The Scottish Government

« Previous | Contents | Next »

Listen

Health in Scotland 2003

CHAPTER 4 HEALTH SERVICES

Coronary Heart Disease and Stroke

The year following the publication of the Coronary Heart Disease (CHD) and Stroke Strategy for Scotland in October 2002 was one of considerable activity both within the Health Department and more widely across NHSScotland. A major strand of that activity was the allocation of the additional 10 million funding made available in 2003/04, the first tranche of a total of 40 million, over a three year period, to support the implementation of the Strategy.

Pump-priming of Managed Clinical Networks (MCNs) for Cardiac Services and Stroke was the first call on the additional investment, to enable Boards to appoint Network Managers to support lead clinicians. MCN development is more advanced in some areas than others but it is fair to say that steady progress is being made across Scotland. As part of the overall advisory framework for the Strategy ( Figure 4.1) two MCN Sub-Groups have been established and seminars have been organised to engage the wider clinical communities involved in MCN development. In addition, the Stroke MCN Sub-Group helped to organise (jointly with the Royal College of Radiologists) a meeting of stroke physicians and radiologists in November 2003.

Because of the national importance of this programme, funding has also been provided for a Strategy Manager and the development of national databases for CHD and Stroke. This work will build on projects already on the ground and in line with the national e-health strategy.

The balance of 6.5 million left from the extra 10 million available in 2003/04 was distributed approximately according to the Arbuthnott formula to each Board, to fund as many of the bids received as possible. A further letter issued to Boards and their MCNs in early December 2003, inviting bids against the 15 million additional funding available for Year 2 of the Strategy.

Following publication of the Strategy, two Advisory Groups were established: the National Advisory Committee for Stroke and the Scottish Cardiac Intervention Network Project Group. It fairly quickly became clear that what was required for CHD was (as in the area of stroke) a National Advisory Committee with a remit to provide advice across the whole range of coronary heart disease, from primary prevention to cardiac rehabilitation. The CHD advisory structure has therefore been restructured as indicated in Figure 4.1. In October 2003, Professor Ross Lorimer (who previously chaired the CHD and Stroke Task Force) was appointed by the Minister for Health and Community Care to the Chair of the National Advisory Committee for CHD and as lead clinician for the CHD element of the Strategy.

Figure 4. 1: New Structure for Taking Forward CHD Strategy in Scotland

In November 2003 the Minister announced a National Review of Cardiac Capacity in Scotland, to ensure that available capacity across all Cardiac Centres in Scotland, including the Golden Jubilee National Hospital, is used optimally over the next couple of years. The Review is being undertaken through the mechanism of the Regional Planning Groups and the National Advisory Committee on CHD, in close collaboration with the National Waiting Times Unit and the Departmental Implementation Group for CHD, chaired by Dr Aileen Keel, the Deputy Chief Medical Officer. It is expected to report in early 2004.

The Minister also brought forward a shorter waiting time target for coronary revascularisation. The current target of 24 weeks was due to fall to 18 weeks by the end of December 2004. Instead, this will now apply from June 2004 in light of the very significant reductions seen in waiting times for coronary revascularisation over recent months. The 18 week target is a minimum, rather than a ceiling beyond which Boards cannot go. Efforts to reduce further waiting times will require the optimal use of all spare capacity to provide better and quicker treatment for patients. This should help to sustain the continued progress in reducing mortality from CHD, as illustrated in Table 4.1. It should be noted that the rates are slightly different from tables published in previous reports. This is due to GRO revising the population estimates from 1982 onwards as a result of the 2001 census population.

