Scottish Budget 2020-2021: Equality and Fairer Scotland budget statement

Chapter 11 Health and Sport

Introduction

The Health and Sport Portfolio is responsible for protecting and improving the health and wellbeing of Scotland's population. Our health and social care services and our communities play a vital role in improving the outcomes and wellbeing of the people of Scotland. Improvements in physical and mental health and support to be active citizens are central to our wellbeing and contribute directly to our economic growth and national ambitions as a wellbeing economy.

While progress continues to be made, significant health inequalities persist over a range of indicators.

Key Inequalities of Outcome

Improving the nation's health and wellbeing will contribute to a number of our National Outcomes and Indicators on our National Performance Framework, including:

• We are healthy and active;
• We respect, protect and fulfil human rights and live free from discrimination;
• We grow up loved, safe and respected so we realise our full potential;
• We live in communities that are inclusive, empowered, resilient and safe;
• We tackle poverty by sharing opportunities wealth and power;
• We value, enjoy, protect and enhance our environment; and,
• We have thriving and innovative businesses with quality jobs and fair work for everyone.

To achieve these National Outcomes, we need to see an overall improvement in our population's health and wellbeing, reduce the health inequalities that exist across Scotland, and ensure people have access to the support they need to live a fulfilling life.

This includes the recognition that adverse childhood experiences such as abuse, neglect and other traumatic experiences are more prevalent in our society than was previously recognised and can have devastating and long lasting effects on people's lives. The impact can result in inequalities in physical and mental health and wellbeing, employment prospects and access to services. These experiences can result in people disconnecting from society and from the services set up to help them.

To this end, the Health and Sport portfolio in line with the Scottish approach is shifting our focus towards prevention, improving performance, and working collaboratively to deliver improved outcomes for people.

Recent evidence from the Scottish Health Survey (SHeS) shows that health inequalities exist across the protected characteristics in Scotland.

• Scotland has seen substantial improvements in life expectancy over the last few decades. However, the rate of improvement in life expectancy and mortality in Scotland has slowed and life expectancy has now remained virtually unchanged since 2012-14. Those living in the most deprived places in Scotland have been most affected by the slow-down in improvements, exacerbating the already wide inequalities.
• In 2018, older people (aged 75 or older) were less likely to report being in good or very good health (57%) than younger people (85% for those aged 16-24).
• Mental health and wellbeing continues to be clearly linked to deprivation. In 2018, 26% of adults living in the most deprived areas scored a GHQ-12 score^[1] of four or more (indicative of a possible psychiatric disorder). This compares to 14% of adults in the least deprived areas.
• In 2018, those living in the most deprived areas were almost twice as likely to experience feelings of loneliness as those living in the least deprived areas (28% compared to 15%). Also, people living with a long-term physical or mental health condition were more than twice as likely to experience loneliness as those without (35% compared to 16%).^[2]
• In 2018, adults in the most deprived areas were more likely to have very low activity levels than those in the least deprived areas (32% compared to 12% respectively). Those with a limiting long-term condition were also more likely to have very low levels of physical activity (35%) than those with no long-term condition (12%).^[3]
• In 2017-2018, the provision of unpaid care was higher among adults living in the most deprived areas (18%), compared with the least deprived areas (13%). Unpaid care provision was also higher among women (18%) than men (12%).
• In 2018, adults living in the most deprived areas continued to be around three times more likely to smoke than those in the least deprived areas (30% and 9% respectively).
• In 2017-2018, 16% of adults in the most deprived areas reported being worried about running out of food, compared with 4% in the least deprived areas.

In addition to the indicators above, evidence^[4] has repeatedly shown that the most deprived areas see higher prevalence rates of many health conditions such as alcohol-related harms, cardiovascular conditions, heart disease and diabetes, along with experiencing poorer mental wellbeing.

Alcohol-related hospital admissions (under-75-year-olds)

When comparing the most deprived and least deprived areas, in 2018 alcohol-related hospital admissions were four times higher in the most deprived areas although this ratio has been reducing since 1996, when alcohol-related hospital admissions were seven times higher.

There has also been a general downward trend observed in relative inequalities for alcohol-related hospital admissions since 1996. While there have been some fluctuations between 1997 and 2018, the 2018 relative inequalities value is the lowest in the current series.

