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Health in Scotland 2001

CHAPTER 3: WORKING IN PARTNERSHIP TO IMPROVE LIFE CIRCUMSTANCES

The key theme of this Report is working together in partnership to improve health in Scotland. This chapter focuses on some specific cross sectoral issues and gives further examples from NHS Boards of partnership working to tackle inequalities and improve life circumstances.

Improvements in Scotland's health in recent times have not been shared equally by all Scots. Improving Scotland's health therefore means improving the health of the poorest members of society and closing the gap in health between the most and the least deprived sectors of society. The Government's social justice agenda includes work in partnership with all parts of Scottish public and private life to improve Scotland's health. In addition to promoting healthier lifestyles this includes wider issues which impact on health such as:

• realising potential in education

• addressing housing needs

• providing social work services for vulnerable people and groups

• the provision of wholesome food and the means to buy and prepare it

• supporting individuals in adversity.

The Executive is committed to tackling inequalities in health and improving life circumstances including the socio-economic environment, income, occupation and housing quality. Policy reflects the multiple influences on health and involves a threefold approach:

• influencing key lifestyle factors which affect health. Action on smoking, diet, obesity, physical activity, alcohol and drug misuse, have been covered in Chapter 1 with special emphasis on tackling the influence of deprivation

• focusing on priority health topics - including coronary heart disease, cancer and mental health and protection of health, discussed in Chapter 2

• improving life circumstances to influence the wider determinants of health which are discussed in this chapter.

Improving Life Circumstances

Tackling adverse life circumstances is a vital part of tackling health inequalities. Attempts to address life circumstances are primarily by cross sectoral action on poverty and promoting social inclusion. A wide range of actions is being undertaken.

However, 29% of children still live in low-income households. The proportion of working age people living in relatively low-income households has changed little since the mid-1990s. Although unemployment has fallen in the most disadvantaged parts of Scotland, the ratio between the worst areas and the Scottish average has only decreased slightly.

Fig. 3.1 Unemployment rates in the worst areas and the Scottish average

Better Housing in Disadvantaged Areas

Improving the quality of housing in our most disadvantaged areas has also been important for the Executive. The 1996 Scottish Housing Condition Survey estimated that 8% of all dwellings in Scotland suffered from dampness and 21% suffered from problems of condensation. The 2002 Survey will allow us to assess what progress has been made.

Are We Making Enough Progress?

Routine statistics suggest that although health is generally improving in Scotland, little progress is being made in tackling inequalities. For most of the major causes of mortality, the gap between the least deprived and the most deprived has remained the same or widened over the 1990s.

We cannot expect recent initiatives to show immediate impacts on deaths from diseases like coronary heart disease and cancer. However, lifestyles may be influenced in the short term and will influence future health. There have been some small but encouraging reductions in smoking prevalence in women from the most deprived areas of Scotland in the late 1990s. The next Scottish Health Survey, which is due to be undertaken later this year, will show whether these improvements have been sustained. However, other lifestyle statistics are less promising. In particular, differences in diet appear to be increasing.

The commitment to tackling life circumstances is a key aspect of tackling health inequalities. There have been some encouraging changes, in particular the reduction of children living in poverty and this is likely to show long-term benefits. However, more progress is essential. External factors, such as the economic cycle, will inevitably influence future progress.

Improvements in health and reductions in inequalities are likely to be a long-term process. In all these areas continued cross sectoral, multi-disciplinary action is essential if these efforts are
to succeed.

Further Action in Collaboration with the Health Department

A wide range of actions is being undertaken. These include:

• Four national health demonstration projects which include tackling health inequalities within their aims

• Healthy Living Centres

• Social Inclusion Partnerships

• Action across a range of Executive departments and beyond.

Health Demonstration Projects

There are four health demonstration projects, in the priority areas of:

• child health

• sexual health of young people

• coronary heart disease

• cancer.

