CHAPTER 5: A HEALTHIER SCOTLAND
Help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.
People living in Scotland should enjoy the best physical and mental health they can, free from preventable illness and disability. Good health and wellbeing is also vital in delivering our Purpose. By making Scotland healthier through tackling health inequalities and supporting healthier lifestyles and choices, supplemented by early interventions and anticipatory, responsive services, we will increase the productivity of Scotland's workforce, reduce absenteeism, improve public sector efficiency and increase participation in the labour market by reducing the number of people on incapacity benefit.
Our aim is to support people to lead longer, healthier lives and our approach will involve a particular focus on the health and wellbeing of the areas and communities with the worst health record.
This will mean taking on the challenge of the health inequalities that currently exist in Scotland, including the gap in healthy life expectancy, to improve the life chances that are needed to support better health. It also means ensuring that services are high quality, responsive, person-centred, convenient and efficient. In response to increasing demands and expectations, Scotland's health and care services must continue to harness the most advanced technology and treatments and put these within reach of all of those who need them.
To help achieve a healthier Scotland, the Scottish Government will:
- invest over £37 million - £12.5 million each year - to strengthen primary health care in the most deprived areas;
- provide a new fund deployed by Community Planning Partnerships, to tackle poverty and deprivation and to help more people overcome barriers and get back into work, amounting to £145 million a year within the local government settlement;
- invest a total of £1.47 billion (£430.0m/£507.8m/£533.2m) in new and better housing across Scotland, including our most deprived communities;
- invest £47.4m/£53.9m/£54.9m in sport to increase participation and improve sporting performance, contributing to a range of outcomes including better physical and mental health. This includes £4.1m/£6.6m/£11.6m which will be invested in delivering a successful Commonwealth Games in Scotland in 2014;
- as part of an overall investment of over £100 million extra a year in health improvement and better public health, invest £85 million (£20.1m/£30.1m/£35.1m) to reduce the harm done by misuse of alcohol, £3 million a year for further action to reduce smoking; and an £11.5 million a year programme on diet and physical activity for health and to help prevent obesity. All of which will improve health, have a positive impact on productivity, and enhance the economic wellbeing and life chances of our population;
- invest in prevention, screening and early detection of serious illnesses, with a new immunisation programme to protect women against cervical cancer (£18.0m/£18.5m/£27.5m); a commitment of £12.0m/£21.0m/£21.0m to screen people admitted to hospital for MRSA and to help prevent the spread of infection; and a £16.3m/£14.2m/£10.8m national screening programme to detect serious illnesses early;
- invest £30 million (£10 million each year) to ensure more flexible access to primary care and £270 million (£90 million a year) to ensure that, by the end of 2011, nobody will wait longer than 18 weeks from GP referral to treatment for routine conditions;
- invest £97 million (£20.0m/£32.0m/£45.0m) to phase out prescription charges to ensure that sick people are not financially disadvantaged;
- uprate free personal and nursing care payments, ensuring that older people in care homes are not financially disadvantaged;
- invest £19.5 million (£4.5m/£6.0m/£9.0m) in better access to NHS dental services by introducing a prevention-based school service, starting in the most deprived areas, and by establishing a third dental school for Scotland in Aberdeen; and
- invest over £500 million each year to train and develop existing and future NHS staff.
OUR AMBITION FOR A HEALTHIER SCOTLAND
People living in Scotland should enjoy the best physical and mental health they can, free from preventable illness and disability. They deserve ready access to top quality services to help them keep well and to care for them when they are ill. Good health and wellbeing are vital to enable the people of Scotland to participate in a successful Scottish economy, where everyone who wants to work is able to do so and people live free from material deprivation. Good health underpins our capacity to learn and can be profoundly affected by life circumstances.
Life expectancy in Scotland for both men and women is below the Western European average. There is considerable variation in life expectancy within Scotland linked to inequalities that include environmental influences in our living and working conditions, employment status, levels of education and skills and income. We need to tackle these inequalities if we are to improve the health and wellbeing of individuals, families and communities. Just as a fairer society with less inequality promotes social cohesion and safer, stronger communities, so building opportunities for all in Scotland to share the benefits of sustainable economic growth will also help to improve everyone's life chances.
Improving health and reducing inequalities requires contributions from across government, from the NHS, local authorities and other Community Planning partners, from employment services and employers, from our universities and colleges through the medical research and training which they undertake, from the third sector and of course from individuals. Prioritising better physical and mental health will help ensure that our children have the best start in life and are ready to contribute to Scotland's success, and will improve life chances for children, young people and families at risk.
As Scotland's economy grows and strengthens, so will the expectations of its people towards their public services. For public services, the key challenge in supporting longer, healthier lives is in delivering effective services that enable all people, including the most vulnerable, to make the right decisions on their health and wellbeing, and to access and use services when they are needed.
