Equally Well Implementation Plan

1.

The Government should produce a practical implementation plan by the end of 2008, setting out how the Task Force's recommendations will be turned into action and who will be responsible, at both national and local levels.

SG

Introduction

2.

Those responsible for implementing the Task Force's recommendations should carry out equality impact assessments on the action they are taking to ensure this is legally compliant; systematically consider the needs of the diversity of the population; ensure action does not adversely affect any part of the population; and consider how they can promote equality.

SG

Introduction

3.

Reducing health inequalities should be a key outcome for the Early years framework being developed jointly by the Government and COSLA.

• The Government should, as a priority, examine targeted early access to pre-school education for under 3's. This will build on previous experience of earlier entry to pre-school for high risk groups and acknowledge the significant role that pre-school and early education have in addressing future inequalities.

SG

Progress on action -Early years

4.

NHS Boards should improve the capacity of ante-natal services to reach higher risk groups and identify and manage risks during pregnancy.

SG

Progress on action -Early years

5.

The Government should arrange a Scottish survey of the incidence of Foetal Alcohol Syndrome.

SG

Progress on action - Early years

6.

NHS Boards should improve breastfeeding rates in deprived areas and among disadvantaged groups.

SG

Progress on action - Early years

7.

The Government should lead the development of holistic support services for families with very young children at risk of poor health and other poor outcomes.

SG

Progress on action - Early years

8.

There should be a range of services that identify need and provide support to the most vulnerable children and families. As part of that, the Government should develop a community-based integrated school health team approach, targeting children at risk and increasing the nursing staff and other professionals supporting schools.

SG

Progress on action - Early years

9.

The Government should continue to improve support for children at risk in households where alcohol or drugs are misused.

• The Government should continue to work with local partners to look at ways to improve identification, assessment, recording and planning for children at risk in substance misusing households, build capacity and improve services in this area and improve the management of immediate risk.

CPP

Progress on action - Early years

10.

Curriculum for Excellence should continue its strong focus on literacy and numeracy, with every teacher taking responsibility for delivery across the curriculum.

CPP

Progress on action - Education, information and engagement for young people

11.

Curriculum for Excellence should take a holistic approach to health and wellbeing outcomes, including active and healthy lifestyles, supported by the new school health team approach.

CPP

Progress on action - Education, information and engagement for young people

12.

The ethos within which Curriculum for Excellence is implemented should place the child at the centre of the process.

CPP

Progress on action - Education, information and engagement for young people

13.

Curriculum for Excellence should provide continuity and progression through school to post-school, aimed at retaining young people in learning after the age of 16.

CPP

Progress on action - Education, information and engagement for young people

14.

Physical environments that promote healthy lifestyles for young children, including opportunities for play, physical activity and healthy eating, should be a priority for local authorities and other public services.

CPP

Progress on action - Physical environments

15.

Each NHS Board should assess the physical, mental and emotional health needs of looked after children and young people and act on these assessments, with local partner agencies.

CPP

Progress on action - Early years

16.

Fairer Scotland Fund resources deployed by community planning partnerships should contribute to health outcomes and improving healthy life expectancy.

CPP

Progress on action - Poverty

17.

Universal public services should build on the examples of effective financial inclusion activity, to engage people at risk of poverty with the financial advice and services they need.

CPP

Progress on action - Poverty

18.

The Government should help people to maximise their income and encourage them to take up means-tested benefits, starting with older people and extending activity through intermediary organisations such as Registered Social Landlords and healthcare services.

SG

Progress on action - Poverty

19.

Any future Government action on fuel poverty should consider explicitly whether improvements in health and reductions in health inequalities can be expected as a result.

SG

Progress on action - Fuel poverty

20.

The Government should encourage local leadership in activating business participation in the community planning process. New agencies and current statutory partners should be involved in responding to local needs. In particular, NHS Boards should play an active part in employability partnerships across Scotland.

CPP

Progress on action - Business, employment & health

21.

