Working Together for a Healthier Scotland

Chapter 5 - Roles, Responsibilities and Action - continued

167. Beyond the national screening programmes there are opportunities for the primary care professions to undertake opportunistic screening, for example, for high blood pressure and for depression. It is also possible to identify those at particular risk by, for example, action to establish genetic risk factors.

168. In all these areas the Government seek to build on recent trends, taking support and services into the community through primary care rather than expecting people to come into an institutional setting. On a pilot basis this principle has been extended to take health promotion and risk awareness into people’s homes. Evidence suggests that volunteers taking part in such intensive programmes benefit without (in most cases) receiving any additional medication. Much excellent work is also done in schools and the Government are keen to develop a stronger focus on making it easy for individuals to access services. Libraries, shopping centres and schools are among possible locations which could be used more and to greater effect.

169. More broadly, while each health professional has his or her own particular skills the most effective work is often done by bringing professionals together in new ways. The Government believe that to deliver integrated health services - including health promotion - there should be increasing stress on the breaking down of boundaries between health professionals to provide a seamless service. Designed to Care deals in more detail with ways of promoting greater structural integration across the whole range of primary care.

170. Nowhere is all this more important than in areas of deprivation. Reducing health inequalities by effective frontline delivery of the full range of health services - including health promotion - in areas of deprivation is a key priority for the next few years. The Government have already taken steps to broaden the range of potential contracts for GPs, in particular under the Primary Care Act Pilots, offering new salaried options which can be used to bridge current gaps in practice provision. Building on this, the Government are considering a mapping exercise to identify systematically areas disadvantaged in terms of service provision so that new initiatives can be focused there.

171. In addition to strengthening the role of health professionals in advising patients, there is also a clear need for the Health Service to adopt a wide range of policies which establish it as a health promoting institution, promoting positive health and well-being within hospitals and health centres and thereby setting an example to the organisations in the community at large. The network of Health Promoting Hospitals is expanding and HEBS are working with Health Service colleagues on a framework for the Health Promoting Health Service. This will develop a common framework for health promotion which can be used by commissioners, providers and practitioners across all Health Service settings to ensure that health promotion is an integral and sustainable part of health care, service delivery and organisational development. The new Project 2000 training of nurses, which focuses much more on their health promoting role, contributes to the greater effort towards prevention and health promotion which the Government expect from all sectors of the Health Service.

Views are invited on how best the contribution of the Health Service to health improvement can be maximised. The Service itself is invited, in particular, to

• respond to this Green Paper with ideas and proposals which reflect their knowledge and experience
• lead by example, taking every opportunity to promote health to patients, staff and the community they serve
• assist local agencies in auditing their policies for their impact on health
• support local community initiatives
• bring together the local agencies, whether in a lead or support role, for health gain.

Directors of Public Health

172. Directors of Public Health and their colleagues in public health medicine, as an integral part of each Health Board, have a key role in supporting their Boards and the NHS generally in fulfilling their corporate responsibilities for improving health. The DPH also serves as Designated Medical Officer (DMO) of the local authorities within the Board area and thus is a valuable bridge between Health Boards and councils across the broad spectrum of their activities which impinge upon health.

173. At local level, the DsPH and their teams can play a major role in the development and delivery of the comprehensive programme of action, which will be required to tackle multiple deprivation and associated health problems, especially in the Urban Partnership areas. As already stated, in order to maximise the health gain potential of local policies, it is envisaged that DsPH, in their capacity as DMO, can assist health impact assessments by local agencies on policies most likely to impinge on health. In their Health Board role, the DsPH, with strategic specialist health promotion advice, can help Boards fulfil their responsibility for planning and coordinating activity which increases health gain. The many facets of this role include assessing health needs, assigning priorities and helping to ensure that the NHS provides a health promoting environment for both its users and its employees.

174. The Scottish DPH Group, which brings together DsPH from every part of Scotland, is well placed to share the outcome of initiatives and experience in their areas of tackling public health issues, especially in relation to health inequalities. The Government propose that the Group should be invited to produce a periodic report of effective good practice for the benefit of councils and Health Boards.

175. The Chief Medical Officer has periodic meetings with DsPH, allowing opportunity for a two-way exchange of information. It is proposed that this arrangement should be strengthened to enhance knowledge about emerging public health problems and issues and to assist in the development of measures to improve the public health. The Government also believe it would be useful to strengthen the practice of regular reports by DsPH about the health of their populations.

Views are invited on the foregoing and on how the DPH’s role might be further enhanced.

HEALTH EDUCATION BOARD FOR SCOTLAND

176. The Health Education Board for Scotland (HEBS) is the lead organisation for health education in Scotland. The Government believe that the Board’s Strategic Plan for 1997 to 2002 has a key part to play in the wider strategy for a healthier Scotland. The Plan is available from the Board and on HEBSWeb.

177. Through its general public programme, HEBS will have a key responsibility for high-profile health education initiatives in priority health and lifestyle topics. The strategic campaign on Scotland’s ‘Big 3’, which draws together CHD, cancer and stroke and related lifestyle factors, is important. So too is the developing campaign to encourage healthy decision-making among young people, with its interlinking action on smoking, drug misuse, alcohol misuse and sexual health.

