Last week’s Scottish Government reshuffle saw a new Cabinet Secretary for Health take up post – the fourth in as many years – with a promise to reform and improve the service. It badly needs it. Almost everyone has a family member on a waiting list, A&E performance falls far short of targets and GP appointments are like hens' teeth.

So what should the new Cabinet Secretary do ?

Firstly, what he shouldn’t do. The last thing we need is another ‘New Deal’, announced to great fanfare only to struggle to meet expectations a few months down the road. Business, and local government, can testify to that.

Strategy is important, a clear sense of direction coming from the top. But it needs to be followed through with decisive delivery. Government’s record here isn’t always great. The 10-year National Strategy for Economic Transformation (NSET) for example, now in year three, is being given a ‘refresh’ – standard procedure when there’s a need to buy more time. Audit Scotland recently highlighted a lack of collective political leadership and clear targets around its implementation. And two years on from the ScotWind auction we still wait for a Green Industrial Strategy, to detail how our vast renewable energy resources will be converted into high-paying jobs.

I’ve written about the challenges , and opportunities, our health and social care service previously, but here are some things the new Cabinet Secretary could focus on.

Firstly, shift resources to the front line. This is hampered by there being no data on how much is spent on management and administration costs across the service. We know how many billions each health board receives, but what they spent it on, and which are best in class when it comes to allocating resources efficiently is unknown. Everyone agrees that 14 territorial health boards in a country of five million people is too many. A wholesale reorganisation will take time to deliver, but more immediate steps to ensure all boards perform to the level of the best, and that unnecessary duplicate processes and layers of management are stripped out can be delivered more quickly.

Secondly, focus on throughput, and identify how to dramatically increase capacity in the system. That’s the only way waiting lists will come down. Only 1.5% of operations performed in the service makes use of robotic technology – which can double throughput and half bed stays while significantly improving patient outcomes. The use of digitisation, AI in for example radiography, and sensor technology to support care at home can all help increase capacity.

Thirdly, ensure best practice is delivered at pace and scale throughout the whole system. The service is littered with pockets of excellence that never make it out of one health board, or even out of one ward. Scotland’s world leading life science sector is full of great businesses with transformational technology that is being used all over the world but not being adopted here at home. A programme to identify what works and mandate its roll-out at scale can serve to raise performance across the service.

There also needs to be absolute clarity on the purpose of the proposed new National Care Service. Its basic principles are easy to agree with – standardising service levels, promoting dignity and focusing on early intervention.

But how that is to be translated into concrete action, and whether a new quango is actually needed to deliver that, is still uncertain. Even with its revised costings NCS funding runs into hundreds of millions. That’s just for administration – it doesn’t include any funds to increase pay rates for frontline workers or investment to improve data systems.

While the temptation to deliver an iconic legacy is tempting – like the Attlee government did when it created the NHS – clear heads need to ask what the NCS will actually do to address the main problem facing the sector – how to fund increased pay rates to attract and retain staff ?

Every hundred million spend on a new bureaucracy is a hundred million less spent on rewarding those low-paid care workers the service relies on. Meanwhile, 160 civil servants are racking up a bill of almost a million pounds a month talking about it.

And finally, empower staff. Removing layers of management will help free up the people who know the service best to do the best for patients, with resources applied where they will deliver the greatest impact.

None of this is easy. The new Cabinet Secretary has his work cut out. Success, or the absence of it, will be obvious to all those who use the service. I wish him well.