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Highland Health Board

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									                                                                            Highland NHS Board
                                                                               2 September 2008
                                                                                        Item 5.2

HEALTH IMPROVEMENT POLICIES

Report by Cathy Steer, Head of Health Improvement

 The Board is asked to:

         Note the publication of the recent health improvement policies on key priority areas.
         Note the implications of these policies for the Board.



1           Background and Summary

The key priority areas for NHS Boards health improvement work are set within the
overarching policy „Better health, Better Care‟, and the key ministerial targets for health
improvement (HEAT) in the Local Delivery Plan.

Since the publication of „Better Health, Better Care‟ in December 2007, the Scottish
Government have published a number of health improvement policies to provide further
guidance to the NHS and partner organisations on taking forward work on the priority areas
for health improvement.

This paper summarises the main health improvement policies that have been developed in
recent months and describes the implications of each for the Board.


2            Health Improvement Policies

2.1         Policy Summaries

The following current significant national policies have been developed recently to guide and
support health improvement activity across Scotland:

Description:                       Equally Well, report of the ministerial task force on health
                                   inequalities
Publication date:                  June 2008
Supports Target:                   H1: Reduce mortality from Coronary Heart Disease in the
                                   under 75’s in deprived areas
Summary:
The Ministerial Task Force was set up to bring together thinking on not only responding to
the consequences of health inequalities, but also to tackle its causes. While Scotland‟s
health is improving, there remain significant differences between rich and poor. The report
primarily focuses on health inequalities that result from socioeconomic circumstances; it also
considers how health and other public services respond to the range of complex factors
which affect people‟s health.

The report takes the emerging understanding of the underlying causes of health inequalities
such as deprivation and other forms of chronic stress, and children‟s earliest experiences,
and recommends linked action across all government responsibilities. It recognises that
health inequalities cannot be tackled by health policy and health care systems alone.
The report identifies the following priorities where action is most needed:

           Children‟s very early years, where inequalities may first arise and influence the rest of
            children‟s lives.
      The high economic, social and health burden imposed by mental illness, and the
       corresponding requirement to improve mental wellbeing.
      The „big killer‟ diseases: cardiovascular disease and cancer, and the risk factors that
       are strongly linked to deprivation such as smoking.
      Drug and alcohol problems and links to violence that affect younger men in particular
       and where inequalities are widening

The Task Force agreed key principles to drive this work. These include:

 Improving the whole range of circumstances and environments that offer opportunities to
  improve people‟s life circumstances and hence their health
 Addressing the inter-generational factors that risk perpetuating Scotland‟s health
  inequalities from parent to child, particularly by supporting the best possible start in life for
  all children in Scotland
 Engaging individuals, families and communities most at risk of poor health in services and
  decisions relevant to their health
 Delivering health and other public services that are universal, but also targeted and
  tailored to meet the needs of those most at risk of poor health. Need to prevent problems
  arising in the future, as well as addressing them if they do.

The main recommendations of the report come under six headings:

Early years and young people – Long term action required to improve educational
achievement, skills, employment and income. Shorter term improvements relate to the need
to reduce the numbers of women smoking during pregnancy and children‟s diet and physical
activity.

Tackling poverty and increasing employment – Improving health through work needs to
be integrated with economic development, public sector organisations should act as
exemplar employers in supporting healthy employment for vulnerable groups, support to
maximise income should be extended and the Fairer Scotland Fund should contribute to
health outcomes.

Physical environments and transport – Action includes improving opportunities to enjoy
safe green and open spaces, action to promote active transport and improvements to
physical environments to promote healthy weight and prevent risks to community safety.

Harms to health and wellbeing: alcohol, drugs and violence – The longer term aim of
reversing the rising inequalities in harm to health from alcohol, drugs and violence will be
achieved through action to increase programmes that support and engage with young
offenders, provide support for parents whose children display violent or anti-social behaviour,
and provide more positive activities for young people. In addition the report recommends
developments in drug and alcohol treatment services that support wider problems and life
circumstances, be more joined up and target resources at deprived groups and communities.

Health and Wellbeing – The key focus is on access to health and social care services and
the results that these services achieve for them. Particular focus on developing health
checks and anticipatory care for high risk groups and ensuring treatment and support is
available for those who need it. Reform of funding of primary care services to meet the
needs of those most at risk of health inequalities. Particular focus on health assessments for
those with learning disabilities, access to addictions services for offenders, and development
of communication, translation and interpreting services for the NHS.

Delivering change – The Task Force have pledged to publish an implementation plan for
health inequalities later in 2008, giving more practical information on how the
recommendations can be achieved. An additional £15m over 3 years will be provided to
support work with children and families most at risk. Local test sites will be developed to

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show what changes in public service can be achieved within existing resources, new
headline measures of health inequalities will be developed and the government will review
progress on implementation in 2010.

A full list of the reports 78 recommendations can be found in Appendix 1.

Implications for the Board:
There are likely to be a number of implications for NHS Boards from the Task Force report,
the detail of which is expected to be in the implementation plan due later in 2008. However
the main implications relating to the Boards from the Task Force report are:
     The need to contribute to the improvements in the wider factors determining health
       inequalities through engagement in partnership working particularly in the areas of
       support for vulnerable families and employability initiatives.
     Emphasis on using contractual mechanisms to target available primary care
       resources towards areas of greater need including locally enhanced services and
       community pharmacy contracts.
     Further develop anticipatory care approaches including health checks.
     Improved support for voluntary and community groups.
     Development of effective approaches to reaching and engaging the most vulnerable
       groups.
     Develop a more systematic way of assessing the impact on health inequalities of
       health policies and programmes and targeting resource at those most in need,
       essentially „inequality proofing‟ policies.
     Review accessibility of services and take action to remove physical, administrative,
       attitudinal and structural barriers to services.


Description:                  Changing Scotland’s relationship with alcohol: a
                              discussion paper on our strategic approach
Publication Date:             June 2008 (Consultation document, responses by
                              September 2008)
Supports Target:              H4: Achieve agreed number of screenings using the
                              setting-appropriate screening tool and appropriate alcohol
                              brief intervention, in line with SIGN 74 guidelines
Summary:
This discussion document, currently out for consultation sets out the strategic approach to
tackling alcohol misuse. It is estimated that the total cost of alcohol misuse to Scotland is
estimated to be around £2.25billion, over £500 per year for every adult living in Scotland.
The cost to NHS Scotland is estimated at around £400 million. Those living in the most
deprived communities are six times more likely to be admitted to hospital and to die due to
alcohol misuse than those from the most affluent areas.

