Equally Well: Report of the Ministerial Task Force on Health Inequalities

ANNEX 4 - RECOMMENDATIONS

No. / Recommendation

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.

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.

Early years and young people

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

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

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

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

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.

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.

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

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

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.

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

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.

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.

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.

Tackling poverty and increasing employment

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

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.

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.

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.

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.

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.

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

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

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.

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.

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

Physical environments and transport

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.

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

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.

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

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.

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

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.

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

Harms to health and wellbeing: alcohol, drugs and violence

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.

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

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.

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.

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.

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.

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

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.

Health and wellbeing

Children and Young People

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.

Primary Care

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

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

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

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.

Mental Health and Wellbeing

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.

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.

Smoking

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.

Vulnerable Groups: access to services

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.

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

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.

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.

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.

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.

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.

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.

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

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

NHS Wider Role

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.

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.

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

Delivering change

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.

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.

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.

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.

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 contained in criteria for the Fund.

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.

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.

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 anaylsis 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.

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.

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.

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).

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

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.

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.