Scottish draft Budget 2018-2019: equality statement

Chapter 4
Health and Sport

Introduction

The main purpose of the Health and Sport portfolio is to maintain and improve the health and wellbeing of people in Scotland. Its role is in providing support to ensure that the NHS and wider health and care services meet the health and care needs of the people of Scotland effectively and at the right time.

Despite significant improvements in recent years, Scotland continues to have a poor record with regards to 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.

The portfolio 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, the Scottish Government’s first priority is to protect and invest in frontline services across health and social care.

At the same time, the Scottish Government will continue to pursue a preventative agenda, matching our successful actions on smoking and alcohol with new initiatives to reduce obesity, boost active travel, improve mental health and tackle air pollution. This will help reduce the long-term challenges facing our health service and allow our people to live healthier for longer.

A key focus for prevention and intervention will be the earliest years of life, building strong foundations and reducing the number of adverse childhood experiences that we know can have lasting impacts on our children and shape their lives as adults.

We will continue to break down the barriers between health and social care services, particularly for our older people. More support must be provided in people’s homes and communities, enriching their lives and extending healthy life expectancy. The Scottish Government is integrating health and social care and will invest an increasing proportion of the budget in primary, community, mental health and social care services to support the shift in the balance of care that is required.

The Health and Sport portfolio has an important role to play in achieving inclusive growth for Scotland. Although unemployment is at historically low levels, there are many who still struggle to secure and sustain jobs. Disabled people, those with long-term health problems – particularly mental ill health – and those with low levels of qualifications are particularly disadvantaged in the labour market and often experience worsening ill health and poverty as a result. Health and care services can help ensure that as many people as possible benefit from being in work; not only in terms of income and maximising our workforce, but also from the self-worth and expression that can come from employment.

Equality Implications Of The Draft Budget 2018-19

The Scottish Government has increased funding for Early Years in order to give our children the best start in life, supporting the implementation of recommendations from the Best Start review of Maternity and Neonatal Care. The increased £16.9 million funding for the Family Nurse Partnership programme will help complete the roll-out of the programme beyond first-time teenage mothers to cover vulnerable first-time mothers up to the age of 24, specifically benefiting eligible young women and their children. The increase in early years funding will also allow us to deliver a Baby Box to all newborns in Scotland.

Care at birth and in the early years of life will be supported by increased staffing in key areas. As part of the reform and improvement of health visiting services, the Scottish Government will increase the number of health visitors by 500. This will be supported by funding which has increased over four years to reach an annually recurring figure of £20 million. The resultant increase in frontline staff will be of particular benefit to women and their young children.

Similarly, £2.6 million of new funding for breastfeeding resources will support mothers, particularly in the days immediately following the birth, and help infants receive the health benefits that breastfeeding can provide.

In 2018, we will publish our Child and Adolescent Health and Wellbeing Action Plan, which will set out concrete actions to support all children to become, and remain, healthy and successful, putting children and young people at the centre of policies that affect them. Increased funding in 2018-19 to support the development of the action plan will help ensure that children and young people’s wishes and views are taken into account alongside views sought from equality groups, parents and carers.

Long-term mental health problems that limit people’s day-to-day activities are recognised as a disability. Increased funding for mental health in 2018-19, part of a five-year investment of £150 million, will be guided by the Scottish Government’s 10-year mental health strategy which includes actions covering prevention and intervention, and access to services. This funding will have a positive impact on individuals with mental health problems through reducing waiting times and supporting them to manage their own conditions and stay well.

This investment in mental health will impact positively on lesbian, gay, bisexual, transgender and intersex ( LGBTI) people who have higher rates of attempted suicide, self-harm, depression and anxiety. 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 on children and young people.

The Scottish Government will provide additional investment over the next five years, rising to £35 million in the fifth year, for 800 additional mental health workers in key settings. This will give increased access to dedicated mental health professionals in Accident and Emergency and GP practices, every police station custody suite, and to our prisons. This will help all those in need of mental health support. The main users of the increased mental health support in custodial environments are likely to be young men – the demographic group most likely to be in prison.