Increasing trends in alcohol consumption mean that many Scots are now drinking above
sensible guidelines. Over recent years, increased consumption has been influenced by
factors such as a decline in the relative cost of alcohol; increased availability; and changing
cultural attitudes. Excessive alcohol consumption is closely linked to harm: the more we
drink the greater the risks.

Many actions are already underway which will contribute to tackling both the underlying
causes of, and the negative effects resulting from Scotland‟s complex relationship with
alcohol, but evidence shows that more direct and effective action to tackle alcohol misuse is
needed.

To deliver the long term sustainable change required it is essential that a wide range of
partners are involved. Based on knowledge and understanding of alcohol misuse, it‟s
drivers, and evidence-based interventions, sustained action is required in four broad areas:

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      Reduced alcohol consumption
      Supporting families and communities
      Positive public attitudes towards alcohol and individuals better placed to make
       positive choices about the role of alcohol in their lives
      Improved support and treatment for those who require it

The discussion paper sets out some measures to reduce alcohol-related harm in Scotland,
forming the base of a comprehensive strategic approach which will contribute to achieving
the aims of reducing alcohol related harm. It sets out key actions already underway; existing
commitments for action; and new proposals on which views are invited. In particular:
     Further action to end irresponsible promotion and below-cost selling of alcoholic
       drinks in licensed premises.
     The introduction of minimum retail pricing of alcohol.
     What particular information parents would find helpful in relation to alcohol
     Raising the minimum purchase age to 21 in off-sales.
     The introduction of a „social responsibility fee‟ applied to some alcohol retailers to
       offset the costs of dealing with the consequences of alcohol misuse.
     Further restrictions on promotional material in licensed premises.
     The desirability of separate checkouts for alcohol sales.

Implications for the Board:
While the proposals have a focus on legislative action, there are a number of key
implications for the Board. These can be summarised as follows:
    Workforce development and capacity to deliver the brief intervention and screening
        for alcohol.
    Service development and capacity to deliver appropriate treatment services,
        particularly around alcohol related brain damage.
    Partnership working and the changing role of Drug and Alcohol Action Teams
    Targeting support to families and children where alcohol misuse is present
    Awareness raising and campaign work on sensible drinking and development of
        prevention programmes for young people.



Description:                  The Road to Recovery: A New Approach to Tackling
                              Scotland’s Drug Problem
Publication Date:             May 2008
Supports target:
Summary:
The first national drugs strategy since devolution was launched on 29th May 2008, when
Community Safety Minister, Fergus Ewing, hailed it as "a new era" in Scotland's approach to
tackling drugs.

Promoting recovery from drug problems will now form the focus of efforts to tackle drug use.
Ministers believe the strategy will help cut the estimated annual £2.6 billion financial burden
of problem drug use to the Scottish economy and society.

Other key measures include:

      A recognition tackling problem drug use will only be done through effective policies on
       the economy, tackling poverty, and supporting families and children

      A fresh approach to drugs education, including the provision of factual information on
       drugs to every household with parents or grandparents in Scotland

      The tracking of investment in drug services and the outcomes they deliver


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      A commitment to strengthen existing powers to seize assets from drug dealers

      A new approach to achieve better quality of drug treatment across all prisons

The Strategy aims to reform how drugs services are planned, commissioned and delivered.
The Scottish Government will ensure that services deliver recovery outcomes within the
context of new Single Outcome Agreements and NHS Accountability arrangements.

The strategy reflects the Drug Misuse and Dependence: UK Guidelines on Clinical
Management which were published in 2007 and reinforces the need for a clear partnership
when planning and delivering services.

A new National Support capacity is being set-up to help support local partners deliver the
recovery approach in drug services, while recovery will be embedded within training and
workforce development. The Scottish Government will also set up a Drug Misuse Recovery
Network to facilitate the shift in thinking needed by both service providers and service users.

The programme of action will be supported by a package of £94 million over the next three
years. Health Boards will receive a 3.8 per cent increase in funding for drug treatment
services. Funds are also spent on tackling drug use from other general budgets allocated by
Government to local authorities.

The Action Plan from "The Road To Recovery: Action Plan" is attached in Appendix 4.

Implications for the Board:
There are a number of key implications for the Board. They are summarised as follows:
    Development of co-ordinated and integral approach to drug prevention and education
       programmes in schools and youth settings in partnership with Local Authorities.
    Workforce development and capacity to meet the needs particularly of children and
       families affected by drug problems.
    Capacity to deliver a range of options for drug treatment services and accessibility of
       these services.
    Delivery of „moving on‟ services to support recovery, particularly through
       employability and skills development for individuals recovering from drug problems.
    Support for homeless people and issues of stigma.
    The need to ensure services are set up to deal with changing drug trends.



Description:                  Healthy Eating, Active Living: An action plan to improve
                              diet, increase physical activity and tackle obesity (2008-
                              2011)
Publication Date:             June 2008
Supports Target:              H3: Achieve agreed completion rates for child healthy
                              weight intervention by 2010/11
Summary:
This policy outlines how the Scottish Government will, over the next 3 years, use the
resources identified (a commitment to spend £56 million, of which £40m is new money) to
improve the nation‟s diet, encourage greater physical activity and begin to establish a base
for tackling obesity through both targeted interventions and by supporting us all in achieving
and maintaining healthy weight. This policy builds on the actions outlined in existing
strategies for physical activity and healthy eating.

It has been estimated that the cost to the NHS in Scotland of obesity in 2003 was £171
million. The Foresight Report, Tackling Obesities (2007) stated that if current trends across
the UK at the present rate then by 2050 it is estimated that the cost to the UK‟s health
service will be almost £50 billion at today‟s prices.

