Equally Well Implementation Plan

EXECUTIVE SUMMARY

Purpose of the Implementation Plan

Equally Well sets an ambitious and radical programme for change across the key priority areas of children's very early years; the big killer diseases of cardiovascular disease and cancer; drug and alcohol problems and links to violence; and mental health and wellbeing. Action on many fronts is already being taken forward. The purpose of this implementation plan is to support further progress and change, both at local and national level. It describes how the Government and community planning partnerships can and will turn the Task Force's recommendations into action in the short to medium term across the four priority areas, and identifies which organisations can most helpfully be involved at each stage. The plan includes examples of action already starting to happen across Scotland.

Links with high-level social policies

The Scottish Government and COSLA are publishing in late 2008 frameworks on tackling poverty and early years, which are closely related to Equally Well. The three major social policy approaches link in the following ways:

• All have been developed jointly by central and local government.
• All are about major and intractable social problems that are interlinked and work across generations to hold back Scotland's progress: children's start in life and cycles of poverty, inequality and poor health.
• These are complex issues with often complex solutions which cannot be sorted out overnight.
• Each framework supports the others and sets out specific actions needed to meet shared long-term health and other outcomes and aspirations.
• Commitments to rooting out inequality and promoting equality are central.
• The frameworks are vital in driving the Government's and COSLA's shared early intervention approach, moving from crisis management to early intervention and preventing and breaking cycles of poor outcomes.
• We aim to shift the focus from providing services (doing things for or to people) to building the capacity of individuals, families and communities, and addressing the external barriers people may face to making use of the high quality, accessible public services they require.
• A major purpose of Government activity is to support local change and development.
• Real change will happen through community planning and joined up action by the partner organisations locally. Often this requires small, innovative steps that will build up over time to have a big impact.
• It is vital to base action on what will benefit users of public service and communities directly.
• For example, the Equally Well test sites are all about better client pathways into, through, and eventually out of key public services, and joining up those local services for individuals, to address the whole range of their needs.
• Single Outcome Agreements with Government are the way to articulate joint local accountability for outcomes and change to meet local need.

Equality and diversity

In addition to planning for reductions in health inequalities, recommendation 2 of Equally Well requires action to be subject to equality impact assessment. The Government will continue to reinforce the point in all further central and local policy and action on Equally Well recommendations.

The Government's Mutuality, Equality and Human Rights Board has established a group to promote good relations within communities and recognise the impact of discrimination and disadvantage on health. The group will scope existing activity across health and other sectors, explore new approaches for the NHS in Scotland, test out ideas and disseminate effective ways of working.

NHS Health Scotland is leading the development of an accessible communication, translation and interpreting strategy and action plan for use by NHS Boards. This will provide a consistent approach to enhancing and improving communication with patients from all backgrounds.

NHS Health Scotland is working with partners in NHS Greater Glasgow and Clyde (which is already implementing its own Language and Communication Support Plan) and other Boards. The strategy and action plan will be available by spring 2009.

In addition, and in order to meet Equally Well recommendations 74 and 75 on equalities data, NHS Health Scotland will undertake a review of equalities data for health needs. This will be linked to the UK-wide requirement to review equalities data which resulted from a recent UK statistics commission assessment. The review will use outputs from the current NHSNSS Equality and Diversity Information project. It will also examine the relevance of existing HEAT targets for each equalities dimension and advise on the development of appropriate measures. The review will be carried out in 2009. Its report will set out a plan for data development and collection, with timescales and costs. Following this review, targets will be considered to support work on patient monitoring and equalities data collection. This is likely to be in 2010.

Test sites

Local test sites are a key way in which the Equally Well recommendations will be taken forward. These are areas where local authorities and their community planning partners intend to improve on both the reach and impact of local services within existing resources, taking the opportunity to use ideas from frontline staff who deliver services, and from the people who use them.

The plan describes how the test sites will transform and redesign public services, to improve client pathways through services that have a big effect on their health and wellbeing. The test sites are exploring joined-up local service responses to health inequalities. The test sites will learn from each other and we shall make sure that learning is spread more widely and effectively than has been possible through previous pilot- and project-based approaches.

