Scotland’s Prevention Push Leaves Community Groups Squeezed

A survey of 67 community health organisations across Scotland has found that 54% report worsening relationships with public health partners over the past three years, even as new Scottish Government strategies cast the same groups as central to national prevention goals.

Dr Lisa Garnham of the University of Strathclyde’s Centre for Health Policy supported the work led by the Scottish Community Development Centre, Scottish Communities for Health and Wellbeing and the ALLIANCE. The findings land after years of funding cuts and repeated public-sector reforms that have left many groups handling more complex cases with fewer resources.

67 Organisations Map the Partnership Breakdown

Respondents support hundreds or thousands of people each year. Many said they are never invited to strategic forums. When they are included, the contact often feels tokenistic. Decisions on priorities, cuts and referral routes are taken without the organisations that deliver the frontline work.

Lived experience and community knowledge rarely shape policy. At the same time, 69% of respondents said public health partners do not understand the capacity and resources available to community health organisations. Some partners still view the third sector as amateurs or “froth” that can be cut easily.

• 54% reported relationships with public health partners had worsened since 2022.
• 69% said partners do not grasp CHO capacity and resources.
• 49% do not believe they work co-productively with those partners.
• 87% still want to build better relationships.

High staff turnover on the public side forces repeated rebuilding of trust. Partnerships that once felt genuine have become transactional. Multiple organisations reported zero joint service delivery. Earlier joint programmes have simply ended when funding stopped, despite clear demand.

Health Improvement Teams were the partners most often named as constructive. Where time is spent on mutual understanding and CHO expertise is valued, the work holds. The problem is that these cases remain exceptions.

Scotland’s Prevention Frameworks Name the Sector

In 2025 the Scottish Government published three major strategies. Scotland’s Population Health Framework 2025-2035 and the Public Service Reform Strategy both put prevention and joined-up working at the centre of efforts to improve health and cut inequality. The Health and Social Care Service Renewal Framework stresses the vital role of community-led services, especially for prevention.

The recognition is real on paper. Community and voluntary organisations are described as uniquely placed to reach people, build trust and deliver person-centred support that public services often cannot. Sector summaries prepared with the frameworks spell out their contribution to social and economic factors, places and communities, and equitable access.

Yet the survey window of 2022-25 covers the same period of fiscal austerity and successive reforms that disrupted links with local authorities, Health and Social Care Partnerships, NHS boards and improvement teams. The welcome framing arrives after the damage has already been done to many of those links.

Demand Up, Funding Down and Risk Shifted

Policy language has grown stronger on early intervention. On the ground the picture is inverted. Organisations built for mild-to-moderate preventative support are managing crisis-level cases. Demand has risen sharply against pre-pandemic levels while funding has fallen or vanished.

Groups deliver thousands of appointments and accept statutory referrals without matching statutory resources. They run on short-term grants yet are expected to offer consistent long-term support. The result is a transfer of risk: people with severe mental health conditions, including suicidal ideation, arrive at organisations that lack the remit, training or capacity to manage them safely.

Information sharing is often inadequate, so risk assessments are compromised. Safety for both service users and staff is put at stake. Previous joint programmes that met real need have closed when the money stopped.

This pressure sits against a wider backdrop. Public Health Scotland reported that healthy life expectancy has fallen to near a ten-year low, with females expecting 60 years and males 59.6 years of good health at birth in the latest figures available at the time of the frameworks. Gaps between council areas and between the most and least deprived communities remain large. Later data for 2022-2024 showed further softening to 59.4 years for females and 59.1 for males, with women in the least deprived areas enjoying 26.7 more healthy years than those in the most deprived.

An urgent call to overhaul stroke prevention has already highlighted how system-level prevention gaps play out in specific conditions. The same pattern of late intervention and stretched community capacity appears across the wider landscape.

How Referrals Became a Safety Gap

The survey recorded clear examples of inappropriate pathways. Organisations designed for preventative and early support receive people whose needs exceed what they can safely handle. Statutory services appear to offload risk rather than share it.