Alcohol-related deaths (45-to-74-year-olds)

The alcohol-specific death rate (for those aged 45-74 years) in Scotland's most deprived areas is five times higher than that observed in the least deprived areas, which is the second lowest rate in the time series. The peak alcohol-specific death rate was in 2002 with a death rate 14 times higher in the most deprived areas. Although the rate of alcohol-specific deaths in the least deprived areas has remained reasonably static since 1997, there has been a reduction in the rate in the most deprived areas.

Drug-related hospital admissions (under-75-year-olds)

In 2017-18, the admission rate in Scotland's most deprived areas was 21 times greater than that of the least deprived areas. Since 1996-97 admission rates (aged under 75) have ranged from 15-28 times higher in the most deprived areas compared to the least deprived areas.

Relative inequality levels for patients with drug-related hospital admissions have fluctuated over time, peaking in 1998-99. Following some slight decreases, there have been increases every year for the last five years and the current relative inequalities value is higher than at the start of the series in 1996-97.

Investment in general health and wellbeing across the Scottish population will also help to address equalities issues for older people, women and infants, children and young people, young males, lesbian, gay, bisexual, transgender (LGBT) living with poor mental health and/or disabilities, and people who have lost their voice or have difficulty speaking,^[5] or people who have a sensory impairment. Also, consistent with our commitment to protect and enhance basic human rights we are committed to better supporting children, young people and adults whose lives have been impacted by trauma and adversity.

Key Strategic Budget Priorities

The key priorities of the Health and Sport portfolio are:

• to improve mental health services, ensuring the service is accessible across all age groups while developing the range and support of other public services to provide early intervention and prevention of emerging mental health and wellbeing challenges;
• to place a greater emphasis on community-based and more joined-up, anticipatory and preventative care, in order to improve care and support for those who use health and social care services;
• to reduce health inequalities and increase healthy life expectancy of the Scottish population;
• to raise the profile, quality, and sustainability of social care support, including the status of social care as a profession;
• to support Scotland's 700,000-800,000 unpaid carers to look after their own health and wellbeing and reduce any negative impacts of their caring role;
• to successfully deliver our vision for Public Health Reform. This will be achieved, in part, through the establishment of Public Health Scotland (PHS) on 1 April 2020, who will be tasked with making the best use of Scotland's public health assets; and
• to improve the co-ordination of care – through the expansion of multi-disciplinary teams (MDT) to deliver improved primary and community care.

Equality Implications of The Budget

The investments and actions outlined in the Scottish Budget are expected to have a positive impact on the health and wellbeing of social groups who possess protected characteristics.

The budget for the portfolio is set out in the Scottish Budget document showing that around 80% of the funding is directed to NHS territorial or special boards. As public bodies, NHS Boards are subject to the Public Sector Equality Duty and its Scottish specific duties. They are required to produce a mainstreaming report which explains how they will ensure that as an organisation they value diversity and promote equality. For this reason this chapter does not analyse spend directed to NHS territorial or special boards.

The rest of the chapter focuses primarily on budgets consisting of more than £100 million although it is important to note that many smaller budgets within the portfolio will also have important positive impacts in reducing health inequalities.

Mental Health Services

Mental ill health is one of Scotland's most pressing public health challenges, and accounts for a significant proportion of premature mortality and disability within the Scottish population. Evidence suggests the causes of inequalities in mental health outcomes, and of inequalities experienced by people with mental health problems, are complex, and are due to a number of social causes. These may prevent or delay individuals from seeking help, and reduce the accessibility or effectiveness of services for certain groups.

A budget of £117 million for 2020-21 will help deliver key mental health priorities to improve access to services and deliver the package of measures set out in the 2017-18 and 2018-19 Programmes for Government to support positive mental health and to respond effectively to mental ill health.

Evidence suggests^[6] that mental health issues can impact on different groups of society in different ways.

