CHAPTER 4 IMPROVING HEALTH AND REDUCING INEQUALITIES
NHSScotland has a vital role in improving and maintaining the good health of the people of Scotland, and in reducing health inequalities. This is central to the aim for NHSScotland to become a world leader in terms of healthcare quality, and to the wider Scottish Government objectives to support people to live longer healthier lives, and to reduce inequality through early intervention and anticipatory care. This chapter sets out the key areas of achievement by NHSScotland in support of health improvement across Scotland during 2011/12.
CHANGING SCOTLAND'S RELATIONSHIP WITH ALCOHOL
A Progress Report* on Changing Scotland's Relationship with Alcohol: A Framework for Action* was published in February 2012. The report outlines the progress made against each of the measures in the Framework as we take action to tackle a major challenge affecting Scottish society through legislative change, improved treatment and support services, and by building an environment that supports cultural change in the longer term.
Considerable progress has been made on implementing key aspects of the Alcohol Framework, including: a record investment in tackling alcohol misuse of over £196 million since 2008; delivery of over 272,000 Alcohol Brief Interventions by NHSScotland; the establishment of 30 Alcohol and Drug Partnerships (ADPs); development of an implementation plan to deliver the recommendations of the Quality Alcohol Treatment and Support report*; the commencement of the Alcohol etc. (Scotland) Act 2010 and the passing of the Alcohol (Minimum Pricing) (Scotland) Act 2012 in June.
MINIMUM UNIT PRICING OF ALCOHOL
The Alcohol (Minimum Pricing) (Scotland) Bill was introduced in October 2011 and subsequently passed stage 3 in the Scottish Parliament on 24 May 2012. The Bill re-introduced the proposal to set a minimum price per unit of alcohol as a key part of tackling Scotland's unhealthy relationship with alcohol. Evidence shows that addressing price is an important element in any long-term strategy to tackle alcohol misuse given the link between consumption and harm, and the evidence that affordability is one of the drivers of increased consumption. Minimum pricing will target heavy drinkers as they tend to drink the cheap, high-strength alcohol that will be most affected by the policy. The Scottish Government believes that a minimum price per unit of alcohol would be the most effective and efficient way to tackle alcohol misuse in Scotland.
ALCOHOL AND DRUG PARTNERSHIPS
The Scottish Government has been working in partnership with Alcohol and Drug Partnerships (ADPs) to strengthen governance and accountability arrangements by developing and agreeing a set of core ADP outcomes and indicators. These outcomes and indicators support the embedding of outcomes-based planning and reporting at local level, helping ADPs to self-assess their performance (including benchmarking against other ADPs) and to articulate their contribution to their local Single Outcome Agreements. They also help provide a national picture of progress in alcohol and drug prevention, support and treatment.
ALCOHOL BRIEF INTERVENTIONS
There has been excellent progress of the national Alcohol Brief Interventions (ABI) programme across Scotland. Over 272,000 ABIs - including 97,830 ABIs in 2011/12 - have been delivered to date by NHSScotland to help individuals to cut down on their drinking to within safer guidelines. These person-centred, evidence-based and cost-effective preventative interventions potentially reduce the requirement for more costly alcohol-related treatments later on.
To achieve agreed number of screenings using the setting-appropriate screening tool and appropriate Alcohol Brief Intervention in line with SIGN 74 Guideline during 2011/12.
The target was for NHSScotland to deliver 61,081 Alcohol Brief Interventions during 2011/12. A total of 97,830 interventions were delivered during this time, 60 per cent more than the target.
The ABI HEAT target became a HEAT standard for 2012/13, supporting the long-term aim that ABIs should be embedded into routine practice. NHS Boards and Alcohol and Drug Partnerships (ADPs) will sustain and embed ABIs in priority settings (Primary Care, Accident & Emergency, antenatal) and develop ABI delivery in wider settings. This provides a sustainable approach, effective partnership working and emphasises robust delivery of ABIs to build the evidence base and remain a cornerstone of our efforts to reduce alcohol-related harm in Scotland.