Key problems reported include:

• Referrals of individuals with severe mental health conditions or active suicidal risk to groups without clinical capacity.
• Missing or incomplete information that blocks proper risk assessment.
• Expectation that community staff will manage long-term cases without the funding that statutory partners receive for the same work.
• Collapse of earlier joint delivery arrangements once short-term grants ended.

Forty-nine percent of respondents do not see their current relationships as co-productive. The gap between policy talk of partnership and the operational reality is wide.

Health Improvement Teams Still Get It Right

Positive practice exists. Health Improvement Teams were repeatedly named as partners who invest time, understand community capacity and value frontline expertise. Where those conditions hold, organisations report effective collaboration that benefits the people who need support.

The survey and a follow-up workshop showed strong appetite for change. Eighty-seven percent of respondents want better relationships. Workshop attendees described a vision of genuine partnership that would serve communities, statutory services and individuals alike. They insisted the path requires honest conversation and real commitment from every sector.

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.

Dr Lisa Garnham, Centre for Health Policy, University of Strathclyde

A detailed report of the survey and workshop findings is available via Scottish Communities for Health and Wellbeing.

Workshop Vision Meets the Equal Partner Test

In September 2025 a group of third and community sector intermediaries issued a joint statement on prevention. They welcomed the three frameworks but warned that preventative work by many community-led organisations may not survive into the next financial year without immediate action.

They called for a clear and consistently applied definition of prevention, deliberate attention to the hard elements of implementation such as power-sharing and long-term investment, and a sustainably resourced third sector treated as an equal partner. The statement noted that healthy life expectancy has fallen to near a ten-year low and that the need for collective action has never been more urgent.

SCVO’s Autumn 2025 third sector tracker, drawing on 663 organisations, found volunteer shortages now the top challenge, funding delays or reductions cited by 28%, and the rise in employer National Insurance contributions hitting the finances of 43% of groups. Over half said limits on resources, skills or capacity hinder delivery. Secure multi-year funding for core costs remains the single most requested change.

The survey of community health organisations and the wider sector data point to the same test. Scotland’s frameworks correctly identify community-led groups as essential. The practical question is whether funding stability, decision-making access and realistic referral pathways will follow, or whether the sector will continue to absorb rising demand while its capacity erodes.

The organisations that responded have already shown they want the partnership. The next move sits with the public bodies that hold the budgets and the strategic tables.

Frequently Asked Questions

What did the 2025 survey of Scottish community health organisations find about relationships with public partners?

Of the 67 organisations that responded, 54% said relationships with public health partners had worsened over the three years to 2025, 69% believed partners do not understand their capacity, and 49% did not view the working relationship as co-productive, while 87% still wanted to improve those links.

Which three Scottish Government strategies published in 2025 emphasise prevention and community-led services?

The Population Health Framework 2025-2035, the Public Service Reform Strategy and the Health and Social Care Service Renewal Framework all highlight prevention, joined-up working and the role of community-led organisations in meeting health and social care needs.

How has healthy life expectancy changed in Scotland according to recent Public Health Scotland figures?

Figures for 2021-2023 showed females could expect 60 years and males 59.6 years of good health at birth, described as near a ten-year low; later 2022-2024 estimates fell further to 59.4 and 59.1 years, with gaps of more than 25 years between the most and least deprived areas.

What specific risks do community health organisations report from inappropriate referrals?

Groups designed for mild-to-moderate preventative support say they are receiving people with severe mental health conditions including suicidal tendencies, often without adequate information for risk assessment, transferring safety risks onto organisations that lack the clinical capacity or resources to manage them.

Do community health organisations still want closer partnership with public health bodies?

Yes. Despite the reported deterioration, 87% of survey respondents expressed a desire to develop improved relationships, and Health Improvement Teams were frequently cited as examples of partners with whom constructive working already happens when mutual understanding is present.