Moving Scotland Forward: The Government's Programme for Scotland 2008-09

SECTION 6 - A HEALTHIER SCOTLAND

A Healthier Scotland - Help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health.

Having higher aspirations for Scotland is also about being ambitious for the health and wellbeing of our people. Our social democratic contract with the people of Scotland is based on excellent public services and good social provision. Over the past year, this has been illustrated, for example, by:

Keeping and enhancing children's cancer services in Edinburgh, Glasgow, Aberdeen and Dundee; and
Giving the go-ahead for the new children's and adult hospital on the site of the current Southern General Hospital in Glasgow. The £842m project will be publicly funded, ensuring good value for Scottish taxpayers.

Scotland has a long and proud tradition of supporting fairness, justice and compassion. We have upheld and built on these important elements of our society and enhanced our identity during our first year in government by:

Cutting prescription charges in April 2008, as a first step on the road to getting rid of the charges by 2011, ending the unfair tax on sick and vulnerable people;
Reducing waiting times for patients. We have set a challenging target of achieving a maximum waiting time of 18 weeks from referral to treatment, by the end of 2011. As milestones towards this standard, NHSScotland has been set targets to reduce the longest maximum waits for a first outpatient appointment from 18 weeks to 15 weeks, for diagnostics tests from 9 weeks to 6 weeks and for inpatient and day case treatment from 18 weeks to 15 weeks, by the end March 2009; and
Establishing the Sutherland Review to look at the funding of free personal care for the elderly, responding to concerns that it is currently underfunded. In the meantime, through working with local authorities, payments for personal and nursing care will increase in line with inflation from April 2008. In Scotland, we believe that our older people should have care and dignity in their later years.

A more successful Scotland will be one in which each and every one of us takes more responsibility for our own long-term health and wellbeing. Ultimately some of the most important health choices are ones we take ourselves. We have been working to enable people to make healthier and better choices:

We are helping at least 20,000 overweight and obese children, so that they and their parents have the information and tools to make better choices;
Infection, prevention and control in our health services is everyone's business. Simple measures, such as hand hygiene, are measures we must all take responsibility for. The fact that NHS compliance with hand hygiene rules has risen by 19% in a year to 87% is to be welcomed, but we are determined to build on this progress and our investment of over £50m over the next three years is to drive all infections down year on year. One of the key areas will be our national MRSA Screening Programme from 2009-10, but a whole range of new measures are being introduced over the next three years to tackle all Healthcare Associated Infections, including Clostridium difficile; and
We are engaging people in discussions about a lasting legacy for Scotland from the Glasgow 2014 Commonwealth Games.

Our approach to a healthier Scotland as set out in Better Health Better Care, the Government's action plan for a healthier Scotland, involves giving a voice to a wider range of people and organisations. We want to encourage debate and discussion, forging a future agenda based on agreement about the type of health service and health priorities that people want. As part of this, we have already:

Enabled local priorities to be more closely considered, and by doing so we have reversed the decisions to close Accident and Emergency services in Ayr and Monklands;
Consulted on more patient and community involvement in health services. The Health Boards (Membership and Elections)(Scotland) Bill which will deliver on this and on direct elections to NHS Boards is already one of the package of bills currently scheduled to go through Parliament. Bringing our NHS closer to local people will be a key task in the coming months; and
Brought together a task force with key partners, which reported in June 2008, to tackle the major health inequalities Scotland faces. Over the next year, it will be a priority to implement the task force's recommendations.

Health inequalities
Scotland's health status is held back by the poor health of its most deprived communities. The Ministerial Task Force on Health Inequalities was set up to tackle those inequalities, that left unaddressed will prevent Scotland from achieving the Government's overall Purpose of sustainable economic growth, supported by increased healthy life expectancy. The Task Force has embodied the Government's new way of working. It included Ministers from across the Government, key partners from local authorities, NHSScotland, the research community and the third sector. It has looked across Ministerial portfolios to address the underlying causes of health inequalities and bring together thinking on poverty, lack of employment, children's lives and support for families, physical and social environments, as well as on health and wellbeing. The Task Force's approach and the way it envisages change being delivered align with the Government's new relationship with local authorities and their community planning partners. COSLA has been a full partner in developing policy within the Task Force's joined-up approach, and the recommendations, and the way in which they will be delivered, are in the spirit and framework of the Concordat between national and local government. The Task Force's approach will be tested out in learning networks in some local test sites. Starting from the client's perspective, and making best use of good practice and evidence, they will refocus a range of public services locally to support resilience and wellbeing and, in the longer term, people's capacity to improve their own health. Reducing inequalities in health will play a significant part in creating a skilled, resilient population with the sense of wellbeing and control over their own lives, keen to look after their own health and able to participate in the economy and employment opportunities of the future.

Health inequalities

Scotland's health status is held back by the poor health of its most deprived communities. The Ministerial Task Force on Health Inequalities was set up to tackle those inequalities, that left unaddressed will prevent Scotland from achieving the Government's overall Purpose of sustainable economic growth, supported by increased healthy life expectancy.

The Task Force has embodied the Government's new way of working. It included Ministers from across the Government, key partners from local authorities, NHSScotland, the research community and the third sector. It has looked across Ministerial portfolios to address the underlying causes of health inequalities and bring together thinking on poverty, lack of employment, children's lives and support for families, physical and social environments, as well as on health and wellbeing. The Task Force's approach and the way it envisages change being delivered align with the Government's new relationship with local authorities and their community planning partners. COSLA has been a full partner in developing policy within the Task Force's joined-up approach, and the recommendations, and the way in which they will be delivered, are in the spirit and framework of the Concordat between national and local government.