DRUG AND ALCOHOL TREATMENT WAITING TIMES
The HEAT (A11) Drug and Alcohol Treatment Waiting Times Target sets out that, by March 2013, 90 per cent of clients will wait no longer than three weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. Data to support this target is published on a quarterly basis and the latest statistics (April-June 2012) highlight that we are well on track to achieve the target with 90 per cent of people being treated within three weeks or less. ADPs will continue to be key to achieving this target by engaging problem drug and alcohol users with appropriate treatment services at an earlier stage, which is likely to achieve a higher rate of successful outcomes for the client.
ALCOHOL AND OFFENDERS GUIDANCE STATEMENT PUBLICATION
The Alcohol and Offenders Guidance Statement* was published in April 2012. It is intended to provide guidance and support for those who have a responsibility for developing strategic responses to alcohol problems amongst offenders. Key amongst those are ADPs which are required to develop and implement local strategies for the provision of effective alcohol and drug services to meet the needs of their population, including offenders.
* All publications referred to within this document can be found in the publications section of the appendices.
A new smoking cessation HEAT target was introduced from April 2011 to build on the success of the previous target. This new target is for NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one-month post quit) including 48,000 in the 40 per cent most deprived within-Board Scottish Index of Multiple Deprivation (SIMD) areas over the three years ending March 2014. For the first time, the target has a specific focus on inequalities with the aim of reducing the significant disparities in smoking rates between the most and least disadvantaged populations across Scotland. This in turn is a major contributor to premature mortality and health inequalities. NHSScotland is on track to meet the overall target in 2014, supporting 44,137 smokers to quit (measured at one-month following the agreed quit date) in 2011/12, with 24,529 of these quits from within the 40 per cent most deprived areas.
Physical inactivity is one of our major health challenges, contributing to nearly 2,500 deaths in Scotland each year. The Green Exercise Partnership, which includes NHS Health Scotland, Forestry Commission Scotland and Scottish Natural Heritage, is working with NHS Boards to maximise opportunities to use NHSScotland's outdoor estate as a resource to promote the health of patients, visitors, staff and the surrounding community. These developments provide increased opportunities for physical activity and mental health benefits as well as contributing to delivering NHSScotland's responsibilities on sustainability, the Healthier Working Lives agendas and the Quality Strategy.
In 2011/12, eight NHS Boards started or completed estate improvements, or new developments such as large-scale projects at Ninewells Hospital in NHS Tayside and NHS Forth Valley Royal Hospital in Larbert. The Scottish Government will continue to work closely with NHS Boards to take forward its active agenda alongside other partners including the Royal Colleges and sportscotland. The next step will be to set out the role of the NHS in the implementation plan for the Scottish version of the Toronto charter, regarded as the international best practice for investment in physical activity.
Delivery of Keep Well and Well North (the remote and rural adaptation) health checks continued throughout 2011/12. NHS Boards also took forward planning for the mainstreaming of the programme from April 2012. Under the programme, 40 to 64-year-olds living in deprived communities are invited to attend a health check, typically within their local GP practice but also in other local settings. The health checks focus primarily on Cardiovascular Disease (CVD) and its main risk factors, such as blood pressure, cholesterol, smoking and diabetes, but also covers wider lifestyle issues such as employability, benefits support and mental wellbeing.
Achieve agreed number of inequalities targeted cardiovascular health checks during 2011/12.
The target was for NHSScotland to deliver 26,682 inequalities targeted cardiovascular health checks during 2011/12. A total of 47,776 health checks were delivered during this time, 79 per cent more than the target.
WORKING HEALTH SERVICES PILOT
Working Health Services Scotland (WHSS) is a pilot NHSScotland service that aims to assist employees of small to medium-sized enterprises (SMEs) to remain in or return to work quickly after a period of absence. Most SMEs do not provide access to occupational health services or employee assistance programmes. In 2011/12, the Working Health Services Scotland pilot provided health support for 3,316 people working for small and medium-sized enterprises. Of those who received support: 80 per cent reported an improvement in their health-related quality of life; 75 per cent reported more satisfaction with their occupational performance; 29 per cent reported decreases in their levels of anxiety; and 22 per cent reported decreases in their level of depression. Of those who completed the discharge stage of the programme, 95 per cent remained in or returned to work from sickness absence.