Table 4.1: Coronary Heart Disease mortality - directly standardised rate by NHS Board of Residence

Notes
1 Cause of Death from 1992 to 1999 was based on ICD9 codes and from 2000 onwards GRO Death records use ICD10 codes. Please note that there is not a one-to-one mapping between these classification therefore trend analyses should be treated with caution. Diagnosis codes ICD9: 410-414, ICD10 I20-I25.
2 The age standardised rates were calculated using the direct method, standardised to the European population. GRO Population Estimates were used in the calculation of the crude and standardised rates.
Reference: Acute Care Information Group, IR2003-01563
Source: ISD (based on data from GROS)

The review of hospital stroke services by NHS QIS against the Standards published in 2003 will similarly help to continue the downward trend in stroke mortality shown in Table 4.2.

Table 4.2: Stroke mortality - directly standardised rate by NHS Board of Residence

Notes
1 Cause of Death from 1992 to 1999 was based on ICD9 codes and from 2000 onwards GRO Death records use ICD10 codes. Please note that there is not a one-to-one mapping between these classification therefore trend analyses should be treated with caution. Diagnosis codes ICD9: 431-438, ICD10 I60-I69, G45.
2 The age standardised rates were calculated using the direct method, standardised to the European population. GRO Population Estimates were used in the calculation of the crude and standardised rates.

Reference: Acute Care Information Group, IR2003-01563
Source: ISD (based on data from GROS)

The Scottish Ambulance Service has been undertaking work to reduce the time taken for patients with suspected myocardial infarction to receive thrombolytic ('clot busting') therapy. This 'call-to-needle' time is a critical interval and it is generally accepted that it should not exceed one hour. In remote and rural communities such a standard can be achieved only by thrombolysis being delivered pre-hospital. Two models of delivery have been under evaluation.

In a project funded by the Remote and Rural Areas Resource Initiative (RARARI), the Scottish Ambulance Service has been testing the dual response model where the rural GP attends a patient presenting with chest pain simultaneously with an ambulance paramedic. The latter provides the 12 lead ECG and thrombolytic therapy. This model has been applied to 23 ambulance locations within five NHS Board areas which met the criteria of more than 30 minutes' travelling time to hospital, adequate paramedic staffing and expressions of interest by local GPs. Joint training took place in 20 one-day workshops. The thrombolysis agent was supplied and funded by the NHS Board.

Between December 2000 and the RARARI project going live, 227 patients from the pilot sites were given thrombolytic therapy, 150 (66%) in a District General Hospital (DGH) and 77 (34%) by GPs pre-hospital. Between going live and November 2003, 357 patients received thrombolytic therapy, 197 (55%) in a DGH and 160 (45%) pre-hospital. Included in the latter figure are 46 patients who received tenecteplase administered by GPs assisted by the ambulance service (dual response). The median call-to-needle time for these patients was 48 minutes, with 78% being under 60 minutes.

Following the introduction of dual response, the proportion of patients receiving pre-hospital thrombolysis increased from 34% to 45% and the median call-to-needle time fell from 115 to 90 minutes. It is interesting to note that in these rural communities the first call was most often for a general practitioner (72%) and 88% of patients were seen by a doctor before referral to hospital.

At the same time as the RARARI Project, a different model of pre-hospital thrombolysis provision was pioneered in Angus, resulting in a change of service following the suspension of acute medical receiving at Stracathro Hospital. Here the paramedics deliver thrombolysis on their own under a patient group direction but with decision support from a specialist centre using telemetric transmission of the 12 lead ECG.

In the first 12 month period, 201 patients were studied with changes in the ECG that were diagnostic of acute myocardial infarction or who received thrombolysis for suspected myocardial infarction. The median call-to-needle time for patients treated before arrival in hospital (n=28) was 52 minutes: patients from similar rural areas who were treated in hospital (n=43) had a median call-to-needle time of 125 minutes. There was a median time saving of 73 minutes.

Eighteen of the 28 'pre-hospital' patients had received thrombolysis within 60 minutes compared with two out of 43 in a cohort from similar areas. Twenty-five of the 28 patients had the diagnosis of acute myocardial infarction confirmed. The Angus study showed that paramedics, with telemedicine decision support, could safely and effectively administer thrombolysis early after the presentation of acute myocardial infarction with significant reduction in call-to-needle time in patients from rural areas.