To achieve the potential of business and enterprise in contributing to local community action, the outcome of improving health through work should be integrated with the remit of economic development agencies at national, sectoral and local authority levels including urban regeneration initiatives.

• Health and education outcomes should be included in the Urban Regeneration Corporation ( URC) monitoring and evaluation framework. There is significant Government investment in URCs, which are required to bridge the gap between physical, economic and social regeneration of some of the most deprived communities in Scotland.

CPP

Progress on action - Business, employment & health

22.

NHS Boards and public sector employers should act as exemplars in increasing and supporting healthy employment for vulnerable groups.

CPP

Progress on action - Public sector employers

23.

Public sector leaders should promote the evidence on the health benefits of employment with staff, patients and clients.

• The Government should identify best employability practice from existing services such as Working for Families, condition management approaches, vocational rehabilitation and person centred approaches. These should be used to replicate effective action throughout NHSScotland. Evidence should also be shared with the Task Force's learning networks and with community planning partnerships more generally, in order to influence the design of local services.

CPP

Progress on action - Public sector employers

24.

Professional bodies in the field of occupational and public health should be consulted on incorporating the evidence on the health benefits of employment into professional development and practice.

SG

Progress on action - Public sector employers

25.

The Scottish Centre for Healthy Working Lives should refine the Healthy Working Lives Award scheme to make it more flexible and accessible to smaller businesses.

• The Scottish Centre for Healthy Working Lives should incorporate in its work programme:
  a) promoting the benefits of safe and healthy workplaces to employers, particularly to SMEs. This will require a range of innovative approaches including social marketing techniques, case studies, and use of high performing businesses as buddies and champions.
  b) promoting to employers current tools and materials about mental health and wellbeing in the workplace, for example Mental Health First Aid Training and HSE guidance on tackling stress.
  c) promoting to employers the benefits from supporting employment for people currently out of work as a result of ill health or injury.
  d) identifying and supporting opportunities for early interventions and rapid access to occupational health services and advice.
• The Government should review progress under the Scottish Action Plan on Health and Safety and improve integration of health and wellbeing advice with business support.

SG

Progress on action - Business, employment & health

26.

Public sector organisations to increase the use of community benefits clauses in their contracting processes.

CPP

Progress on action - Public sector employers

27.

Government action on the physical environment should include: evidence-based environmental improvements to promote healthy weight, and improving the quality of local neighbourhoods through providing more environmental "goods" to foster better physical and mental health, improve community cohesion and prevent risks to community safety.

CPP

Progress on action - Physical environments

28.

The Government and local agencies and partnerships should apply the "precautionary principle" across policy development affecting greenspace in environment, education and health.

CPP

Progress on action - Physical environments

29.

The Government, NHS Boards and other public sector organisations should take specific steps to encourage the use and enjoyment of greenspace by all, with a view to improving health. Public sector organisations should provide materials, resources and training and evaluation of specific initiatives, eg the prescription of "greenspace use" by GPs and clinical practitioners.

• Action to improve the provision of greenspace should be assessed and evaluated for its impact on health inequalities, as part of Government research programmes.

CPP

Progress on action - Physical environments

30.

Local authorities and others should foster greater public responsibility for maintaining local environments.

CPP

Progress on action - Physical environments

31.

Children's play areas and recreation areas for young people generally should have high priority in both planning and subsequent maintenance by the responsible authorities.

CPP

Progress on action - Physical environments

32.

The National Transport Strategy delivery plan, currently being worked up by the Government, should include specific actions likely to improve health and reduce health inequalities.

SG

Progress on action - Transport

33.

Health inequalities should be addressed specifically in the Government's first formal review of the National Transport Strategy, which will report in 2010.

SG

Progress on action - Transport

34.

The Government should take forward action targeting children from disadvantaged areas who are at greater risk of injury in road accidents and to encourage local authorities to follow existing good practice in this area.

SG

Progress on action - Transport

35.

New Government whole-community demonstration initiatives should be measured on their impact on health and health inequalities outcomes.

