several years of de-funding, as part of wider fiscal austerity measures, as well as being buffeted by successive waves of public sector reforms that have disrupted relationships with public health partners, including Local Authorities, Health and Social Care Partnerships (HSCPs), NHS Health Boards, and Healthcare Improvement Teams (HITs).
The Survey
To explore this issue, a collective of organisations from within the community and voluntary sector decided to launch a survey, to capture experiences of organisations across the sector. They included… . I offered support with research methods, contributing to the collective discussion on how to compile the survey, as well as how to analyse, interpret and present its results.
The aim of the survey was to explore the sector’s relationships with public health partners, how they have changed across 2022-25, and identify ‘key takeaways’ that need to be addressed to meet the Scottish Government’s vision of preventative health. A total of 67 community health organisations across Scotland responded.
The Findings
The survey responses revealed significant systemic challenges in relationships with public health partners, alongside a strong willingness to collaborate and examples of positive practice.
Structural Exclusion: Organisations supporting hundreds or thousands of people annually report never being invited to strategic forums or decision-making discussions. Where involvement exists, it is often described as "tokenistic”. Decisions about service priorities, funding cuts, and referral pathways are being made without input from organisations delivering frontline support, whilst lived experience and community intelligence fails to inform policy development.
Rhetoric vs Reality: Policy frameworks increasingly emphasise prevention and early intervention, yet organisations designed for preventative support are being defunded whilst simultaneously managing increasingly complex, crisis-level cases. Demand has increased significantly compared to pre-pandemic levels, yet funding has declined sharply or disappeared entirely. Organisations are delivering thousands of appointments, supporting statutory referrals without statutory resources, and operating on precarious short-term grants, yet are expected to provide consistent long-term support.
Deteriorating Relationships: 54% of respondents report worsening relationships with public health partners over the past three years. High staff turnover means relationships must be rebuilt repeatedly. There has been a shift from genuine partnership to transactional relationships. 69% of respondents believe public health partners do not understand the capacity and resources available to CHOs, with the third sector viewed as "amateurs" or "froth" that can be easily cut.
Inappropriate referral pathways: Risk is being transferred from statutory services to community organisations through inappropriate referrals. Organisations designed for mild-to-moderate preventative work are receiving people with severe mental health conditions, including suicidal tendencies, which are beyond their remit and capacity to manage safely. Information sharing has been inadequate, affecting organisations' ability to conduct proper risk assessments and compromising safety.
Limited Joint Working: 49% of respondents do not believe they work co-productively with public health partners. Multiple organisations reported "zero" joint service delivery. Previous joint programmes have ended due to funding cuts despite clear demand, suggesting partnership rhetoric at policy level has not translated into operational practice.
The Path Forward: Despite these challenges, 87% of respondents expressed desire to develop improved relationships. Health Improvement Teams were frequently cited as constructive partners. Where time is invested in relationships, where there is mutual understanding, and where CHO expertise is valued, partnerships work effectively. The challenge is making these positive examples the norm rather than the exception. This requires honest conversation and genuine commitment from all sectors to create communities supported by an integrated, collaborative system that values all its partners.
What Next?
The positive examples offered by respondents to the survey demonstrate that good partnerships are possible. Where time is invested in relationships, where there is mutual understanding, where funding provides stability, and where community health organisation’s expertise is valued, partnerships can work effectively.
The challenge is making these positive examples the norm rather than the exception. Clear, meaningful and collaborative action is evidently needed to shift the dial and recognise the role of the sector as an equal partner in delivering prevention.
Following the survey, the group organised a workshop for community health organisations, to discuss the implications of the survey findings and ways forward. Attendees articulated a vision of genuine partnership that could benefit communities, statutory services, and most importantly, the people who need support. But they also felt that the path forward required honest conversation and a genuine commitment from all sectors, to create communities supported by an integrated, collaborative system that values all its partners.
The findings of both the survey and workshop demonstrate not only the urgency of reform, but also the significant opportunity to build stronger, more preventative and community-led public health systems across Scotland.
A report that outlines the detailed findings of both the survey and the workshop can be found here