On the basis of these studies the Scottish Ambulance Service has agreed with the Health Department on a strategy for training and equipping all paramedics in the Scottish Ambulance Service to deliver early thrombolysis where appropriate. This strategy is due to be in place by the end of fiscal year 2005 and discussions are being held with each NHS Board on plans for local implementation.

Since the launch of Cancer in Scotland: Action for Change in 2001, there have been considerable changes in the way that Scotland thinks about, plans and manages cancer services. The additional investment that is now in place has secured at least 330 extra staff including doctors, nurses, radiographers and pharmacists. Almost 13 million has provided vital equipment for diagnosis and treatment, bringing significant improvements in standards of care and more rapid diagnosis and treatment. The 25 million recurring investment will continue to be dedicated until at least 2005/06 when the position will be reviewed again.

The Cancer in Scotland: Action for Change Annual Report was published in October 2003 at the third Cancer Open Forum. It includes details of specific investments and outcomes. Twice yearly regional monitoring reports are also available from www.cancerinscotland.scot.nhs.uk .

Survival from Cancer

In 1999, the Scottish Executive committed itself to a 20% reduction in deaths from cancer in the under 75s by 2010. While results are on track to achieve that, there is still some way to go. In 2002 there were 150.6 deaths from cancer per 100,000 of population, which is an improvement of 10.4% on the 1995 baseline.

Screening Programmes

The past year has seen the start of further developments in both the breast and cervical cancer screening programmes. Raising the upper age for routine invitation for breast screening to 70 years is being introduced on a phased basis across Scotland from spring 2003. Once fully introduced, women over 70 can continue to refer themselves for screening. Liquid based cytology (LBC) is being introduced into the cervical screening programme and it is expected to reduce the number of women requiring a repeat smear. A new national cervical screening call-recall system should be fully introduced by the end of 2006.

The Evaluation Report on the Colorectal Cancer Screening pilot was released in July 2003. It confirmed the potential benefits of colorectal cancer screening and that screening through faecal occult blood (FOB) testing was feasible in an NHS setting. A number of areas for further work were identified, including the impact on primary and secondary care services and workforce and training requirements. These issues are being considered and the process of planning for the introduction of a national screening programme has started. It is expected that this will take up to five years. The UK National Screening Committee will be considering the Evaluation Report and their advice will be taken into account as part of the planning work.

Breast cancer waiting times

Our National Health: A plan for action, a plan for change, published in December 2000, stated: "By October 2001, women who have breast cancer and are referred for urgent treatment will begin that treatment within one month of diagnosis, where clinically appropriate." This target is challenging. Through the additional support provided by the Cancer Service Improvement Programme and a continuing focus on service redesign, further improvements in performance are anticipated in the coming year. The most recent report shows that, nationally, 81% of women who have breast cancer begin their treatment within one month of diagnosis, where clinically appropriate.

Cancer Service Improvement Programme

Service redesign is an important feature of implementation of Cancer in Scotland. An additional 1 million is being invested to accelerate the pace of change across the three regional cancer networks, with a view to improving experiences and outcomes for patients. The first phase of the programme is aimed at colorectal, gynaecological and lung cancer services in each of the three networks.

Positron emission tomography (PET)

In October 2002, the Health Technology Board for Scotland published a Health Technology Assessment on positron emission tomography (PET) imaging in cancer management, recommending that a PET imaging facility should be established in Scotland. In March 2003, the Minister for Health and Community Care announced 5 million capital funding from 2004 to 2005 to support the programme. Guidance was issued to NHSScotland in December 2003, setting out next steps in planning for the provision of PET services in Scotland.

Radiotherapy equipment planning for the next decade

Against a background of significant projected increases in the incidence of cancer in Scotland, the Minister ordered a review of radiotherapy activity pathways. The implications of current provision, future demand and possible locations of radiotherapy services on patient journey times were analysed by a short-life working group. The report was considered by the Health Department Management Board who agreed that an appraisal should be carried out, involving economic and further statistical input and modelling, to assess the options to meet the projected level of need.