These were set up to run for 3 years and act as testing grounds for action and a learning resource for the rest of Scotland. Starting Well, Healthy Respect and Have a Heart Paisley were all launched in Autumn 2000 and Cancer Challenge was launched in May 2000 as part of a UK-wide pilot of screening for colorectal cancer.

Each project has specific aims and objectives, appropriate to its own topic, but all share certain key principles including the important principle of "an emphasis on reducing inequalities in health and tackling adverse life circumstances". Lessons learned from the projects will help to inform policy and practice nationally. Key elements of the Demonstration Projects are now in place. The projects are starting to consider what lessons can be learnt for policy and practice generally, including how to access, involve and meet the needs of priority groups and decrease health inequalities. Scotland-wide Learning Networks will be set up in the coming year.

Healthy Living Centres

Healthy Living Centres are intended to provide a focus for communities to develop better health at the local level and concentrate, in particular, on areas of socio-economic deprivation. The centres vary according to local need. Examples of projects include:

• the Inverkeithing Area Project led by West Fife Local Health Services which has a community flat providing a base for services and advice to young people and families with young children

• the Stirling Health Hub led by Stirling Health and Wellbeing Alliance, which provides a base for staff to provide outreach services and well-being activities to six regeneration areas

• the Health Hit Squad led by East Ayrshire Council which uses a staffed mobile resource unit to raise awareness of health issues and promote healthy lifestyle in 17 regeneration areas.

Action by the Health Education Board for Scotland

Tackling deprivation and social exclusion is crucial to success in health promotion. Factors such as these present the greatest challenges to the health improvement effort as they act directly on people's health and on their life circumstances in a way that can present major barriers to people's capacity to change. The activities of the Health Education Board for Scotland (HEBS) are geared towards helping communities, organisations and individuals to increase their involvement in health improvement activities. Key to this is HEBS support to a wide range of workers from statutory and voluntary sectors in developing their health promoter roles. Some of HEBS initiatives on topic based priorities have been given earlier in Chapters 1 and 2. Other activities by HEBS include the following:

• HEBS continued the funding of the Community Health Exchange (CHEX), which provides networking support and training for community health workers developing good practice guides and contributing to policy development. In partnership with Glasgow Healthy Cities Project, work was undertaken on a guide on community development and health and this incorporates the popular Understanding the Policy Maze and a Directory of Community Health Projects in Scotland.

• In partnership with Edinburgh University and CHEX, HEBS extended the network of trained tutors who can deliver the Health Issues in the Community course in communities
  across Scotland.

• Open Doors, a youth work project at Polmont Young Offenders Institution, was managed in 2001 by a partnership involving HEBS, Community Learning Scotland, the voluntary sector and a range of statutory organisations including employment and housing. A very positive evaluation of this multi-agency project has revealed the potential for addressing health promotion needs of this particularly vulnerable group of young people with a generic youth work approach.

• The Health Promoting Health Service Framework was launched in June 2001 and provided a flexible tool to assist health service staff in their health promotion roles. HEBS is encouraging wide uptake of the Framework and it is being tracked for impact at nine specific sites ranging from a community pharmacy to a whole Trust.

• Funding support was maintained for Voluntary Health Scotland, thus providing opportunities for networking and co-ordinated input into health promotion policy.

• HEBS started work on establishing three new programmes, with support from the Health Improvement Fund, for

  • Children and Families

  • Young People, with a special emphasis on tobacco

  • Health in Later Life.

• HEBS has been an active partner in the CoSLA-led initiative to pilot public health training for senior local government officers and elected members. Workshops were delivered initially in three council areas on, for example, inequalities in health and the importance of a shared understanding between local authorities and NHS Boards in improving health through the community planning process. By the end of the year, plans were being made to roll the programme out to other areas.

• HEBS mass media campaigns continued to focus for adults on the Big 3, covering the prevention of coronary heart disease, cancer and stroke. Advertising and PR highlighted the preventability of Scotland's main killers whilst encouraging the public to make small but manageable changes to their behaviour in terms of tobacco, eating and physical activity.

