ANNUAL REPORT of theDirectorPublicHealth2002/2003 1 ANNUAL REPORT of the Director of Public Health 2002/2003 2 ANNUAL REPORT of the Director of Public Health 2002/2003 If youwouldlike: www.nhsgrampian.org People inPartnership email: [email protected] Te Aberdeen AB252ZN Foresterhill Aberdeen RoyalInfi We Corporate Communications Shaunagh Kirby please contact: l: 01224558814 • • • • • st Gate

to fi more informationonissuesandinitiativeswhicharementioned this informationinlargeprint,Braille,audiotapeoranotherlanguage additional copiesof to giveusyourviewsonthispublication

nd outhowto‘getinvolved’

rmary isalsoavailableonline at (click onpublications) People inPartnership REFERENCES

CHALLENGES

FORCES ANDDRIVERS STRATEGIC OBJECTIVES INTRODUCTION CONTENTS h a owr ...... The Way Forward eore ...... Resources i o ups ...... Fit forPurpose Making itHappen......

Communities The Workplace T

Early Years eenage Transition ocuin...... 20 ...... Conclusion oilIcuin...... 20 ...... Social Inclusion elhadHmlsns...... 20 Health andHomelessness...... etlHat ...... 19 ...... Dental Health odadHat ...... 19 ...... Food andHealth etlHat...... 18 Mental Health...... ooayHatDsae...... 17 ...... HeartDisease Coronary acr...... 17 Cancer...... loo n te rg...... 17 Alcohol andotherDrugs...... rtcino elh...... 14 Protection ofHealth...... elhaeSrie ...... 14 ...... Healthcare Services elhEprec...... 13 Health Experience...... T M...... 10 SMS...... pca ed ...... 9 ...... Special Needs hl elhSrelac ...... 9 ...... Child HealthSurveillance ratedn...... 8 Breastfeeding...... neaa/entlSreig...... 8 ...... Antenatal/Neonatal Screening hlho muiain...... 8 ...... Childhood Immunisation bco...... 11 obacco...... 23 ...... 21 ...... 8 ...... 4 ...... 12 ...... 11 ...... 8 ...... 9 ...... 6 ...... 23 22 22 21

3 ANNUAL REPORT of the Director of Public Health 2002/2003 4 ANNUAL REPORT of the Director of Public Health 2002/2003 of Scotland.TheScottishExecutive’s WhitePaper, involved theNHSinGrampian, asinallotherareas major change,particularlyin theNHS.Thishas The pastyear, 2002/2003,hasbeena yearof Scotland’s health,andnationalpolicystrategy. local, itmustalsobesetinthecontextof shaping prioritiesforthefuture.Whileessentially professionals andpublic,particularlyintermsof healthcare. Itaimstoinformandinvolveboth focusing onthepopulationaspectsofhealthand Health Planinthatitgivesapersonalview, NHS Board’s AnnualReportandtheGrampian Grampian. However, thisisdifferenttoGrampian jointly toimprovehealthandhealthcarein basis forplanningtheactionweneedtotake The aimofthisdocumentistoprovideauseful Grampian NHSBoard. asDesignatedMedicalOffi serve Aberdeen City, AberdeenshireandMoray, whomI This reportismadetothethreelocalauthorities, change locally. tothewayhealthcould look forward over thepastyear, andanattemptto health ofthepeopleGrampian as such,butapersonalreviewofthe Report isnotacorporatedocument different.MyAnnual actually very produced byNHSGrampian,itis to anumberofcorporatedocuments similar Although thismayappearvery FOR 2002/2003 ANNUAL REPORT WELCOME TOMY INTRODUCTION

cer, aswellto challenges whichundoubtedlylieahead. report illustrateshowwearegearingupforthe this signifi been changinginanticipationofthepublication of theindividual.InGrampianwehadalready designedaroundtheneeds healthcare services, national standardstoensureintegrated,quality this throughpartnershipwithpatients,using for the21stcentury” of health and the creation of a health service fi of healthandthecreationaservice The aimsof organisations. NHSScotland, andinhowitworkswithitspartner Partnership forCare

cant policydocument.Ihopethatthis Partnership forCare 1 signalledmajorchangein . Thefocusisondelivering are “the promotion

t help thisreportwouldnothavebeenpossible. Council andTheMoraywithoutwhose Grampian, AberdeenCityCouncil,Aberdeenshire the pastyear, andourmanycolleaguesinNHS Public HealthUnitfortheirsignifi a teameffort.Iwishtothankallmembersofthe The productionofthisreporthas,asalways,been have gonealongwaytoachievingitspurpose. about healthandwellbeinginGrampianitwill nothing otherthanprovokedebateanddiscussion comprehensive norexhaustive.Ifthisreportdoes nature,areportofthistypecanbeneither very issues forthenextfewyears.Byvirtueofits professional judgement,aresomeoftheimportant towhat,inmy long-term goals.Ialsolookforward and drivers’-thechallengestodeliveringthese term goalsoverthepastyear-so-called‘forces that haveaffectedprogresstowardstheselong- In thisreportIhavesoughttoexaminethefactors email: [email protected] Te Aberdeen AB252ZN Foresterhill Aberdeen RoyalInfi We Corporate Communications Please contact: If youwouldlike: www.nhsgrampian.org This reportisalsoavailableontheNHSGrampianwebsite l: 01224554400 • • • • • • st Gate

Grampian.... to fi to giveusyourviews more informationonspecifi other documentsreferredtointhisreport another language) this informationinanalternativeformat(eg.largetype,audio,Brailleor additional copiesofthisreport

nd out how to ‘get involved’ in helping improve health and services in nd outhowto‘getinvolved’inhelpingimprove healthandservices

rmary

cant effortsover

c issuesandinitiatives Director ofPublicHealth DR ERICBAIJAL or commission. must takeresponsibilityforanyerrorsofomission issueindetail,and,asalways,I or examineevery It isnotpossibleinthisreporttodetailallactivity 5 ANNUAL REPORT of the Director of Public Health 2002/2003 6 ANNUAL REPORT of the Director of Public Health 2002/2003 Community PlanningPartnerships: are refl I ampleasedtoreportthattheseaspirations we: health system,workingtogethertoensurethat of anintegrated,connectedandcollaborative contribution tothis,weneedrealiseourvision thebesthealthpossible.Todeserve makeour NHS Grampianbelievesthatpeoplein vision ofahealthyGrampian. objectives tomoveustowardsthe deliver onanumberofstrategic and itspartnershavesoughtto Over thepastyear, NHSGrampian OBJECTIVES STRATEGIC SECTION ONE (Aberdeenshire) in Aberdeenshire” everyone “Working togetherforthebest quality oflifefor (Aberdeen City) communities andtargetinequalities” and socialwellbeing,wherewepromotehealthy “The citywillbeknownasaplaceofgoodhealth • • •

