Scottish Draft Budget 2017-2018: equality statement

Chapter 4 Health and Sport

Introduction

The Health and Sport portfolio is responsible for helping the people of Scotland maintain and improve their health and wellbeing. The pressing demands for this portfolio include a growing and ageing population, the presence of more people living with multiple conditions, and expectations arising from new drugs, treatments and technologies.

Despite significant improvements in recent years, Scotland continues to have a poor record with regards healthy life expectancy. People in Scotland's most deprived communities still have significantly lower health life expectancies than those in the least deprived areas and are more likely to smoke, be physically inactive, and have an unhealthy diet. The portfolio is therefore key to tackling socio-economic disadvantage. It also has a vital role in promoting equality through investments in areas such as child and women's health, older people's care, and support for disabled people.

Key Strategic Priorities

With increasing demand for services, our first priority is to protect and invest in frontline services across health and care. Our delivery plan will bring together our ground breaking reforms, including the integration of health and social care, the National Clinical Strategy, regional services, workforce and financial planning and our work on population health. These reforms provide the basis for delivering the 2020 Vision and our longer-term strategy up to 2030.

We will continue to pursue a preventative agenda, including tackling key drivers in Scotland's health inequalities, such as alcohol- and tobacco-related harm. Knowing that prevention must begin in the earliest years, the Scottish Government is committed to the Early Years Collaborative model and investing in the health and wellbeing of children, young people, and families.

Further improvement to the quality of care will also be prioritised, benefiting all those that use NHS services, in particular older people living with multiple physical and mental health conditions.

Equality Implications of the Draft Budget 2017-18

Long-term mental health problems that limit people's day-to-day activities are recognised as a disability. The five-year investment of £150 million in mental health as well as the forthcoming mental health strategy will have a positive impact by reducing waiting times and supporting these individuals to manage their own conditions and stay well.

The focus on prevention and anticipation of mental health problems through attention to early years, child and adolescent mental health will have a positive impact for children and young people. In particular, young women currently report lower levels of mental wellbeing than other population groups and are more likely to self-harm.

The investment in mental health will also have a positive impact for lesbian, gay, bisexual, transgender and intersex ( LGBTI) people who have higher rates of attempted suicide, self-harm, depression and anxiety.

The integration of Health and Social Care will be supported by the additional investment of £107 million for Integration Authorities in order to support the delivery of improved outcomes in social care. Through the development of commissioning plans and equality outcomes as required by statute, Integration Authorities have identified the needs and priorities of each individual locality by engaging with a range of stakeholders, including local communities. By addressing the very particular needs of local communities within each Integration Authority and their localities, services and support will be planned and tailored to the specific needs of local people taking into account different equality groups.

This investment also enables adult care workers to receive the Living Wage - a development that will impact positively on women who are more likely to fill these roles.

The continued investment to increase the Health Visitor Workforce will have a positive impact on women and children by ensuring that every child in Scotland receives quality health development support. Similarly, increased funding of £5 million for the Family Nurse Partnership programme and its expansion beyond first-time teenage mothers to cover vulnerable first-time mothers up to the age of 24 will also have a positive impact for women and children.

Primary care is at the heart of the healthcare system and the means by which the majority of health interactions take place. It is a universal service which provides care to people who share protected characteristics throughout every stage of life. The Primary Care Fund, which is used to support transformational change and improvement in primary care services, will increase significantly to £72 million in 2017-18. The fund will allow services to provide a continuing and transforming service, and deliver our six key outcomes for primary care. These outcomes include addressing health inequalities and informing and empowering patients.

The Scottish Government has committed to increasing the number of community Links Workers in disadvantaged areas to 250 over the next five years. New funding of £2 million for 2017-18 will help recruit 40 workers in the first year to ensure that anyone who needs psychosocial support receives it. The twin objectives of this programme are that it will enable people to live well within their community, thereby reducing inequality, and also help to ease pressure on general practices. The focus is on the areas of greatest deprivation, but also reaching pockets of deprivation in rural communities.

