Supporting Young People's Health & Wellbeing - A Summary of Scottish Government Policy

Section 1: Context

National Policy Context

Health policy is not developed or delivered in a vacuum. In order to understand the broader policy context, some overarching national policy context is provided below:

The Scottish Government's overarching Purpose is "to focus government and public services on creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth".

At present, it is clear that global economic conditions remain challenging and the impact of the financial crisis will resonate for a number of years to come. The Scottish Government's top priority is therefore accelerating economic recovery, boosting jobs and promoting economic security. The Government Economic Strategy sets out the series of measures which will be taken to

secure the recovery and build the foundations for long-term sustainable economic growth. See: http://www.scotland.gov.uk/Resource/Doc/357756/0120893.pdf

Actions across the life course to improve health and wellbeing contribute to delivering the Government's overall Purpose of increasing sustainable economic growth. Improving Scotland's health record is both an essential driver of growth and a key outcome of economic success. The Purpose is supported by the Strategic Objective for Health which is "Helping people to improve and sustain their health, especially in disadvantaged communities, ensuring better, local and faster access to health care", and by 16 National Outcomes, a number of which are particularly relevant to children and young people's health and wellbeing:

• Our children have the best start in life and are ready to succeed
• Our young people are successful learners, confident individuals, effective contributors and responsible citizens
• We have improved the life chances for children, young people and families at risk
• We live longer, healthier lives
• We have tackled the significant inequalities in Scottish society

Key Scottish Government Objectives 2012-13

The Scottish Government set out its key objectives in Working for Scotland: The Government's Programme for Scotland 2012-13. See: http://www.scotland.gov.uk/Resource/0040/00401237.pdf

The key objectives set out in Working for Scotland that relate directly to young people are:

A Smarter Scotland

• Ministers will introduce the Children and Young People Bill which will make real the Scottish Government's aspirations for Scotland to be the best place in which to grow up by putting children and young people at the heart of planning and delivery of services and embedding their rights across the public sector.

• The Post-16 Education Reform Bill will support wider reforms of Post-16 education and training. In particular, the Bill will support Ministers' aim of developing a system which is better aligned to the needs of learners and employers.

Economic Recovery

• The Government will continue to tackle youth unemployment. It will support youth employment through the all-Government, all-Scotland response outlined in the Scottish Government's youth employment Strategy, Action for Jobs - Supporting Young Scots Into Work.

Public Service Reform

In the current economic climate, public service reform is critical to meeting the long-term financial and demand challenges of the future. In September 2011, the Scottish Government published its response to the Christie Commission on the Future Delivery of Public Services - Renewing Scotland's Public Services - Priorities for Reform in response to the Christie Commission. The approach set out there is built on four pillars all of which are pertinent to the delivery of health services in Scotland, including those for young people:

• a decisive shift towards prevention;
• greater integration of public services at a local level driven by better partnership, collaboration and effective local delivery;
• greater investment in the people who deliver services through enhanced workforce development and effective leadership; and
• a sharp focus on improving performance, through greater transparency, innovation and use of digital technology.

See: http://www.scotland.gov.ukbd5fe059-d0fc-4b3b-a7b9-6bde6636ba18

Recent Approaches to Policy Development

In addition to the approach set out in Renewing Scotland's Public Services, asset based approaches increasingly inform Scottish Government policy development. Across Scotland, national and local delivery organisations are developing asset based approaches as a means to tackle the deep rooted social problems that persist across Scotland. These approaches focus on the assets within individuals and communities rather than on their deficits (needs or problems) and were highlighted in the 2010 Annual Report of Scotland's Chief Medical Officer (2011).

The asset approach to health improvement is based on Aaron Antonovsky's concept of salutogenesis (the creation of positive health and wellbeing). It is a set of concepts and actions which seem to offer the most coherent and evidence based approach to the creation of health and wellbeing. A key aspect of Antonovsky's theory is the idea that having control of one's life and circumstances is health enhancing. Central to the asset approach is the idea of helping people to be in control of their lives by developing the capacities and capabilities of individuals and communities. It draws on existing approaches that foster effective and appropriate involvement of the people and the professionals who serve them.