ected inthevisionsofourthreelocal infl sponsor andsupportthepromotionofhealth opportunities forhealthgain. tomaximise develop healthservices range offactorswhichinfl partner organisationstoimprovethewide

uence andworkeffectivelywithour

uence health Health inScotland:theChallenge contract forGPs,andimportantly, above, theseincludedtheproposednewnational addition to policy documentswerepublishedin2002.In national policy. Anumberofimportantnational Our jointstrategicobjectivesareshapedby a usefulbuildingblockinthe process. Plan forGrampian.Ihopethat thisreportwillbe is fundamentaltodeveloping theLocalHealth NHS Board-toconfi Developing anexplicitprocess-involvingthe our partnerorganisationsandcommunities. in activedebate,notonlyinternally, butwithall for GrampianrequiresNHStoengage Ensuring thatweallagreeonthehealthpriorities I suggestlaterinthisreport. most important-healthprioritiesforGrampian,as Grampian. Theyarenothowevertheonly-or how thesenationalprioritiesarealsofor as the‘FocusonFour’.Thisreportwillillustrate Communities. Thesethemeshavebecomeknown Ye national prioritiesintofourmainthemes:Early the Scottishpopulation.Helpfully, itgroupsthe to deliveradirectimprovementinthehealthof This latterpolicydocumentfocusesonactions (Moray) Moray” in “Achieving abetterqualityoflifeforeveryone ars, Teenage Transition, TheWorkplace, and Partnership forCare

rm ourlocalhealthpriorities , mentioned 2 . Improving health workforce. TheHealthPlanfor2003/04 anddevelopingthe a progressivehealthservice, strategic planks:improvinghealth,planningfor The GrampianHealthPlanhasthreemain to demonstratethattheyare‘publichealth and itspartnerlocalauthoritiesalsoneed effective healthimprovement.NHSGrampian is necessary, itisnotsuffi Although havingasenseofstrategicdirection population. plansforspecifi area, andservice Health ImprovementPlanslocaltoeachcouncil above. ThiswillalsohelpustodevelopJoint of engagementwiththestakeholdersmentioned agreed followingthetransparent,explicitprocess on allthelocalhealthprioritieswhichwehave do notonlythesame,butalsofocusonaction Four’. TheHealthPlanfornextyearneedsto identifi !

es actionstohelpuslocally‘Focuson organisations andpublicto agree healthprioritiesforGrampian. RECOMMENDATION:

cient alonetodeliver

c groupsinour NHSGrampianshouldlead anactivedebatewithitspartner 3

are committedtoachievingforourpopulation. make arealitythe‘step-change’inhealththatwe were sharedwithourpartners-helpusjointlyto We evaluation ofthecurrentorganisationalchange. insponsoringthis congratulated onitsbravery The leadershipofNHSGrampianistobe by aresearcher fromNHSHealthScotland. of ourjourneythroughorganisationalchange Grampian sponsoredanindependentevaluation an objectiveassessmentofourprogress,NHS they willbetterachieveourgoals.To gain ways ofworkingwhenthereisevidencethat but alsoinculture,andembracingnew requiring notonlychangesininfrastructure, Change inanyorganisationisalwayschallenging, serve. which workinpartnershipwiththepublicthey organisations’ whicharefi hopethatthefi

ndings fromthiswork-which

t forpurpose,and 7 ANNUAL REPORT of the Director of Public Health 2002/2003 8 ANNUAL REPORT of the Director of Public Health 2002/2003 national targets. achieving ourvision,whichrefl of milestonesalongtheroadto important) infl from conception(whenthehealthofparentsis years oflife.Experiencesinearlychildhood, programme ofhealthimprovementintheearly This themeisaboutcreatinganintegrated EARLY YEARS Health inScotland:thechallenge Four’ -thethemesfrom the broadheadingsof‘Focuson improving healthinGrampianunder In thissectionIreviewprogressin DRIVERS FORCES AND SECTION TWO We signifi cycle. Ithereforeurgeallparents andclinicians is thelevelweneedtopreventepidemic was 86.8%.Thenationaltargetis95%,which December 1996.AttheendofMarch 2003it end ofMarch 2002,contrastingwith97.2%in Grampian residentchildrenwas88.8%atthe percentage uptakeofMMRatagetwofor of childhoodimmunisationinGrampian.The I remaingravelyconcernedabouttheuptake Childhood Immunisation year haveincludedscreeningandnutrition. haveidentifi !

cant way. Areas ofprogressoverthepast redress thedeclineinuptake ofchildhoodimmunisation. RECOMMENDATION:

uence healththroughoutlifeina

ed anumber Improving NHSGrampiananditspartner organisationsshouldsupportactionto

. ect 2

However, inourcurrentfi neonatal babies,andeyetestsforfouryear-olds. what isknownastheuniversalhearingtestfor We thegeneforthiscondition. carrying year,such babiesevery and another2-3whoare We identifi 2003,andhasalready began inFebruary Screening ofneonatalbabiesforcysticfi Grampian areagreeingtothistest. suggest that90%ofpregnantmothersin screening inNovember2002.Initialreports NHS GrampianimplementedantenatalHIV Antenatal/Neonatal Screening continue toleadactionremedythissituation. sometimes seriouscomplicationsofmumps.Iwill suffering,hospitalisation,and the unnecessary prevent theproblemsofcongenitalrubella,and is stillapotentiallyfatalconditioninBritain), immunised toprotectthemfrommeasles(which working withfamiliestoensurethatchildrenare Strategy priority actionsintheGrampianBreastfeeding Good progressisbeingmadeintakingforward Breastfeeding with otherstodeterminepriorities. proposed newdevelopmentmustbecompared arecurrentlyworkingonplanstointroduce expectthistesttohelpusidentifyearly2-3