SG

Progress on action - Whole community demonstrations

36.

Local authorities, Third Sector organisations and other partners should increase programmes designed to support and engage with those young people who have started on the cycle of offending but not yet escalated to serious violence.

CPP

Progress on action - Alcohol, drugs, violence

37.

Local authorities and their partners should provide more positive activities for young people including improved access to existing facilities.

CPP

Progress on action - Alcohol, drugs, violence

38.

NHS drug treatment services, which will incorporate the new emphasis on recovery, should be required to link locally to other forms of support that address clients' wider problems and life circumstances.

CPP

Progress on action - Joining up of drug treatment

39.

The Government should ensure more effective local delivery of joined-up services for problem drug and alcohol users, through reform of the current Alcohol and Drug Action Team ( ADAT) arrangements. The resources that member agencies contribute to ADAT activities should be more targeted to deprived groups and communities.

• As the Government develops its long term strategic approach towards tackling alcohol misuse, it should take into account the underlying factors that determine inequalities in alcohol-related harm and address the impact of alcohol on crime, local communities and employment, as well as on health and wellbeing.
• Research commissioned under the Government's Scottish Alcohol Research Framework should consider inequality issues, with specific work being undertaken to help understand the links between alcohol consumption, serious alcohol-attributable disease and deprivation.
• Action should continue to focus on preventing drug misuse and addressing fundamental causes such as relative poverty, poor educational attainment and lack of opportunities, particularly for young people and in communities affected by high levels of crime.
• Drug strategy objectives should continue to be identified as part of other related Government-led policy development, eg in the fields of early years, mental health and wellbeing, alcohol, violence, young work, reform of the school curriculum.
• The Government's national evidence group that will inform future policy and practice in addressing drug misuse should develop as part of its work the evidence on effectiveness in reducing drug-related health inequalities.

SG and CPP

Progress on action - Alcohol, drugs, violence

40.

Strong leadership for joint working addressing the underlying causes of violence at local level is required through, for example, greater NHS involvement in local community safety partnerships and police participation in relevant health and education forums. Such partnerships should be built on effective cross-agency information sharing to ensure risk is identified early and managed effectively.

• A partnership between police, Government and the research community should promote better co-ordination of research on violence, in particular on the inter-relationships between alcohol, drugs, violence and deprivation, to ensure that scientific findings are translated into effective practice.

CPP

Progress on action - Alcohol, drugs, violence

41.

The Government should support improved data collection, analysis and sharing by all agencies, to ensure that the true level of violence and opportunities for joint solutions are identified. The National Injury Surveillance Model currently being trialled by NHS Lanarkshire should be evaluated and then rolled out, in order that hospital injury data can be shared across agencies, to ensure more effective enforcement and prevention action.

CPP

Progress on action - Alcohol, drugs, violence

42.

NHS Boards should ensure that all women attending key NHS services are asked routinely if they are or have been victim of domestic abuse.

SG

Progress on action - Domestic violence

43.

NHS Boards and community health partnerships, with other local organisations, should ensure a swift and effective response to the needs of women and children experiencing abuse.

SG

Progress on action - Domestic violence

44.

Local agencies should provide high quality, consistent information to young people in a whole range of settings, including easily accessible drop-in services, staffed by health professionals and youth workers.

CPP

Progress on action - Education, information and engagement for young people

45.

Keep Well health checks in deprived areas should identify people with depression and anxiety and make sure they get treatment and support.

SG

Progress on action - Anticipatory care, primary care, dental health

46.

The Government commitment to health checks for all at age 40 should be implemented in ways that build on the Keep Well programme.

SG

Progress on action - Anticipatory care, primary care, dental health

47.

The Government should create and fund new evidence-based anticipatory care programmes for other groups at high risk of health problems.

SG

Progress on action - Anticipatory care, primary care, dental health

48.

The Government should continue to reform the funding of primary care. Service developments through the Scottish Enhanced Services Programme should address the needs of groups and communities most at risk of health inequalities.