The eight test sites are in:

• Whitecrook, West Dunbartonshire - targeting the high prevalence of smoking in the area.
• East Lothian - looking at health inequalities in early years in Prestonpans, Musselburgh East and Tranent.
• Govanhill, Glasgow - looking at community regeneration and development through the adoption of a neighbourhood management approach involving all key community planning partners.
• Blairgowrie - looking at delivering health inequality sensitive services in a rural setting for people with multiple and complex needs.
• Lanarkshire - focusing on sustained employment and supporting people to find decent work.
• Fife - focusing on anti-social behaviour in relation to alcohol and underage drinking.
• Dundee - focusing on methods of improving wellbeing.
• Glasgow City - looking at integrating health into current and future city planning.

Each of the test sites is a collaboration between local public services. Each has high-level buy-in from those with the authority to manage permanent change and direct spend in an area, and so will demonstrate how mainstream services can be transformed within existing resources to fit with what their clients really need.

The test sites approach embodies the new relationship between central and local government in Scotland: shared vision for high level outcomes and effective local action to help achieve those outcomes.

Planning and Reporting Progress

In order to deliver the changes Equally Well seeks across Scotland, we need to identify:

• How long-term reductions in the key health inequalities will be monitored and reported through community planning and the Single Outcome Agreement ( SOA) process.
• How medium-term change can be planned and managed, again through community planning and SOAs and the accountability arrangements within community planning partner organisations.

The Government has adopted the health inequality indicators and measures recommended
in Equally Well, which will be used to report regularly on long-term progress across the whole of Scotland.

The Government will expect coverage of health inequalities in 2009-10 SOAs, where there are relevant local issues and problems, and where local action can contribute to addressing both local and national health inequalities. There will be no separate reporting arrangements for implementation of Equally Well.

Role of Community Health Partnerships

Community Health Partnerships ( CHPs) play a critical role in addressing both causes and consequences of health inequalities. They are responsible for many relevant services jointly managed by NHSScotland and local authorities. They are critical in community planning at both whole-Council and smaller-area levels, and are well-placed to engage directly with the local community on the design and delivery of health and other services to meet local needs, including involvement of the Third Sector.

By Easter 2009, the Government and NHS Health Scotland will publish updated briefing for CHPs on improving health and reducing health inequalities.

Progress on action on recommendations

The plan provides an update on how the recommendations in Equally Well are being implemented. It identifies further actions that will be taking place over the next two years. This information supports local delivery of change by describing relevant national strategies, frameworks and other outputs that provide practical tools for local use.

We have not attempted to prioritise the recommendations. All are potentially important to achieving long-term shifts in health inequalities. Community planning partners will identify the relevance to their local circumstances and the outcomes they commit to achieving.

The implementation plan clusters the recommendations in smaller groups than those referred to in Equally Well and brings linked recommendations together with the intention of making it easier for organisations involved in local delivery to identify actions that are relevant for them. For example there are clusters relating to educating young people, and tackling poverty and regenerating communities.

Key actions that progress the Equally Well recommendations include:

Early Years:

• Scottish Government publishing the early years framework (December 2008).
• The Nurse Family Partnership pilot in NHS Lothian, which will provide holistic support services for families with very young children at risk of poor health and other poor outcomes (to start in 2009).
• The two year project to increase health and wellbeing support in schools, with demonstration sites in four NHS Boards (started autumn 2008).
• The Scottish Government's drugs strategy, The Road to Recovery, which includes 17 actions that will improve support for children and young people affected by parental substance misuse (published May 2008).

Education, information and engagement for young people:

• The Scottish Government published Curriculum for Excellence: Building the Curriculum 3: A Framework for Learning and Teaching (June 2008).
• 16+ Learning Choices (implemented from December 2008), which will ensure that every young person has an appropriate, relevant and attractive offer of learning made to them well in advance of their school leaving date.

Mental health and wellbeing:

• Pilot initiatives to widen access and offer innovative approaches to self-help cognitive behaviour therapy and guided self-help for people with depression and anxiety (August 2008).
• Publication of an action plan to improve mental health and wellbeing in Scotland (in early 2009).

Poverty and Fuel Poverty:

• Scottish Government published Achieving our Potential, its framework for tackling poverty (November 2008).
• Scottish Government to invest in income maximisation work, including building on pilots with Age Concern Scotland and DWP to increase pension credit take-up (during 2009-10).
• Start of the Energy Assistance Package, providing advice on all aspects of fuel poverty, packages of insulation measures, and enhanced energy efficiency improvements (April 2009).