ed ababylikelytodevelopthiscondition. 4 . Thishasincludedbetterhelp and

nancial situation, every nancial situation,every

brosis work. partnership betweenhealth, educationandsocial mucha I ampleasedtoreportthatthisisvery special needswithafocusonAberdeenCity. forchildrenwith review ofpre-schoolservices Capability Scotland.Thisisbeingfollowedby with specialneedshasbeenconductedby forchildren for Grampian.Areviewofservices component oftheplannedChildHealthStrategy Initial workhascommencedonthe‘earlyyears’ Children withSpecialNeeds the outcomeofnationalreviewonthisissue. Children (Hall4) with thenationalpolicydocument programme,whichisinline Health Surveillance visitors andGPsdeliveringthePre-schoolChild A guidancemanualhasbeenproducedforhealth Child HealthSurveillance more effectively. but thissystemwouldhelpustargetourefforts affl is awidedifferenceinratesbetweenthemore we cantakeforourchildren.We knowthatthere health promotingandillness-preventingmeasures that breastfeedingisoneofthemostimportant, important, becauseevidenceshowsbeyonddoubt monitoring ofbreastfeedingrates.Thisis computer systemadequatelytoallowmeaningful yet implementedthenationalchildhealth in previousreports,NHSGrampianhasnot I amconcernedthat,despitemyrecommendation produced duetopopulardemand. Where tobreastfeedinGrampian underway, andasecondeditionofthedirectory support formidwivesandhealthvisitorsarealso breastfeeders. Furthertraininginitiativesand ‘coached’ byothermumswhoareexperienced This offersnewmumsthebenefi Banff andBuchanBreastfeedingCoachingProject. support forbreastfeedingmums,suchasthe practice inthisfi

uent anddeprivedcommunitiesinGrampian, ! monitoring ofbreastfeedingrates. RECOMMENDATION: 5

eld. Atthesametime,weawait , thelatestguidanceonbest hasbeen

ts ofbeing Health forAll NHSGrampianmustimplementasystemtoallowmeaningful they fulfi young peoplefeelsupportedtotheextentthat we wanttocreateasetofcircumstances where are subjecttomajorexternalinfl of greatchange,andatimewhenyoungpeople education andadolescencetoadulthoodareatime school The yearsfromtheearlystagesofsecondary TEENAGE TRANSITION initiative central tothenationalNewCommunitySchools The conceptoftheHealthPromotingSchoolis related behaviourofyoungpeople. community, canmakeadifferencetothehealth- Schools, inpartnershipwiththehomeand These workerswillprovidedirect supportto health posts,alongsidethetwo existingposts. Community Schoolsfunding forthreenew Aberdeenshire improvement work,inPeterheadandTurriff, Recognising thevalueofexistinghealth Community Schoolmodellocally. active approachtotherolloutofIntegrated three partnerlocalauthoritieshavetakenan I ampleasedtoreportthatNHSGrampian’s forpupilsandtheirfamilies. integrated services social inclusion.Akeyelementofthisistodeliver raising attainmentandimprovingwhatwecall as theyarenowknown,havethetwinaimsof crucial. NeworIntegratedCommunitySchools, development. Thehealthinputtotheinitiativeis mental, physicalandsocialwell-beinghealthy extra-curricular activitiesandpartnershipsfoster curriculum, buttheschoolethos,policies,services, not onlyishealtheducationintegraltothe individual componentparts. want todomuchmorethanthesumofthese being, dietandphysicalactivity. However, we sexual health,alcohol,mentalhealthandwell- strands dealingwithissueslikesmoking,drugs, and otherhazards.Thisapproachrequiresspecifi avoid awiderangeofhealth-damagingbehaviours

6 l theirpotential,maintainself-esteem,and . Within HealthPromotingSchools, intends tocommitNew

uences. Locally

c 9 ANNUAL REPORT of the Director of Public Health 2002/2003 10

ANNUAL REPORT of the Director of Public Health 2002/2003 The neighbourhood areas. working andhealthimprovementwithinthethree more opportunitytostrengthenpartnership- Aberdeen CityCommunityPlan),willprovide all schools.Therolloutof Promoting Schoolshasbeenaccessedbyvirtually Grampian tohelpschoolsbecomeHealth In Laurencekirk areas. Fraserburgh, Banff,Oldmeldrum,Portlethenand inthe Promoting Schoolinitiativeforward whole schoolcommunitiesintakingtheHealth the fundingtointroducethem tosocialand identify andsupportyoung people, andprovide a Chance.Partnershavecome togetherto This isjustwhathashappened withGiveKids share resources, knowledgeandexpertise. requires partnerorganisationstoworktogether our mostvulnerableyoungpeopleinGrampian self-esteem andstrongpersonalskills.Helping wellbeing ofyoungpeoplerequiresbothgood recognising thatimprovingthehealthand headings ofTeenage Transition andCommunities, work undertakenbyNHSGrampianunderthe Give KidsaChance Give KidsaChance people andtheirfamilies. collective efforttoimprovehealthforouryoung planning partnerorganisations,tomaximiseour health inschools),additiontoourcommunity responsibilityfor colleagues (whohaveastatutory continue toworkwithschoolhealthservice to beHealthPromotingSchoolsby2007.We Scottish ExecutiverequiringallschoolsinScotland fundamental drivelocallyandnationally, withthe Improving healthwithintheschoolsettingisa engaged inactivitytoimprovehealth. Moray in2002,andall54schoolsare Schools modelwasrolledouttoallschoolsin the Moraycommitment.TheNewCommunity towards becominghealthpromoting,illustrates improvement workertohelpschoolswork concept. Theappointmentofadedicatedhealth supporter oftheHealthPromotingSchool Aberdeen City Moray Council hasbeenaconsistent , trainingdevelopedbyNHS 8 isacomponentofthe Aberdeen Futures 7 (the SMS prioritise nominationstothescheme. networks ofprofessionalsmeettogetherto Peterhead andMoray. Intheseareas,wider Give KidsaChancealsooperatesinFraserburgh, St Machar. Seaton, Fersands/Printfi Aberdeen CityareasofTullos/Torry, Kincorth, by communityworkersandsocialinthe people arenominatedforaplaceonthescheme or drugmisuse,anti-socialbehaviour. Young them fromnegativepastimes,suchasalcohol sustain interestsandhobbieswhichwilldivert support vulnerableyoungpeopletodevelopand Give KidsaChanceaimstoencourageand and providingtransport. offer theirtime,skillsandexperienceincoaching their ownfundraisingevents,andeightvolunteers have alsocontributedtotheprojectbyorganising Aberdeen CityCommonGoodFund.Individuals project, includingagrantof£25,000fromthe areas ofGrampianhavealsosupportedthe Safety Partnershipsinthethreelocalauthority Ledingham ChalmersandScotoil.Community Production, TheWood Group,StenaDrilling, sector partnerssuchasShellUKExploration& scheme, fundinghasbeenprovidedbyprivate taken theroleofleadpartnertoco-ordinate leisure activities.WhileNHSGrampianhas advertising campaignandthe recruitmentand aspects oftheprojectfrominitial planningtothe have given.Young peoplewere involvedinall sofar,the service andthepositivefeedbackthey in the309boysand340girls whohaveused people, foryoungandthisisrefl hasbeentailormadebyyoung The service hours eachSaturdayafternoon. and healthinformationassistant,openfortwo staffed byafamilyplanningdoctor, specialistnurse drop-in offersanadaptedfamilyplanningservice, health, exercise, healthyeating,andstress.The including alcohol,drugs,smoking,STI/sexual one-to-one andgroupadviceonalllifestyletopics andsupportareonofferfrom variety ofservices to theyoungpeopleofMorayon1June2002.A Health ImprovementFund,whichopeneditsdoors SMS isayoungpeople’s drop-in, fundedbythe