SG

Progress on action - Anticipatory care, primary care, dental health

49.

NHS Board interventions to address depression, stress and anxiety should be increasingly targeted in deprived communities, ensuring that approaches and materials used are appropriate.

SG

Progress on action - Mental health and wellbeing

50.

The next phase of Government-led work, following the National Programme for Improving Mental Health and Wellbeing should apply evidence of what works, in particular for those in disadvantaged groups and areas whose future health is most at risk.

CPP

Progress on action - Mental health and wellbeing

51.

It should be a key priority within the Government's smoking strategy that NHS Boards and their local partners act to prevent young people in deprived communities from smoking, and to provide more effective support to smokers in those communities to quit.

CPP

Progress on action - Smoking

52.

NHS Boards should target health promotion and health improvement action better for people with learning disabilities and others who may need support with access to information, in line with statutory disability requirements.

SG

Progress on action - Health literacy and learning disabilities

53.

The Government should lead development of a framework for regular health assessments for people with learning disabilities in all NHS Board areas.

SG

Progress on action - Health literacy and learning disabilities

54.

Each NHS Board should have a designated senior post responsible for ensuring that people with learning disabilities receive fair and equitable treatment from health services.

SG

Progress on action - Health literacy and learning disabilities

55.

The Government should roll out a programme for improving the dental health of vulnerable groups, addressing the needs of, for example, older people, prisoners and homeless people.

SG

Progress on action - Anticipatory care, primary care, dental health

56.

NHS Boards and local authorities should work together to maximise the potential of self-directed support which allows disabled people and others to buy their own social care.

CPP

Progress on action - Self-directed support

57.

Offenders and ex-offenders should have access to the health and other public services they need and benefit from the same quality of service as the rest of the population.

• A research and evaluation programme should be set up to test the effectiveness of the Task Force's recommendations on health and wellbeing of offenders. One component of the programme should be an integrated stream of research into health, resilience and wellbeing and prevention of reoffending.

CPP

Progress on action - Offenders' health

58.

Criminal justice agencies and NHS Boards should work together to ensure that offenders who have engaged with the Throughcare Addiction Service are assessed for and able to access addiction and health services within six weeks of release from prison.

CPP

Progress on action - Offenders' health

59.

Criminal justice services should work with other public and Third Sector organisations and user groups to respond to studies led by the Prison Reform Trust that aim to improve the experience and wellbeing of people with learning disabilities who are in trouble with the law.

CPP

Progress on action - Offenders' health

60.

Scottish Prison Service approaches to promoting positive mental health and wellbeing should be extended across all criminal justice settings.

CPP

Progress on action - Offenders' health

61.

The Scottish Prison Service should offer family and relationships support from the date of entry to prison.

SG

Progress on action - Offenders' health

62.

NHS Boards should take opportunities to play a leadership role in promoting good relations within communities, recognising the impact of discrimination and disadvantage on health.

SG

Introduction

63.

All contractors and providers commissioned by the NHS should be explicitly required to monitor their services in accordance with public sector equality duties, ensuring that their analysis uses qualitative and quantitative data to monitor the needs of different groups.

SG

Introduction

64.

NHS Health Scotland should deliver an accessible communication, translation and interpreting strategy and action plan, with clear outcome measures.

SG

Introduction

65.

The Government should provide resources to test and promote the Task Force's approach to redesigning and refocusing public services through health inequalities learning networks. These will operate initially through a small number of test sites within community planning partnerships. Resources will be required to apply continuous improvement techniques locally, as well as to bring together all the evidence available to inform good practice, track progress and spread learning in order to influence change in public services more widely.