We enjoy good health and social care services in Scotland. We want to be sure that they will continue to respond positively, sustainably and affordably to rising expectations while providing excellent clinical treatment where required. Sustainable economic growth is vital to make sure that excellent services can be provided. Our ambition for health care services in Scotland is that they will be provided, as far as possible, in the communities where people live. We will work in partnership with local government to ensure that our health and social care workforce is trained to deliver high quality person-centred care, involving integrated working across professional and organisational boundaries, that can stand comparison with services across the world.
DELIVERING A HEALTHIER SCOTLAND
By achieving our objective of a healthier Scotland, we will support people to live longer, healthier lives; we will tackle inequalities; and we will enable people to access the health and social care services they need. Excellent services with high public value come at a high cost and so they must be as efficient and productive as possible.
Outcome: We live longer, healthier lives
We will prioritise programmes aimed at supporting people to follow healthier lifestyles. Many of these depend on strong collaborative working between Community Planning partners, particularly local authorities and NHS Boards. The focus will be on healthy weight, improved mental wellbeing, reduced alcohol harm and smoking, less inequality in premature deaths particularly from heart disease, and better dental health - particularly in children. We will invest over £100 million extra a year on action to improve health in Scotland.
We will promote physical activity, because this reduces the risks of heart disease and other health problems. We will continue to promote participation and excellence in sport, which can have a positive impact on physical and mental health as well as contributing to other outcomes including improved educational attainment and stronger communities. We will create opportunities for people to take action to improve their mental wellbeing because this directly contributes to fuller, more productive lives for people and their families. We will promote maternal and infant nutrition, including breastfeeding and immunisation programmes along with other measures to give our children the best possible start in life. We will act to provide free fruit for pregnant women and pre-school children.
We will intensify efforts to further reduce smoking levels. We have already raised the legal age for buying tobacco from 16 to 18. Now we will fund additional measures to support people to quit smoking and cut their risk of heart disease and lung cancer. We will tackle the misuse of alcohol in Scotland as a significant challenge, because this will reduce risks of heart and liver disease, reduce cancer and help address problems in families and communities caused by alcohol misuse. Over the coming year, we will develop a long term strategy on alcohol backed by £20.1m/£30.1m/£35.1m of additional investment to introduce a radical range of measures to reduce alcohol-related harm and encourage sensible and healthy consumption. Again, this will allow more people to live productive lives and contribute to sustainable economic growth in Scotland.
We will work to reduce dental disease, especially in children, including the introduction of a prevention-based school dental service. Dental disease affects deprived people disproportionately, so we will ensure that these programmes help the most vulnerable groups. We will also take timely action to keep people well with anticipatory care, targeted at those most at risk. We will boost national screening programmes by introducing new measures to protect health including a new £18.0m/£18.5m/£27.5m immunisation programme for girls to protect against cervical cancer and £12.0m/£21.0m/£21.0m to screen people admitted to hospital for MRSA and to continue actions to help prevent the spread of infection. We will maintain support for better sexual health services (at a cost of £5.2 million a year) to reduce the number of unintended teenage pregnancies; sexually transmitted infections including HIV; and terminations of pregnancy. In addition, we will invest £0.5 million a year to support improved access to independent sexual health information and advice in rural as well as urban areas.
Outcome: We have tackled the significant inequalities in Scottish society
Health inequalities, poverty and economic and environmental inequalities, access to learning, early life experiences, and exposure to risks of crime and danger often go together and so reducing inequalities requires a shared endeavour across Scotland to tackle the root causes. Government actions to tackle inequalities must reinforce and complement each other across a number of areas of responsibility. For example, by improving employability, housing and communities, we will help reduce health and education inequalities. And by giving our children the best possible start in life we will help reduce inequalities later in life.
A Ministerial Task Force, bringing together a range of relevant perspectives from education and other backgrounds, will refresh our approach to tackling health inequalities with new action ensuring that the work of all the relevant partners and sectors is aligned.
We must work closely and collaboratively with our partners to get results. Local government has a major contribution to make in addressing housing regeneration and in delivering education and social services and tailored services for families and children. The community and voluntary sectors make a major contribution to tackling inequalities, particularly through engaging with people in difficult situations or who are hard to reach with some public services. By working with services such as Jobcentre Plus, NHS Boards must increasingly play a crucial role in helping move those who are inactive and wish to work towards the labour market and out of poverty.
Disadvantaged people tend to suffer poorer health and often have difficulty in accessing the health care they need. NHS provision must respond to the needs of the most vulnerable. Positive health interventions building on initiatives such as Keep Well and including health checks for the over 40s, will focus efforts on deprived areas and groups with £12.5 million each year to strengthen primary health care in the most deprived areas and provide services to those most in need of them.
We will make it easier for people to take actions and make choices that are good for their health and wellbeing, because we want to encourage everyone, including people who experience health inequalities, to take more ownership of their health. As part of this approach, we will develop services, including those addressing addictions, to provide quicker, more effective responses and address addiction problems as a component of inequality.