• The Think About It teenage health initiative continued its track record of using new and sometimes unusual approaches in challenging teenagers to think about their health, behaviour and relationships. The Think About It campaign includes materials on tobacco, alcohol, drugs and sexual relationships.

Action by the Public Health Institute of Scotland

The Public Health Institute of Scotland (PHIS) was established in January 2001, following the recommendations of the Review of the Public Health Function. The main role of PHIS is to help increase the effect of the combined efforts of the many national, regional and local organisations and groups that work to improve health in Scotland. PHIS is committed to working with existing public health networks and creating new ones from across Scotland to develop and strengthen practice. It also plays a key role in improving communications about public health in Scotland, contributing to national policy developments and serving as a reliable and respected source of advice on public health.

The PHIS work plan reflects discussions with the many constituencies in Scotland, both within and outwith the NHS, with an interest in health improvement. The work plan is organised under three main themes:

• Public health information

• Evidence

• Skills.

During 2001 significant milestones were achieved.

• The launch of the constituency profiles in March was the first expression of one of the major pieces of work in the PHIS programme, the Public Health Information project.

• Since then a Public Health Information Network for Scotland has been established with over 100 members. Network seminars were held in April and November to share information about a variety of relevant projects including pilots aimed at developing holistic or integrated datasets in local areas in Scotland. In addition three working groups of the network were established to test the use of such "holistic" data.

• PHIS has supported the development of the new LHCC Public Health Practitioner (PHP) posts, in conjunction with the Scottish Executive. Almost all PHPs were in post by the end of 2001 and PHIS has contributed to:

  • the production of an agreed competency framework for the posts

  • the creation of a national network

  • the development of a national training programme

  • the commissioning of a national evaluation process.

The Public Health Workforce

Throughout 2001 PHIS was involved in debates about the definition and development needs of the public health workforce. Agreement was reached with the Public Health Function Implementation Group that work should focus initially on multi-disciplinary public health professionals with a full time public health role and on the wider group of professionals who contribute to the improvement of health but are not full time public health professionals. PHIS will produce in 2002 a framework for taking forward the development of a postgraduate level qualification for the first group and training opportunities for the wider group.

Induction Programmes for NHS Boards

PHIS also had significant input into the induction programmes for the unified NHS Boards and led a consultation exercise on maximising the contribution of health promotion to health improvement. In other areas of work, good progress was made on the establishment of a wide range of working groups and networks, looking at issues such as healthy public policy, public health pharmacy, the healthy environment and health impact assessment.

Better Communications

PHIS has actively sought to develop its links with organisations outside Scotland, particularly with the Health Development Agency and the King's Fund, who share many of the same interests as PHIS. Several meetings have also been held with the Public Health Observatories in England, leading to discussion in Scotland on the formation of a Scottish Public Health Observatory comprising ISD, SCIEH, HEBS and PHIS. PHIS will take the lead on this and link in with the developing network in England.

PHIS is committed to maintaining two-way communication with its constituencies and has produced a leaflet "What is PHIS?" outlining its objectives and ways of working. This leaflet has been distributed widely to the health service, local government, the academic sector, the voluntary sector, community groups and many others. "What is PHIS?" emphasises that PHIS is a resource for all of Scotland and includes a feedback slip so that people can register their interest in being involved in PHIS working groups and networks and comment on the work and approach being taken.

2001 was a "start-up" year for PHIS, during which a great deal was achieved establishing the organisation, clarifying its work programme and developing extensive networks involving all parts of Scotland and a great many organisations and groups. PHIS has already made its mark in influencing and defining the health improvement agenda for Scotland and as it enters its second year of life the work of its many networks should make a significant contribution to moving that agenda on.

Examples of work from the NHS Boards, Forth Valley, Grampian and Highland have already been given earlier in Chapters 1 and 2 and further examples follow in this section.