178. Complementary to this high-profile work will be HEBS’s lead role in encouraging and enabling health promotion commitment, capabilities, strategies and action in the NHS, schools, the workplace and communities as a whole, and in the voluntary sector. The Government intend to enable HEBS to extend its involvement in this regard through a new programme centred on further and higher education institutions.

179. There is a need also to continue to develop health promoting schools in Scotland. Local councils are well placed to implement this concept. The nature of the educational experience young people have in schools is closely related to the extent to which schools can nurture and support the pupils’ emotional, social and physical health needs. There is evidence from research in Scotland that when young people have conflict at home but feel good about their school, they are less likely than other vulnerable young people to be involved in health-damaging activities.

180. The Government, therefore, believe strongly that the health promoting school movement, which had its origins in the health sector, should become fully integrated into current initiatives in the education sector. It is proposed, therefore, that HEBS, in conjunction with COSLA and the Scottish Consultative Council on the Curriculum, consider establishing a specialist unit, to further develop health education and health promotion in schools. Such a development would provide both the curricular aspects of health education and have an impact on the wider life of schools and the school/community interface.

Views are invited on this proposal.

181. HEBS also will further develop its role in education and training to increase the expertise of the many professionals and agencies which have parts to play in health promotion. It will continue to harness information technology for health promotion.

182. More widely, the rapid advances in information technology, such as NHSnet (the NHS telecommunications network), and HEBSWeb will increasingly enable health and health education and promotion information and resources to be accessed on line by the public in a range of settings, for example at home, at work, in schools, in hospitals and GP surgeries and clinics.

Views are invited on ways to optimise the benefits to health of the increasing availability of information technology within the community.

183. HEBS will also develop the evidence base for health promotion, devise properly targeted initiatives across Scotland, and evaluate and promote good practice. Due emphasis will be placed on research concerned with reducing health inequalities, which may flow from the Acheson Inquiry, identifying factors which generate good health, developing intermediate community indicators and assessing the impact of interventions on inequalities. While serving the population as a whole, HEBS will be expected to give high priority to tackling inequalities through ascertaining and addressing the circumstances of groups and communities with the greatest needs.

184. The Government fully support the Board’s emphasis on stepping up its strategic leadership role and collaborative working. Health Boards will remain vitally important partners, and a new working relationship with COSLA is being developed, to complement and facilitate alliances between Health Boards and local authorities.

Views are invited on the role of HEBS particularly in relation to the tackling of health inequalities; on new initiatives which it should undertake; on how its partnerships with other key agencies might be strengthened; and on how its work in various arenas might be developed further.

OTHER PLAYERS

185. Clearly, then, the contribution of all in the public sector is crucial to health improvement. But the private and voluntary sectors have also a vital part to play. Some of the players are identified below, but the Government are conscious that the list is not exhaustive. Good health is everyone’s business.

Industry and Commerce

186. Industrial and commericial policies, practices and products can have major effects on health, beneficial or harmful, and these can go unrecognised. Businesses are encouraged to consider the possible health consequences of their decisions and actions and to make choices which are as health promoting as possible.

187. There are also clear links between employment and health. Having a secure, rewarding job, in addition to providing the wherewithal to live, can do much to provide the social support and motivation so vital to good mental health. Conversely, poorly paid, unsafe jobs can undermine the potential for good health.

188. Employers and trades unions have a particular interest in developing the health of workforces both to increase the well-being of employees and to reduce sick absences so that output is maintained or increased. The dissemination of health promoting messages for employees and the provision of facilities to enhance fitness are key measures in this respect. For example, employers can help address alcohol misuse by having enlightened policies for the workplace, focusing on education, early detection of problems, and opportunities for help in changing drinking habits. Businesses can also contribute to community development and regeneration through the creation of jobs, and, by attention to pollution-reducing measures, help create a better local environment.

189. As a prerequisite to maintaining and improving health at work, employers, employees, trades unions, staff associations and employer organisations should demonstrate a fundamental commitment to implementing good health and safety at work policies and procedures.

190. The Scotland’s Health at Work award scheme was launched in 1996. By meeting set criteria, companies and organisations can achieve three levels of award and, in so doing, gain prestige for themselves and, importantly, encourage health enhancing practices in their workplaces. The Government wish to encourage all workplaces to work towards achieving the award standards.

Views are invited on how health can best be promoted through industry and commerce and in the workplace.

The Voluntary Sector

191. The voluntary sector has its own distinctive part to play in improving health, often providing services in a way the public sector cannot. The value of voluntary agencies working in partnership with statutory bodies has been recognised in Scotland for many years.

192. The strengths of voluntary agencies are most visible in the work undertaken to support client groups concerned about, or affected by, particular health-related issues. They are also well placed to speak on behalf of client groups about the needs that specific population groups have, to identify policy and service requirements, and encourage community participation in decision-making processes. It is the Government’s intention to stimulate a thriving and innovative voluntary sector.

193. Healthy Living Centres (see paragraph 118) will also provide major opportunities for voluntary organisations to apply for support funding for innovative projects.

194. Voluntary organisations are often built around single topics or client groups. This is right and understandable. There is also a need, however, to ensure that adequate co-ordination and integration of effort are achieved against the background of priorities set out in this Green Paper.

Views are invited on how the voluntary sector can further develop its contribution to health improvement in Scotland.

195. The key actions by the key interests for improving Scotland’s health are summarised in Table 3.

Table 3: Key Actions By Key Interests