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Building a Sustainable Scotland: Sustainable Development and the Spending Review 2002
HEALTH AND COMMUNITY CARE
To improve the health and quality of life of people in Scotland and deliver integrated community care services, making sure there is support and protection for those members of society who are in greatest need
Social Justice
Financial resources will continue to be allocated to NHS Boards over the period of the current Spending Review on a basis which, in the financial year 2001-2002, recognised for the first time not only population size, age and gender but also deprivation and rurality/remoteness. As from 1 April 2002 capital has been allocated on a broadly similar basis to that used for revenue resources but will additionally recognise cross border flows for specialised regional services.
Enhanced expenditure levels are therefore being increasingly targeted to ensure that not only should the overall health of the people of Scotland be improved relative to other European nations but, by including deprivation and rurality/remoteness in the formula for allocating revenue and capital resources, we will progressively reduce the inequalities which currently exist in the health of Scotland's population. Given that such inequalities exist it is accepted that better indicators of health inequality are required. An expert group has been created to produce such indicators and a programme of research is also underway. Establishing such indicators will assist in enabling future financial resources to be even more effectively targeted and will enable NHSScotland to measure progress in reducing existing inequalities.
Considerable effort will continue to be expended on health improvement and the promotion of healthy lifestyles. Resources spent in these areas should result in a positive impact on the overall health of the population of Scotland which will further ensure that we can make best use of finite financial resources. Initiatives tackling inequalities are aimed at a variety of levels - geographic area, income level, and age, with particular emphasis being placed on improving the life circumstances and lifestyles of young people.
For example, by reducing the proportion of women who smoke during pregnancy and increasing the proportion of mothers breast-feeding we aim to transform the health of Scots in the early years of life. Such measures will be reinforced not only by initiatives targeted at teenagers, which aim to reduce the level of inappropriate drinking and smoking of this age group and to increase the proportion engaging in physical exercise, but also by similar initiatives targeted at those of working age.
By targeting in this way we will help to achieve a healthy productive population for Scotland for the foreseeable future. These initiatives are seen as having significant sustainable development benefits at a time when the elderly population will continue to increase as a proportion of Scotland's population and the proportion of the population of working age will decrease.
Admittedly some of the initiatives may appear to have a relatively insignificant impact but collectively they should be significant and are very much in accord with the Sustainable Scotland "butterfly" campaign and its philosophy of "do a little, change a lot" delivered through a focused and integrated approach.
Energy
NHSScotland has an impressive record in energy efficiency with total energy consumption for 2000-2001 showing a 6% reduction from the previous year. 2000-2001 was the last year in a 15-year target period, which saw energy consumption fall by a total of 34%. Although this is a significant achievement we are determined to pursue further reductions. Accordingly over the period 2001-2010 we are determined to achieve a further 2% annual reduction in energy use, which will have a significant environmental impact.
Waste Management
Although waste management standards are generally high within NHSScotland the Department is keen to secure further reductions not only in the quantum of waste produced but also in the amount of waste which can be classified as domestic waste and thus appropriate for recycling. Research is ongoing to determine how recycling levels can be improved by improving technical and operational best practice which will be shared among NHS bodies. For example NHS bodies are now required to introduce segregation policies for clinical and domestic waste which should further contribute to recycling initiatives.
Environmental Management Policy
The Department's Environmental Management Policy is currently being reviewed and a central tenet of this policy is that all NHS bodies must have an effective environmental policy in place by which these bodies can continually improve the environmental performance of their buildings and pursue procedures consistent with the European Union and Scottish Executive commitment to Sustainable Development.
At a national level carbon dioxide emissions continue to fall and emissions associated with NHSScotland Trusts' use of energy were 35% lower in 2000-2001 than in the 1989-1990 base year. Water consumption also continues to drop and the volume of trade effluent produced is now levelling off.
That progress continues to be made in environmental management by NHSScotland is confirmed by four NHS Trusts now having achieved ISO 14001 certification - the International Environmental Management Standard. The development of Greencode, an Environmental Management Tool developed by NHSScotland, has been central to those achievements and further work is being undertaken to develop a corporate form of Greencode which should enable further Trusts, particularly Primary Care Trusts to achieve ISO accreditation. The success of Greencode can be further demonstrated by its growth outwith Scotland, with 36 Trusts in England and Wales and one in the Republic of Ireland registering as users.
Travel
Consultants have recently reported on a study entitled
Transport Impacts of Major Healthcare Developments. This study considered how transport issues were taken into account in the decision to locate the new Royal Infirmary of Edinburgh at Little France and produced recommendations on those issues to be incorporated into future appraisals for capital investment in healthcare facilities. These recommendations were taken into account as part of the Glasgow Acute Strategies Review and will be required to be considered in future Acute Strategy Reviews in Forth Valley, Fife and Tayside.
The Department requires NHS bodies to have in place Environmental Management Policies which address the need for Travel Plans to be prepared when considering capital investments. As an example North Glasgow University Hospitals NHS Trust are currently in discussion with the local planning authority concerning measures to facilitate travel by public transport to its Gartnavel site, which will be upgraded in the near future. Measures under consideration include the building of pedestrian over-bridges to access local train/underground stations; subsidies to staff to encourage travel by public transport and car-parking charges.
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