• Disabled adults are more likely to report mental ill health compared to non-disabled people.^[7] Deaf people also experience a range of mental health inequalities greater than the general population.^[8]
• Mental health difficulties are more common in adolescents compared to the general population – as reflected in the growing demand for specialist child and adolescent mental health services (CAMHS) in recent years.^[9]
• Key risk factors for depression can disproportionately affect older adults due to presence of disability, long-term condition, or experience of bereavement.^[10]
• Both adults and young carers often experience poorer mental health than those without caring responsibilities.^[11]
• People who identify as lesbian, gay, bisexual (LGB) or "other" in Scotland report slightly lower wellbeing scores than heterosexual people.^[12]

In 2020-21 we will provide funding to support our improvement approach to infant, children, young people, adult, and older people's mental health which aims to impact positively on outcomes for socio-disadvantaged people.

Community Pharmaceutical Services Priorities

To ensure better outcomes for patients, and to support the wider primary care reform programme, the Budget for 2020-21 sets out an investment of £198 million^[13] (up from £192 million in 2019-20) to deliver NHS Pharmaceutical Care Services on behalf of NHS Scotland. The service seeks to ensure that patients have access to quality pharmaceutical care and advice, as well as timely dispensing of prescribed medication.

Spend in this area will have a direct impact on addressing inequalities in Scotland. For example, from April 2020, community pharmacy teams will deliver a new NHS Pharmacy First Service replacing the existing Minor Ailment Service and removing the existing eligibility criteria. The new NHS Pharmacy First Service will become a service available to all residents in Scotland, irrespective of circumstances. This approach will allow us to reach those hardest-to-reach in our communities, making community pharmacy into the first port of call for NHS Services to the homeless, Gypsy Travellers, those in care, and care homes for the elderly.

Reducing inequalities through investment in alcohol and drug services

The levels of alcohol-related and drug-related deaths in Scotland continues to be a significant driver of health and social inequalities in Scotland. The level of drug-related deaths increased by 27% in 2018 with 1,187 deaths recorded.

The most stark inequality exists between men and women. Males accounted for 72% of drug deaths in 2018, although deaths among females has increased disproportionately in recent years. Older age is also a significant risk factor, as is having just been released from prison.

The alcohol and drugs funding in the Budget is intended to target all vulnerable groups but those who are disproportionately affected by drugs harm are likely to benefit most. The funding also covers improved public health surveillance which will provide better evidence of the impact the funding will have in terms of inequalities. In 2020-21, we will make an additional £12.7 million available to tackle the harm associated with the use of illicit drugs and alcohol.

Prevalence of problematic use of alcohol and other drugs is characteristically weighted towards our least well-off communities. Problematic use is more prevalent among our unemployed people. So there is a strong correlation between deprivation and drug death. These deaths are focused around our largest cities and most commonly found in our least well off communities.

There is strong evidence that targeting alcohol and drug initiatives will have a disproportionately positive impact in our poorest communities.

Reducing inequalities through diet and physical activity

'A Scotland where we eat well, have a healthy weight and are physically active' is one of our six Public Health Priorities. This recognises that poor diet and unhealthy weight are key drivers of health inequalities in Scotland.

We know, for example, that obesity rates are consistently higher in Scotland's most deprived areas compared to the least deprived, with a particularly pronounced gap for women. Over 40% of women in our most deprived areas are obese, compared to 20% in the least deprived. Moreover, by the time they start primary school, children living in our poorest communities are twice as likely to be at risk of obesity.

In 'A Healthier Future: Scotland's diet and healthy weight delivery plan', published in July 2018, we set out a vision for a Scotland where everyone eats well and has a healthy weight. The plan set out the government's ambition to halve childhood obesity and to significantly reduce diet-related health inequalities. We recognise that tackling obesity is complex and requires bold, complementary action on a number of fronts. To that end, in 2020-21, we will continue to invest in the prevention and treatment of childhood obesity and Type Two diabetes. Funding will support the re-design and expansion of high quality services across Scotland so that children and families get the right support, no matter where they live. This sits alongside a very wide range of action and support for children and families so that we establish healthy eating habits in those vital early years.

In July 2018 we also published 'Active Scotland Delivery Plan' which sets out actions that we and our partners are undertaking to encourage and support people to be more active, more often. Increasing physical activity is important in terms of improving public health and forms a vital part of the multi-faceted approach needed to support people to maintain a healthy weight.