HEALTH PROMOTING HEALTH SERVICE
The Health Promoting Health Service approach sees every healthcare contact as a health improvement opportunity. It aims to support the development of a health promoting culture and embed effective health improvement practice within NHSScotland. Hospitals are a key platform upon which we can start to incorporate health improvement into day-to-day activities and interactions, taking advantage of opportunities to change behaviours amongst patients, visitors and staff. Furthermore, given the proportionally greater use of acute services by patients from deprived communities, health promotion in hospital and maternity settings offers a major opportunity to reduce health inequalities and improve health amongst those at most risk of poor health. Further guidance, issued in January 2012, set out actions covering a range of topic areas including: smoking; alcohol; breastfeeding; diet; health and work; sexual health; physical activity; and active travel. The guidance aims to encourage more engagement from senior managers and clinicians.
All NHS Boards are required to deliver a programme of child healthy weight interventions. The interventions incorporate diet, physical activity and behaviour change components to children aged 2-15 years and their families. NHS Boards have developed a range of programmes which include whole class, school-based interventions and small group and one-to-one interventions in community and/or clinical settings. The school-based programmes have proved successful in overcoming the problems of stigmatisation and parental avoidance of the issue. All NHS Boards met or exceeded their 2008-11 targets completing 8,406 interventions against a target of 6,317. NHS Boards are now working towards the new overall target of 14,910 interventions by March 2014. Between April 2011 and March 2012 a total of 5,052 interventions had been completed.
MATERNAL AND INFANT NUTRITION
An implementation group has been set up to oversee the implementation of Improving Maternal and Infant Nutrition: A Framework for Action* which was published in January 2011. This provided a framework for action by NHS Boards, local authorities and others in partnership to improve the nutrition of pregnant women, babies and young children and is the first to consider effective support to: improve the nutrition of mothers before and during pregnancy; promote the benefits of breastfeeding; and encourage a healthy diet throughout early childhood.
* All publications referred to within this document can be found in the publications section of the appendices.
SEASONAL FLU VACCINATION PROGRAMME
NHSScotland successfully delivered seasonal flu vaccine to those who were at risk from the virus, achieving higher levels of uptake amongst under 65s than ever before, and successfully meeting the vaccination target for the over 65's group. Unlike other parts of the UK where there were reported vaccine problems, no such difficulties were encountered in Scotland and the vaccination programme successfully provided protection for everyone who came forward. Success was driven by excellent working relationships between GPs, Community Pharmacists and NHS Boards, and underpinned by a high-profile awareness-raising campaign.
The third year of the Human Papillomavirus (HPV) vaccination programme has recently been completed, which marks the last year of the catch-up element of the programme (vaccination of older girls). Uptake figures for the schools-based element of the third year of the programme indicate that, by mid-August 2011, uptake of the first dose in S2 reached 91.8 per cent, with 90.2 per cent achieved for the second dose and 81.0 per cent for the third dose. These figures compare favourably to those collected for other parts of the UK. Amongst the catch-up cohort, by mid-August 2012, 73.9 per cent of all girls in the catch-up cohort had received one dose of HPV immunisation, 71.0 per cent had received two doses and 65.5 per cent had completed the three dose course. Again these compare favourably with other parts of the UK.
SEXUAL HEALTH AND BLOOD BORNE VIRUS FRAMEWORK
For the first time, sexual health, HIV, hepatitis C and hepatitis B have been brought together under one integrated strategy to promote a holistic, multi-agency approach to tackling poor sexual health and blood borne viruses in Scotland. It adopts an outcomes-based approach with five high-level outcomes monitored by a series of indicators and supported recommendations. The Framework is based on the solid foundations of existing policy as well as establishing a policy landscape for hepatitis B. This ambitious framework recognises the importance of active links with other policy areas such as substance misuse, education, gender-based violence and the early years as well as joined-up working between the Scottish Government, NHS Boards, local authorities and the third sector.
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