WORKING TOGETHER TO IMPROVE HEALTH IN FORTH VALLEY

Many factors impact on this and they all require an approach by all agencies working in partnership. Central Scotland Police and NHS Forth Valley 2 years ago developed a post unique in Scotland: that of an NHS police liaison officer working in and as a full member of the Directorate of Public Health.

This has been a most fruitful partnership and a large number of issues and problems have been addressed and resolved or improved through this post. Examples of the type of areas of work have included:

Improving the Safety and Security of NHS Staff, Patients and Visitors

The safety and security of persons using NHS property is paramount. A survey in August 2000 of NHS staff at both Falkirk and Stirling Royal Infirmaries showed that 21% have been the victim of crime in the workplace (the greatest proportion relating to assault). In order to reduce these risks training courses on management of violence and aggression have now been set for all
staff working in Forth Valley Acute and Primary Care Hospitals. Similar training is also provided for GPs and staff. Security and safety surveys have also been carried out at Acute Trust and PCT property with relevant advice provided in order to improve personal safety and security at
those premises.

Domestic Violence

It is considered that one in five of all women and children experience domestic violence. The problem is however often not even broached by NHS staff for fear of being unable to respond or because they feel it is not any of their business. Police, social services, primary health care, hospital staff and others can tackle this much more effectively together. Forth Valley was one of the first areas in Scotland to take a partnership approach to this. A domestic violence training worker for both NHS and Council staff now works in Forth Valley to raise awareness and help to ensure women experiencing domestic violence are supported and directed to help and not ignored or turned away. Only by working in partnership can we achieve the change in culture and attitudes that means that it is unacceptable in all sectors of the community for a man to be violent to his wife or partner.

Grampian has made a substantial investment in joint working for health, particularly in the last four years and welcomed the Scottish Executive's initiative to build public health capacity with a health improvement post in each local authority in Scotland. The additional funding supports each local authority as it develops its public health role, to tackle health inequalities and to promote the health of communities. The challenges in producing and implementing joint local health improvement plans within the framework of the community planning process will be assisted by working towards a shared understanding of the respective roles in improving the health of our communities.

Health Imperatives

In order to meet the health, social, educational and economic needs of the people of Grampian, a wide range of public organisations are working together sharing their skills, knowledge and resources. The development of data sharing agreements with the community planning partners will improve our data and planning to address life circumstance. As a priority, two networks are being developed. A Child Health Network will be established by March 2003 to develop a co-ordinated strategy for child health services.

Priority action includes targeting children, young people and their families in low-income households in disadvantaged communities. The two social inclusion partnerships tackle determinants of ill health in four communities of Aberdeen City and with young people in Moray.

Child Health in Grampian

Improving child and family health is both a national and Grampian priority. The importance accorded to this group is evidenced in the multi-agency attendance and input to the locally convened Child Health Improvement Programme Child Health Seminar held at the end of 2000. The outcome of this event and more recently, the application of the Health Improvement Fund resources was an acknowledgement of the need to improve the co-ordination of the planning and delivery of children's health services in Grampian. In response to this a review of current issues and working arrangements was commissioned with the ultimate objective of making recommendations to NHS Grampian on a way forward to developing a strategic framework for children's health services. The recommendations are for the appointment of a strategic co-ordinator and a clinical lead who will work together in partnership to develop the strategic framework. Central to this will be the development of a Grampian-wide NHS-based network which, ultimately, will expand to include local authorities, the voluntary sector and other agencies involved in the provision of services to children and their families.

Scotland's Health at Work in Grampian

Scotland's Health at Work is the national award scheme established in 1996 to reward employers who demonstrate commitment to improving health and well-being in their workforce. This unique partnership between private and public sector partners (CBI, STUC, Enterprise companies, CoSLA, Federation of Small Businesses, NHSScotland) now reaches almost 21% of the Scottish workforce with 661 organisations involved in the scheme. SHAW's energies in 2002-03 will be focused on working with small and medium sized enterprises plus supporting our public sector partners.