eld, Middlefi

eld, Powisand

ected specifi Scotland andNHSHealthprojects Moray hasalsobecomeapilotsitefortheASH the saleoftobaccotochildren. for theLordAdvocate’s reviewofguidelineson pleased tonotethatMorayhasbecomeatestsite Grampian Tobacco AllianceNetwork.Iam and communicatedmorewidelythroughthe reported totherelevantcouncilcommittees, on anationalandlocallevel.Localactivityis progress, andkeepingabreastofdevelopments three Grampiandepartmentsexists,monitoring organisations, andclosenetworkingbetweenthe Standards departmentsaretheobviouslead access toage-restrictedproducts.Trading our colleaguesinTrading Standardsinreducing The GrampianTobacco AllianceNetworksupports T added confi or mixedgroups,whichseemstogivethemthe people comingeitherindividuallyorinsinglesex people ‘dropping-in’isfrom13-19,theyoung selection ofstaff.Theagerangetheyoung total of33delegatesattended, includingworkers young peoplethemselves.Over 2002/2003a developed byNHSGrampian, withinputfrom ‘young peopleandtobacco’ traininghasbeen young peopleontheissueof smoking,specialist To for youngpeopleinrelationtosmoking. -providesadviceandhelp and otherlocalservices Aberdeenshire Councils,andalsoinvolvesyouth partnership betweenNHSGrampian,Morayand Information Bus(MIB),-whichinvolvesa general youthwork.Forexample,theMobile Addressing smokingisalsoincorporatedinto other aidstogivingup. groups whowanttostopsmokinguseNRTand 2003whichhashelpedpeopleofallage January in addedacommunitypharmacyservice Service to youngpeople.Grampian’s SmokingAdvice of providingNicotineReplacementTherapy(NRT) National developmentsmeanthereisnowaway Break initiative. involved indevelopingthethree-yearfundedFag stop smoking,withlocalyoungpeopleactively obacco supportstaffandvolunteerswhoworkwith

cally designedtohelpyoungpeople

dence toaskforadvice. Development inScotland in health problems.Somekeylinkagesaresetout problems orwhohaveexperiencedmental opportunities forpeoplewithmentalhealth work, andsecuringmorebetteremployment people whodevelopmentalhealthproblemsat is vital.Thisincludessupportingjobretentionfor Promoting goodmentalhealthintheworkplace increase thenumberofpeopleinemployment. health oftheworkforce, andtomaintain and will dependinpartonourabilitytoimprovethe improved businessgrowthandperformance W independent foraslongpossible. good physicalandmentalhealth,remain to continuebeeconomicallyactive,enjoy maximising theirfunctionalcapacity, areable aimedat access toprogrammesandservices adult life,arenotmadeillbytheirwork,have individuals maintainhealthylifestylesthroughout for healthimprovementmustbetoensurethat for healthimprovement.Partofourstrategy The workplacesettingisamajoropportunity THE WORKPLACE school communityandtopicadvisors. with thehelpofstafffromallsections all schoolsinGrampian.Thepackwasdeveloped pack wasproducedontobaccoandsuppliedto authorities, aHealthPromotingSchoolresource Supported bythethreeGrampianlocal pilot projects. the ASHScotland/HealthScotlandyoungpeople from otherareasinScotlandwhoareinvolved ith anageingpopulation(seepage13), The Way -FrameworkforEconomic Forward • •

for interventions thatprotecttheworkforcefor interventions The workplaceisanidealsetting notjust Europe. compared withtherestof UKand poor lifeexpectancyofpeopleinScotland go alongwaytoaddressingtherelatively make animpactonthesediseases,itwould disease.Ifwewereableto and respiratory levels ofheartdisease,cancer, diabetes W orking agepeoplesufferfromhigh 9 : 11

ANNUAL REPORT of the Director of Public Health 2002/2003 12

ANNUAL REPORT of the Director of Public Health 2002/2003 to leadbyexampleinrelation toworkplacehealth partner organisationsarealso beingencouraged with considerablesuccess.Community Planning sectororganisations businesses andvoluntary have beenencouragedtoact asmentorsforsmall 60% haveachievedanaward.Largeemployers the nationaltarget.Ofparticipatingemployers, Grampian workingpopulation,whichiscloseto Locally theschemenowcoversalmost40%of workshops weredelivered. SHAW successful scheme,and anumberofvery sized Enterprises(SMEs)wererecruitedontothe sector. Seventy-twonewSmalltoMedium In 2002/2003,thefocuswasonsmallbusiness workplace healthactivity. Scotland’s HealthatWork asthebasisforall engaging withemployersinGrampian,using programme adoptsabusinessapproachto scheme (SHAW) of thenationalScotland’s HealthatWork with NHSGrampianhostingthemanagement Grampian isinthevanguardofsuchwork, protecting theirphysicalandmentalhealth. to declineworkexcessivehours,thereby T made inotherareas.Forexample,theWorking Executive. Morerecently, progresshasbeen legislation andtheworkofHealthSafety being maintainedthroughUKhealthandsafety This remainsimportant,withcontinuingprogress focused onpreventingaccidentsandinjuries. In thepast,healthinworkplacewasprimarily ime Directivemakesitpossibleforemployees • •