Development of Cancer Managed Clinical Networks

To support the ongoing development of tumour specific networks, regular national tumour specific learning days were held throughout 2003 for breast, colorectal, gynaecological and lung cancers. A one-day programme focusing on primary care aspects of cancer care was held in April. All these events attracted participation from a wide range of staff from NHSScotland in the primary, secondary and tertiary care settings. Outcomes and reports of the events are available from www.cancerinscotland.scot.nhs.uk .

Cancer Open Forum

The third annual Cancer Open Forum was held in October 2003, focusing on Change and Innovation in Cancer Services. More than 400 delegates heard presentations from international experts from the USA, Europe and England and participated in practical workshop sessions with Scottish lead clinicians and others.

Mental health has a high profile and continues to be a significant area for national and local action. Within the Executive, mental health policy has been centred in the Mental Health Division, bringing together mental health promotion, anti-stigma and suicide prevention, mental health care and treatment services and the implementation of the new Mental Health (Care and Treatment) (Scotland) Act 2003. The Executive can now work more effectively with NHS Boards, Local Authorities, the voluntary sector, people with mental health problems and their carers to implement an integrated mental health policy for Scotland.

Improving Mental Health and Well-Being

The work of the Executive's National Programme for Improving Mental Health and Well-Being continues apace. In June, guidance was given to Local Authorities and their Community Planning Partners on the implementation of the Choose Life National Suicide Prevention Strategy. There are now 32 local Suicide Prevention Action Plans in place and 9 million of support funding is available to increase local action over the next three years. In September, the National Programme's three year Action Plan (2003-06) was published, setting out the agenda for mental health improvement. 24 million is being invested in the implementation of this plan over the next three years.

The second phase of the see me... national anti-stigma campaign which was launched in October has achieved a high level of recognition and is beginning to make an impact in challenging stigmatising attitudes and behaviours.

Improving Services

In June, the Minister addressed an audience of mental health service stakeholders on moving the mental health services agenda forward. The event was an opportunity to listen to users of services, carers and care providers about the progress being made in improving mental health services and to find ways of maintaining momentum to create modern mental health services. NHS Boards and their Local Authority partners spend in excess of 630 million on direct mental health services. Ensuring that services are locally accessible and effective in responding to people's needs is complex and challenging.

Progress is being made across a range of issues in mental health services. For example:

• national workforce planning for mental health services is in progress

• implementing single shared assessment, joint resourcing and joint management of local mental health services is due to be achieved by April 2004

• the development of a Managed Care Network for mentally disordered offenders has begun to help address the organisation of service provision nationally and regionally

• a working group on perinatal mental illness (including postnatal depression) has been set up to provide guidance for services

• the report of the Scottish Needs Assessment Programme (SNAP) review of child and adolescent mental health was published in March. The Child Health Support Group is now taking forward the implementation of its recommendations.

The Mental Health (Care and Treatment) (Scotland) Act 2003 is a milestone in mental health law and will bring real benefits to people with mental health problems and those who care for them. The Minister commissioned an assessment of local services' readiness to cope with the requirements of the new Act, which is to be implemented by April 2005. The interim report and locality profiles, published in November 2003, will inform the joint development of local NHS Board and Local Authority implementation plans. Further funding of 15 million, in addition to the 30 million already allocated, has been made available over the next three years to help the local implementation process.

Doing Well by People with Depression is a 4.5 million programme aimed at supporting a number of local areas in the redesign and improved use of resources to provide better care in the community for people affected by depression. This innovative programme, combining public information, self-help activities and improved local services, will run for three years and will be independently evaluated.

There is considerable concern about the connection between mental illness and poor physical health. Research confirms that people with mental ill-health have increased rates of physical illness, much of which goes undetected, resulting in increased rates of morbidity and mortality. The Executive is keen to see progress in addressing the physical health needs of people with mental health problems. Smoking cessation programmes aimed at people in touch with mental health services are examples of interventions that will help make a great improvement to the quality of life and health of people with mental health problems.