See Chapter 5 of the Chief Medical Officer's 2010 annual report for a fuller discussion of the assets based approach: http://www.scotland.gov.uk/Publications/2011/12/14120931/0

Co-production is the process of active dialogue and engagement between people who use services and those who provide them. It is a process which puts service users on the same level as the service provider. It aims to draw on the knowledge and resources of both to develop solutions to problems and improve interaction between citizens and those who serve them (SCDC, 2011), (Needham and Carr, 2009). The key characteristics of co-production exemplify asset based principles (Stephens et al., 2008):

• Recognising people as assets rather than as problems
• Building on people's existing skills and resources
• Promoting reciprocity, mutual respect and building trust
• Building strong and supportive social networks
• Valuing working differently, facilitating rather than delivering
• Breaking down the divisions between service providers and service users.

Co-production changes the dynamics between individuals and communities, creating more collaborative relationships. Frontline staff are more able and confident in sharing power and are more ready to accept user expertise (Needham and Carr, 2009). Co-produced services work with individuals in a way that treats individuals as people with unique needs, assets and aspirations, but also as people who want support tailored to their needs (Slay and Robinson, 2011). Services learn to work with people and not do things to them.

The influence of protective and risk factors on health

Asset based approaches are concerned with identifying and utilising the protective factors that support health and wellbeing. They offer the potential to enhance both the quality and longevity of life through focusing on the resources that promote the self-esteem and coping abilities of individuals and communities. At present, policy generally reflects a dual strategy of enhancing protective factors for health (e.g. health promoting behaviours, psychosocial factors such as personal resilience, self-esteem, motivation, self-control), while seeking to reduce risk factors to health such as alcohol or drug misuse.

In terms of reducing risk factors, it is increasingly argued that policy makers should move away from siloed, single issue approaches to integrated, multiple risk behaviour approaches which recognise that risk behaviours tend to co-occur. At the same time there should be continued focus on strengthening the protective factors that are understood to mitigate against young people's involvement in health risk behaviours.

Health - Strategic Policy Context

The strategic narrative Achieving Sustainable Quality in Scotland's Healthcare: A 20:20 Vision (September 2011) provides the context for taking forward the required actions to improve efficiency and achieve financial sustainability to meet the significant challenges that Scotland's health services face. Key challenges include Scotland's public health record, changing demography and the economic environment:

Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.

We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission

The '20:20' Vision also confirms the Scottish Government's commitment to the values of NHSScotland - collaboration and cooperation, partnership working across NHSScotland, with patients and with the voluntary sector; of continued investment in the public sector rather than the private sector; of increased flexibility, provision of local services and of openness and accountability to the public.

It also provides the context for taking forward the Healthcare Quality Strategy for NHSScotland (May 2010). The Quality Strategy sets out three clearly articulated and widely accepted ambitions based on what people said they wanted from their NHS - care which is person-centred, safe and effective. See: http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf

The Quality Strategy is a development of Better Health Better Care (2007) which sets out the Scottish Government's programme to deliver a healthier Scotland by helping people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care. See: http://www.scotland.gov.uk/Publications/2007/12/11103453/0

Service providers should ensure that services for young people reflect the Quality ambitions and the 2020 vision.

Health Inequalities - the Social Context

Despite the drive outlined above to provide better healthcare to communities across Scotland and the knowledge that overall, Scotland's health is improving, the rate of improvement in the poorer areas of Scotland remains significantly slower than in the more affluent areas. Inequality in health outcomes continue to exist across Scottish society. Indeed, in his 2011 annual report (December 2012), Scotland's Chief Medical Officer states that the most significant issue he has to face is the problem of health inequalities.

What is clear from the gap in health between rich and poor in Scotland is that the origins of health inequalities is complex and are to be found in the many interactions between social, economic, educational and environmental determinants. Action is required across all the determinants of health. It is widely recognised that the NHS alone will not reduce health inequalities.

The key Social Policy Frameworks

Equally Well: Report of the Ministerial Task Force on Health Inequalities, along with the Early Years Framework and Achieving Our Potential: A Framework for Tackling Poverty and Income Inequality in Scotland, set out the Scottish Government's and COSLA's shared approach to tackling the major and intractable social problems that have affected Scotland for generations. These three social policy frameworks recognise that children's start in life, cycles of poverty and poor health are interlinked. These are complex problems, involving complex solutions, and which require a long-term approach. Scottish Government policy advocates early intervention, moving from crisis management to prevention and breaking cycles of poor outcomes in people's lives.