The Independent Living Fund ( ILF) Scotland will continue to deliver ILF support payments to severely disabled people and £5 million has been provided to enable a new iteration of the scheme to open within the next year. This is a key investment enabling independent living in the community.

The £200 million investment towards expanding the Golden Jubilee Hospital and creating five other elective care centres will have a positive impact for older people who, amidst rising demand, will benefit from planned elective care for hip and knee replacements and cataract operations.

Continuing to increase investment in the palliative care sector by £3 million over three years will drive progress towards our aim that, by 2021, everyone in Scotland who needs palliative care will have access to it. This will have a positive impact for older people and those with a life-limiting condition as they reach the end of their lives.

Over the next five years, £100 million will be invested to enhance cancer services. Currently, cancer incidence and mortality are higher amongst individuals from deprived areas. Preventative efforts relating to tobacco, alcohol and diet, as well as more equitable access to screening, earlier diagnosis, and access to services to support people who are living with cancer, should all impact positively on people from deprived areas.

In some areas of the portfolio, funding is being reduced. Unless mitigated, these reductions may have negative implications for equality groups. However, in some cases, funding reductions are addressed by changes to other budget lines.

Self-directed support ( SDS) allows users of social care, including older people and disabled adults and children, to choose how their support is provided and gives them control of their individual budget. The apparent reduction in funding for SDS is due to the movement of money previously set aside to support the opening of the Independent Living Fund to new users. It does not, therefore, represent a fall in the amount of money available to support SDS.

SDS investment for 2017-18 will be directed towards delivery of the actions identified in the Implementation Plan 2016-18. The plan sets out a new and more focused phase of activity and will support the effective delivery of SDS for all those that use it.

Improved monitoring and review of where best to focus efforts around maternal and infant nutrition has allowed us to utilise resources to better effect. This will help mitigate against the reduction in funding for Infant Nutrition and Maternity Services in 2017-18. A Strategic Review of Maternity and Neonatal Services will report to Ministers at the end of 2016: further funding arrangements will be considered in light of the review's recommendations.

Healthy Start is a demand-led scheme offered to low-income pregnant women and children to provide weekly food and vitamin vouchers. The uptake has remained at 74 per cent for a number of years, but there is a focus on improvement activity to drive this number up through the Children and Young People's Improvement Collaborative. This scheme is offered automatically to all pregnant women under 18. The scheme is still administered by the UK Government, and is based on entitlement through specific benefits. A reduction to this budget is based on previous uptake, but we are mindful that, should uptake increase, we are obliged to meet that cost. Healthy Start is also a component of the Welfare Foods programme which will be devolved to the Scottish Government, with £1 million set aside to assist with that process and help support Healthy Start.

The 'Keys to Life' strategy aims to improve the quality of life for people with learning disabilities in Scotland. In 2016-17, the funding available for the strategy was not fully utilised, and funding for 2017-18 has been held in line with the actual uptake in 2016-17. The Scottish Government will continue to work with our strategic delivery partners - The Scottish Learning Disability Commission and The Scottish Learning Disability Observatory - to target resources effectively at interventions and programmes of activity that the evidence indicates would make the biggest positive difference to people with learning disabilities.

Overall, sports and legacy funding for 2017-18 will be reduced. Any negative impact for lesbian, gay, bisexual, transgender and intersex ( LGBTI) people will be mitigated through the Scottish LGBTI Sports Charter which ensures that funding for all sports includes conditions on specific actions to tackle LGBTI discrimination.

Further, to encourage the removal of barriers to participation in sport, including those for women and LGBTI people, an Equality in Sport and Physical Activity Forum will be established. A Gender Equality in Sport Fund will also be developed in order to address the barriers specific to women's participation.

Conclusion

Equality of opportunity is advanced by the Health and Sport portfolio by ensuring that all individuals have access to the health and social care services that they need. Through supporting Health and Social Care Partnerships to identify and meet the needs of their communities, and developing new models of primary care, the portfolio continues to be responsive to the needs of people across Scotland. It will be important that funding continues to promote equality and meets the varied needs of those receiving care as effectively as possible.