Chapter 2 - A Healthy and Active Nation
The best place in the world to be cared for and healthy
To be a more successful country we need to close the gap between the health of our wealthiest communities and that of our poorest, and we need to see an overall improvement in our population health. We know that keeping us as healthy as possible – both physically and mentally – is not just the job of the NHS. The quality of our housing and natural environment, our job prospects and our childhood experiences all shape our wellbeing. And our wellbeing is directly linked to our economic success as a nation. In the coming year we will step up our efforts to prevent poor physical and mental health by using all the resources available to us.
While the solutions to improving our health are not wholly reliant on the NHS itself, we remain absolutely focused on our NHS meeting our needs now and being fit for the future – and supporting our NHS workforce to continue to care for us.
In the last year we have continued our record investment in our NHS as part of the commitment to increase health funding by at least £2 billion over the lifetime of this Parliament. We have awarded 147,000 NHS staff earning under £80,000 a minimum pay rise of 9% over the next three years and we will proceed with the implementation of a new contract for GPs. We have awarded salaried NHS doctors and dentists earning up to £80,000 a pay rise of up to 3% this year. New investments will deliver better outcomes for people – by the end of 2018 the new trauma centres in Aberdeen and Dundee will be open and in the year ahead we will begin construction on the Golden Jubilee expansion in the West of Scotland and the North of Scotland Elective Care Centre at Raigmore Hospital.
There are challenges – Brexit, meeting our ambitions for everyone to get world-class treatment as quickly as possible and ensuring we live not just longer, but healthier, lives. But we have been ambitious in the past and remain ambitious to deliver the long-term investment and reform our NHS, and wider public services, need.
We will reform the way we respond to and treat mental ill-health. Not only improving clinical services to be more responsive for children, young people, and adults but also building new networks of support easily accessible from schools, communities and workplaces to support our good mental health and wellbeing.
We are also taking bold action for the nation’s health in tackling poor diet and obesity, with the same drive that led us to put in place minimum unit pricing for alcohol earlier this year.
The creation of integration authorities is one of the most significant reforms since the NHS was created 70 years ago. We are starting to see more of the positive impact health and social care integration is having on how we are cared for close to home – reducing unplanned pressures and providing better outcomes for families. Over the next year, we will accelerate our efforts to ensure that the widely supported aims of integration of health and social care translate into positive changes in every community. This work will be guided by the Review of Progress with Integration which we announced in May 2018.
We will continue to shift the balance of care, continuously improving those services offered in our communities with community pharmacists playing a vital role in increasingly becoming the first point of access for care and advice.
We will innovate and think differently about how services should be delivered. We will use our data and digital expertise and learn from the successes at ward, community and regional level to deliver the good health and social care that 21st-century Scotland needs.
And to achieve this we will work with others who want to see the same positive outcomes as we do, to deliver a healthier Scotland.
Improving our support for good mental health
Just as with our physical health, we can take action to keep ourselves in good mental health, but sometimes we need extra support. More of us than ever are open about experiencing poor mental health and recognise that the right help at the right time can build resilience and see us through difficult times. This is not just about ensuring our specialist services can address those whose needs become critical, but that all our public services can support better mental health and wellbeing for all of us.
Increasing Support For good mental health For women, before and After birth
Our approach needs to change to meet the demands of modern day Scotland. We will introduce a comprehensive package of measures to improve mental health services for children, young people and adults, and ensure that support for good mental health is embedded across our public services.
We will invest an additional £250 million over the next five years to support this package of measures and we will work with others to deliver it, across all levels of government, public services, third sector and communities.
Support during pregnancy and after birth
One in five women face mental health problems during their pregnancy. The earlier support and treatment is provided the better for both mother and baby. We know that early experiences have lasting impacts for childhood and beyond so early intervention is crucial. Investing and building up the services that support new and expectant mothers is central to this.