The three social policy frameworks share a commitment to tackling inequality and promoting equality. See:
Equally Well: Report of the Ministerial Task Force on Health Inequalities
Achieving our Potential: A Framework to Tackle Poverty and Income Equality in Scotland
Early Years Framework

In addition, the Child Poverty Act 2010 sets out UK-wide targets relating to the eradication of child poverty. It provides that it is the duty of the UK Government to ensure that the child poverty targets are met in relation to the year commencing 1 April 2020. These targets relate to levels of child poverty in terms of: relative low income, combined low income and material deprivation, absolute low income and persistent poverty.

Child poverty in Scotland is affected by a mix of devolved and reserved policy measures. The Child Poverty Act requires that the UK Government produce a UK-wide child poverty strategy. This will be relevant to tackling child poverty in Scotland in so far as it covers reserved policy measures which apply to and impact on Scotland, such as policy on personal taxation and benefits.

The Child Poverty Act also requires Scottish Ministers to produce a Scottish strategy. The Child Poverty Strategy for Scotland focuses on policy matters that are devolved to the Scottish Parliament and Scottish Ministers. See: http://www.scotland.gov.uk/Publications/2011/03/14094421/0

Principle Policy Frameworks that support Young People's Health & Wellbeing

In Scotland, the policy landscape in respect of children and young people is underpinned by Getting it right for every child (GIRFEC) and Curriculum for Excellence (CfE).

The Scottish Government is committed to improving the health and wellbeing of all children and young people to ensure they have the best start in life, are ready to succeed and live longer, healthier lives. Government expects partners to adopt and promote a range of common approaches in delivering services for young people underpinned by the GIRFEC approach and the principles of prevention and early intervention. In relation to delivering learning opportunities and experiences, the Curriculum for Excellence principles of Curriculum design would apply. See: http://www.educationscotland.gov.uk/thecurriculum/howisthecurriculumorganised/principles/index.asp

The GIRFEC approach overarches all policies relating to children and young people. It is a national approach which enables early, single and multi-agency intervention when there is a concern about a child or young person's wellbeing before the issue escalates. See: A guide to Getting It Right For Every Child

GIRFEC is child centred, founded on the principles of early intervention, through appropriate, proportionate and timely support. The vast majority of children and young people receive all the support they need to ensure their wellbeing from their parents, carers and families. The GIRFEC approach ensures that from birth all Scotland's children, young people and their families have additional consistent and co-ordinated support, when they need it. It specifically promotes co-ordinated action by services to improve the life chances and outcomes for all children and young people in Scotland. To achieve this it encourages a shared understanding by all services of a child's wellbeing in eight areas i.e. that children and young people must be Safe; Healthy; Achieving; Nurtured; Active; Respected; Responsible and Included (SHANARRI).

Ministers intend to legislate for key elements of GIRFEC, including the Named Person, single Child's Plan and a duty on public bodies to co-operate when there is a concern about a child or young person's wellbeing. They also propose putting the definition of wellbeing and the SHANARRI indicators on a statutory basis in relation to GIRFEC.

Curriculum for Excellence is a key vehicle for improving the life chances of children and young people and for contributing to the reduction of health inequalities. It aims to provide a coherent, flexible and more enriched curriculum from age 3-18. Within CfE, learning in Health and Wellbeing ensures that children and young people develop the knowledge, skills and attributes which they need for mental, emotional, social and physical wellbeing now and in the future.

Both GIRFEC and CfE are discussed in greater detail later in this document.

Structure of Paper

In this paper, key Scottish Government policies that aim to support children and young people's health and wellbeing are organised around two key life stages:

• Pre-birth and Early Years (section 2)
• Youth (section 3)

Within the "Youth" section, the eight GIRFEC Wellbeing indicators have been used to structure the information contained there. It is important to note however, that in many cases information referred to under one indicator will also be relevant to other indicators AND that GIRFEC is equally applicable to the early years.