Business, employment and health and Public sector employers:

• Scottish Government to complete its review of the Healthy Working Lives Strategy, aligning the outcomes to Equally Well recommendations (summer 2009).
• Scottish Centre for Healthy Working Lives to produce its three year strategic business plan, setting out a vision for the Centre and how it will develop products and services focused on the needs of SMEs (January 2009).
• Scottish Government to work with COSLA to promote to local authorities a common public sector recruitment approach (2009-10).

Physical environments:

• Beyond the School Gate (part of the Government's Healthy Eating, Active Living action plan), which will help support health promotion across communities and focus on action that encourages physical activity and access to healthier foods (during 2008-09).
• Development of guidance materials and toolkits for developing sustainable management approaches for planning and greenspace (during 2009-10).

Whole community demonstrations:

• Scottish Government announced the proposals to be funded by Smarter Choices, Smarter Places, a partnership project designed to increase active travel and use of public transport, and tackle transport emissions (August 2008).
• Scottish Government to establish Healthy Weight Community Projects, which aim to reduce obesity, particularly amongst children and more deprived groups of people (during 2009-10).

Alcohol, drugs, violence - prevention:

• The Youth Justice Framework, which sets out a shared vision of what national and local agencies working with children and young people who offend (or are at risk of offending) should do to prevent, divert, manage and change that behaviour (published June 2008).
• The multi-agency Glasgow anti-gangs project, which aims to provide effective coordination of all services and community and voluntary groups to reduce gang-related violence (started October 2008).
• Evaluation framework to monitor the impact of the Government's interventions on alcohol misuse (early 2009).

Joining up of drug treatment:

• Scottish Government to publish and respond to the SMACAP/ SACDM Delivery Reform Group's consideration of the future of alcohol and drug delivery arrangements (end 2008, early 2009).

Domestic violence:

• Scottish Government's Chief Executives' Letter ( CEL 41(2008)) to NHS Boards on gender-based violence, which sets up a national three year programme of work on improving the healthcare identification and management of gender-based violence (September 2008).

Anticipatory care, Primary care and dental health:

• The GMS funding contract for 2009-10, which will allow funding to be better targeted at practices in deprived areas with the highest prevalence of ill health (announced October 2008).
• Scottish Government working with NHS Boards to establish inequalities-targeted high risk primary prevention as part of the normal offer of the NHS across Scotland (2009-11).
• Development and roll-out of a coordinated core and client-centred oral health improvement programme for homeless people, an oral health strategy for offenders, and identifying good practice for improved oral health amongst older people (during 2009-10).

Smoking:

• Implementation of the Smoking Prevention Action Plan (2008-11).
• Launching the Enhanced Tobacco Sales Enforcement Programme (2008-09).

Learning disabilities:

• Scottish Government identifying test areas to take forward a change programme of health services for people with learning disabilities (from early 2009).

Offenders' health:

• COSLA to sponsor a workstream on community reintegration, as highlighted in the Report of the Scottish Prisons Committee (July 2008) Scotland's Choice (during 2009-10).
• Provision of anticipatory care for prison populations (2009-10).

Third Sector:

• Scottish Government launched (in June 2008) its investment strategy for the Scottish Investment Fund, with tackling the underlying causes in health inequalities a priority for its first year.
• Scottish Government to provide additional funding for Meeting the Shared Challenge (2009-10).

Resources, monitoring and evaluation

Equally Well identified significant resources already allocated to the public sector that will make a difference to the underlying causes of health inequalities: £1.8 billion over the three years 2008-11.

Implementation of Equally Well will ensure better, more focused use of existing resources. The test sites, in particular, will demonstrate what change is possible within budgets at a local level.

Development of future action on health inequalities will require the Scottish Government to evaluate the policies and actions that Equally Well recommends. In order to do this, the Scottish Government will:

• Develop an evaluation framework that builds on the implementation plan and the analysis of medium-term outcomes.
• Ensure that the test sites are evaluated locally and that lessons are learned from the programme as a whole.
• Work with an external advisory group.
• Enhance opportunities for practitioners, academics and evaluators to share learning and to develop a wider range of approaches to evaluation appropriate for actions designed to reduce health inequalities.

Finally, the Scottish Government will announce by the end of 2009 how the Ministerial Task Force's review of progress will be carried out in 2010. This implementation plan will be a key part of determining progress towards Scotland becoming "Equally Well".