The Scottish Government

• Identification of a lead within the NHS Board to champion implementation of the national Hall 4 guidance and work with local authority partners to consider and address the implications for local authority staff.

2005/06

• Universal and targeted programmes for child health surveillance, screening and health promotion, should be clearly defined and established in each NHS Board. They should be designed to ensure access and take-up by children and families who are vulnerable or at risk of social exclusion. This will require:
  - A review of existing arrangements for universal child health screening and surveillance, including the
  way in which resources are allocated.
  - Close alignment with local authority planning for services for children and families in need.
• Community Health Partnerships ( CHPs) have a key role in the implementation of the national Hall 4 guidance. The additional advice for CHPs on integrated child health services states that CHPs should nominate a member of their senior management team to take the lead responsibility for the operational delivery of child health services. This responsibility will include delivery of child health promotion, screening and surveillance in accordance with this guidance.

2005/06

• NHS Boards should work with their local authority partners to develop and agree a development plan for
  local implementation of the national Hall 4 guidance over a three year period, which:
  - Identifies key actions, milestones, timescales for implementation.
  - Identifies mechanisms to support, train and develop staff across agencies in delivering Hall 4, including inter-agency training and development opportunities.
• NHS Boards should work with their local authority partners to identify appropriate link funding streams such as the Changing Children's Services Fund and those associated with the Additional Support for Learning Act, waiting times initiatives, and the Oral Health Strategy.

2005/06

• NHS Boards should work with their local authority partners to review the numbers, availability, distribution and skills base of staff required to deliver Hall 4, to inform strategic workforce planning and development.

2005/06

• NHS Boards will need to work with their local authority partners to ensure that child care practitioners, teachers and other staff are equipped and supported to use opportunities for health promotion and early identification of problems effectively, and that they are aware of the appropriate response to concerns. This will require:
  - Allocation of a named health visitor or school nurse to each school and early years establishment, with access to a wider network of health support.
  - More and regular health visitor or school nurse time in family centres, early years and school settings, to enable effective liaison, support and training for non-health professionals as well as a source of advice and support for parents.
  - Clear referral protocols and pathways which are familiar and accessible to non-health professionals.
  - Provision of open access services in pre-school settings along the Integrated Community Schools model.
  - A programme of in-service training for non-health professionals.

2005/06

• NHS Boards should ensure that measures are in place to provide professional support for health visitors and school nurses in their work with other agencies to deliver targeted programmes of additional and intensive support for families in need or at risk.

2005/06

• In order to ensure allocation of NHS resources to areas of greatest need, NHS Boards and local authorities will need to consider any measures necessary to attract key professionals to work in areas of high concentration of need - for example, in remote and rural communities and in areas of deprivation.

2005/06

• NHS Boards and their partner agencies should ensure that all parents are provided with written information about pregnancy and birth, and healthy infant and child development (and that information is provided in an alternative format or language if needed).

2005/06

• NHS Boards should provide health promotion advice for parents, children and young people through primary care settings, family centres, childcare and pre-school centres and schools.

2005/06

• NHS Boards should provide access to information and professional advice about specific aspects of child development and behaviour through groups and workshops.

2005/06

• NHS Boards should provide support for parents through local community networks for healthy living - for example breastfeeding networks.

2005/06

• NHS Boards should incorporate health promotion and prevention activities and policies within the core child health programme, including:

- Nutrition and physical activity
- Oral health
- Unintentional injury
- Mental health and wellbeing
- Drugs and alcohol
- Sexual health
- Smoking

2005/06

• NHS Boards should review the way in which health promotion information is provided to ensure maximum impact. This should include:
  - Dissemination of specific health promotion materials at regular contacts (e.g. mail shots for immunisations.), coupled with -
  - Provision of information for parents and young people about access to advice about health and any concerns they have (e.g. NHS 24, special clinics)
  - Community support (e.g. work within existing community networks)

2006/07

• NHS Boards should review and develop targeted health promotion and prevention activity to maximise impact with particularly vulnerable groups.

2005/06

• NHS Boards should ensure co-ordination of the local paediatric audiology programme, including screening, training, audit and monitoring.

