Reimagining the future of health and care

Reimagining the future of health and care

Scotland’s health and care system is increasingly under strain in the face of multiple crises, in particular climate change, the cost of living, the ongoing impact of COVID-19 and persistent health inequalities. Now is the time to look at how we do things differently. This means not just skirting round the edges but overhauling the way in which we design and deliver health and care across Scotland.

Last year, I was inspired by Hillary Cottam’s session at our ALLIANCE Digital Gathering. She highlighted the need to “pivot” and shift our focus beyond institutions towards homes, communities, and workplaces where we create health and focus on the all-important question “What matters to you?”.[1] She acknowledges that this will mean working differently; leading collaboratively with relationships at the centre.

“The pivot is a special kind of change that involves a new vision, a different solution and a new economic model.  It offers the potential for transformation.”[2]

In line with this, the ALLIANCE’s Health and Social Care Academy engaged with individuals and organisations across the sector to refresh the ‘Five Provocations for the Future of Health and Social Care’. These provocations were developed in 2016 and set out the conditions for realising long, term meaningful and sustainable change. We published the new ‘Five Ambitions for the Future of Health and Care’ in December last year.

The Ambitions provide a starting point towards more equitable and sustainable health and social care where people and wellbeing are front and centre.

  • Be Human- We are all human and should be treated with dignity. Everyone can thrive if our rights are protected, defended, and promoted.
  • Lead Courageously- We can all be leaders in our own lives, communities, and workplaces.
  • Share Power- We make changes in our own lives and communities when power is shared.
  • Reimagine Investment- We can transform society for everyone’s benefit with sustainable investment, patience, partnership and valuing one another.
  • Measure Outcomes- We should measure success in health and care with personal outcomes, not just short-term targets.

Like the Five Provocations they replace they shine a light on successful approaches from Scotland and beyond. There are a set of reflective questions and series of case studies which accompany each of the Ambitions. For example, the community links practitioners case study demonstrates ‘Measure Outcomes’ in action. The case study outlines how community links practitioners work collaboratively with individuals to effectively determine how success is measured, basing success on long-term personal outcomes rather than short-term targets.

The importance of relationships is a key theme that runs throughout the Ambitions and is often the starting place when thinking about the first steps towards change. We hope these Ambitions can be used as a tool to start creative and collaborative conversations about how we can pivot and reimagine our health and care.

In 2024, we hope to use them to inspire others, encourage action, and identify the first steps towards change. We are keen to showcase the Ambitions in action and welcome anyone to share examples of good practice.

To find out more about the Five Ambitions and the work of the Academy please get in touch with us at



[1] The pivot: changing our relationship with the health system | The King’s Fund (

[2] Radical Health – Hilary Cottam

Jane Miller

Academy Programme Manager

Health and Social Care Alliance Scotland