                                              5
Based on the Scottish Health Survey (2003), and a review of dietary intakes:
 - Over 30% of children aged 2-15 are of unhealthy weight
 - Over 60% of adults are overweight or obese
 - Although some progress has been made towards reducing total fat intake, there has
    been no change (since 1996) in the intake of saturated fat, fruit and vegetables, bread,
    oil rich fish and breakfast cereals; and there appears to have been an increase in the
    consumption of added sugars
 - There are marked differences in diet between affluent and deprived areas
 - Only 39% of adults and 69% of children meet existing physical activity guidelines

The broad objectives of the current physical activity and diet strategies are to:
 - Create, improve and maintain the supply of natural and built environments encouraging
    more active lifestyles
 - Develop, increase and maintain capacity in a wide range of settings and sectors to
    support people to become more active
 - Stimulate interest in and demand for increased participation in physical activity by
    raising awareness in the general population and relevant professional groups about the
    health and wellbeing benefits and the recommended guidelines for achieving these
 - Promote healthy food choices, meal preparation and eating habits by communicating
    practical achievable steps towards the consumption of a healthier diet
 - Increase access to healthier food choices, particularly for those on low incomes and
    provide support, education and skill development to allow people to break through the
    barriers of food affordability and availability, and the negative impact of culture and lack
    of food skills
 - Work with the food manufacturing, processing and retailing industries to further develop
    and promote healthy choices
 - Ensure that primary food producers at both national and local level contribute fully to the
    achievement of Scottish dietary goals
 - Monitor impact of current activity to ensure current policy and practice are supported by
    the best available evidence

Guidance will be published for NHS Health Boards on locally delivered healthy weight
strategies by the end of 2008; and resources will be provided to Boards to support the
training of primary care professionals to develop a better understanding of obesity and how
to manage the condition.

A Healthy Weight Workforce Development Plan will be developed to support a joined up
workforce working towards common goals.

A focussed enquiry is being conducted to identify highest priorities amongst the aspects of
Scotland‟s environment and infrastructure that promote unhealthy weight and the sectors and
stakeholders that must be engaged in order to address these.

A new strategic approach to communications addressing the health needs of the population
has been adopted, which aims to empower and enable people to make achievable and
lasting changes in their lives.

A list of the main recommendations from the policy can be found in Appendix 2.

Implications for the Board:
The main implications for the Board can be summarised as follows:

      Capacity building within the workforce to deliver on healthy weight outcomes
      Supporting activity to improve access to healthy food (including fresh fruit and
       vegetables) particularly in isolated, rural communities
      Partnership working and integration of principles of healthy weight into planning and

                                               6
       built environment considerations, transport, leisure and opportunities for physical
       activity
      Delivery of child healthy weight interventions as per published targets
      Integration of healthy weight principles across public, private and third sector services



Description:                  Scotland’s Future is Smoke Free: A Smoking Prevention
                              Action Plan
Publication Date:             May 2008
Supports Target:              H6: Through smoking cessation services, support 8% of
                              the boards smoking population in successfully quitting (at
                              one month post quit) over the period 2008/09 to 2010/11
Summary:
Smoking is responsible for around 13,000 deaths and 33,500 hospital admissions each year.
It costs the NHS more than £200 million a year for hospital treatment for smoking related
illnesses.

Backed by £9 million over three years, the proposals aim to deliver a co-ordinated
programme of measures that respond to all the factors which influence smoking behaviour,
including measures to – educate and promote healthy lifestyles; reduce the attractiveness of
cigarettes; reduce the availability of cigarettes and reduce the affordability of cigarettes.
Proposals include plans to licence tobacco retailers and aim to discourage young people
from smoking by:

      Legislating to restrict the display of cigarettes and other tobacco products at points of
       sale

      Updating statutory controls on the sale of tobacco products, with a view to introducing
       licensing and sanctions such as cautions and fixed penalty notices

      Considering issues surrounding outlawing the sale of cigarettes in packs of 10 and
       further steps to reduce underage sales from vending machines

      Introducing a scheme for councils to more vigorously enforce tobacco sales laws

      Cracking down on smuggled and counterfeit cigarettes, in collaboration with Her
       Majesty's Revenue and Customs

      Working with the UK Government and devolved administrations to consider using
       plain packaging for cigarettes

      Stepping up education in schools and other settings to make clear the risks
       associated with smoking

The action plan proposes an ambitious programme of measures which aim to further
denormalise smoking in Scotland. The action plan was developed in consultation with the
Scottish Ministerial Working Group on Tobacco Control which is chaired by the Minister for
Public Health and whose membership is drawn from a range of key interests. The plan
draws on the 31 recommendations made by the Smoking Prevention Working Group in their
report "Towards a future without tobacco"

A summary of the actions from the Action Plan can be found in Appendix 3.

Implications for the Board:
While much of the plan relates to legislative change and action at national level, the main
implications for the Board are:


                                               7
         Work in partnership particularly with Local Authorities to ensure delivery of a robust
          programme of smoking prevention in schools and other youth settings, particularly
          focusing on hard to reach and excluded groups.
         Have a health leadership role in introducing smoke free policies within the NHS and
          across all organisations that have contact with young people.
         Develop smoking prevention programmes to support culture change.


2.2       Conclusion

The above recent policies set out the direction for some of the key priority areas for health
improvement. They pull together the evidence base and summarise best practice for taking
forward health improvement work ranging from one to one interventions to national legislative
and fiscal change required to bring about sustained improvement in health for the population
of Scotland. Further national developments are expected later this year for all of these
policies with the publication of guidance on implementing the policies, and in the case of the
alcohol proposals a firm policy statement following the period of consultation which will end in
September 2008.

There are a number of themes which cut across these policies, the main one being that of
health inequalities which is the key feature within all the policies. The health inequalities task
force reports that change in health inequalities will only be achieved through the efforts of all
staff engaging in new ways of working and in some cases service redesign. The other main
crosscutting themes can be summarised as follows:

             The need to deliver co-ordinated action with community planning partners,
              particularly on the life circumstances issues that will make a significant difference
              to health inequalities, particularly employability and poverty.
             Greater emphasis on support to children and families and the importance of the
              early years.
             The need to target resources much more at those most in need.
             Services to be more responsive to changing need.
             Workforce development and the need to have appropriately trained and skilled
              staff to deliver these programmes on the ground.
             More emphasis on identifying risks to health at an earlier stage and providing
              early intervention and prevention initiatives


3         Contribution to Board Objectives

All of these national policies provide further guidance for taking forward health improvement
work locally and contribute to the Boards objectives of:
             Improving the health of the most disadvantaged
             Shifting the balance of care
             Improving access to services

They also contribute to the HEAT targets:

         H1 Reduce mortality from Coronary Heart Disease among the under 75s in deprived
          areas.
         H2 80% of all three to five year old children to be registered with an NHS dentist by
          2010/2011.
         H3 Achieve agreed completion rates for child healthy weight intervention programme
          by 2010/2011.