We will provide three tiers of support across Scotland, in line with the needs of individuals:
- for those 11,000 women a year who would benefit from help such as counselling we will support the third sector to provide this
- for those 5,500 women in need of more specialist help we will ensure rapid access to psychological assessment and treatment
- for those 2,250 women with the most severe illness we will develop more specialist services and consider the need for a small number of additional inpatient beds or enhanced community provision
Children and young people
The Task Force on Children and Young People’s Mental Health Improvement was announced in June – backed with £5 million funding – and Dr Dame Denise Coia DBE was appointed as Chair. Over the summer, Dame Denise Coia has been listening to the views of young people, clinicians and service providers, as well as examining how other countries have had success in supporting good mental health. We will receive initial recommendations from Dame Denise Coia this autumn. To complement the Task Force we will take action now that draws on those early discussions.
We all experience setbacks and adversity in our lives and for children and young people the stresses of growing up in modern society add to the need for us to have a wider range of support that can be accessed quickly and easily.
The proposals set out here and the work that will be progressed will ensure that:
- parents will have a much clearer understanding of the kind of help that is available, and where and how to access it
- children and young people will have a much wider range of help available to them
- schools will be better supported to deal with wellbeing concerns, and will be able to direct children to counselling services
To make sure that children and young people have the support they need at the earliest possible stage we will:
- invest over £60 million in additional school counselling services across all of Scotland. This will create around 350 counsellors in school education across Scotland ensuring that every secondary school has counselling services
- have an additional 250 school nurses in place by 2022. This will provide a response to mild and moderate emotional and mental health difficulties experienced by young people in the form of local help that is available immediately
- enhance support and professional learning materials for teachers on good mental health, including ensuring that, by the end of academic year 2019-20, every local authority will be offered training for teachers in mental health first aid, using a ‘train the trainer’ model to enable dissemination to all schools
- provide more than 80 additional counsellors in Further and Higher Education over the next four years with an investment of around £20 million
- put in place systems to fast-track those with serious mental illness to specialist treatment
- develop services for community mental wellbeing for 5-24 year olds and their parents to provide direct and immediate access to counselling sessions, self-care advice, family support, peer-to-peer support and group work with links to other care settings
- improve the training and awareness of people working with vulnerable families and deliver improved infant mental health support for those families that need them.
- launch a new website containing trusted help and information for young people and their families
- expand the Distress Brief Intervention ( DBI) programme pilots during 2019 to include people under 18. In essence, DBI, is a form of ‘listening with empathy and practical problem solving’. It is currently testing with adults to positive effect in Lanarkshire, Aberdeen, the Highlands and the Borders
- make mental health and suicide prevention training mandatory for all NHS staff who receive mandatory physical health training. This includes doctors, nurses, psychologists, allied health professionals and pharmacists and will help children, young people and adults
350 school Counsellors And 250 school nurses To support the wellbeing Of pupils
In addition to the package of measures described here we will make changes now to improve the experience of children, young people and families who need specialist support. We have accepted the recommendations made in the Audit of Rejected Referrals which was commissioned as part of last year’s Programme for Government. The Taskforce on Children and Young People’s Mental Health Improvement will work to implement these recommendations ensuring that all children are appropriately triaged and where necessary directed to alternative support services. This will include ensuring that GPs and others have clear consistent guidelines for referral to Child and Adolescent Mental Health Services ( CAMHS).
Building on our programme of work to improve access to mental health support including investment in additional workforce and in mental health in primary care, we will put in place new and improved support for people that fits in with our lives. Good mental health is intrinsically linked to our employment and life opportunities and a healthy population is vital for our aspirations of inclusive and sustainable economic growth.