Joint Working to Improve the Health of Young People

NHS Highland has identified the health and well-being of children, young people and families as a priority. The core aims include:

• developing health and well-being through public health and health promotion activities

• developing a combined child health service within the NHS in Highland

• developing integrated child health services in partnership with the Highland Council and key agencies

• reducing health inequalities and promoting social inclusion amongst children, families and young people.

NHS Highland has worked closely with the Highland Council and its other partners to address these aims. Indeed, structures for integrated children's services delivery are well advanced in Highland.

The Joint Committee on Children & Young People presides over a structure that co-ordinates policy, service development and delivery across the responsibilities of Health, Education and Social Work. At the level of eight distinct areas in Highland ¹, services come together in Area Children's Services Forums. These Forums bring together Area Managers from Education and Social Work and Locality Services Managers from the Local Health Care Co-operatives.

New Community Schools in Highland

One of the principal vehicles for effective joint working has been the piloting of New Community Schools. The New Community School (NCS) concept is essentially about optimising educational opportunities and life prospects for children, by ensuring that they and their families are offered integrated education, social work, family support and health and health promotion services. The initiative is highlighted as a cornerstone of improving life circumstances in the 1999 White Paper Towards a Healthier Scotland.

The Current Situation in Highland

Two school clusters in Highland successfully applied to become New Community Schools - the associated school groups of Inverness High School and Alness Academy. Both are now into the final year of their 3 year programmes.

These pilots have been co-ordinated locally by the Area Children's Services Forum. Integrated multi-agency teams (typically comprising health, social work and community education) are co-located within the school base and are led by an Integration Manager. Multi-agency local management groups provide leadership and support locally and there is a central strategy group.

NHS Highland Input

This occurs at three levels:

• Membership of the NCS Strategy Group by NHS Board (Director of Public Health & Health Policy and Health Promotion Manager) and primary care managers including the Children's Services Manager. The strategy group overviews both NCS projects, as well as ensuring strategic alignment across health, child and family and education policy areas. It is also responsible for the strategic overview of evaluation and future New Community school roll-out. The Director of Education chairs the group.

• NHS membership of NCS local management groups is at LHCC level, though there is also input on an advisory level from Health Promotion and Public Health Specialists (such as in relation to sexual health). Local management groups are responsible, in conjunction with the Integration Manager, for operational planning and management.

• Operational input to NCS, through school nursing and other health professionals.

In addition, a whole time post has been funded from the Health Improvement Fund to support the development of health promoting schools across Highland. The post, which is jointly managed through Education and the Health Promotion Department, is initially focusing on the two New Community Schools. Priorities for the post include nutrition (largely through School Nutrition Action Groups), mental health and accidents.

The Pilots in Highland

The pilot projects' focus has been on the individual child, his or her family and the community. The aim has been to meet each child's needs in the round. The key has been the integrated provision of services - teachers, health professionals, social workers, community education workers, and others working together as a team. Additionally, many other personnel have become formally and informally aligned or associated with these core teams. This has allowed health professionals to work alongside other professionals on common objectives and as part of shared programmes of work.

Each project has fully recognised the extended role of the family and the community. As well as involving the wider community in specific planning events, the NCS pilots have welcomed and deployed volunteers from the community within strands of activity.

Many initiatives have taken a whole school approach, including out-of-school-hour activities, breakfast clubs and health promoting school developments. As well as targeting improved health for children, at both an individual and group level, each pilot has begun to take a real whole school approach by also addressing the health needs of school staff. Services and resources have been targeted at children, families and communities in greatest need. These services have been sustained at times when schools have traditionally been closed to local communities, including in the evenings and school holidays. The schools have also reached out into the local communities, with activities such as breakfast clubs and out-of-school care taking place in
local halls.

Tri-partite quality assurance processes, involving health workers alongside other professionals, have confirmed the success of this approach, in engaging both children and families and in making significant inroads to promote social inclusion:

• enhanced support to families

• improved school attendance

• evidence of sustained achievement

• heightened awareness of healthier lifestyles

• improved nutrition.