                                                  8
       H4 Achieve agreed number of screenings using the setting-appropriate screening tool
        and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by
        2010/2011.
       H5 Reduce suicide rate between 2002 and 2013 by 20%, supported by 50% of key
        frontline staff in mental health and substance misuse services, primary care, and
        accident and emergency being educated and trained in using suicide assessment
        tools/ suicide prevention training programmes by 2010.
       H6 Through smoking cessation services, support 8% of your Board’s smoking
        population in successfully quitting (at one month post quit) over the period 2008/2009
        – 2010/2011.
       H7 Increase the proportion of new-born children exclusively breastfed at 6-8 weeks
        from 26.6% in 2006/07 to 33.3% in 2010/11.


4       Governance Implications

The impact on all the relevant Governance Standards is expected to be as follows

       Staff Governance: No specific additional impact on staff governance is expected as a
        result of these policies
       Patient and Public Involvement: There will be a requirement to have user involvement
        in developing specific implementation plans for the above policies, particularly where
        there will be key service developments.
       Clinical Governance: These policies provide an evidence base and direction for local
        intervention.
       Financial Impact: All of the above health improvement policies have a financial
        allocation, some of which has been devolved to NHS Boards.

Description                  National/Board       Amount
                             Allocation
Equally Well                 National                  £7m in 2008-11 for support services
                                                        for families and to increase the
                                                        healthcare capacity in schools.
                                                       £4m over 3 years to support „test
                                                        sites‟ and learning networks
                                                       £4m      from    2009-11    for play
                                                        (provisional)
Changing         Scotland‟s Board                      £1,496,320 ( £800k new money)
relationship with alcohol
The Road to recovery        National                   £94m over 3 years

                             Board                     £1,031,000 (£38k new money)

Healthy    Eating,   Active National                   £40m for 2008-2011
Living
                             Board                     £126,034

Scotland‟s Future        is Board                      £98,200 per year for 3 years
Smoke Free




                                              9
5     Impact Assessment

An equality and diversity Impact assessment is not required as this paper describes and
summarises national policy documents.




Cathy Steer
Head of Health Improvement
Public Health

22 August 2008




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                                                                                     Appendix 1
List of Task Force Recommendations:

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 tem 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.

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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, e.g. 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.




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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 f 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.
Health and wellbeing – 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.
Health and wellbeing – 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.
Health and wellbeing - 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.
Health and wellbeing – 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.

                                              13
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 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.
Health and wellbeing – wider NHS 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.




                                              14
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 crucial 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.
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 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 & 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.




                                            15
                                                                                      Appendix 2
Healthy Eating, Active Living Summary of Main Action Points

 Early Years         -    £19m available to improve nutrition of women of childbearing age,
                          pregnant women and children under 5 in disadvantaged areas
                     -    Increase uptake of, and extend range of choices available in,
                          Healthy Start
                     -    Promote breastfeeding, maternal and infant nutrition, and
                          importance of folic acid supplementation
                     -    Support the role out of Play@home across Scotland

 Schools and         -    Curriculum for Excellence – including 2 hours of good quality
 School Age               physical education
 Children            -    Support initiatives directly targeting physical activity promotion in
                          young girls
                     -    Healthy living messages and nutritional education directly into
                          schools, building on Hungry for Success
                     -    NHS Boards to deliver participatory and educational child healthy
                          weight interventions as per published targets
                     -    Proposals for a community based integrated school health team
                     -    Guidance on commercial sponsorship in the public sector

Adults and the       -    Support Scottish Centre for Healthy Working Lives
Workplace            -    Continue to fund the national Institute for Sport, Parks and Leisure
                          (ISPAL) physical activity accreditation award
                     -    Promote healthy catering, and the integration of health objectives in
                          the food sector.
                     -    Ensure the NHS fully implement existing NHS Quality Improvement
                          Scotland Clinical Standards for Food, Fluid and Nutritional Care in
                          Hospitals
                     -    Keep Well and Counterweight rolled out across NHS Boards
                     -    Support the development of guidance and promotion of physical
                          activity in primary care settings

 Older People        -    Research commissioned to identify effective interventions to improve
                          nutrition for older people living in the community
                     -    Work with COSLA to develop nutritional standards for the elderly in
                          care
                     -    Support introduction of „Active for Later Life‟ guidance for the
                          physical activity workforce

 Communities     -       Promotion of easy access to quality green space, and protection and
                         use of open spaces for recreation and sport
                 -       Introduce pilot Healthy Weight Community Projects in selected
                         locations
                 -       Support introduction of Smarter Places, Smarter Choices to support
                         sustainable travel demonstration towns
                 -       Continue to support Paths to Health to develop local schemes in key
                         settings
                 -       Support Jog Scotland, Living Streets, Green Gym, Healthyliving
                         Award
                 -       Work with Community Food and Health (Scotland) to explore
                         opportunities for improving food supply chain development




                                                16
                                                                              Appendix 3
Scotland’s Future is Smoke Free: A Smoking Prevention Action Plan

SUMMARY OF ACTIONS FROM SCOTLAND'S FUTURE IS SMOKE FREE: A SMOKING
PREVENTION ACTION PLAN

                   Action                             Delivery Lead           Timescale

Chapter 3: Health Education &
Promotion

1. To facilitate the adoption of a holistic
approach to health and well-being in
Scottish schools to be fostered through
the Health Promoting School and a
                                              Scottish Government/Learning
Curriculum for Excellence, which will be                                     Ongoing
                                              Teaching Scotland
aimed at ensuring the school ethos,
policies, services and extra-curriculum
activities all foster the health and
wellbeing of all the pupils.

2. To produce advice, guidance and
proposals aimed at helping schools and
authorities via an expert steering group
looking at substance misuse education in
schools, to achieve the improvements
sought through Curriculum for Excellence
and The Schools (Health Promotion and
Nutrition) Act 2007 (taking into
                                              Scottish Government            Ongoing
consideration the key findings of the
Evaluation of the Effectiveness of Drugs
Education in Schools), particularly so that
appropriate teaching materials are
available and are being used most
effectively, and education is planned and
delivered in partnership with inputs from
health, the Police and the community.

3. To explore with relevant interests,
including universities and colleges of
further education and other major training
providers, student associations and the
National Union of Students, steps which
                                           NHS Health Scotland               2008/09
they might take to discourage and support
students and trainees from starting to
smoke as a core part of wider substance
use and other risk-taking behaviour
programmes.

