Scottish Government: Long Term Conditions Framework Consultation Paper
Movement for Health response - May 2025
1. Do you agree that Scottish Government should move from a condition specific policy approach to one that has a balance of cross-cutting improvement work for long term conditions alongside condition-specific work? Yes/No. Why do you say this?
At Movement for Health, we agree that the Scottish Government should adopt a cross-cutting approach to support those with long-term health conditions. In our view, a coordinated approach to prevention, care, and support that focuses on shared challenges and solutions can deliver more efficient, equitable, and impactful outcomes across multiple conditions, while being mindful of condition-specific nuances.
2. Are there any improvements in prevention, care or support you have seen in a long term condition you have, or provide care and support for, that would benefit people with other long term conditions?
We believe that a cross-cutting approach to prevention, care and support for people living with long-term health conditions should be centred around physical activity in every shape or form it takes. It is already well evidenced that regular movement offers numerous benefits for everyone, and importantly, movement significantly aids the prevention and management of many health conditions. Yet, evidence also shows that those with health conditions are twice as likely to be physically inactive when compared to the rest of the population. This is putting public services under increasing strain across Scotland, as some 47% of the adult population in Scotland are living with at least one long-term health condition. To better illustrate this point, the World Health Organisation estimates that, globally, the cost of physical inactivity to public health care systems between 2020 and 2030 will be about $300 billion, so approximately $27 billion per year, if levels of physical inactivity are not reduced. If the Scottish Government were to reprioritise the importance of physical activity, supported by partnerships, collaboration, and adequate finance, many public health pressures and health inequalities could be alleviated.
This shift towards prevention and the provision of care and support will require a whole systems approach, which Public Health Scotland is already pioneering. In this system, all sectors collaborate to promote movement for everyone within society. The third sector, community and local government organisations, particularly have a key role to play in developing new referral pathways, including social prescribing, and ways to offer appropriate and available support in the individual’s community. Examples of improvements include interventions such as strength and balance classes in hospitals and care settings, social sessions in the leisure sector, third sector, and other community settings, as well as embedding community link workers and social prescribing in a wider range of communities.
3. Do you have any thoughts about how areas for condition-specific work should be selected? This means work which is very specific to a health condition or group of health conditions, rather than across conditions.
Condition-specific support will remain important and should be prioritised based on lived experience and evidence of need, impact, and inequality. Engaging directly with people who live with long-term conditions and organisations that already support them is essential to ensure that condition-specific work addresses the real challenges they face, including gaps in existing support. However, we believe that condition-specific support must complement the cross-cutting approach to long-term health conditions. Specifically, movement and physical activity are beneficial across the whole spectrum of health conditions, although the type and level of support required differ. Condition-specific work should recognise and address these nuances, as well as more complex needs, without redesigning the overall approach. This is also in line with the whole systems approach we raised in our answer to Question 2, with public health challenges being addressed broadly through collective actions and across environments.
4. What would help people with a long term condition find relevant information and services more easily?
In our view, more effective signposting to locally available services is crucial to enable people with long-term health conditions to access the care and support they need. This should include active, personalised conversations with trusted professionals and community connectors who understand what is available locally and can recommend activities that are appropriate for the individual’s needs and abilities. To support this, we believe that conversations about movement should become a routine and integral part of care, with physical activity embedded into all health and social care pathways.
However, this will also require a transfer of services away from NHS Scotland and into the community to enable a more effective signposting and access to services. A key enabler of this transition is social prescribing, which offers people living with long-term health conditions access to a person-centred care and support system which empowers them to manage their health proactively. Social prescribing is a way for local agencies to refer patients to a link worker for support outside of health services to combat social determinants, through community organisations, local support groups and holistic hubs across multiple sessions – of which physical activity can be a key area of focus. This system also moves away from physical activity targets, which are often unmanageable for people with health conditions, and instead recognises that movement looks different for everyone – from walking to gardening, singing or stretching, to sport. Social prescribing also empowers our local communities to address their own specific needs and challenges, giving them greater control over delivering services.