Quarter Of A Billion Pounds For Improved Mental Health And Wellbeing Support
Our actions to tackle mental health issues experienced by adults include:
- trialling improvements to the NHS 24 Breathing Space service by introducing web-chat with an NHS 24 adviser
- helping those with mild to moderate depression by introducing more widespread online access to Cognitive Behavioural Therapy – this would help around 5,000 more people to combine improving their mental health with working and caring
- strengthening the content of current self-help platforms provided through NHS Inform
- improving access to psychological assessment and therapies in rural areas through the use of technology such as video-conferencing
- enhancing the handling of mental health calls to the 111 service with more specially trained staff providing specialist mental health advice
We are continuing to take action on suicide prevention. We have set out plans to continue the decline in the number of people dying through suicide and want to further reduce Scotland’s suicide rate by 20% by 2022. Backed by a new £3 million innovation fund we will:
- create and implement refreshed mental health and suicide prevention training by May 2019 for Scotland’s public and private sectors
- develop reviews of all deaths by suicide ensuring lessons are shared and acted on
- develop innovative ways to use digital technology to prevent suicide
This work will be led by our National Suicide Prevention Leadership Group.
Getting the right healthcare, in the right place and at the right time
The substantial work on community health services, supported by an additional £500 million invested every year by 2021, is translating into more multi-disciplinary teams of healthcare professionals in the community. Along with the benefits of people not having to travel unnecessarily for care and treatment this reduces pressure on our hospitals and delays in patients being able to return home. Across Scotland, since August 2016, the number of days spent in hospital by people where discharge was delayed has reduced by over 15%.
We have delivered a new General Medical Services contract, taking a distinct Scottish approach to designing the reform with the British Medical Association. This new contract will:
- ensure GPs are recognised as the senior clinicians in the community, leading the delivery of better health outcomes
- support multi-disciplinary community care teams, freeing up GP time to see those with the most complex needs
- reduce barriers to recruitment of GPs through the £30 million GP Premises Sustainability Fund
Community pharmacy already plays an important role in the communities they serve, providing highly accessible services. We want more people to use their community pharmacy and think of their community pharmacist as the first point of access for care and advice. Enhancing these services and the clinical role of community pharmacists is crucial. We will build on the learning from the extended Minor Ailment Service pilot in Inverclyde and the rollout of the Pharmacy First initiative by developing and implementing a redesigned minor ailment and common conditions service available to all in the coming year.
We are also strengthening and refreshing the Chronic Medication Service in order improve how it enables community pharmacists to provide personalised care for people with stable long-term conditions. In the coming months we will say more about how the shape of this service will be enhanced by building in medication review, pharmacist prescribing and monitoring of patient medicines.
We are continuing to take action on dental care as well. We will introduce a new scheme, from April 2019, to ensure people in care homes receive appropriate dental care. We will, over time, expand this to include those people being cared for at home, and we will take forward new approaches to reduce inequalities by supporting communities and families to take positive action to improve oral health through our £2.5 million Community Challenge Fund.
Acute and secondary care
Building on the success of our Scottish Patient Safety Programme, which among other successes has led to a 21% reduction in SEPSIS since 2012, we will continue to deliver quality and safe care in our hospitals and emergency services. Our new Scottish Trauma Network will save more lives and work across traditional specialties and geographic boundaries. We are investing £10.2 million to support the delivery of this Network so that those seriously injured in Scotland get the best possible care and chances for recovery wherever their location. Our investment to enhance elective capacity will help our NHS treat people more quickly and meet increasing demand from a growing older population.