4. To explore with relevant interests and
agencies steps which might be taken to        NHS Health Scotland/ PATH      2008/09
engage with harder to reach groups such
as those who are not in employment,


                                              17
education or training or who are in
occupations or settings with higher than
average smoking levels, including through
engagement with the Scottish Prison
Service and HM Forces.


5. To encourage all those responsible
for smoking prevention activity aimed
at children and young people to
actively involve children and young
                                      All relevant agencies - NHS
people themselves in the planning and                                  Ongoing
                                      Boards, local authorities, etc
delivery of services and programmes
to ensure their perspective is fully
reflected in the approaches adopted
and to encourage active citizenship.

6. To embrace tobacco issues within
the Health Improvement Social
Marketing Strategy (HISMS) to ensure
that future national campaigns and the
local activity underpinning this,        Scottish Government           Ongoing
including by third sector organisations,
provides a clear, supportive and
inclusive route map to positive
behaviour leading to a healthy life.

7. To consider, as part of the
collaborative planning and approval
mechanisms under the HISMS, the
value of developing a multi-faceted
campaign, integrated with local
services and initiatives and engaging
the full range of health and other          Scottish Government/ NHS
                                                                       Ongoing
professionals, which is targeted at         Health Scotland
parents to raise awareness of the
impact of tobacco on their children's
health, including from second-hand
smoke, specifically aimed at
encouraging smoke-free lifestyles,
homes and family vehicles.

8. To ensure as part of the youth
strand of the HISMS an ongoing multi-
stranded media campaign is in place
to discourage uptake of smoking by    Scottish Government              Ongoing
young people and which has a specific
strand focusing on girls and young
women in disadvantaged areas.




                                            18
9. To encourage schools and all youth
work/ community settings where
                                            Local Authorities/ Community
young people gather to adopt clear no
                                            Learning & Development
smoking policies and in addition we                                      Ongoing
                                            Partnerships/YouthLink
ask that they reinforce messages
                                            Scotland/ NHS Boards
concerning the addictiveness and
health risks associated with smoking.

10. To develop and assess the
feasibility of a small number of pilot
interventions designed to discourage
the uptake and/or encourage smoking         NHS Health Scotland/
cessation in young people, particularly     Partnership Action on       2009/10
those living in disadvantaged               Tobacco & Health
circumstances; and, if appropriate, to
evaluate the effectiveness of the most
promising intervention(s).

Chapter 4: Reducing the
attractiveness of tobacco products

11. To introduce legislative controls to
                                                                        At the
further restrict the display of tobacco
                                                                        earliest
products at points of sale, and to work     Scottish Government
                                                                        legislative
with retailers on the implementation of
                                                                        opportunity
these measures.

12. To consider with the UK
Government and other devolved
administrations, the impact of the
Tobacco Advertising and Promotion
Act 2002 and consider further action
which might be taken to reduce
positive images of smoking in the           Scottish Government         Ongoing
media, including examining the impact
of film classification, and the scope for
making anti-smoking adverts
mandatory prior to the screening of
any film which contains smoking
imagery.

13. To consider with the UK
Government and other devolved
administrations the impact of the
introduction by the end of 2008 of
                                            Scottish Government         Ongoing
picture warnings on cigarette packs
and to consider whether it would be
desirable to move towards plain
packaging of tobacco products.

                                            19
14. To encourage all organisations
and agencies who in come into
contact with children and young,
including NHS organisations, local
authorities and care providers, to have
                                        NHS organisations, local
a health leadership role and be at the
                                        authorities and care providers Ongoing
vanguard of changing smoking
                                        etc
cultures in Scotland, by, for example,
introducing smoke-free policies in
external areas frequented by children
and young people such as
playgrounds.

Chapter 5: Reducing the availability
of tobacco products

15. To work in partnership with the
Convention of Scottish Local
Authorities ( COSLA), Scottish local
authorities, the Society of Chief
Officers of Trading Standards in
                                                                      Launch
Scotland ( SCOTSS) and other              Scottish Government/Local
                                                                      scheme by
relevant interests to develop an          authorities
                                                                      end 2008
outcome-focused scheme to secure
more rigorous enforcement of tobacco
sales law. Also, as per Action 20, to
ensure this complements action to
reduce illicit sales of tobacco.

16. To review and update statutory
controls on the sale of tobacco
products. This will involve a number of                               At the
possible measures, including the                                      earliest
                                          Scottish Government
introduction of a system of licensing                                 legislative
and new sanctions such as cautions                                    opportunity
and fixed penalty notices for breaches
of the law.

17. To consider with relevant
stakeholders, including at UK level,
what further steps, including
                                                                      As per
legislative, might be taken to reduce    Scottish Government
                                                                      Action 16
illegal sales of cigarettes from vending
machines as part of the review at
Action 16.

18. To continue to work with all
relevant stakeholders, including          Scottish Government         Ongoing
retailers, to promote and embed a "no

                                          20
proof, no sale" culture, including
through measures to encourage the
uptake of Young Scot/Dialogue Youth
"National Entitlement Card".

Chapter 6 : Reducing the
affordability of tobacco products

19. To keep the pressure on the UK
Government to ensure duty on
tobacco products is sufficiently high to   Scottish Government        Ongoing
keep prices in line with the cost of
living.

20. To collaborate with Her Majesty's
Revenue and Customs to reduce the
impact of illicit sales of tobacco
                                       Scottish Government            Ongoing
products on Scottish communities with
action linked to better enforcement of
tobacco sales law as per Action 15.

21. To consider issues arising from
the sale of cigarettes in packets of
                                                                      As per
less than 20, as part of the planned       Scottish Government
                                                                      Action 16
legislative review proposed at Action
16.

Chapter 7: Delivering, resourcing
and measuring progress

22. To use the Scottish Ministerial
Working Group on Tobacco Control to
                                           Scottish Government        Ongoing
oversee and advise upon the
implementation of this Action Plan.

23. To allocate additional funding to
NHS Boards of £1.5m in each of the
years 2008/09 to 2010/11 to enable
them to co-ordinate action locally to      Scottish Government/ NHS   from
underpin the measures outlined in this     Boards                     2008/09
Action Plan and to ensure this is
reflected in their tobacco control
programmes.

24. To continue to support the
activities of ASH Scotland, the                                       from
                                           Scottish Government
Scottish Tobacco Control Alliance and                                 2008/09
Partnership Action on Tobacco and

                                           21
Health within an agreed outcome
framework specifying their contribution
to the actions identified in this Plan.

25. To allocate funding within the spirit
of the new relationship between the
Scottish Government and local
authorities, of £1.5m in each of the
years 2008/09 to 2010/2011 to enable Scottish Government/Local   from
them, as set out at Actions 15, 18 and authorities               2008/09
20, to step up enforcement of tobacco
sales law and to work in partnership
with HM Revenue and Customs to
tackle illicit sales of tobacco.