The Independent Living Fund Scotland ( ILF) will continue to deliver ILF support payments to disabled people with high support needs – a key investment enabling independent living in the community. ILF funding for 2018-19 includes £5 million for a new scheme for people aged 16 to 21 who are at an important transitional stage in their lives. This scheme will help young disabled people to be active, and to participate and contribute to their local community.

In 2018-19, the Scottish Government will invest an additional £20 million in alcohol and drugs services. This will be of particular benefit to those living in deprived areas who are significantly more likely to experience an alcohol- or drug-related hospital admission and significantly more likely to suffer an alcohol- or drug-related death than those living in the least deprived areas. Additional funding will also benefit men, who are more likely to require hospital treatment in relation to alcohol and drugs.

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 all people, throughout every stage of life. Increased investment of £110 million in the primary care fund in 2018-19 will allow services to provide a continuing and transforming service and deliver our six key outcomes for primary care, including to ‘better address health inequalities’.

This increased funding will be of benefit to disabled people and people with limiting long-term health conditions who are more likely to use GP services, as well as to the significant number of GP patients managing multiple health problems. GP records suggest that older people in particular are more likely to receive care for multiple health problems and are more likely to suffer from mental and physical health problems in tandem.

The Scottish Government will double its investment in cycling and walking for 2018-19. This has the potential to encourage and enable greater physical activity amongst groups that are currently less active, including older people, women, and people in South-Asian ethnic groups.

The active travel investment will also benefit those living in the most deprived areas of Scotland where levels of car ownership are lowest, and yet where levels of physical activity are also lowest. Air pollution impacts on human health, exacerbates respiratory and cardiovascular conditions, and particularly affects vulnerable groups, including the very young and old. This investment, alongside the ‘Cleaner Air for Scotland’ plan, will help work towards reducing traffic-related air pollution.

New funding for weight management will provide support for those who are overweight and obese and help mitigate related health problems. This investment will be supported by the Scottish Government’s developing strategy for diet and obesity, and by action to progress measures to limit the marketing of products high in fat, sugar and salt. The new funding could be of particular benefit to older people as obesity rates increase with age before peaking amongst those aged 65 to 74. Obesity rates for both adults and children are also generally higher for those living in more deprived areas, so action to reduce obesity could have the greatest impact for people in these areas.

The Scottish Government has provided increased social care funding to Health and Social Care Partnerships. This will ensure that vital social care is provided to older people and disabled people, offering them greater choice and control in their lives. This also enables the delivery of the Living Wage to adult social care workers, the majority of whom are women, to be extended to those working sleepovers during 2018-19.

This funding will also support the implementation of the Carers Act coming into effect in April 2018. The Act aims to ensure carers are supported on a more consistent basis to enable them to continue to care, should they wish, in good health and to have a life alongside caring. Women and older people are more likely to be carers, and tend to provide more hours of care, so implementation of the Act will be of particular help to them. The Act will also be of benefit to young carers, for whom there is an additional need to remove inappropriate caring responsibilities.

2018-19 will be the third year of a five-year commitment to invest £100 million in order 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. As the number of people with cancer increases with age, this additional funding for cancer services should also be of benefit to older people.

Self-Directed Support ( SDS) allows users of social care to choose how their support is provided and gives them control of their individual budget. A reduction in funding for SDS could have a negative impact on the range of individuals using social care services, including disabled adults and children. However, the specific SDS budget line relates to transformation funding used to support system change and the provision of information and advice to individuals. Funding for the actual delivery of self-directed support is integral to mainstream social care.

The apparent reduction of this transformation funding in 2018-19 reflects the use of some of this finance to support the closely related policy changes for carers. This is a baseline redistribution to implement related policy goals. The revised figure is in line with actual transformation spending in 2017-18 and should not therefore constrain the support available or have negative equality impacts.

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 that they need. Through providing care and support for those in ill health and taking steps to ensure that those in the wider population are healthy and active, the portfolio can ensure that people in Scotland are able to take advantage of available opportunities. It will be important that funding continues to promote equality and meets the varied needs of those receiving care as effectively as possible.