5. What would help people to access care and support for long term conditions more easily?
Further to our answer to Question 4, we believe that the Scottish Government should develop a national framework for social prescribing with national and local leadership structures to enable effective prescription of physical activity. In addition, the role of link workers, who connect people with practical solutions, is currently underutilised and not available in every part of Scotland. There are also financial barriers, which required a long-term, sustained funding.
Embedding social prescribing as a core part of care pathways will require a joined-up approach between the Scottish Government, NHS Scotland, including primary care and allied health professionals, local government and COSLA, the leisure sector, third sector delivery partners, as well as the academia, with existing social prescribing projects and community link workers placed at the frontline. This partnership approach would work to enhance capacity and allow organisations to expand their reach across Scotland, taking the form of funding collaboration, on the ground support, support for staff, and resource sharing.
6. How could the sharing of health information/data between medical professionals be improved?
There is currently no central point for the evaluation of physical activity and social prescribing services, and insufficient evidence is being collected. The questions in the health survey are not framed to engage with the broad range of movement options. We suggest that existing service providers should collect qualitative data and both short-term and long-term analyses, with academic input into evidence and evaluation. This should incorporate particularly longitudinal studies and studies across a variety of contexts, to allow us to track changes in health and wellbeing, service engagement and outcomes, providing insights into the effectiveness, adherence, and potential barriers to ongoing participation. The collected evidence should be fed into the design process for a national framework. However, not many organisations currently have the financial or staffing resources to prioritise these evaluation methods, further emphasising the need for investment in this area, which we raise throughout our response.
7. What services outside of medical care do you think are helpful in managing long term condition(s)? You may wish to comment on how these services prevent condition(s) from getting worse.
Further to our answer to Question 4 and Question 5, we believe that social prescribing and physical activity pathways are often too embedded within the medical community, meaning control by or access through clinical or medical settings, and there is a need to de-medicalise it. Community-led support – including leisure services or provision through the third sector – often offers relational support in familiar environments that reflect local needs and contexts, allowing for earlier, regular, more preventative support. It helps people feel understood, motivated, and connected, which supports more effective management of conditions, reduces isolation, and prevents deterioration.
8. What barriers, if any, do you think people face accessing these (nonmedical) services?
A major barrier is an insufficient public awareness about programmes supporting people living with long-term health conditions. Many excellent programmes already exist, but unless outreach is sufficient enough, the people they are targeting may not be aware of the resources available to them. We believe that a mapping exercise of community services would be particularly helpful for an improved signposting of services. This includes signposting via ALISS (A Local Information System for Scotland). Shared local directories of available services would ensure that primary care professionals and social prescribers could prescribe appropriate activities in their communities. Movement for Health already supports this work by conducting an annual mapping exercise of services across our membership, which could be expanded across the wider third and leisure sectors with appropriate support.
At an individual level, based on our 2023 mapping report, we do not believe that participant costs are a major barrier for those with long-term health conditions to access resources if they wish to. The vast majority of services across our membership are free for participants to use, or less than £15. However, programme providers are not always transparent about these costs and details of their meetings, which necessitates further inquiry and may act as an obstacle to participants. Another barrier is the cost of transportation – we further explore transport poverty in relation to Question 14.
Finally, leisure and community services are subject to long-term, significant budget pressures, with many critical organisations at risk of closures or already shut. In our view, there is a need to invest in these services to support prevention, care and support. Making this investment now, particularly in prevention, will ultimately save money in the long-term. For example, the NHS is currently not giving sufficient financial support for interventions that they refer to in the community. There is therefore a need for a cultural change, as well as a re-examination of where and how money is being spent. Many organisations also struggle to maintain both staff and volunteers due to limited financial cycles. The third sector and leisure sector need sustained, long-term financial support.