leading roleinimprovingthissituation. physiotherapists andemployerscanplaya countries. Occupationaltherapists, well developedthaninmanycomparable and helpingpeoplereturntoworkareless Our systemsforrehabilitation,jobretention an occupationalhealthservice. employees acrossScotlandhaveaccessto assessment andcare.However, notall andprovidingclinical these interventions organisations haveakeyroleinsupporting andemployer Occupational healthservices and promotegoodhealth. from hazardsbutalsotopreventill-health 10 . NHSGrampian’s workplace fl hospital sites,staffhavebeengivenevengreater into expansion ofthesmokingcessationservice management partnershipforum.Followingthe representatives, andtheNHSGrampianstaff developed withfullinvolvementofstaff,union national assistance)aspartofthepolicyleafl all staff,(includinghelplines,websites,localand of smokingcessationsupportareprovidedfor the NHSGrampianTobacco Policy, fulldetails For NHSGrampianstaff,followingthelaunchof of theSHAW programme. developing workplacepoliciesontobacco,aspart Tr team’s Resources Directscheme. all localworkplacesregisteredontheworkplace initiative, anddistributesinformationaboutthisto MarchDay every asausefulpublicawareness NHS GrampiansupportsthenationalNoSmoking based groupsintheirownlocalarea. established andstaffcanalsojoincommunity- have hadsite-specifi help tostopsmoking.Eighteenlocalworkplaces support forallemployeesinGrampianwhowant Grampian’s provides SmokingAdviceService funding fromtheScottishExecutive. Scotland in2002/03asadirectresultofadditional Boards. Thirty-onenewstaffwererecruitedacross direction toSHAW staffacrosstheother14NHS a nationalbasisinvolvesprovidingleadershipand NHS Grampian’s roleinmanagingtheschemeon using theSHAW standardasabenchmark. relation todevelopingdrugandalcoholpolicies, outcome sofaristhesharingofgoodpracticein and achievingSHAW awards.Oneexcellent our communitiesarewidely recognised. worst-off andthehealthof better-offwithin inequalities thatexistbetween thehealthof have aconsiderableinfl public ofGrampian.Thecommunities welivein are importantinfl There areanumberofforces anddriverswhich COMMUNITIES

exibility toattendsessions. aining andsupportisalsoprovidedfor

uences onthehealthof

c stop-smokinggroups

uence onourhealth.The

et Census is stronglylinkedwith‘rurality’.The2001 for peoplelivinginruralareas,andcarownership so thatthesearenowalmost 5%ofallhouseholds with childrenaged0-15years increasedby50%, 1991 and2001Censuses,lone-parent families Social structureisalsochanging. Betweenthe reduction inMorayoverthesameperiod. increase inAberdeenshire,andarounda3% in populationby2031,whileweexpecta3% Aberdeen Cityexpectstoseea7%reduction within thethreelocalauthorityareasinGrampian. particularly inruralareas,andpopulationshifts trends adecliningbirth-rate,anolderpopulation We by 2016. children andadultsover64),willfallsignifi active individualsperthousandofthetotal ‘dependency ratio’(thenumberofeconomically projection holdsgood,whatisknownasthe is expectedtorise18%by2031.Ifthis of theScottishpopulation.Thisproportion population agedover65,comparedwith16% in Grampianasawhole,with15%ofthe There isageneralincreaseintheolderpopulation vehicles tohouseholds. 66%. Aberdeenshirealsohasthehighestratioof 76%, AberdeenCity, 66%,andScotlandoverall, level inScotland,82%,comparedwithMoray, rural areas.Aberdeenshirenowhasthehighest levels ofhouseholdcarownership,particularlyin affl often usedasanindicatorofdeprivationor Conventionally, householdcarownershipis is anaturaldivisionbetween‘townandcounty’. as wellnaturalgeographiccommunities.There is signifi In thiscontext,thesocialgeographyofGrampian plans whicharejointlyproduced. involved andengagedwiththeagenciestoshape the communityconcerned,suchthatitisactively what wecall‘activecitizenship’onthepartof to realiseitsfullpotential,thereneedsbe health andwellbeing.ForCommunityPlanning to improvelifecircumstances, andconsequently by thelocalauthorities-whichhaspotential Community Planningisamulti-agencyprocess-led

uence. However, acarisespeciallyimportant needtosuperimposeonthesegeneral 11

cant. We have‘communitiesofinterest’, showsacontinuedtrendtowardshigh

cantly percentage ethnicpopulationineachareashows: live inAberdeenCity, asthefollowingtableof more moderate.Mostoftheethnicpopulation Chinese andotherSouthAsianpeoplehasbeen Africa ortheCaribbean,whileincreasein have morethandoubled,asthosefrom that residentsfromtheIndiansub-continent Mixed Background’).However, itisapparent (namely, ‘BlackScottish/OtherBlack’and‘Any of theintroductionextracategoriesin2001 are documentedelsewhere The majorshiftswithinthelocaleconomy 1991 toalmost66%in2001. over 56%ofhouseholdsbeingowner-occupiersin Home ownershipinGrampianhasrisenfromjust the numbersineachgroupisdiffi still comparativelysmall.Directcomparisonof almost doubled,from0.87%to1.63%although ethnic groupsintheGrampianpopulationhas Scotland. Inthesameperiod,proportionof in Grampiancomparedwithalmost7%across of peopledescribingthemselves ashavinga There hasbeenamajorincrease inthenumber (74%) amongstScottishlocal authorities. good health,secondonlyto EastRenfrewshire particularly healthy, with73.6%ofpeoplehaving health was“notgood”.Aberdeenshire good health,andonly7.5%reportingthattheir (after Orkney),with72%ofpeoplereporting Grampian hadthesecondhealthiestpopulation Census includedaquestionaboutgeneralhealth. is alsochanging.Forthefi The healthexperienceofthelocalpopulation Health Experience sector.service employers, havingbecomeovershadowedbythe industries oftheNorth-Eastarenowminority

Scotland 1.3 2.01 2.90% Grampian 0.87 1.63 Moray 0.43 1.46% 0.71 Aberdeenshire 0.47 0.87 Aberdeen City Area 1991 Area 1991 2001 2001 Census Census

rst time,the2001 12 . Thetraditional

cult because 13

ANNUAL REPORT of the Director of Public Health 2002/2003 14

ANNUAL REPORT of the Director of Public Health 2002/2003 known asthe Thishasbecome strategy forhealthcareservices. successfulprocessforthedevelopmentof a very Planning forNHSGrampianhascontinuedtolead that overthepastyearDirectorofCorporate Iampleasedtoreport for healthcareservices. Grampian leadsonthedevelopmentofstrategy for improvinghealth,itiscrucialthatNHS organisations inGrampiantoshareastrategy While itisimportantforpublichealth Healthcare Services 2003. only releasedinmid-February information byhealthboardandcouncilareawas as thefi We maintain thesamerankingorderasin1991: did AberdeenCity, butthethreecouncilareas proportionate risesinlong-termillnessthan Moray andAberdeenshiresawgreater ‘disability’ in2001. the word‘handicap’in1991wasreplacedby the questionaskedonCensusform,where and thecausemaybeduetoaslightchangein in thehealthofpopulationjust10years, that therehasbeensuchagreatdeterioration same proportionaterise.Itisdiffi over 50%.Scotlandasawholehasseenthe to 16.4%in2001,aproportionateincreaseof 10.8% oftheGrampianpopulationin1991 limiting long-termillness.Thishasrisenfrom including representativesof the public. of allthosewhohaveastakeinclinicalservices, to planningisopenandtransparentinclusive