26. To set new separate targets for
boys and girls aged 13 and 15 and for
16 to 24 year olds to reflect the action
within this plan as follows:
To reduce the level of smoking
amongst:
      13 year old girls from 5% in
       2006 to 3% in 2014.
                                                                 from
                                           Scottish Government
      13 year old boys from 3% in                               2008/09
       2006 to 2% in 2014.
      15 year old girls from 18% in
       2006 to 14% in 2014.
      15 year old boys from 12% in
       2006 to 9% in 2014.
      16 to 24 year olds from 26.5%
       in 2006 to 22.9% in 2012.

27. To develop a research and
evaluation framework to support the
action in this plan setting clear
timelines for action under the plan to
                                       NHS Health Scotland       2008/09
be reviewed, as part of the wider
tobacco control research and
evaluation programme for "A Breath of
Fresh Air for Scotland".




                                           22
                                                                                       Appendix 4
The Road to Recovery: Action Plan


                           THE ROAD TO RECOVERY: ACTION PLAN

        KEY ACTIONS                    OUTCOME             RESPONSIBILITY            TIMESCALE

                                       Promoting recovery

To set up a Drug Recovery
                                   To effect cultural
Network to promote and
                                   change among
support the concept of recovery
                                   those working with,   Scottish Government        From May 2008
among local partners, service
                                   or affected by
providers and people with
                                   problem drug use.
problem drug use.

An appropriate range of drug       To see more people
treatment and rehabilitation       recover from
services to promote recovery,      problem drug use to   Local strategic partners
from all types of drug use, not    live longer,
                                                         Local service
just opiate dependency, which      healthier lives                                  From May 2008
                                                         commissioners
is based on local needs and        making a positive
circumstances, must be             contribution to       Service providers
available in each part of          society and the
Scotland.                          economy.


Better integration of medical                          Local service
treatment with wider range of      To see more people commissioners
services such as social care,      recover from
                                                       Service providers
housing, mental health,            problem drug use to
education and training, to         live longer,        Any practitioners who
enable people to recover.          healthier lives     work with people with        From May 2008
Specific attention should be       making a positive   problem drug use
paid to Scotland's Employability   contribution to     including housing,
Framework ' Workforce Plus'        society and the     training and
and More Choices, More             economy.            employment, social
Chances for Young People.                              care.

                                   To see more people
Services should offer individual   recover from
care plans to people with          problem drug use to
problem drug use to enable         live longer,
them to recover from problem       healthier lives     Service providers            From May 2008
drug use, in line with the         making a positive
National Quality Standards for     contribution to
Substance Misuse.                  society and the
                                   economy.

The principles of recovery are                           Scottish Government
                                   Cultural change
reflected in training and
                                   among                                            From May 2008
workforce development                                    Scottish Training on
                                   practitioners.
programmes, in particular the                            Drugs and Alcohol

                                                 23
developing Scottish Alcohol                                 (STRADA)
and Drugs Workforce                                         Scottish Alcohol and
Development Strategy.                                       Drugs Workforce
                                                            Development Strategy
                                                            Steering Group

Better integration of problem        More joined-up
drug use within other national       approach which         Scottish Government
and local plans and strategies       sees more people                                  From May 2008
which take full account of the       recover from           Local strategic partners
need to promote recovery.            problem drug use.

Health Boards, in
commissioning and monitoring
their local negotiated Enhanced
                                                            Health Boards
Services with GPs and/or other
providers, should ensure that in                            GPs
relation to drug use there is an
appropriate level of service
                                     To see more people Other appropriate
capacity given local needs; that                        providers
                                     recovering from                                   From May 2008
Health Boards work with local
                                     problem drug use.  Service providers
authorities and other partners
to provide co-ordinated and
holistic care; and that services                            Local Authorities
ensure data collection and
                                                            Other partners
ongoing evaluation of the
outcome of treatment is carried
out.

Health Boards should review
local service arrangements in
relation to local services,                                 Health Boards
                                     To facilitate people
including pharmacies, to ensure
                                     moving on and
that they offer flexible access to                          Pharmacies                 From May 2008
                                     recovering from
service provision allowing
                                     problem drug use.      Service providers
people with problem drug use
to attend work, education and
employment.

The Government will continue
to support the Scottish Network
for Families Affected by Drugs
                                     Stronger, more         Scottish Government
(SNFAD) to support Family
                                     resilient families                                From May 2008
Support Groups and individual                               SNFAD
                                     and communities.
families through a dedicated
helpline, information and
training.

Publication of the Government's      New action to help
response to the first annual         reduce the number
report published by the National     of drug related-       Scottish Government        May 2008
Forum on Drug-related Deaths         deaths so people
in December 2007.                    live longer,


                                                    24
                                   healthier lives.

                                   Delivering the recovery model

                                   To see more people
                                   recover from
Set up a national support          problem drug use to
function to take forward the       live longer,
development and                    healthier lives     Scottish Government        Summer 2008
implementation of the recovery     making a positive
model in drugs services.           contribution to
                                   society and the
                                   economy.

                                   To see more people
                                   recover from
Development of an outcomes         problem drug use to
based framework for assessing      live longer,        Scottish Government        Implementation
and managing performance at        healthier lives     SACDM Delivery             from 1 April
a local level focused clearly on   making a positive   Reform Group               2009
recovery.                          contribution to
                                   society and the
                                   economy.

                                   To see more people
                                   recover from
                                   problem drug use to
Development of a clear                                 Scottish Government
                                   live longer,                                   Implementation
statement of the strategic
                                   healthier lives     SACDM Delivery             from 1 April
functions needed to implement
                                   making a positive   Reform Group               2009
the national strategy locally.
                                   contribution to
                                   society and the
                                   economy.

                                   Resources are
                                   used efficiently and
Robust accountability                                      Scottish Government
                                   effectively and local                          Implementation
arrangements between central
                                   partners can            SACDM Delivery         from 1 April
government and partner
                                   demonstrate to          Reform Group           2009
organisations.
                                   Government this is
                                   the case.