New Major trauma Centres Opening in aberdeen And dundee this autumn
- open the Major Trauma Centres in Aberdeen in October and Dundee in November, with centres in Glasgow and Edinburgh to follow
- begin construction on the Golden Jubilee expansion in the West of Scotland in early 2019 and the North of Scotland Elective Care Centre at Raigmore Hospital in Inverness by mid 2019
- open, by April 2019, a ScotsSTAR base in the North to improve arrangements for specialist patient retrieval and transfer
- support the improvements to person-centred visiting in our NHS so that patients can be with the important people in their lives while in hospital – flexible visiting will be in place across our NHS by 2020
- continue to progress the Health and Care (Staffing) Bill through Parliament and provide additional investment to expand workforce planning infrastructure in the NHS and in social care
- continue to progress the Human Tissue (Authorisation) Bill through Parliament, changing the current ‘opt in’ to an ‘opt out’ system
- consult on proposals to reform the law on adults with incapacity with the aim of people receiving more support to make their own decisions and better access to the right care and support
We will publish a plan, later this month, to substantially and sustainably improve waiting times performance in the face of rising demand for services. This will complement the existing range of activities in support of waiting times, including the additional funding provided to NHS Boards earlier this year and the Access Collaborative launched last year with core professional and patient representative involvement.
In the coming year we will provide national service improvement and workforce development support to modernise specialist dementia hospital care. The re-designing of specialist hospital and community services will mean more people can be supported to stay at home or in a homely setting for longer as their dementia advances.
To improve care and support for people living with neurological conditions we are developing Scotland’s first ever National Action Plan on Neurological Conditions. A draft plan will be published for consultation in October with the final plan being published in early 2019.
We will also develop a National Falls and Fracture Prevention Strategy. Often, falls can be prevented and making sure we take a consistent and joined-up approach to falls prevention and management across Scotland can make a significant difference to the lives of many people in our communities.
Social care and support
Social care provides vital support for thousands of people in Scotland. As a population we are enjoying longer lives and with that comes often more complex care needs. That means demand for social care and support is growing faster than our traditional services were designed for. We therefore need to think differently about what social care is, the value we place on it as a society and how people can access the support that is right for them in a way which is sustainable.
We are working with COSLA, Health and Social Care Partnerships, people who use social care, and a wide range of other partners, to make sure our social care is fit for the future. Together we will continue to build on existing work to:
- embed the recently established rights for Scotland’s 790,000 unpaid carers under the Carers (Scotland) Act. The Act gives carers rights to be listened to and to access social care support to help protect their health and wellbeing. This includes supporting them to achieve their personal goals (such as returning to work or undertaking studies or training), alongside caring
- give people greater choice and control over what their social care support is and how it is delivered. This year, with partners, we will reinvigorate this work by focusing on improving ways of working to make sure that everyone who receives social care is able to make choices that are right for them
- continue to implement Frank’s Law, which will see people of all age groups who need it be eligible for free personal care by April 2019, rather than only those over the age of 65 as was the case in the past
While we are making progress, there are still significant challenges facing social care. That is why, over the next year, with partners, we will develop a national programme to support local reform of adult social care. This will involve:
- accelerating work at a local level to make sure that those working in social services and healthcare, local organisations and communities can work together to support people to live independently for as long as possible
- at a national level, raise awareness of the role of social care in Scotland, and its social and economic value. This will allow us to together create and realise a vision for social care which focuses on the right things and delivers the right mix of support to ensure that it is sustainable for the future
We will also gather views and consider evidence for a potential new national scheme to provide extra financial support to people with the highest social care needs, so that they can choose to live independently in their homes and in their local communities.
Improving our population health
In the summer we celebrated the 70th birthday of our NHS and in those 70 years the overall health of our population has improved. But an unacceptable gap exists between our life expectancy and that of our Western European neighbours – and the health gap between our most deprived communities and our wealthiest is too large. It is these health deficits that threaten our future prosperity, and why we are renewing our focus on improving our population health.
One of our greatest health challenges is now poor diet and obesity. We are committed to halving the level of childhood obesity by 2030 meaning that approximately 56,000 fewer children will be at risk of being obese.
