Fairer Scotland action plan: progress report 2019

Health, including mental health

Improving the health of the nation, both physical and mental, is fundamental to helping people lead longer, healthier lives.  There remain significant health inequalities between the most and least deprived communities in Scotland, and reducing these is essential to improving people’s quality of life and increasing life expectancy. 

Health is an enabler of social and economic participation in daily life and a key determinant of wellbeing, happiness and satisfaction.  Inequalities in health are a symptom of wider social inequalities, which is why the Scottish Government sees reducing health inequalities as critical to achieving its aim of making Scotland a better, healthier place for everyone, no matter where they live.  Taking a preventative approach that reduces inequalities in income, power and wealth is fundamental to improving health outcomes.  That is why we are taking action to tackle alcohol, tobacco and drug consumption, while also improving levels of physical activity and supporting people to eat well and have a healthy weight.  A healthy population – from our children and young people through to our older generations – is essential to creating a stronger, fairer Scotland.

Our Better Mental Health in Scotland Delivery Plan^[45] is the next step in implementing our Mental Health Strategy.  It sets out how we will deliver against our commitment to improve mental health in Scotland by improving access to support alongside enabling services respond to people seeking help.  This is complemented by specific work to support prevention and early intervention work for children and young people’s mental health across health, education and children’s services. 

Health support for young families

Our commitment to provide 500 additional health visitors by the end of 2018 was achieved, and as of June 2019 we have an additional 501.2 whole time equivalent health visitors in Scotland.  Family Nurse Partnership are in place in 11 Health Boards, with work underway to extend this provision to Island Boards.

We have committed to have an additional 250 Community Link Workers (CLWs) in place by the end of this Parliament, and as at September 2019, we remain on track to meet this target with over 100 CLWs already in post. 

Furthermore, a routine enquiry on household income in our Universal Health Visitor Pathway specifies points in time for health visitors and family nurses to ask about family finances and refer or signpost to relevant advice and services.  The Universal Pathway Quality Improvement Collaborative, launched on 5 November 2019, will support health visiting teams and money advice services across Scotland to focus on income maximisation measures for families. 

Scotland’s Baby Box strongly signals our determination that every child, regardless of their circumstances, should get the best start in life.  Baby Boxes help to tackle deprivation, improve health and support parents by ensuring that every family with a newborn has access to essential items needed in the first six months of a child’s life.  As of 8 November 2019 111,305 Baby Boxes have been delivered to families across Scotland since their launch in August 2017.  96% of expectant parents are now taking up the opportunity to receive a Baby Box, while the latest parent survey showed 100% satisfaction with the box and contents.

Our flagship and award winning Childsmile Programme, where nursery and schoolchildren receive regular tooth brushing instruction and fluoride varnish application, is at the leading edge of prevention-based oral health care provision.  In 2017, we expanded Childsmile to ensure all children in the poorest 20% of areas in Scotland received additional fluoride varnish application.  The 2019 report by the National Dental Inspection Programme shows that this has been successful in narrowing in oral health inequalities, with 80% of primary 7 children having no obvious decay experience, compared with a figure of 53% in 2005 when this data was first recorded.  This successful improvement in oral health is also reflected in the number of fillings in children made in a primary care setting which show a 62% decrease since 2000-01, including a reduction of 4.6% in 2018-19 from the previous year.

Mental health

The Children and Young People’s Mental Health taskforce chaired by Dr Dame Denise Coia published a set of final recommendations in July this year which are being delivered by a new group – the Children and Young People’s Mental Health and Wellbeing Programme Board – in partnership with CoSLA.  A priority for the new Board is to successfully put in place new and effective community wellbeing support services.  Children and young people aged five to 24 and their families can self-refer to these services in order to access flexible support to meet their needs.  The Programme Board is also working to ensure children, young people and their parents can get support and access services both on a community basis and in a crisis anytime, anywhere.  A 24/7 telephone and text service will be rolled out across Scotland to enhance our crisis response. 

We have committed to ensure that every secondary school in Scotland has access to a school counsellor, with 350 counsellors available by September 2020.  Additionally, a Student Mental Health and Wellbeing Working Group has been established to collaboratively support our work to provide more than 80 additional counsellors in further and higher education over the next four years, supported by investment of around £20 million. 

We are also working towards meeting our target of having an additional 250 school nurses in place by 2022 with the training of 50 additional staff starting this year.  Further tranches will follow until 2022 alongside ensuring that teachers across every school are offered training in mental health first aid.

Last year, we increased our funding by an additional £4 million for 80 new staff for the Children and Adolescent Mental Health Services.  In addition, action 15 of our Mental Health Strategy outlines the Scottish Government’s commitment to funding 800 additional mental health workers in key settings, including A&E, GP practices, police station custody suites, and prisons.  This ensures that local provision and support is at the heart of our plans, with funding for this work increasing to £35 million in 2021-22.  As of 1 October 2019, 327.5 additional staff were employed.

In 2018, we launched a three year National Trauma Training Programme to support our commitment to develop a trauma and adversity informed workforce and services across Scotland.  There has been huge demand for training with over 3,000 workers being trained within the first year, supported by a range of universally available trauma training resources published by NHS Education for Scotland, including tailored resources specifically for anyone working with Children and Young People^[46].  Service Level Agreements are in place with Health Boards for specialist training supervision and coaching, and £120,000 dedicated funding is supporting three local delivery trials underway in Glasgow, Midlothian, and Argyll and Bute.