The Task Force's approach will be tested out in learning networks in some local test sites. Starting from the client's perspective, and making best use of good practice and evidence, they will refocus a range of public services locally to support resilience and wellbeing and, in the longer term, people's capacity to improve their own health.

Reducing inequalities in health will play a significant part in creating a skilled, resilient population with the sense of wellbeing and control over their own lives, keen to look after their own health and able to participate in the economy and employment opportunities of the future.

Social partnership and finding common ground will continue to be a priority over the coming year. As we move to Single Outcome Agreements for Community Planning Partnerships, they will increasingly impact on health issues, involving work across the public sector and engagement with the third sector.

We will encourage health services and local government to work together to deliver local health and community care centres, using the Scottish Futures Trust.
We will introduce a Health Bill. This will include measures to support the delivery of our new smoking prevention action plan, setting out the next steps in controlling the availability and promotion of tobacco. It will also debar commercial companies from bidding to provide GP services, to ensure that the central role of General Practice continues to be delivered from within the traditional NHS family.
We will also legislate to tackle the major issue of alcohol misuse in Scotland. The measures that we will put in place will depend on the outcome of our current consultation on alcohol misuse Changing Scotland's relationship with alcohol: a discussion paper on our strategic approach. Subject to the consultation results, measures such as prohibiting offsales to under 21s; minimum pricing; social responsibility fee; and alcohol-only checkouts, may be delivered through planned criminal justice and licensing legislation.

Alcohol framework
The total cost of alcohol misuse to Scotland is estimated to be around £2.25bn in 2006-07. This includes an estimated cost of £400m to Scottish industry in lost productivity and absence and a similar cost to NHSScotland. Alcohol-related deaths in Scotland have more than doubled in the last 15 years and in the last decade alcohol-related attendances at Scottish hospitals have increased by almost 50%. Over the last 20 years Scotland has had one of the fastest growing chronic liver disease and cirrhosis rates in the world. 45% of Scottish prisoners in 2007 said they were drunk at the time of their offence and an audit of Scottish Emergency Departments suggested that at least 70% of assaults presenting may be alcohol-related. There were 990 casualties on Scottish roads in 2005 as a result of accidents involving illegal alcohol levels. 40% of 15 year olds and 15% of 13 year olds drank alcohol in the week before they were surveyed. It is estimated that 65,000 Scottish children live with a parent whose drinking is problematic. These statistics show that harms associated with alcohol misuse are neither limited to health nor experienced solely by the drinker and can damage family and friends, communities, employers and Scotland as a whole. We are determined to provide the necessary leadership to tackle alcohol misuse, but we recognise that we cannot deliver the long-term sustainable change required alone. It is essential that we work in partnership with a wide range of other bodies and groups such as local government, NHSScotland, the police, the third sector and the alcohol industry. We have published proposals on tackling alcohol misuse for consultation, however, we actively welcome ideas and suggestions from our partners and the public to help refine our approach and to ensure that we can change Scotland's relationship with alcohol for good and use our resources effectively to address the problems we are facing today.

Alcohol framework

The total cost of alcohol misuse to Scotland is estimated to be around £2.25bn in 2006-07. This includes an estimated cost of £400m to Scottish industry in lost productivity and absence and a similar cost to NHSScotland. Alcohol-related deaths in Scotland have more than doubled in the last 15 years and in the last decade alcohol-related attendances at Scottish hospitals have increased by almost 50%. Over the last 20 years Scotland has had one of the fastest growing chronic liver disease and cirrhosis rates in the world.

45% of Scottish prisoners in 2007 said they were drunk at the time of their offence and an audit of Scottish Emergency Departments suggested that at least 70% of assaults presenting may be alcohol-related. There were 990 casualties on Scottish roads in 2005 as a result of accidents involving illegal alcohol levels. 40% of 15 year olds and 15% of 13 year olds drank alcohol in the week before they were surveyed. It is estimated that 65,000 Scottish children live with a parent whose drinking is problematic.

These statistics show that harms associated with alcohol misuse are neither limited to health nor experienced solely by the drinker and can damage family and friends, communities, employers and Scotland as a whole.

We are determined to provide the necessary leadership to tackle alcohol misuse, but we recognise that we cannot deliver the long-term sustainable change required alone. It is essential that we work in partnership with a wide range of other bodies and groups such as local government, NHSScotland, the police, the third sector and the alcohol industry. We have published proposals on tackling alcohol misuse for consultation, however, we actively welcome ideas and suggestions from our partners and the public to help refine our approach and to ensure that we can change Scotland's relationship with alcohol for good and use our resources effectively to address the problems we are facing today.

We will take forward the recommendations in Lord Sutherland's Independent Review of Free Personal and Nursing Care, including introducing secondary legislation to remove charges for food preparation and seeking the return to Scotland of £30m a year in lost Attendance Allowance funding. We will work with our partners, including local government, to take forward a programme of response to the action points arising from the review.
We will make a further cut to the price of prescription charges and prepayment certificates, the second cut in the process of abolishing charges by 2011.

Over the next year, these measures will begin to put Scotland further on the path to a healthier future.

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Moving Scotland Forward: The Government's Programme for Scotland 2008-09

SECTION 6 - A HEALTHIER SCOTLAND