To focus our efforts on improving the health of our population we have, together with COSLA, set out our Public Health Priorities for the next decade. They are shaping our actions over the coming year, including:
- creating Public Health Scotland, to lead, support and enable progress against our priorities
- progressing action to address adverse childhood experiences ( ACEs)
- consulting this autumn to restrict the promotion and marketing of targeted food and drink high in fat, sugar or salt
- providing practical support to SMEs to help them reformulate their products, making them healthier, including dedicated support through Scottish Enterprise’s Make Innovation Happen programme
- banning tobacco in prisons from 30 November 2018
We will also increase our support for children and families affected by Fetal Alcohol Spectrum Disorder ( FASD). Over the next year, we will work to set up a third sector hub that will focus on both preventing instances of FASD arising in the first place and supporting families following diagnosis.
An active nation
Scotland is one of the first countries in the world to set out what we are doing to address the range of priorities in the World Health Organization’s Global Action Plan, which put forward a target of a 15% relative reduction in the global prevalence of physical inactivity in adults and adolescents by 2030. In the coming year our work includes:
- providing £1 million for the Changing Lives Through Sport and Physical Activity Fund to help transform lives
- expanding the ‘cycling without age’ project across Scotland
- encouraging walking and cycling for recreation and travel via the Active Nation Commissioner role
- supporting the walking football programme to encourage participation in sport and physical activity
- increasing support to Community Sports Hubs within our 5% most deprived communities
- increasing participation in sport by women and girls, working with the Women and Girls in Sport Advisory Board
Tackling key health challenges
Our focus on improving our population health has a direct link to preventing two of our biggest health challenges, cancer and diabetes.
Although more of us are being diagnosed with cancer, fewer of us are dying of this disease, as a result of earlier detection and improved treatment options. In addition to our work on prevention and early detection we will continue to implement other actions in our £100 million cancer strategy, with enhanced radiotherapy services through new technology and recruitment which will help to improve outcomes for cancer patients and reduce waiting times. As part of this we are investing up to £2.5 million over five years in improving cancer care for teenagers and young adults including additional key workers in the North of Scotland.
Overall, we spend around 9% of our NHS budget treating type 2 diabetes. For many, the onset of type 2 diabetes, which is closely associated with being overweight or obese, can be slowed down or reversed through intensive weight management. In the coming year we will begin a five-year plan to invest an additional £42 million to improve the range of weight management services offered by our NHS as a core part of treatment services for people with, or at risk of, type 2 diabetes.
Scottish Patient Safety Programme
This year marks a decade of the Scottish Patient Safety Programme ( SPSP) – the first national safety programme in the world. The now world-renowned SPSP has made our hospitals safer and improved health for some of Scotland’s most vulnerable people – including a 21% reduction in SEPSIS since 2012. From its beginnings in acute adult care it is now expanded to maternity, mental health, primary care, dentistry and pharmacy.
In the coming year, another success from the Programme, a project started in Raigmore Hospital, Inverness to support clinical teams to use combined quality and cost data to deliver better patient outcomes at lower cost will be developed and adapted beyond the Highlands to other areas in Scotland.
Using research, innovation, digital and data capabilities to improve health
We have a strong pedigree in leading research and innovations in healthcare. We will continue to support the development of excellence in medical innovation in Scotland. For example, our understanding of genes and the consequences of genetic variations, known as genomics, offers the potential for a more rapid and complete diagnosis and treatment of genetic conditions. This year we will:
- establish a genomics data facility
- continue enrolment of Scottish patients into the 100,000 genomes programme
- support our NHS to provide continuity of testing when access to genetic testing services in England will be reconfigured
We will work with stakeholders to develop the single national formulary for medicines during 2019, to reduce unwarranted variation in the medicines prescribed in different parts of the country.
We will implement our Digital Health and Care Strategy, launched in April 2018, to ensure that digital enhances the delivery of health and care services. As part of this, work has started to develop a ‘national digital platform’ that will enable the development of clinical and care systems which are easy to use, enable excellent care, support front-line staff, and empower people to manage their own health and wellbeing.
We will continue to support technological solutions for managing health and wellbeing. This includes the ‘Attend Anywhere’ video consultation service which allows for a secure clinician to patient consultation that can be accessed anywhere by using a web browser or app on a laptop, tablet or smart phone. Work is under way to scale up this service across Scotland as soon as possible.
