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 healthcare quality, and to the wider Scottish Government's 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 2010/11.
Smoking remains one of the principle causes of ill-health in Scotland. It is estimated that it costs NHSScotland £409 million a year to treat smoking-related diseases. The Tobacco and Primary Medical Services (Scotland) Act 2010 contains a number of new controls on the sale and display of tobacco, including a new tobacco retailers' registration scheme, new offences of underage and proxy purchase and a ban on the display of tobacco and related products in shops. Some of these measures, relating to the sale and purchase of tobacco, commenced on 1 April 2011, while the remaining measures, most notably the display ban regulations, will be enacted over the next few years. The legislation will reduce the availability and attractiveness of cigarettes to children, helping to stop them becoming regular smokers.
The original smoking cessation HEAT target ran from April 2008 to March 2011. Accompanied by funding of over £40 million during the previous spending review period, this raised the profile considerably of the importance of evidence-based support services for smokers wishing to quit. This is a central part of tackling tobacco-related harm in Scotland and is in line with the World Health Organisation's Framework Convention on Tobacco Control. The new Community Pharmacy smoking cessation service was also launched in 2008 as part of the national Public Health Service Pharmacy Contract.
NHSScotland delivered the target to support 8 per cent of its estimated smoking population to quit over the three years, measured at one-month following the agreed quit date; supporting 89,075 smokers to successfully quit against the target of 83,975. The Scottish Government will continue to work particularly closely with NHS Boards to deliver the new smoking cessation HEAT target for 2011-2014. For the first time, this has a specific inequalities-focused aspect aimed at reducing the significant disparities in smoking rates between the most and least disadvantaged populations within Scotland, which in turn is a major contributor to premature mortality and health inequalities.
CHANGING SCOTLAND'S RELATIONSHIP WITH ALCOHOL
The Alcohol etc. (Scotland) Act 2010, which was passed in November 2010, is a significant step in the battle against Scotland's unhealthy relationship with alcohol. Its key measures are: a ban on quantity discounts in off-sales that encourage customers to purchase more than they might have; a restriction on where material promoting alcohol may be displayed; the involvement of NHS Boards in licensing issues; a requirement for an age verification policy which is to be set at 25; and the setting out of a broad framework for a Social Responsibility Levy.
The final report and recommendations from the Scottish Ministerial Advisory Committee on Alcohol Problems ( SMACAP) Essential Services Working Group were published in March 2011. The Scottish Ministerial Advisory Committee on Alcohol Problems ( SMACAP) Essential Services Working Group: Quality Alcohol Treatment and Support ( QATS) * report delivers on a key commitment within Changing Scotland's Relationship with Alcohol: A Framework for Action *. The report sets out 14 recommendations for the Scottish Government, Alcohol and Drug Partnerships ( ADPs) and their partners, and specialist alcohol treatment services. The next step will be to develop an implementation plan for the recommendations.
ALCOHOL AND DRUG PARTNERSHIPS
Alcohol and Drug Partnerships ( ADPs) are currently publishing their local recovery oriented strategies. These recovery oriented systems of care are based on the needs of individuals with problem drug or alcohol use and the communities in which they live, and are being developed through service redesign and improved partnership working. ADPs have been instrumental in supporting progress against the drug and alcohol HEAT waiting times target with the interim four weeks assessment and treatment milestones delivered on time in December 2010. As a result of an increased focus on recovery from drug and alcohol misuse, we are seeing more local recovery communities emerge through Scotland.
Alcohol Brief Interventions ( ABIs) are time-limited interactions or conversations between a practitioner and patient, focused on helping people to cut down their drinking to within sensible guidelines. The initial three-year HEAT target for 2008-2011, for NHS Boards to collectively deliver 149,449 alcohol brief interventions ( ABIs) by March 2011, was successfully achieved with 174,205 ABIs delivered. In order to ensure ABIs are embedded into routine practice, the target has been extended for 2011/12. For this fourth and final year of the HEAT target, work will now focus on the long term approach to delivery.
TB ACTION PLAN FOR SCOTLAND
Scotland's first Tuberculosis ( TB) Action Plan * was published in March 2011. Although the rate of TB in Scotland has been low in recent years, evidence suggests that it is slowly increasing and that there is unacceptable variation across the NHS in the way in which TB is tackled. The Action Plan, which was developed by a range of professionals from across Scotland, sets out actions that NHSScotland needs to deliver to improve clinical services, reduce unnecessary variation in treatments and interventions, and promote a multi-disciplinary approach to the management of and responses to the disease.
Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight *, sets out the long term commitment of both national and local government to tackling overweight and obesity to help achieve a healthier Scotland and contribute towards sustainable economic growth. The action plan and key indicators for measuring progress were published in March 2011. NHS Boards achieved the HEAT Child Healthy Weight target delivering 8,406 interventions against a target of 6,317. This required NHS Boards to fill a gap in local service provision for weight management support and promotion of the principles underpinning healthy weight to an agreed number of overweight and obese children aged 5-15 years. Services provided in small groups and in one-to-one situations allowed close working with young people and their families in a person-centred way to identify and take forward behaviour change goals tailored to their family circumstances. These were complemented by a series of school-based interventions to widen the reach of the programme.
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 65s 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). Provisional uptake figures for the schools-based element of the third year of the programme indicate that, by February 2011, uptake of the first dose in S2 reached 91.2 per cent, with 85.5 per cent achieved for the second dose. These figures compare favourably to those collected for other parts of the UK. Amongst the catch-up cohort, rates reached 49.3 per cent for the first dose and 41.0 per cent for the second. Again these compare favourably with other parts of the UK.
MATERNAL AND INFANT NUTRITION
In January 2011, the Improving Maternal and Infant Nutrition: A Framework for Action * was launched to enable NHS Boards, local authorities and others to improve the nutrition of pregnant women, babies and young children. The framework is the first to look at the nutrition of mothers before and during pregnancy, supporting and promoting the benefits of breastfeeding and the importance of a healthy diet throughout early childhood.
Delivery of the Keep Well and Well North (the remote and rural adaptation) programmes of inequalities-targets health checks continued throughout 2010/11. Under the programme, 40-64 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 Cardio-vascular 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. NHS Boards delivered 41,107 targeted health checks against a HEAT target of 23,597. The Keep Well programme will be mainstreamed across NHSScotland from April 2012.
As part of the Equally Well approach to tackling health inequalities, the Chief Medical Officer hosted an event in December 2010 to launch an Assets Alliance. The Alliance aims to promote assets-based approaches to addressing Scotland's major social challenges. The approach is based on increasing the resilience of individuals and communities, building their assets and circumstances more effectively, in order to lead to sustainable improvements in their health and wellbeing, skills, aspirations and life chances. The Scottish Government will continue to lead this agenda through sponsoring research and compiling case studies to help show the improved outcomes that assets-based approaches can deliver.