Evaluation

Evaluation of New Community Schools is being undertaken on a national and local basis. The Scottish Executive is managing the national evaluation. Locally, both quantitative and qualitative measures are being used, including those considering social inclusion, educational and health outcomes. Lifestyle surveys have been conducted in each school cluster, and both NCS have been subject to quality assurance (QA) visits undertaken by a multi-agency team comprising health, education and social work.

The Future

It is the intention of the Scottish Executive to roll out NCS across all schools in Scotland. Additional resources have been earmarked, which in Highland will amount to over 1 million per annum, with both existing and other new resources being added to order to enable roll out. The roll out of the New Community School approach across all schools in Highland is now being planned. This will focus around a number of key targets, including outcomes for improved health:

• percentage increase in number of 5-15 year olds free of dental caries

• percentage decrease in number of young people aged 12-15 engaging in drug, alcohol and substance misuse

• percentage reduction in pregnancy rates for 13-15 year olds

• percentage increase of schools with Health Promoting School status

• percentage of children looked after for more than 6 months with health needs - including mental health - assessed at least annually.

Nursing and Midwifery

2001 saw the publication of two landmark documents, Caring for Scotland - the Strategy for Nursing and Midwifery in Scotland and Nursing for Health - A Review of the Contribution of Nurses, Midwives and Health Visitors to Improving the Public's Health. Together these strategic reports set out the future direction for nursing and midwifery in Scotland. A direction based upon:

• Promoting health as well as health care

• Community and user participation in service development and delivery

• Social justice

• Effective partnership working between different professions, sectors and agencies

• Integrating clinical governance and effectiveness into service delivery

• Gaining maximum benefit from information technology.

Caring for Scotland

Caring for Scotland recognised that advances in knowledge and technology combined with public demands for greater involvement in deciding where, when and how care is delivered, require increasing flexibility and accountability from healthcare staff. The determination underwriting Caring for Scotland is that whatever the future shape of health care, Nurses and Midwives will be prepared to respond. They will be at the forefront in providing the best possible standards of care built on principles of partnership, accountability and professional excellence.

Some specific highlights of development over the year are summarised below:

National Review of the Contribution of Nurses to the Care and Support of People with Learning Disabilities

Health is important to all in Scotland and no more so for people with learning disabilities, many of whom have considerable health needs. As part of the evolving agenda set by The Same as You? A review of service for people with learning disabilities, it is important to identify the contributions made by health professionals, including nurses, where the emphasis is on promoting independence and social inclusion for all people with learning disabilities. A National Review of the contribution of nurses to the care and support of people with learning disabilities commenced in June 2001. Work involving users, carers, nurses and many others took place across Scotland to identify the range of contributions made by nurses and midwives now and the developments required in the future.

Clinical Leadership

Caring for Scotland and Nursing for Health recognised the importance of clinical leadership as a driver for improving the quality of care. Clinical leaders in nursing and midwifery need to have the ability to lead in their local teams and organisations, across professional and agency boundaries and in national forums. Sisters/charge nurses in hospitals and community settings are already acknowledged leaders who make crucial contributions to ensuring high standards of clinical care. Significant investment in developing the leadership skills of this group was made during 2001 as a vital component of leadership development in NHSScotland.

Professional Regulation

Legislation to introduce a new regulatory body for nursing was introduced to the Westminster Parliament in November 2001. On 1 April 2002, the Nursing and Midwifery Council (NMC) took over from the UK Central Council for Nursing, Midwifery & Health Visiting (UKCC) which has governed nurses for the past 22 years. The new streamlined organisation will be more flexible, more responsive and will allow development of professional standards to reflect the changing workforce needed by the modern NHS. As part of the establishment of the NMC, the role of the National Board for Nursing, Midwifery & Health Visiting for Scotland also ended on 31 March. Caring for Scotland proposed the establishment of a Scottish Nursing & Midwifery Education Council with a remit to support post-registration education. Development work during 2001 ultimately led to a more creative solution, bringing together responsibility for the education of all NHS staff into a new Special Health Board, NHS Education for Scotland. It will take a strategic approach to the development of multi-disciplinary skills, helping to underpin new models of working crucial to the modernisation of NHSScotland.