In partnership with Community Planning Partners across Scotland, we will work towards the eradication of child poverty, promote social inclusion and encourage the regeneration of Scotland's most disadvantaged communities. This will build stronger communities and help address economic inequalities as well as inequalities associated with our built environments and access to our natural environments.
Poor housing conditions undermine health and are closely associated with deprivation. As a significant outcome of our new relationship with local government we will work in partnership with local government and other housing providers towards a Scotland where everyone will have a secure, warm house at a cost they can afford. And, because being homeless is often caused by or leads to physical and mental ill-health, we will prevent and tackle homelessness by ensuring everyone who needs it is able to access appropriate accommodation, advice or support.
Some people experience inequalities as a result of discrimination, prejudice, harassment and abuse and this can lead to physical and mental health problems. We will tackle the causes of inequalities of this kind as well as treating the problems.
Outcome: Our public services are high quality, continually improving, efficient and responsive to local people's needs
People in Scotland expect health and social care services provided by local authorities and NHS Boards to be responsive, convenient, and of high quality. Quite justifiably, they do not expect to wait a long time to access services. They also expect services to be person-centred and to join up to support people at home or in the community, with admission to hospital taking place only when it is really necessary.
People in Scotland rely heavily on publicly-funded health and social care services. Last year, around 79.5 million prescriptions were dispensed; GPs were consulted over 15 million times; people visited hospital Accident and Emergency departments about 1.5 million times and consulted hospital specialists in hospital outpatient departments 4.4 million times; and there were about 1 million admissions to hospital for treatment. Local authorities carried out about 300,000 assessments and reviews, and provided packages of care to around 330,000 clients.
Demands on health and social care services will go on growing, even with improvements in healthy life expectancy. Most of us need more health and social care in older age. As the population ages, we need to plan approaches to health and social care that allow people to remain happy, safely and free from poverty in their own homes and communities for as long as possible, and that help carers look after family members.
The government's discussion document Better Health, Better Care sets out some proposals for the further development of health care services, including getting the balance right between community and hospital services. Our action plan, which we aim to publish in December, will provide details on the delivery of the actions summarised below.
We will work with local authorities and NHS Boards to develop social care services and make further improvements both to standards of care and access to care. The provision of responsive, person-centred integrated services maximises people's independence and quality of life so they can remain longer in their own homes. We will work with local authorities to ensure the long-term sustainability of free personal care for older people. We will invest £32 million (£2.0m/£10.0m/£20.0m) in specialist children's services including cancer care and high dependency facilities, and services for chronically ill children including cystic fibrosis patients. We also want our delivery partners to be efficient and to be accountable. In the case of NHS Boards, which report directly to the Scottish Government, we will provide rigorous performance management based on key targets and measures, and transparent reporting of progress and achievements.
We will work to achieve the right balance of care so that as much health care as possible is delivered close to home, at health centres and community hospitals, with increased access to diagnostics and other services. Services delivered in this way are more convenient and responsive, and people want care and treatment at or near home. We will launch an e-Health strategy in the spring of 2008 to enable clinicians and other care workers to collaborate more effectively and to help make services more efficient. We will also champion the introduction of tele-care, tele-health and tele-medicine services, because these will support people in their own homes and extend the range of services provided locally.
We will work with local authorities and NHS Boards to improve support for unpaid carers, in particular the provision of respite care, both to protect carers' own health and because of their essential contribution to the health and support of those they care for. We will ensure provision of services for people suffering from chronic and long-term conditions and their carers, because this will enable them to manage these conditions and stay well for longer at home. We will remove the tax on ill-health by phasing out prescription charges at a cost of £20.0m/£32.0m/£45.0m.
NHS Boards and local authorities will work to identify people most at risk of serious illnesses or hospital admission, and provide them with preventative care services, supported by technology. This will reduce their risk of requiring more intensive treatment or hospital admission later. As a top priority for the NHS, we will abolish hidden waiting lists for people needing hospital care. We will ensure that the NHS delivers on targets and introduce by the end of 2011 a maximum waiting time of 18 weeks for the period from being referred to a hospital consultant to treatment starting. We will invest £90 million each year to make this happen because long waits cause anxiety and distress. We are also committed to improving access to NHS dental services and we will continue to invest in new dental facilities. We will expand the dental workforce through the establishment of a third dental school for Scotland in Aberdeen.
Supporting mental health and wellbeing makes a vital contribution to a healthier Scotland. However, dementia is a mental health challenge that has not been sufficiently addressed in the past and so we will prioritise improvement in the diagnosis, care and treatment of dementia sufferers.
To produce the results we need, we will invest some £500 million each year in developing and training existing and potential health care staff, and we will design the health care workforce around patient services. This will ensure that staff can continue to provide effective, responsive, patient-centred care and at the same time will contribute to Scotland's economy by building expertise, improving the skills base, and enhancing Scotland's reputation in health care and in science and research.