Social care support

In 2020-21 the Scottish Government will increase its package of investment in social care and integration by a further £100 million. Social care support is an investment in Scotland's people, society and economy. An estimated 230,117 people of all ages in Scotland received social care support and services during 2017-18. Our focus is on supporting people to live independently, be active citizens who participate in and contribute to society, and maintain dignity and human rights.

Evidence gathered during an engagement process in 2018^[14] highlighted innovation and opportunities in relation to social care support in Scotland, but also key challenges. This emphasised specific barriers that people and communities with protected characteristics may face when accessing services, for example: language and cultural barriers; the ability to navigate complex systems; physical and learning disabilities, and others.

We have been working with people who use, or who need support, unpaid carers, The Convention of Scottish Local Authorities (COSLA) and the social care sector to use this and a range of other evidence to develop a reform programme for adult social care. The programme was launched in June 2019. Our aim is to help deliver sustainability and consistency of support for people, to encourage greater co-operation between statutory provision and community and voluntary support, and to attract and retain people working in care as a career of choice, ultimately improving people's experience of social care and outcomes for them. Currently the vast majority of people working in the care industry are women who will be positively impacted by this action.

The Budget for 2020-21 will continue to support this crucial work, including:

• developing a vision and plan for a sustainable care home sector;
• working with health and social care partnerships, local authorities, social care providers and improvement organisations to make it easier to design and implement models of care which support the workforce to provide flexible, consistent care and support for people across care at home, care homes and other types of support;
• continuing to support the sector to commission care and support services that are flexible and person-centred;
• protecting the health and wellbeing of unpaid carers through: improving carer support via the continued implementation of the Carers (Scotland) Act; ensuring short breaks for carers by providing the short breaks fund through the third sector; and promoting awareness and support for carers to enter or maintain employment alongside caring if they so wish; and
• supporting Social Work Scotland to work with local authorities and others to design and test a framework of practice for self-directed support across Scotland, including approaches to assessment and resource allocation. This will result in more consistent experiences, making it easier for supported people to move from one area of Scotland to another.

Our approach to the reform programme is co-production. We are working with a range of groups representing people and communities with protected characteristics or particular life experiences to ensure that the programme helps to reduce inequalities across Scotland, and can evidence this.

Free personal care

Free personal care has been in place in Scotland since 2002 for people over the age of 65. In April 2019, this was extended to all adults. This means that any adult in Scotland, regardless of their age, condition or means, will receive personal care free of charge if they are found eligible for services. In 2017-18, nearly 78,000 older people benefitted from free personal care across Scotland. The Budget for 2020-21 will continue to support the commitment of free personal care to all eligible adults, which is part of our overall ambition to ensure that social care supports people to live independently, be active citizens who participate in and contribute to society, and maintain dignity and human rights.

Workforce and Nursing

Supporting the health and social care workforce is critical to delivering our priorities including actions to tackle the gender pay gap. Portfolio spend will focus on key workforce issues, including the provision of:

• 800 more GPs (headcount) over the next 10 years;
• 100 more medical undergraduate places by 2021;
• 2,600 extra nurse and midwifery training places by the end of this Parliament;
• an increase in GP specialty training posts from 300 to 400 per year;
• 50 more radiology specialty training posts over the next five years, supported by an additional £3 million investment;
• 500 more advanced nurse practitioners trained by the end of this Parliament;
• 1,000 additional paramedics by 2021;
• a national campaign to promote recruitment to the social care sector which will launch on 27th January 2020;
• a programme of work, through the reform of the adult social care programme, which will focus on improving fair work practices for the social care workforce;
• support for the development of additional mental health officer capacity within local authorities, supporting rights-based and person-centred approaches to decisions on the care of those with mental ill-health;
• support for regulation and development of the social care workforce to improve outcomes for users of social services, to improve public protection (including that for the most vulnerable in our society) and to ensure that workers have the skills and knowledge to undertake their roles.

Increasing medical undergraduate students

The 100 extra medical undergraduate places were mentioned in the National Workforce Plan and formed part of our commitment towards a more sustainable medical workforce. The majority of places commenced from the 2019-20 academic year. The extra places consist of 15 extra places added to the Scottish Graduate Entry Programme (ScotGEM) for 2018-19, and 85 places which Scotland's Universities submitted bids for.