Nursing for Health

Nursing for Health recognised that nurses, midwives and particularly health visitors are all key members of the public health workforce. In doing so, it has created new opportunities and contributed to a new climate for health improvement work in NHSScotland. In particular, the creation of Public Health Practitioner roles in each LHCC has enhanced the value of public health work within LHCCs and created a vital bridge between public health practice and leadership. The new practitioners, coming from a variety of clinical backgrounds, will be catalysts for change, forming new partnerships and helping co-ordinate local activity to more effectively meet the health needs of communities.

The development of the public health nurse role, bringing together health visiting and school nursing into a single discipline, better equipped to meet the health needs of local communities, is already starting to have an impact on the effectiveness of practice. Further work during 2002 will focus on developing and applying the skills of the public health nursing community.

Facing the Future

On 19 November, the then Minister for Health, Susan Deacon, welcomed key players from the nursing and midwifery professions, the NHS, education and the private sector to a major recruitment and retention convention in Edinburgh. The purpose of the convention was to begin to address the long-term workforce needs of the NHS. Following the convention the Minister for Health and Community Care announced a 5 million investment in new initiatives to launch the national year of recruitment and retention in 2002. The initiative includes:

• Return to Practice programme

• Guaranteed minimum of 1 year's employment in NHS for 1,500 newly qualified nurses graduating by October 2002

• Creation of 1,000 clinical leaders by December 2002

• Nurse cadet schemes.

Taken together these developments reflect the vibrant nature of nursing and midwifery in Scotland. 2001 saw significant development building upon existing strengths to create an exciting vision of future practice.

Examples

Glasgow Primary Care Liaison Team

As part of the national review of the contribution of nurses to the care and support of people with learning disabilities, new and innovative nursing practice has been identified. The Glasgow Primary Care Liaison Team is one such example. Initially funded for 2 years by Greater Glasgow NHS Board, the Team, comprises specialist Community Learning Disability Nurses, a Health Promotion Officer, Speech and Language Therapist, Administrator, Research Assistant and sessional General Practitioners. The team all work collaboratively with Primary Care Teams, Glasgow University, Glasgow Healthy City Partnership, service users and carers to assess health need individually and across Glasgow. The Primary Care Liaison Team aims to improve access to and support Primary Care services by developing and promoting best practice. The work of the Team is being evaluated as part of on-going research and offers a potential model that could be developed across Scotland in the future.

NURSE/MIDWIFE CONSULTANTS

The advent of the Nurse/Midwife Consultant is recognised as a real opportunity for nurses and midwives to strengthen clinical leadership within the profession. Establishing nurse/midwife consultant posts will contribute to better outcomes for patients, clients or communities' multi-disciplinary teams, by improving services and quality of care. These posts more often involve cross-boundary, interagency and interdisciplinary collaboration and will reflect the local health planning and national policies and strategies. For example:

Nurse Consultant in Cancer Care

As part of their Trust Cancer Strategy North Glasgow University Hospitals NHS Trust developed a new clinical leadership post responsible for leading and developing cancer nursing practice in the Beatson Oncology Unit. The post holder has a key role influencing the development of cancer services in Scotland predominately through the Scottish Cancer Group, West of Scotland Regional Cancer Advisory Group and the Lead Cancer Nurses Forum (Scotland).

Consultant Public Health Nurse

Tayside NHS Board have developed the post of Consultant Public Health Nurse. The post holder takes a lead in identifying and addressing the health needs of homeless people as well as playing a key role in the Board's public health and primary care network and leading the development of public health nursing both locally and nationally.

1 Inverness, Nairn, Badenoch & Strathspey, Lochaber, Caithness, Sutherland, East, Mid & West Ross, and Skye & Lochalsh

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