                                   More educated,          Scottish Alcohol and   Publish late
Publish a Substance Misuse                                                        2008.
                                   skilled and             Drugs Workforce
Workforce Development
                                   successful              Development Strategy   In force Spring
Strategy.
                                   workforce.              Steering Group         2009

An investigation into the scale    More targeted and       Audit Scotland         Report to be
and effectiveness of public        effective use of                               published in
expenditure on drugs.              drugs funding.          Scottish Government    Spring 2009



                                                  25
Establishment of a National
Evidence Group to develop a co-        Strengthened evidence base
ordinated approach to identify gaps    which improves policy and         Scottish
                                                                                      Ongoing
in research; improving links with UK   practice at national and local    Government
and EU; and encouraging                level.
innovation.

Work with Information Statistics
Division (ISD) to deliver an                                             Scottish
enhanced Scottish Drug Misuse          Better outcome data to inform     Government   April
Database to improve outcome data       policy and practice.                           2008
on a person's journey through                                            ISD
treatment.

Work with Information Statistics
Division (ISD) to create a Drug-    New data that local partners         Scottish
                                                                         Government   Summer
related Deaths Database to give a   could use to prevent future drug-
                                                                                      2008
more complete picture of a person's related deaths.                      ISD
treatment pathway prior to death.

Set up a new national drug strategy
website to bring together all policy   Improved communication
and research in one place for          between central government and    Scottish     May
academics, practitioners, key          local partners leading to         Government   2008
experts, service users and the         improved practice locally.
public.

Expand the remit and membership
of the Scottish Advisory Committee
on Drug Misuse (SACDM) to give         Authoritative, expert and wide-
                                                                         Scottish     August
the Committee a key role to play in    ranging advice for Ministers on
                                                                         Government   2008
monitoring and developing the          drug use.
implementation of the drugs
strategy and raise its profile.

                                       Preventing drug use

                                                                               Consultation
Development of a framework to          Enhanced life                           ended on 2 May
tackle poverty, inequality and         chances and                             2008.
                                                                Scottish
deprivation which is informed by a     incentives to those in
                                                                Government     Framework to
discussion paper, currently out to     the most deprived
consultation.                          communities.                            follow in due
                                                                               course.

Publication of the report of the
Ministerial Task Force on Health
Inequalities with recommendations      Reduce health            Scottish
                                                                               June 2008
for practical actions, based on        inequalities.            Government
emerging scientific evidence of
how deprivation and other forms of


                                                  26
chronic stress lead to poor health.

                                                                Scottish
                                                                Government
                                                                Learning and
                                                                Teaching
                                                                Scotland ( LTS)
                                       Children that are        Scottish
Implementation of the Curriculum
                                       successful learners,     Qualifications
for Excellence programme and, in
                                       confident learners,      Authority
particular, publication of the draft
                                       effective contributors   COSLA               Implementation
learning outcomes for health and
                                       and responsible          Health Boards       ongoing
well-being which will be trialled in
                                       citizens and therefore   Her Majesty's
schools. Joint delivery with
                                       less likely to develop   Inspectorate of
COSLA.
                                       problem drug use.        Education (
                                                                HMIE)
                                                                Local Authorities
                                                                Schools
                                                                Other education
                                                                providers

                                                                Scottish
                                                                Government
Establishment of a Steering Group      Children that are
                                                                LTS
to develop more effective              successful learners,
                                                                NHS Health
substance misuse education in          confident learners,
                                                                Scotland
schools, produce advice, guidance      effective contributors                       Interim report
                                                                Health Boards
and proposals aimed at helping         and responsible                              early 2009
                                                                HMIE
schools and authorities to achieve     citizens and therefore
                                                                scdea
the outcomes sought through            less likely to develop
                                                                COSLA
Curriculum for Excellence.             problem drug use.
                                                                Schools
                                                                Local Authorities

Further targeted development of        More people have
the Know the Score public              access to credible
                                                                Scottish            May 2008
information campaign, including        and accurate
                                                                Government          onwards
information for parents and other      information about the
family members.                        use of drugs.

Publication of an Early Years          Improved life chances
Framework which aims to                for children, young      Scottish
transform the way that public          people and families,     Government          Autumn 2008
services interact with families and    especially those at      COSLA
young people.                          risk.

Publication of a Youth Framework       Improved life chances
to ensure that young people in all     for children and         Scottish
our communities have access to         young people,            Government          2008
facilities that promote positive       especially those at      COSLA
behaviours.                            risk.

Monies from the Proceeds of Crime Improved life chances         Scottish
Act 2002 are used to fund more    for children and                                  Ongoing
                                                                Government
choices and chances for positive  young people,


                                                 27
opportunities for young people in       especially those at
those communities hardest hit by        risk.
crime.

                                        People live longer,
Publication, for consultation, of the
                                        healthier lives and   Scottish
Government's long-term approach                                                   Summer 2008
                                        communities are safer Government
to tackling alcohol misuse.
                                        and stronger.

                                             Enforcement

An in-depth analysis to map the         Reducing the supply
scale and extent of serious             of drugs into our       Scottish
organised crime in Scotland to get      communities making      Government
                                                                                  Ongoing
a better understanding of the           them stronger and       Scottish Police
threats and risks it poses to our       safer places to live,   Forces
communities.                            work and invest.

                                                                Scottish
Develop the Serious Organised                                   Government
Crime Taskforce to provide              Stronger and safer
direction and co-ordination for all     communities to live,    SCDEA             Ongoing
the organisations fighting serious      work and invest.
organised crime in Scotland.                                    Scottish Police
                                                                Forces

Building a crime campus at
Gartcosh to further enhance
working relationships between           Stronger and safer
                                                                Scottish
SCDEA and its UK enforcement            communities to live,                      Ongoing
                                                                Government
partners and improve development        work and invest.
in forensic analysis to help tackle
drugs crime.

                                        Recover more of the
                                        assets of people who
Work with the Home Office to                                   Scottish
                                        have benefited from
consider how we can further                                    Government
                                        having a criminal                         Ongoing
strengthen the Proceeds of Crime
                                        lifestyle and deter    Home Office
Act 2002.
                                        others from entering a
                                        criminal lifestyle.

Publish a full external evaluation of
                                        To see more people
mandatory drug testing and
                                        recover from problem    Scottish
consider whether or not it should                                                 2009/10
                                        drug use and reduce     Government
be rolled out to other areas of high
                                        drug-related crime.
drugs prevalence.

                                        To see more people
Review the success and                  recover from problem    Scottish
                                                                                  Spring 2009
effectiveness of drug courts.           drug use and reduce     Government
                                        drug-related crime.