We want to see more innovative solutions such as those led by the Digital Health and Care Institute ( DHI). Their work includes moving away from the traditional colonoscopy for the inspection of gastroenterology to a camera contained in a pill that can be swallowed, avoiding the need for more invasive procedures and allowing for the timing of any investigations to be more flexible. We will continue to work with the DHI in the development of a demonstrator and simulation environment that, among many other benefits, will allow for industry to develop ‘fit-for-purpose’ products and allow for the use of data in a much more collated and meaningful way, by linking the national digital platform.
Smarter booking system
We are developing a new smarter booking system for use in our NHS by the end of April 2019. The new system is being developed as part of CivTech, the Scottish Government’s innovative technology acceleration programme and will allow patients to make, change and cancel outpatient appointments online, as well as providing text message reminders. The smarter booking system will also help ensure patients are seen by the right person, in the right place and at the right time – reducing unnecessary appointments.
Working across public services for better health
We know that people’s health and wellbeing is so much more than the services our NHS can provide. We will join up our work across public services to meet our goal of increased wellbeing for all.
Building on the success of the Navigators programme in Glasgow and Edinburgh Royal Infirmaries, we will expand this to the Queen Elizabeth University Hospital in Glasgow and Crosshouse Hospital in Ayrshire. The Navigators work alongside NHS staff within A&E and hospital wards reaching out to people living chaotic lifestyles and providing support that continues after the person has left hospital.
We will do more to reduce unintentional harm, including targeted safety messages for new families, to reduce the 500,000 A&E visits and one million GP appointments it is estimated result from accidental injury.
We will work to improve health and social care services in Scottish prisons to help reduce inequalities and tackle health-related causes of offending such as drug and alcohol misuse. We will empower frontline practitioners and prison officers to improve and redesign services through support from a dedicated improvement fund.
Our approach to drugs policy is underpinned by a public health approach, guided by a principle of ensuring the best health outcomes for people who are, or have been, drug users. We are sympathetic to proposals being pursued by Glasgow City Health and Social Care Partnership to pilot a safer drug consumption facility in the city centre – designed for an estimated 400-500 people who inject publicly in the city centre and experience high levels of harm. In particular, it is anticipated that the facility will significantly reduce the risk of further outbreaks of blood-borne viruses. Drug legislation is currently reserved to the Westminster Parliament and we will continue to press the UK Government to make the necessary changes in the law, and if they are not willing to do so, to devolve the powers in this area so the Scottish Parliament has an opportunity to act and allow the facility to proceed.
Our NHS workforce
We recognise that our hardworking workforce is the greatest asset of our NHS. We also recognise the impact that years of pay restraint have had on our staff. This year, we scrapped the pay cap and awarded 147,000 NHS staff earning under £80,000 a minimum pay rise of 9% over three years with a total additional investment of £989 million. NHS salaried doctors and dentists earning under £80,000 were awarded a pay rise of up to 3% this year with a total additional investment of over £60 million.
We will continue to progress our work on Transforming Nursing Roles so that we maximise the potential of our much valued nursing, midwifery and health professional workforce to help meet the current and future needs of Scotland’s health and social care system.
The pool of EU workers that Scotland has been able to attract, particularly in hard-to-recruit specialisms and rural areas, is at risk because of the UK Government’s approach to Brexit and migration. We are working with others to mitigate these challenges and be as prepared as we can be for all the possible scenarios. In particular, we have made absolutely clear that we value those EU citizens living and working in Scotland and that we want them to stay. We will meet the settled status fee for EU citizens working in devolved public services. We will also take forward further work to ensure EU citizens working in health and social care in Scotland have the advice and support they need over the challenging period to come.
Email: Kathryn Fergusson
Phone: 0300 244 4000 – Central Enquiry Unit
The Scottish Government
St Andrew's House