• Local learning approaches and support to community planning partnerships for their use of the Fairer Scotland Fund should link to the health inequalities learning networks approach.
• The Government's Multiple and Complex Needs projects should be evaluated to identify the impact they can have on health and wellbeing and the changes in service design required. This learning should inform the approach to service redesign adopted in the Task Force's test sites.
• Addressing the inter-related issues of alcohol, drugs, violence and poor mental health should be part of the health inequalities learning networks approach as an early priority.
• The health inequalities learning networks should incorporate the potential for a whole spectrum of local services to include the promotion of good health to those at risk of poor health outcomes. The evidence base for such action will include the NHS's health promoting health service activities.
• The Violence Reduction Unit should be involved in the Task Force's learning networks and advise on applying effective approaches to prevention in the test sites.
• Frontline housing services should be included in the health inequalities learning networks approach.

SG

Test sites

66.

The Government should establish a short life, cross-sector working group to enable different sectors and those working within them to recognise and share common values, knowledge and skills and develop a joint educational/training framework to support practice which is sensitive to inequalities.

SG

Progress on action - Delivering change

67.

Government should use existing experience in work on Changing Lives, Working for Families and in the early years field to develop a wider concept of a key worker role and the competencies and skills required to carry it out.

SG

Progress on action - Delivering change

68.

The Government should protect current resources targeted at reducing health inequalities and consider the need for further investment in its longer-term spending plans, based on experience from the Task Force's learning networks about any further resources required for public services to address health inequalities and their underlying causes more effectively.

SG

Introduction

69.

Funding for Third Sector organisations through the Government's new Scottish Investment Fund should support Third Sector action in the priority areas identified in the Task Force's recommendations, and this should be explicit in criteria for the Fund.

SG

Progress on action - Third sector

70.

The Government should adopt the recommended new headline indicators and measures for reporting on long-term progress in reducing health inequalities in Scotland and driving action on the underlying causes of the most important inequalities.

SG

Introduction

71.

The Government should publish in Summer 2008 detailed proposals for the new high level indicators and measures of health inequalities, along with current levels and trends for each measure.

SG

Introduction

72.

The Government should arrange for a clear analysis of the medium-term outcome indicators critical to achieving reductions in the key health inequalities outcomes. This analysis should reflect the National Performance Framework and the new relationship between the Scottish Government and local authorities as embodied in the Single Outcome Agreement process. It should be published by autumn 2008, in order to guide community planning partnerships and their constituent organisations in their own planning and performance reporting.

SG

Introduction

73.

The Government should work with existing and new expert organisations in Scotland to develop a wider repertoire of approaches to outcome and impact evaluation, appropriate for specific interventions and complex and comprehensive packages of actions designed to reduce health inequalities.

SG

Monitoring and evaluation

74.

The Government should commission a review of health data needs that covers gender, ethnicity, age, disability, religion and belief, sexual orientation and transgender. The review should be published and include a plan of action with milestones to fill information gaps identified.

SG

Introduction

75.

NHS targets should be set to support work on patient monitoring and collection of equalities data, led by the Equality and Diversity Information Project at NHS National Services for Scotland ( ISD).

SG

Introduction

76.

The Government, with advice from relevant experts, should work towards better information to describe health inequalities based on socioeconomic status, for example looking at low income of individuals, not just at average income of people living in small areas.

SG

Monitoring and evaluation

77.

Integrated impact assessment processes for public policies and programmes should be developed and implemented at national and local levels, within constraints of the relevant formal systems. Impact on health inequalities should be a clear component. The Government should ensure that there is guidance and support to develop the knowledge and skills to enable impact assessment to be carried out, and health inequalities issues to be incorporated effectively.

• The policies and actions that the Task Force recommends should be implemented in ways that will allow for proper evaluation of their effectiveness. Evaluation needs to address the differential impacts of policies and actions on different sub-groups (socioeconomic, gender, ethnicity) and cost effectiveness.
• While it is not necessary to evaluate all actions designed to reduce health inequalities to the same extent, an adequate proportion of resources should be devoted to evaluation. The guiding principle is to focus evaluation on the areas of greatest uncertainty and where the need to build evidence is greatest.

SG

Monitoring and evaluation

78.

The Government should review progress in implementing the Task Force's recommendations and publish a report, including any further action required, by summer 2010. The Task Force should be reconvened to sign off the review of progress.

SG

Monitoring and evaluation