As a result, 25 places were allocated to Edinburgh university to start a medical degree course online for healthcare professionals; 30 places went to Glasgow University for its Community Oriented Medical Experience Track (COMET) immersive programme giving students experience in 'deep end' (100 most deprived) practices plus exposure to primary care in a remote and rural context, and 30 places were also allocated to Aberdeen University for their Enhanced GP Programme with a similar remit. All 100 places were fully funded by the Scottish Government, ensuring equality of opportunity to study medicine regardless of gender, income etc.

• By also offering a £4,000 per annum bursary to ScotGEM students we are ensuring that all students have access to additional financial support to undertake their studies including those who have children or would otherwise not be able to afford to fund their second degree.
• The Edinburgh University online degree course will allow existing healthcare professionals to continue earning money whilst studying from home, thus ensuring accessibility for those whose childcare, caring or financial status would otherwise prevent them from studying at this level and allowing people who are socio-economically disadvantaged to access a degree in medicine. It is an equal opportunity for existing NHS staff who would like to train in this field.
• The immersive Glasgow COMET programme encourages students to think about practicing in underserved areas such as 'deep end' or remote and rural practices, aiming to bridge the gap between the quality of medical care experienced in low and high deprivation index areas. The funding has allowed for these additional places to be created, ensuring better access to medical care in future years for these socio-economically disadvantaged areas.
• The Aberdeen GP Enhanced Programme involves GP in admissions processes. Outreach allows students more contact with GPs and experiences. This is in order to encourage medical students to take up a career in general practice and become immersed in primary care, supporting our less well served communities whose main/only access to medical care is through their GPs.

Increasing GP speciality training posts

One hundred additional GP training posts were first advertised from 2017, with the salaries and associated training costs fully funded by the Scottish Government. This increase is now consolidated within the overall Scottish General Practitioner Specialty Training (GPST) establishment overseen by NHS Education for Scotland. The additional posts increases the opportunity for anyone who meets the entry criteria to train as a GP in Scotland. The annual advertisement, recruitment and selection process for these posts forms part of UK-wide medical selection and recruitment via the Oriel recruitment system, which ensures a fair, open and transparent process for all applicants who meet the entry requirements for such posts, thereby fulfilling equal opportunity obligations. The 100 additional places increase the opportunity for anyone who would like to train in these fields.

Additional radiology trainee posts

The additional radiology trainee posts, announced in 2017, formed part of the Scottish Government's response to increasing patient demand for diagnostic testing and commitments to improve the sustainability of Scotland's medical workforce. The ongoing training and associated costs are fully funded by the Scottish Government. In order to manage this significant expansion, 10 extra posts per annum have been added to annual trainee recruitment. The additional posts increase the opportunity for anyone who meets the entry criteria to train as a radiologist in Scotland. As in the GPST posts mentioned above, recruitment and selection via the Oriel system ensures a fair, open and transparent process and fulfils equal opportunity obligations.

Increasing the number of paramedics

An additional 1,000 paramedics will be trained by May 2021, equipped with the skills and abilities to support people in their local communities and helping to build further capacity within the ambulance workforce.

This has supported both career progression opportunities for staff, within the Scottish Ambulance Service, and provided opportunities for those who wish to join the profession.

This uplift in paramedic numbers will help improve health inequalities in a number of ways.

• Additional paramedic posts across the country will provide secure and paid work for more people working within their communities, supporting integrated health and social care provision.
• Increased access to development for staff who wish to apply for paramedic roles, will provide increased earning potential.
• The first paramedic undergraduate programme commenced in Scotland in 2017, increasing the range of access opportunities available to individuals seeking to work in the profession.
• From 2020, BSc paramedic degree programmes will be available through five universities located across Scotland as part of the plan to build and sustain paramedic numbers in Scotland, and improve accessibility to local education programmes for potential applicants.
• Through the expansion of undergraduate routes to paramedic qualifications, people from a range of socio-economic backgrounds will be able to apply for support offered through the student awards body and universities.
• The Scottish Ambulance Service is working with universities to ensure programmes are accessible to students across diverse backgrounds.
• The Service is also engaging with a wide range of communities, including those living in areas of deprivation, to promote the paramedic role as a career choice.