2005/06

• NHS Boards should abandon universal distraction testing at 7-9 months once Universal Neonatal Hearing Screening has been in place for one year.

2005/06

• NHS Boards should continue the school entry hearing sweep test, unless already abandoned. No further routine hearing testing should be undertaken.

2005/06

• NHS Boards should review local arrangements for access to paediatric audiology services and staff training to ensure efficient referral and testing for children with suspected hearing loss.

2005/06

• Each NHS Board should designate a Child Health Vision Screening Co-ordinator (similar to the Pregnancy & Newborn Screening Co-ordinator) to take overall responsibility for monitoring vision screening programmes and ensuring the Hall 4 recommendations on vision screening are imlemented.

2005/06

• All children should be screened by an orthoptist in their pre-school year, between the ages of four and five years. Once this is in place, vision screening on school entry should cease.

2006/07

• Until an orthoptist pre-school vision screening programme is in place, children's visual acuity should be tested on school entry by an orthoptist, or through a programme which is supervised by an orthoptist or an optometrist.

2005/06

• NHS Boards should continue vision screening in secondary school at a single point only, unless already abandoned. No further routine vision screening should be undertaken.

2006/07

• NHS Boards and local authorities should make arrangements for any child undergoing assessment for educational under achievement or other school problems to have a visual acuity check.

2005/06

• NHS Boards should ensure that vision screening is undertaken in schools for children with hearing impairment.

2005/06

• NHS Boards should make arrangements for routine recording of height, weight and BMI at school entry. No further routine recording, except on a 3-yearly basis at P7, to be triggered by the Child Health Surveillance Schools System.

2006/07

• NHS Boards should work with their partner agencies to introduce the core programme for the early years as described in Annex 1 of the national Hall 4 guidance, including arrangements to provide care in line with the diagram on page 5.

2006/07

• NHS Boards should ensure that a universal health promotion contact is provided for all families with children at aged 2 years, in line with the approach described on page 35 of the national Hall 4 guidance.

2006/07

• NHS Boards should work with their key partners to establish explicit care pathways for parents or early years professionals who have concerns about a child's health or development. These should be developed and disseminated in line with advice on page 38 of the national Hall 4 guidance.

2006/07

• NHS Boards should ensure that parents are provided with accurate information about the normal range of child development and where to seek advice if they have concerns. NHS Boards and local authorities should ensure that information is available about local services.

2006/07

• Where there are concerns about a child's presentation or development, a formal assessment should be undertaken to confirm or refute initial suspicions. This should be undertaken as part of a more comprehensive clinical assessment involving the network of child development services and should include consideration of referral to a community paediatrician.

2006/07

• NHS Boards should work with their partner agencies to implement the core programme described in Annex 1 of the national Hall 4 guidance, and ensure that services and systems are in place to meet any additional or intensive support that children and young people require.

2006/07

• NHS Boards should work with their local authority partners to ensure that robust mechanisms are in place for the efficient transfer of any information about a child's health needs when a child moves between educational establishments and between education and health settings.

2006/07

• Independent schools should ensure that arrangements are in place for pupils to receive health promotion advice and child health checks, consistent with this guidance and other health improvement policies.

2006/07

• NHS Boards should work with their local authority partners to identify children and young people who are not in school, and to ensure that they receive care and support consistent with the core child health programme outlined in the national Hall 4 guidance.

2006/07

• NHS Boards should work with their local authority partners to assess patterns of need within communities in their area. Allocation of NHS resources, such as input from health visitors, public health practitioners and health promotion professionals, should reflect concentration of need.

2005/06

• NHS Boards should redesign health visiting services to provide more effective support for those individual children and families most in need.

2005/06

• NHS Boards will need to ensure that mechanisms are in place for recording decisions about individual families' assessed level of need and associated health visitor input.

2005/06

• NHS Boards, local authorities and voluntary agencies should work together to provide universal and targeted parenting support.

2005/07

• NHS Boards should ensure that parents (and, where appropriate, young people) are provided with information about how data about their health is collected, stored and shared, and the safeguards in place to ensure that only those who need it will have access to patient or client information.

2005/06