Significant progress was made during the year to take forward the commitments in the Scottish Diabetes Framework (April 2002), which sets out a national strategy for the improvement of diabetes care. The Scottish Diabetes Group continues to monitor and support the implementation of the Framework on behalf of the Executive.

Managed Clinical Networks are at the centre the Framework's ambitions for fully integrated diabetes services and pump-priming funding of 50,000 per NHS Board was made available from May 2003 to allow for the appointment of a Network Manager. Boards are making progress with these appointments and the identification of Lead Clinicians for the Networks.

Diabetes is the leading cause of blindness among people of working age and is perhaps the most feared complication of the condition. In June 2003 the Scottish Diabetes Group published Diabetic Retinopathy Screening Services in Scotland: Recommendations for Implementation which set out recommendations for developing a national screening programme. The report was accompanied by a Health Department Letter (HDL(2003)33) setting out the steps which NHS Boards should take to evolve a comprehensive service, based on digital photography, by March 2006. In May 2003, NHS QIS published draft standards for diabetic retinopathy screening and the Scottish Diabetes Group has produced a Training Handbook aimed at those involved in grading images. National Services Division is helping to develop a programme capable of offering annual eye screening to all 160,000 people with diabetes in Scotland.

A cornerstone for the delivery of effective and efficient care is high quality patient data. A shared patient record is being created which (subject to appropriate data security safeguards) all members of the healthcare team can access and add to. Implementation of the SCI-DC clinical management system continued throughout 2003, with notable progress in Lothian and Greater Glasgow. In January 2003, the Scottish Diabetes Core Dataset was published, defining the data items to be incorporated into clinical information systems and shared among all those caring for people with diabetes. This report was followed in December 2003 by the Scottish Diabetes Core Dataset: Primary Care Subset and Extension which focuses on the diabetes data requirements of primary care, in particular those items which relate to the new General Medical Services (GMS) contract.

During 2003, NHS QIS reviewers visited each NHS Board to assess performance against the clinical standards for diabetes services, published in October 2002. The reports of these visits will provide an invaluable assessment of diabetes services in Scotland, highlighting examples of innovation and good practice as well as pointing to areas requiring improvement.

The Scottish Diabetes Group worked with the National Resource Centre for Ethnic Minority Health during the year in preparing a report on the prevalence and impact of diabetes on minority black and ethnic groups in Scotland.

A competency framework for health professionals involved in the care of those with diabetes was published by NES in March 2003. Two part-time project officers have been appointed to help develop a framework for inter-professional education and training in diabetes management.

Framework for Nursing in Schools

The Framework was launched in March by the Minister for Health and Community Care and the Minister for Education and Young People. For the first time, clear standards for nursing services in schools and a clear direction for the future are provided. The Framework sets out a strong health improvement role for school nursing linked with a reduction in screening, as proposed by Health for All Children, fourth edition. It also recognises the growing need to develop specialist skills in order to support children with complex health needs who, thanks to medical interventions, are living longer but increasingly requiring packages of care and support in school. The Framework is only the start and NHS Boards will develop action plans for its implementation with their Education partners.

Family Health Nurse Project

The Family Health Nurse is a skilled generalist with a focus on health as well as caring for those who need help through illness or disability. He/she works with families rather than with individuals within them.

A pilot of the WHO's Family Health Nurse concept has been ongoing in the Highlands, Western Isles, Orkney and Argyll and Clyde since 2001. It is the furthest advanced of ten sites across the WHO European Region. The focus has been on developing the role in remote and rural areas, providing clinical skills in these areas which have traditionally relied on nurses with multiple qualifications. Thirty-one nurses were trained in the pilot sites, each of whom completed a one year degree programme at Stirling University.