Nursing and midwifery training places

The increase in nursing and midwifery student intake by 2,600 increases the opportunity for anyone who would like to train in these fields. We are currently on track to meet this target. This spend line positively affects inequalities in a number of ways.

• We are encouraging universities to engage with, and encourage more men into nursing and midwifery, and have funded two research projects to consider this issue.
• By increasing the nursing and midwifery student bursary, we are ensuring that all students are financially supported, including those who have had care experience. The bursary has additional allowances for single parents, those with dependants, childcare and disabled people.
• We are working with universities to ensure meaningful exposure to remote and rural placements at undergraduate level and meet the costs of students' placements.

The budget for this area will also allow for additional places to be created, allowing people who are socio-economically disadvantaged to access a nursing degree, either:

• through the Open University we provide funding for Healthcare Support Workers (HCSWs) to undertaken nursing degrees through the Open University; or
• through an Higher National Certificate (HNC) route. We provide funding for Healthcare Support Workers (HCSWs) to undertake an HNC to enable them to matriculation into Year Two of a nursing degree. This allows HCSWs to remain in employment whilst studying. At present over 200 HCSWs are undertaking the endorsed HNC programme.

Both this, and the Open University route, allow HCSWs to 'earn and learn' as they remain in post.

Advanced Nurse Practitioners

The 2016 Programme for Government announced a commitment to train an additional 500 Advanced Nurse Practitioners by 2021. This was to equip nurses across Scotland to maximise their leading role in the integrated health care of the future, to improve patient care, and to contribute to a seamless care journey for patients.

The increase in training more Advanced Nurse Practitioners is an equal opportunity for any nurse who would like to train in this field if agreed by their employer.

Fairer Scotland Implications of The Budget

The Scottish Budget 2020-21 incorporates a wide range of decisions with the potential to reduce socio-economic inequality. A selection of these are outlined below and illustrate the broad range of work being taken forward as part of the Scottish Budget 2020-21.

General Dental Services

To ensure that people who wish to have access to NHS dental care are able to do so, the Budget for 2020-21 sets out an investment of £429 million^[15] to ensure the provision of NHS General Dental Services. As at 30 September 2019, 94% of children and 92% of adults were registered for NHS General Dental Services.

Everyone in Scotland receives free NHS dental check-ups. In addition, there are a variety of groups who are already entitled to free NHS dental treatment. These include children; young people; expectant mothers; and adults in receipt of certain benefits. In sum, approximately 40% of all patients, including children, do not have to pay a contribution towards the cost of their NHS dental care.

For adults who do not meet any of the criteria for free NHS dental treatment, they may qualify for help towards the cost of their NHS dental treatment through the NHS Low Income Scheme. This is an income-related scheme, which considers the applicant's (and partner's) weekly income and expenses to calculate how much, if anything, the person should pay towards the cost of their NHS dental treatment. Around 20,000 applications were made to the Low Income Scheme for the 12-month period to September 2019.

Investing in general dental services contributes to the following Outcomes:

• our children have the best start in life and are ready to succeed;
• we live longer, healthier lives;
• we have improved the life chances for children, young people and families at risk.

Evidence for the improvement in child oral health is now compelling, and Scotland is internationally recognised in preventive oral health amongst children through the Childsmile Programme. The programme was introduced in 2006 and offers supervised tooth-brushing instruction in nursery, early school years and dental practice. Since 2009, the proportion of Primary seven children with 'no obvious decay experience' has increased from 64% in 2009 to 80% in 2019. Equivalent data for Primary one children also shows an increasing trend, from 58% in 2008 to 71% in 2018.

The latest report on child oral health also shows a slight narrowing in oral health inequalities, but the gap remains significant; 80% of children from the most affluent 20% of the population 'have no obvious decay experience', compared with 53% of children living in the most deprived areas. In 2017 the Scottish Government expanded the Childsmile Programme to ensure that children in the 20% most deprived areas of Scotland received fluoride varnish application.