9. What should we know about the challenges of managing one or more long term conditions?
Living with a long-term condition means dealing with a wide range of symptoms, from pain to chronic lethargy, reduced mobility, to anxiety and isolation, as well as other emotional, social and practical challenges. These symptoms often fluctuate and overlap, making even small daily tasks feel difficult or unmanageable. One of the most overlooked aspects of managing long-term conditions is the importance of minor movement. We need to meet people where they are and value what can be achieved, not limiting progress by only counting what meets the best-case-scenario physical activity guidelines. Our future approaches instead need to recognise that every action, no matter how small, can have a major impact on someone's physical, mental and social health. For this to work, our communities need encouragement and access to safe, welcoming environments that help them stay active in a way that works for their condition.
It is also vital to recognise the importance of rest, not only as a response to flare-ups but as an important part of self-management and recovery. We need to be mindful of the realities people living with long-term health conditions face, with many needing to prioritise activities which matter to them because they require significant recovery time. Rest is not a sign of failure or inactivity; it is often the key that enables participation, preserves energy, and helps people participate meaningfully in the things they value. Any approaches we take must support people in balancing movement with adequate rest.
10. What would strengthen good communication and relationships between professionals who provide care and support and people with long-term condition(s)?
Good communication and relationships between professionals and people living with long-term conditions are built on trust, continuity, and mutual respect. Due to various pressures and some attitudes in medical settings, interactions tend to be rushed and focused on diagnosis and medical treatment, with a propensity to see little value in non-medicalised models. We believe that instead of a predetermined transfer of information, health and care interactions should offer consistent, person-centred conversations about someone’s needs, preferences, and goals.
With a new national framework in place, including new referral pathways and social prescribing, people living with long-term conditions would be able to access the required care and support with the most appropriate practitioner. While primary care professionals are often times the first point of contact and have a vital role in our communities, not all patients need medical interventions. Health and care professionals should be trained and empowered to initiate person-centred conversations and then connect individuals to a broader network of professionals and community-based services who can offer ongoing, tailored support. This would also alleviate the strain GPs and other primary care professionals are currently under, without placing undue pressure on any single part of the system. Such a shift requires regular training for health and care professionals so that they are supported to understand the value of non-clinical interventions, with a mapping exercise and a local directory required as we raised in our answer to Question 8.
11. What digital tools or resources provide support to people with long-term conditions?
Virtual tools and resources are diverse and allow those with access to the appropriate technology to partake in the movement that is possible for them. Many of these virtual services started during the outset of COVID-19 and have continued, in addition to the increasing availability of online resource such as physical activity guides. While we believe that the continued availability of online tools and resources is helpful for some, in-person programmes are invaluable and often more effective for people with long-term conditions. Many in-person events integrate socialisation components into their activities, which provides the benefits of human connection and routine, personalised guidance. This is why they should also be prioritised.
12. What new digital tools or resources do you think are needed to support people with long-term conditions?
We refer to our answer to Question 11.
13. How do you think long-term conditions can be detected earlier more easily?
It is estimated that some 3,000 preventable deaths in Scotland are directly attributable to inactivity annually. While the importance of prevention is widely recognised, the pathway to practical and systemic change remains unclear, and there is a need for changed behaviours, improved patient pathways and referral systems and a genuine partnership approach to support patients. This includes greater early intervention through education, support in the workplace and for families, as well as changing investment priorities from short-term clinical interventions to longer term investment and funding for the voluntary sector.
14. What barriers do people face making healthy decisions in preventing or slowing the progress of long-term condition(s)?
There is a range of barriers, many of which are shaped by wider social, economic, and environmental factors. Poverty and inequalities, insecure housing, limited access to green spaces, lack of time, and caring responsibilities can all make it more difficult to prioritise health.
For example, transport poverty is a major issue with a big impact on public health and welfare. Transport poverty covers a wide range of factors, including rurality, finance, disability and many more, which could significantly accentuate health inequalities. Everyone should be able to access services locally and there is a need to ensure that walking and wheeling are prioritised, followed by cycling and then public transport, which should be reflected in our health and planning policies.
16. Is there anything currently working well within your community to prevent or slow progression of long term conditions?