At an International Conference in October, delegates from the WHO pilot areas came together to discuss the development of this new role. A project report and an evaluation report of the pilot were published to inform the future direction of the project and its wider implications for community nursing. The next phase of development was also launched. This will include a re-focusing of the education programme and a new pilot site in Glasgow to test the approach on an inner city population.

Framework for Nursing in General Practice

Work is underway to develop a Framework to support the development of nursing alongside the implementation of the new GMS contract. Changes in the contract are likely to support greater diversity of roles and delegation of duties to other team members. The Framework will be a resource to practices in supporting local flexibility and development within a structure of good staff governance. The Framework will be published in spring 2004.

Scottish Maternity Development Programme

The aim of the Programme is to develop relevant, quality assured maternity courses that will be accredited by NHS Education for Scotland (NES). In order to facilitate the accreditation, a Scottish Multiprofessional Maternity Education Group has been established. The Royal College of Midwives will act as the host organisation for this group with responsibility for organising Institutional approval, leading on validation, events and administration. Funding has been earmarked for training and education to increase the skills of midwives and to employ newly qualified midwives in order to release existing staff for training.

Facing the Future

Several initiatives have been taken forward under Facing the Future. There has been the successful return to practice of 273 nurses and midwives, of whom 90% are now working in NHSScotland. A similar number are expected to return in 2003/04. There has also been a marked increase in the recruitment of student nurses, with 525 additional places being filled. In order to support these initiatives, the Health Department is working with NHS Trusts, Higher Education Institutions and NES to establish 100 Practice Educators.

Research and Development Nursing and Midwifery

Nursing and Midwifery are relatively new players in the research and development field, with a history that spans only 40 years or so. Partnership and collaboration are identified as the key to effectively harnessing the range of skills, experience and abilities available to NHSScotland in the pursuit of excellent care for service users and carers.

SEHD, Chief Scientist Office (CSO) and NES with the Scottish Higher Education Funding Council (SHEFC) have agreed to support initiatives to develop research capacity and capability in nursing, midwifery and allied health professions. This is part of a national commitment to extend research excellence in healthcare and promote investment in high quality health and community research.

Nurse Consultants

Consultant nurse/midwife posts are intended to provide better outcomes for patients by improving services and the quality of care across the healthcare system. There are now 19 nurse consultants in post across NHSScotland with a further six posts awaiting appointment, bringing this to a total of 25 consultant nurse/midwife posts in Scotland. There is a commitment to increase the number to 54.

Nurse Prescribing

Nurses are now able to work as Supplementary Prescribers, as well as District Nurse/Health Visitor and Extended Independent Prescribers. Supplementary Prescribers prescribe in partnership with a doctor or dentist. They are able to prescribe all medicines (with the current exceptions of Controlled Drugs, unlicensed drugs unless they are part of a clinical trial and any restrictions set by Schedules 10 and 11 of the NHS (General Medical Services) Regulations). They may prescribe for the full range of medical conditions, provided that they do so under the terms of a patient-specific Clinical Management Plan (CMP). There are now around 300 nurses qualified as Extended Independent and Supplementary Prescribers in Scotland, with numbers increasing all the time.

Children's oral health in Scotland remains poorer than that in England and Wales and in many comparable European countries such as the Netherlands. However, some progress has been achieved to date, with 45% of Scottish five year olds now being free from dental decay. The national target is to have 60% of five year olds free from dental decay by 2010.

National Dental Inspection Programme (NDIP) data for 2003 demonstrate a continuing gap between the best and the poorest levels of oral health in Scotland. In NHS Borders, dental disease levels compare favourably with the best oral health in Europe but in Boards such as Argyll and Clyde and Greater Glasgow oral disease levels are comparable with the less well-developed European nations.