Investment in this area is already generating positive outcomes for addressing inequalities. This can be demonstrated by the introduction of the Oral Health Challenge Fund Programme. The fund was launched on 1 July 2019, with funding for 22 projects across Scotland. The purpose of the Fund is to enable third sector organisations to deliver projects that support families with young children living in areas of multiple deprivation to reduce oral health inequalities and support better early years oral health. The Scottish Government has committed £2.5 million from July 2019 to March 2022 to the fund.

Alongside this investment, the latest Programme for Government announced a new commitment – to extend the eligibility for free NHS dental care to care-experienced people between the ages of 18 and 26. It is hoped this commitment will reduce the negative impacts that poor dental health can have on physical health, mental wellbeing, and self-confidence, ensuring their oral health experience is closer to more advantaged groups.

General Ophthalmic Services (GOS) Priorities

To ensure regular, free eye examinations of high quality are available to all Scottish residents, the Scottish Government is continuing to invest in General Ophthalmic Services (GOS). In 2020-21, the estimated budget for providing GOS will be £110 million.

Evidence suggests that there is increased demand for GOS, with the number of primary and supplementary eye care examinations in Scotland steadily increasing between 2006-07 and 2018-19.

Evidence also suggests that people are less likely to attend an eye examination if they live in a more deprived area. Of those people who attended a primary eye examination in 2018-19, 28.6% were in SIMD one (most deprived) compared with 33.6% in SIMD five (least deprived).

In order to tackle health inequalities, a national group is being formed with Optometry Scotland and other key stakeholders.

In addition, the policy area is supporting the development of a national low vision service. There is strong evidence^[16] that access to low vision aids is presently a 'postcode lottery', and that improvements to the service would greatly increase a visually impaired person's independence, mental health, and general wellbeing.

Conclusion

The Health and Sport budget is responsible for protecting and improving the health and wellbeing of Scotland's population. The portfolio is crucial in ensuring that we are healthy and active, live in communities that are inclusive, empowered, resilient and safe, and can fulfil our human rights. Improvements in these outcomes will contribute directly to our economic growth and national ambitions as a wellbeing economy.

Footnotes

1. General Health Questionnaire 12 (GHQ-12) is a standard measure of mental distress and mental ill-health consisting of 12 questions on concentration abilities, sleeping patterns, self-esteem, stress, despair, depression and confidence in the previous few weeks.

2. Source: Scottish Household Survey

3. Source: SHeS

4. Users should note that figures from the long-term monitoring of health inequalities report compare deciles where the figures from SHeS above are comparisons between the least and most deprived quintiles.

5. http://www.legislation.gov.uk/asp/2016/14/part/4/enacted

6. http://www.healthscotland.scot/media/1626/inequalities-briefing-10_mental-health_english_nov_2017.pdf

7. Scottish Government (2018) Scottish Surveys Core Questions 2016. Edinburgh: Scottish Government.

8. Fellinger, J., Holzinger, D., & Pollard, R. (2012). Mental health of deaf people. Lancet, 17, 1037-44.

9. Scottish Government (2017) Scottish Schools Adolescent Lifestyle and Substance Use Survey 2015: mental wellbeing report. Edinburgh: Scottish Government.

10. Luppa, M., Sikorski, C., Luck, T., Ehreke, L., Konnopka, A., Wiese, B., Weyerer, S., König, H.H., & Riedel-Heller, S.G. (2012). Age- and gender-specific prevalence of depression in latest-life – systematic review and analysis. Journal of Affective Disorders, 136, 212-221.

11. Scottish Government (2015) Scotland's Carers. Edinburgh: Scottish Government.

12. Scottish Government (2019) Scottish Surveys Core Questions 2017. Edinburgh: Scottish Government.

13. 2020-21 Budgets subject to Scottish Parliament approval of draft budget and outcome of negotiations with contractor body.

14. https://www.gov.scot/publications/summary-report-discussion-paper-responses-analysis-responses-joint-discussion-paper-scottish-government-cosla-building-national-programme-support-adult-social-care-reform/pages/11/

15. To note – these figures are based on the latest information provided by Health Finance, and may not correspond exactly with published information as part of the budget process.

16. Scottish Government Review of Low Vision Service Provision in Scotland (2017) https://www.gov.scot/publications/review-low-vision-service-provision-scotland/ Court H, McLean G, Guthrie B, Mercer SW, Smith DJ. Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study.