Scotland 13.7 17.5% 20.3 Grampian 10.8 16.4 Moray 10.1 15.3 12.5% Aberdeenshire 9.5 16.7 Aberdeen City Area 1991 Area 1991 2001 2001 havemoretolearnaboutthesechanges, !

rst detailedbreakdownofCensus RECOMMENDATION: Diagnostic andTreatment attheirhub. Centres,withspecialistacuteservices provided tocommunities implementthemodelofhealthcarebasedonanetwork of HealthFit process Census Census 13 . Thisapproach

cult tobelieve

NHS Grampian should progress the reorganisation of services NHSGrampianshouldprogress thereorganisationofservices The fi Severe Acquired Syndrome Respiratory (SARS) preparation. a continuedprogrammeofawarenessand for theforeseeablefutureandwhichwillrequire is onethatunavoidablyhighontheagenda to theselocalpriorities,theissueofbioterrorism and healthcareassociatedinfections.Inaddition bloodborne viruses,sexuallytransmittedinfections (childhood immunisation),andaddressing children fromvaccine-preventablediseases This includesessentialactivitysuchasprotecting from hazardswhichcoulddamagetheirhealth. has akeyroletoplayinprotectingthepopulation colleagues andotherpartners,NHSGrampian Wo The ProtectionofHealth context forNHSGrampian. implemented despitethechallengingfi and translatedintoactionplanswhichare Clearly itisimportantthattakenforward, widespread supportfromtheclinicalcommunity. accessibility. Mysenseisthatthisstrategyhas withlocalconvenienceand clinically safeservices to suchinnovation,balancingtheneedprovide T hospitals. Thedevelopmentof‘Diagnosticand ofacute who donotrequirethespecialistservices than normallyprovidedatGPpracticelevelbut provide forpatientswhorequiremoresupport will careclinicians.Theseservices secondary and providedjointlybyprimary care services enable thedevelopmentofnewintermediate hub. Clearerdefi atthe care withhospital-basedacuteservices The strategyfocusesonintegratednetworksof in Grampianoverthenextfi From thisworkhasevolvedavisionofhealthcare Service wasalerted,and GPswere,fromtime Service referring anysuspectedcase.TheAmbulance andinformthehospitalbefore than insurgery) (including examiningpatientsathomerather suspected cases,ensureinfectioncontrolmeasures 2003. AtthatpointweaskedGPstonotifyall reatment Centres’willallowrapidpatientaccess rking closelywithenvironmentalhealth

rst globalSARSalertwasissuedon12March

nition of specialist services will nition ofspecialistservices

ve totenyears.

nancial information isonlyavailable onpeoplewhohave HIV statisticsshouldbeinterpreted withcaution,as The incidenceofHIVcontinuestorise fi treating andcaringforthesepeoplehassignifi Scotland, secondonlytoGlasgow. Thecostof people diagnosedasHCVantibody-positivein This givesGrampianthesecondhighestrateof ofinjectingdruguse. associated withahistory with hepatitisCinGrampian,and73%were At June2002,1,708peoplehadbeenidentifi small, butincreasing,numberofpeoplewithHIV. have anincreasingprevalenceofhepatitisC,anda because wehavehadhighratesofhepatitisB, C) continuetobealocalpriorityinGrampian, Bloodborne viruses(HIV, hepatitisBand Bloodborne Viruses already beencreated,basedonnationalguidance. andcontacttracingdatabasehas A surveillance from theScottishExecutiveHealthDepartment. SARS managementplan,basedondraftguidance port healthstafftoprepareanNHSGrampian careand currently workingwithhospital,primary The NHSGrampianHealthProtectionTeam is to beSARS. Fortunately, thiswassubsequentlynotconfi suggestive ofSARSonreturnfromHongKong. symptoms resident whodevelopedrespiratory notifi Health (SCIEH)forupdates.InGrampian,ourfi Scottish CentreforInfectionandEnvironmental to time,advisedaccessthewebsiteof now over, preventionactivitiesmustcontinue. Although recentoutbreaksofhepatitisAandBare both formallyandinformally. adopted inGrampiantopromote thismessage equipment. Therehavebeenvariousapproaches safer sexandpreventingthesharingofinjecting about HIV, withparticularreferencetopromoting HIV, mustrelyoncontinuallyraisingawareness Prevention ofinfection,andtheconsequences Our mosteffectiveweaponremainsprevention. learn beforeaneffectivevaccinationisdeveloped. encouraging information,thereisstillmuchto with diffi quest foranHIVvaccinehasbeenfraught

nancial implicationsforNHSGrampian.

cation wasinmid-March 2003,ofanOrkney

culty. Althoughrecenttrialsyielded 14 . The

rmed

ed

cant

rst

The numberofnewdrugusers reportedbythe resulting inincreasingdemands onservices. in druguseandsexuallytransmitted diseases, in theincidenceofbloodborne virusesbutalso Grampian hasnotonlyseen ageneralincrease care inthefuture. mean thatmorepatientswillrequirelong-term whilst thesechangesareencouraging,theyalso progression fromHIVinfectiontoAIDS,and, in anti-retroviraltreatmentshavedelayed living withAIDSinGrampian.Improvements period, buttherearesixpeopleknowntobe and no-onediedfromAIDSduringthereporting still alive.NonewcasesofAIDSwerediagnosed HIV casesinGrampianwas214,ofwhom151are At March 2003,thecumulativetotalofreported infected heterosexually. compared topreviousyears44%ofthose infected heterosexuallyhasslightlyincreased in Europe(seeFigure2).Thenumberofwomen Asia, 4(10%)inThailand,1theCaribbean, (73%) acquiredtheirinfectioninAfrica,3(7%) unknown. Ofthe41importedHIVinfections30 ofinfectionfortheremaining10%is the country 23% acquiredtheinfectionwithinUK,whilst HIV heterosexually, 67%wereimportedcases, 1996/97, ofthe61individualswhohaveacquired UK. ThismirrorsotherareasofScotland.Since have mainlyacquiredtheirinfectionwithinthe abroad, asopposedtothehomosexualswho heterosexually, themajorityhavebecomeinfected Of thosewhohaveacquiredtheinfection and 27%in1999/00.Figure1illustratesthis. compared to74%in2001/02,50%2000/01 all newinfectionswereheterosexually-acquired, heterosexual transmission.In2002/03,80%of have seenadramaticshiftfromhomosexualto one toinjectingdruguse.Thelastfewyears sexual intercourse betweenmen(MSM),and attributed toheterosexualtransmission,two in Grampian.Twelve ofthesecaseswere 2003, 15newcasesofHIVwerediagnosed During theperiodApril2002toMarch statistics willnotrefl or donotchoosetobetested.Accordingly, some peopleareeitherunawareoftheirinfection opted tobetested.Dueavarietyofreasons,