However, significant progress has been made towards establishing a culture of regular oral self-care amongst young children in Scotland, which should be reflected in their future oral health. This has been achieved through a sustained community programme supporting the distribution of free toothbrushes and toothpaste to all Scottish children in infancy and early childhood, with particular emphasis on reaching children in areas of deprivation. This measure encourages the development of a life-long awareness of the importance of good oral hygiene and, in the absence of fluoridation of the public water supply in Scotland, helps to ensure the delivery of fluoride to the developing teeth of the most vulnerable children.

In addition, the introduction in 2001 of the Caries Prevention Scheme for children aged six and seven has helped to promote a more preventive approach to the oral care of children. The scheme encourages a holistic approach to oral care, including fissure sealing of the first molar teeth at risk of decay and the delivery of preventive advice.

It is accepted that reaching the national oral health target for five year olds requires a broader approach, involving a wide range of stakeholders throughout Scotland. The consultation on children's oral health Towards Better Oral Health in Children (2002) highlighted the value of individuals, health professionals and organisations working together to bring about real and sustained progress in improving children's oral health in Scotland. NHS Boards, Local Authorities, health professionals and educational establishments all have a part to play.

Health Visitors have traditionally been closely involved in supporting parents in achieving good oral health for their children. This role should be developed and supported. The potential for school nurses to build on this work with older children, through contribution to school health policy, is set out in the Scottish Framework for Nursing in Schools (2003).

There is considerable potential for Community Health Partnerships to take an active role in improving health, including oral health, by providing a focus for local integration of health and Local Authority policy to ensure the best possible opportunities for health improvement. This, combined with the ongoing review of dental services, will provide a real opportunity to reshape oral health services in Scotland. It should ensure that preventive oral healthcare is encouraged and rewarded in any new dental service framework in a manner which will bring about sustained improvements for the oral health of children in Scotland.

By 2031, there will be 1.2 million people over 65 (compared with 787,000 in 2000) and 150,000 over 85 (compared with 84,000 in 2000) living in Scotland. NHSScotland must therefore plan strategically to meet the healthcare needs of older people. Success is more likely if the views of today's and tomorrow's older people are sought at an early stage.

The healthcare of older people is a priority for NHSScotland. An Expert Group on the Healthcare of Older People (EGHOP) published its report Adding Life to Years in January 2002 as a focus for improvements in health and healthcare of older people. An Implementation Group has been set up to monitor the work being done throughout Scotland to ensure that older people have the services they need, both now and in the future.

Its first annual report, published in December 2003, is linked to and reflects discussions at the first national conference exploring the main themes of the original EGHOP report. Together, they provide an opportunity for all the interests involved in the preparation of Adding Life to Years to maintain their participation in these issues and for the voices of older people to continue to be heard. The report reviews progress, identifies promising developments and looks beyond healthcare to the wider set of policies on ageing.

There have been several important developments in relation to older people in 2003. The National Physical Activity Strategy Let's Make Scotland More Active was launched in February 2003. It highlights recommendations specifically for older people. It emphasises the physiological, psychological and social benefits of physical activity for older people and identifies ways to support adults in later life to become more physically active. Inspections of care homes will include an assessment of the opportunities for physical activity.

A programme designed to meet the health education needs of older people is being developed by NHS Health Scotland and older people are one of the six priority areas in the National Programme for Improving Mental Health and Well-being. Over the period to 2006, NHS Health Scotland will work with others to develop Health in Later Life Interest groups across Scotland, to fund local initiatives aimed at supporting and promoting mental health and well-being in later life and research and dissemination work.

These initiatives complement other work which also impacts on well-being, including tackling pensioner poverty, improving housing, health and access to transport. Other significant areas of work include:

• extending the pneumococcal vaccination policy to include all people aged 65 years and over

• increasing to 70 the upper age of invitation for breast screening

• funding support to modernise audiology services

• measuring performance against standards for older people in acute care

• Joint Future Agenda being implemented across older people's services from April 2003

• continuing to tackle delayed discharge

• developing a National Equality and Diversity Strategy for NHSScotland

• tackling fuel poverty through the Central Heating Programme and Warm Deal.

« Previous | Contents | Next »