                                                  28
Publish a full external evaluation of
the pilot of Drug Treatment and         To see more people
Testing Orders ( Dittos) for lower      recover from problem    Scottish
                                                                                  2010
tariff offenders and consider           drug use and reduce     Government
whether or not it should be rolled      drug-related crime.
out more widely.

Review a 'pilot' project in HMP         To see more people
Edinburgh to improve the                recovering from
integration of medical treatment        problem drug use and    Scottish Prison
                                                                                  Autumn 2008
with wider 'wraparound' therapeutic     reduce future drug-     Service
support and consider rolling it out     related crime and
across all prison establishments.       drug-related deaths.

Develop and implement an
                                        Improved continuity of
information sharing protocol
                                        care on admission,
between Throughcare Addiction                                  Scottish Prison
                                        during a sentence                         Autumn 2008
Services ( TAS) and Enhanced                                   Service
                                        and on release into
Addiction Casework Service (
                                        the community.
EACS).

                                        Improved continuity of
                                        care on admission,
Review the issue of chaotic drug
                                        during a sentence
users who stay for short periods in
                                        and on release to the Scottish Prison
custody following the report from                                                 June 2008
                                        community to reduce Service
the Independent Prisons
                                        the risk of drug-
Commission.
                                        related death soon
                                        after release.

                                        To see more people
                                        recovering from
Publish a new Substance Misuse
                                        problem drug use and    Scottish Prison
Strategy, which fits with the                                                     Autumn 2008
                                        reduce future drug-     Service
Government's drugs strategy.
                                        related crime and
                                        drug-related deaths.

Review the feasibility of a potential
transfer of primary health care to      To address health       Scottish
the NHS                                                                           2008-09
                                        inequalities.           Government



                        Children affected by substance misusing families


Provision of ongoing multi-agency                               Scottish
training to help identify children at   Improve the life        Government
risk at an early stage; to know         chances for children,                     From October
                                                                COSLA
when to seek support from               young people and                          2008
specialist areas; and when to share     families at risk.       Local
information.                                                    government


                                                  29
                                                                Scottish
Support sharing and embedding of        Improve the life        Government     Initial guidance
good practice around single and         chances for children,                  from Highland
inter-agency assessment of and          young people and        GIRFEC         partnership April
planning for children.                  families at risk.       pathfinder     2008
                                                                partners

Upgrading of eCare Framework to
                                        Improve the life
improve inter-agency information
                                        chances for children,   Scottish
sharing especially on the most                                                 End 2009
                                        young people and        Government
vulnerable citizens, such as
                                        families at risk.
children.

Through developing data
standards, determine what                                       Scottish
                                        Improve the life
information is collected and can be                             Government
                                        chances for children,                  From Summer
shared and how it is recorded so
                                        young people and        Local          2008
that it can be brought together as
                                        families at risk.       government
required for those who need to see
it.

Work with partners to develop
                                        Improve the life
more accurate prevalence figures
                                        chances for children,   Scottish       From Summer
for children affected by substance
                                        young people and        Government     2008
misuse to support effective
                                        families at risk.
planning at a local level.

Strengthen the focus of adult
                                        Improve the life        Scottish
substance misuse services on the
                                        chances for children,   Government     From Summer
needs of children and families by
                                        young people and        partners and   2008
including relevant outcomes in the
                                        families at risk.       stakeholders
commissioning framework.

Promote the creation of integrated
services to provide equality of
access to treatment for all drug
                                        Improve the life        Scottish
users across Scotland, so that
                                        chances for children,   Government     From Summer
every child affected by their
                                        young people and        partners and   2008
parents' substance misuse can be
                                        families at risk.       stakeholders
sure their parents will receive the
treatment they feel will be effective
for them.

In the context of the Early Years
Framework, work to improve              Improve the life        Scottish
parenting capacity, recognising the     chances for children,   Government     From Summer
role of wider family and community      young people and        partners and   2008
networks in promoting resilience in     families at risk.       stakeholders
children and their families.

Support the learning for child          Improve the life        SCCPN          From June 2008
protection front-line professionals     chances for children,


                                                  30
based on good practice and            young people and
evidence as an element of the 3-      families at risk.
year post for the Scottish Child
Care and Protection Network,
already provided in support of
delivery of Recommendation 27 of
the SWIA investigation of the
Western Isles case.

                                      Improve the life
Citizen's Advice Scotland to
                                      chances for children,   Citizen's Advice
provide specialist information                                                   September 2008
                                      young people and        Scotland
service for all kinship carers.
                                      families at risk.

Promote support for young carers.
This will include building on
existing work, such as the            Improve the life        Scottish
development of a national young       chances for children,   Government         From Summer
carers' festival and young carers     young people and                           2008
services self-evaluation toolkit to   families at risk.       COSLA
enable services to evaluate and
improve the services they provide.

Develop a risk assessment             Improve the life        Scottish
framework to support appropriate      chances for children,   Government         From Summer
and consistent intervention in the    young people and        partners and       2008
management of immediate risk.         families at risk.       stakeholders

Promote collaborative working
                                      Improve the life        Scottish
between Child Protection
                                      chances for children,   Government         From Summer
Committees and ADATs in
                                      young people and        partners and       2008
planning and meeting the needs of
                                      families at risk.       stakeholders
this group.

Develop and disseminate effective     Improve the life        Scottish
strategies to engage parents,         chances for children,   Government         From Summer
including compulsory measures as      young people and        partners and       2008
appropriate.                          families at risk.       stakeholders

Work with ADATs to ensure that        Improve the life        Scottish
significant improvements in access    chances for children,   Government         From Summer
to treatment for parents bring        young people and        partners and       2008
positive benefits for children.       families at risk.       stakeholders

Set up learning partners in
strategic partnerships to test out    Improve the life
how to apply GIRFEC principles to     chances for children,   Scottish
                                                                                 2008-09
addressing the needs of children      young people and        Government
affected by parental drug and/or      families at risk.
alcohol misuse.




                                                31
                                                                         Scottish
Promotion of good practice around supporting                             Government
                                                     Improve the life
children affecting by parental substance misuse
                                                     chances for         Local strategic
and the development of local information sharing                                           Summer
                                                     children, young     partnerships
protocols between national strategic partnerships                                          2008
                                                     people and
and Child Protection Committees by the national                          Child
                                                     families at risk.
support function.                                                        Protection
                                                                         Committees




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