ect thewholepicture. 15

ANNUAL REPORT of the Director of Public Health 2002/2003 16

ANNUAL REPORT of the Director of Public Health 2002/2003

Nos of reports sexually transmittedinfectionscontinueswith 14% ofthoseinfected.Work onpreventionof injecting drugusersinfectedwithHIVtojust helped, forexample,tokeepourproportionof aimed atinjectingdrugusers,andwhichhave There hasbeenawealthofpreventioninitiatives an increaseof18%from2000. during2002, through theGrampianlaboratory 1,492 newcasesofchlamydiawerediagnosed infections continuestoescalate.Forexample, The numberofpeoplewithsexuallytransmitted increase of29%comparedtothepreviousyear. 2002/2003 forGrampianwas978.Thisisan Division(ISD)during national InformationServices 100 120 140 160 180 200 20 40 60 80 0 29 39 49 95/96 94/95 93/94 92/93 Others IDU Heterosexual MSM Nos of reports 10 12 14 16 0 2 4 6 8 969 979 989 990 000 010 2002-03 2001-02 2000-01 1999-00 1998-99 1997-98 1996-97 69 79 89 920 000 2002/03 2000/01 99/2000 98/99 97/98 96/97 Y ear Within UK Outwith UK Not Known Y ear (Apr - March) affected. investigation andmanagementofthepatients spread oftheseinfections,andensureeffective viruses, encouragetimelydiagnosis,reducethe action toraiseawarenessofbloodborne sectorstooversee andstatutory voluntary inthe collaborates withallrelevantservices The GrampianBloodborneVirus Group health andwellbeingofthelocalpopulation. healthcare, suchthatweimprovethesexual quality, consistent,appropriate,accessible, to promotingsexualhealth,andensurehigh basis toprovideacoherent,plannedapproach currently beingdevelopedonamulti-agency vigour. AGrampianSexualHealthStrategyis exposure geographic areaof transmission by HIV heterosexual Figure 2-Trends in March 2003) risk factor(cumulativeto HIV infectedpersonsby Figure 1-Newlyreported drink drivelimit through drinkordrugswhileoverthelegal driving, orbeinginchargeofavehiclewhileunfi breathalysed werereportedforoffencesrelatedto the calendaryear2002,almost13%ofdrivers that alcoholpresentstohealthinGrampian.In However, thisisonlyonepartofthechallenge the alcoholconsumptionofyoungpeople. In mylastannualreport,Iraisedconcernsabout Alcohol andOtherDrugs One areahighlightedisthe diffi in thesubsequentreport. positive observations day wasgenerallygood,and thereweremany the endofMarch 2003.Initial feedbackonthe at North EastScotlandbreast-screening service NHS QualityImprovementScotlandvisitedthe Breast Screening targets). in someareasislessgood(althoughstillabove screening, includingAberdeenCity, whereuptake to achievehighuptakeforbreastandcervical is thereforegratifyingtoreportthatwecontinue in Grampian,and,assuch,isourbiggestkiller. It day four ofthe14orsodeathsthatoccurevery Cancer remainsaseriousproblem,causingabout Cancer develop appropriatemessages. Grampian Policewithconvicteddrinkdriversto A studywillbecarriedoutbyNHSGrampianand people’s alcoholconsumption,anddrinkdriving. change inadultsisneededtosupportyoung Action Team (DAAT) identifyingthatculture Local workincludestheMorayDrugandAlcohol conditions broughtonbyalcoholabuse. not includedeathsduetoillnessesormedical causeofdeath.Itdoes given asacontributory where alcoholorintoxicationhasbeen reported bythePolicetoProcuratorFiscal This statisticrelatesonlytosuddendeaths Grampian in2002,ofwhich29wereAberdeen. deaths directlyattributabletoalcoholmisusein Despite thesefi with purchasing alcoholforunder18yearolds. 18 yearolds,andthreepeoplewerecharged cases oflicensedpremisessellingalcoholtounder incapable offencesinAberdeen.Therewere20 In 2002,27peoplewerearrestedfordrunkand

scal interventions, therewere51 scal interventions, 15 .

culty the service culty theservice

t There hasbeendiffi ScreeningCervical March 2004. the ageextensionto69yearsbydeadlineof However, plansarewelladvancedtobringin diffi and pathologywhererecruitmentisvery medical staff.Thisisespeciallytrueofradiology take place.Thisisduetopressureonthescarce meetings has inensuringcertainmulti-disciplinary prescribing NicotineReplacement Therapy(NRT) careandstrokeunits,adviceon coronary hasbeenintegrated intocardiacand Service particular, theNHSGrampian SmokingAdvice in localcommunities.In to developthisservice (NOF), andthishasprovidedmoreopportunity Fund (HIF)andtheNewOpportunities has beensought,suchastheHealthImprovement Additionalfunding helped usimprovetheservice. andthishas views ofpeopleusingtheseservices, Grampian LocalHealthCounciltogatherthe in Grampianwascomplementedbywork for peoplewhohavesufferedaheartattack A reviewoflocalcardiacrehabilitationservices dayinGrampian. occur every causing aboutthreedeathsoftheaverage14that heartdiseaseremains aseriousproblem, Coronary Coronary HeartDisease improve overthenextfewmonths. staff. We hopethatreportingtimeswillstartto andwiththelaboratory for being‘unsatisfactory’) women (asfewersmearswillneedtoberepeated carestaff,with popular developmentwithprimary hopefulthatthiswillbea ago andwearevery Grampian tookpartintheLBCpilottwoyears smears phasedoutbytheendofJune2004. Grampian andareintendingtohaveconventional We new LiquidBasedCytology(LBC)smears. a timetoenablethembetrainedinreadingthe March totakescreeningstaffoffsmearreadingfor diffi staffcontinuestobe and retaininglaboratory 2003. Thishasbeenfortworeasons.Recruiting 2003to5.7weeksinMay 2.6 weeksinJanuary smear beingtakenandreadwentupfrom their smeartest.Theaveragetimebetweena to thetimewomenwaitreceiveresultof havenowrolledoutLBCtoallpracticesin