Parkinson’s is one of many conditions where being physically active has been found to support management of symptoms and, in some cases, slow the progression of the disease. Movement for Health members, Parkinson’s UK Scotland, share this story of Jo Holland as an example: Exercise drumming for Parkinson's: The beat goes on | Parkinson's UK
15. How can the Scottish Government involve communities in preventing or slowing the progress of long term conditions?
The Scottish Government should embed prevention, self-management, and physical activity into places where people live, work, study, and connect. This means that every sector (i.e., government, healthcare, public works etc.) must have relevant information to create policy and the resources to have infrastructure which accommodates those who need it. Without accounting for this type of intersectionality, society can only be set up to benefit the majority, forgetting the minority who need more assistance and consideration. If this narrative were to be reversed and those with the most need were whom systems and frameworks are designed to support, society as a whole would benefit. Solutions include sustained investment, communication and public education about workplace health and wellbeing, in educational settings as well as in community, leisure and third sector programmes and continuous training across these sectors. Ultimately, this also means shifting decision-making structures and resources into local hands, supporting cross-Scotland and cross-sector collaboration, and creating long-term, sustainable opportunities for people to take control of their health in ways that work for them.
This solution will not be a one-size-fits-all all approach, so it is key to have different voices involved at inception. As such, we urge the Scottish Government to co-design services and policies with people who have lived experience of long-term conditions and organisations which support them. This includes funding participatory approaches, supporting local leadership, and enabling flexibility so that programmes can adapt to what works locally.
17. Are there additional important considerations for people with long term conditions? For example, people who; live in deprived areas and rural and/or island areas, have protected characteristics e.g. race, disability, who are in inclusion health groups e.g. homelessness, or who experience stigma due to perceptions of their long term condition e.g. people with dementia?
Yes, particularly due to low incomes, limited access to services and green spaces, fewer transport options, and reduced availability of inclusive opportunities. These barriers can deepen isolation and make it harder for individuals to manage their health and wellbeing. Our 2023 mapping report particularly highlights that most programmes are located across the Central Belt, specifically, there is a disproportionate unavailability of services in rural and/or island communities. For example, across our membership, the least services are available in Shetland, Orkney, the Western Isles, as well as East Renfrewshire, East Dunbartonshire, South Lanarkshire, and North Ayrshire. Many of our members have a desire to reach out further to these areas, but are unable to do so due to staffing and funding constraints. This is a sentiment often expressed by other organisations beyond our coalition.
At present, there is no overarching strategy or a set of principles to guide policy making to tackle health inequalities in Scotland. We believe that addressing inequalities requires targeted investment and action from the Scottish Government and its delivery partners to reach those most at risk, alongside services that are locally tailored and co-produced with communities. Without this, the cycle of poor health and disadvantage will continue, and the burden of long-term conditions will remain highest where resources and opportunities are lowest.
18. Given that racism and discrimination are key drivers of inequalities, what specific actions are necessary to address racism and discrimination in healthcare?
Further to our answer to Question 17, we agree that there are many vulnerable groups that already experience or are at a particular risk of experiencing health and other inequalities. This includes the needs of older people, as well as people living with complex needs. While we recognise the importance of prioritising certain groups, all communities will benefit from services being made available in their local contexts. However, as we raised previously, this also required a proactive approach to co-designing of services and policies, sustained funding and cross-sectoral collaboration.
19. Is there anything else you would like to raise that was not covered elsewhere in the consultation paper?
We would like to reiterate that, to unlock the value of prevention and a cross-cutting approach to prevention, care and support, it is essential to have adequate, sustained, and long term funding across Scotland. Without this, we cannot realise the full potential of community-based programmes and initiatives such as social prescribing. While this does require a change in investment priorities, much of this could be met through a review of existing budgets and realignment of spending across healthcare, social care, local government, the third sector and community services to better support preventative approaches. At the same time, new funding should be seen not as a cost, but as an investment with a clear return: for example our member Chest Heart & Stroke Scotland has calculated that for every £1 invested in physical activity-related policies, there is the potential for a £14 return. Strategic funding now will reduce long-term pressures on services supporting those who live with long-term health conditions, improve population health, and build more resilient, empowered communities across Scotland.