cult. Theotherreasonwastheneedlast

culty inrecentmonthsrelating

cult. 17

ANNUAL REPORT of the Director of Public Health 2002/2003 18

ANNUAL REPORT of the Director of Public Health 2002/2003 bronze awardattheScottish PRAwards 2003for Communicators Awards 2003.Italsoreceiveda of theUK’s NationalAssociationofHealthcare won fi the perhaps unsurprisinglygivensuchrecognition, or adapt.Iampleasedtobeablereportthat, useful frameworkforotherNHSareastoadopt Scottish Executiveforfurtherfunding,andasa a modelcasestudyintheirapproachtothe and thenationalcampaignusedGrampianas Grampian thananywhereelseinScotland, a greaterlevelofawarenesstheissuesin A subsequentregionalevaluationrevealed mental healthoftheGrampianpopulation. Grampian, inadditiontogenerallyimprovingthe the stigmasurroundingmentalill-healthin locallythenationalcampaigntoreduce forward In 2002,NHSGrampianledlocaleffortstotake forhelp. people comingforward has aconsiderableimpactonthenumberof would notwantanybodytoknowaboutit.This if theydevelopedamentalhealthproblem problem issohighthat50%ofrespondentssaid However, theshameofhavingamentalhealth are centraltothehealthimprovementagenda. and providinghighqualitymentalhealthservices stigma associatedwithmentalhealthproblems, Promoting positivementalhealth,reducingthe forcriticalintervention. mental healthservices illness withapproximately2%beingreferredto Around 10%ofthesehaveadiagnosismental Grampian aresufferingfrommentalill-health. with one.Anestimated25-31%ofadultsin quarters knowsomeonewhohasbeendiagnosed a mentalhealthproblem,andnearlythree- four oftheScottishpopulationhasexperienced in2001revealedthatone A nationalsurvey Mental Health ‘phase 4’exercise classesforpatients. (BACR) trainingtoexpandlocalopportunitiesfor British AssociationforCardiacRehabilitation sector,voluntary localinstructorshaveundergone Aberdeenshire andAberdeenCitythe In partnershipwiththelocalauthoritiesinMoray, patients. has beenissuedtoallstaffinrelationcardiology Grampian MentalHealthMonth

rst placeintheservice-specifi

campaign c category c category to giveupsmoking. of drugs(suchasZyban)which canhelppeople GPs inGrampiantoensure that bestuseismade workscloselywith The SmokingAdviceService places inacommunitygroupfollowingdischarge. hospital, withthosewhowishbeingallocated To in thefollowingclinicalspecialities: W Aberdeen RoyalInfi been prioritisedacrossfourmainhospitalsites: Helping peopleinhospitaltostopsmokinghas person’s pilotproject. Scotland/Health Scotlandfundingforayoung andASH an integratedhospitalbasedservice 105 clientswith53pharmacistsregistered), community pharmacistscheme(currently Further developmentsthisyearincludea withinourcommunities. service community venues,areusedtoprovidethis together withGPpracticesandotherlocal cessation support.Communityhospitals, register foraprogrammeofintensivesmoking with8,469clientschoosingto to theservice, needs. To date,11,555clientshavebeenreferred Grampian haveaccesstosupportthatsuitstheir smokers whowouldlikehelptostopsmokingin hascontinuedtoensureall Advice Service Over thelastyearNHSGrampianSmoking Smoking Cessation Best CommunityCampaign. oolmanhill, and Cornhill. Services areprovided oolmanhill, andCornhill.Services date,163clientshavebeenseenwhilein • • • • • • •

pregnancy. and localpriorityintermsofsmoking toaddressanational Maternity services, Mental healthservices Maxillo-facial department Pre-operation outpatientsclinic Diabetes services stroke managed clinicalnetworkforCHDand (linkingwiththedeveloping services care&stroke Cardiac andcoronary Respiratory, thoracic,chestclinic

rmary, DrGray’s inElgin, the HealthPromotingSchools initiativeto Food inschools Promotions. previouslydevelopedbyHealth Helpings service basedontheHealthy locally-based service and localNHSstafftohelpthemdelivera own weight,includingtrainingforcommunity convenient helpforpeopletomanagetheir Food andweight years3,4and5. pupils insecondary investigating foodpreparationeducationfor pursuing accreditationforparticipants,and the trainingofcommunity-basedfacilitators, budgeting andcreatingabalanceddiet,through skills suchaspurchasing, preparation,handling, Food skills which donotcurrentlyhaveashop. encouraging foodco-opstosupportcommunities supporting theroleofruralshops,and particularlyfruitandvegetables, Lhanbryde, available tomorepeopleinSpeysideand Food access project focusesonthekeyissuesof: a strategytointer-linklocalfoodinitiatives.The fi communities whowishtogainthehealth(and of howwecanbestsupportpeopleinallour contributed toincreasingourunderstanding issues affectingpeopleonlowincomeshaveall V - ADietActionPlanforScotland obesity anddiet-relatedissuesin promotion work.Thisprojectaddressesthekey Moray Counciltoundertakecommunityhealth accessing QualityofLifefundingfromThe the multi-agencyMorayFood&HealthGroup One exampleofworkover2002/2003hasbeen Food andHealth volunteers workinginourcommunities. providing specialisttrainingforprofessionalsand to helpingpeopleimprovetheirhealth,whilst has alsohelpedustoadopta‘holistic’approach

nancial) benefi arious localprojectstoexaminethehealth ! -encouragethedevelopmentoffood -makebetterfoodchoicesmore RECOMMENDATION: health services inGrampian andimplementplansbasedonit. health services -workwithschoolsthrough

ts ofstoppingsmoking.Thiswork - provideimprovedand 16 , bydesigning Eating forHealth

NHSGrampianneedstodevelop astrategicframeworkfordental decay. Atthe moment,thepercentage is44%. fi national targetfortheyear2010is60%of tooth decaywhichoccursinchildren.The The poorest10%ofchildrenhave50%the Dental Health in mynextannualreport. reporting ontheprogressinthisimportantwork to diabetes ashealthproblems,Ilookforward Given thegrowingimportanceofobesityand shops andvendingmachines. community inaddressingschoolmeals,tuck involve children,teachers,cateringstaffandthe develop SchoolNutritionActionGroupsto of manpower in local dental services. Iam of manpowerinlocaldental services. the dentalprofessiontoimproveavailability the needforNHSGrampiantoworkactivelywith last twoannualreports,Ihavecommentedon to improvingdentalhealthinGrampian.Inmy are thetwostrands providing appropriateservices, certain locations.Preventingdentaldisease,and in threatening theviabilityofsomeservices clinical staffacrossallareasofthedentalservice, areas. Thisiscompoundedbyashortageof head ofpopulation,particularlyinourmorerural for theratioofGeneralDentalPractitionersper Grampian farespoorlyagainstthenationalaverage

ve-year oldstohavenoexperienceofdental 19

ANNUAL REPORT of the Director of Public Health 2002/2003 20

ANNUAL REPORT of the Director of Public Health 2002/2003 They alsohavepoorerdentalhealth. problems -ismorecommoninhomelesspeople. alcohol anddrugs-alongwiththeresulting they havepoorermentalhealth.Misuseof earlier, thanthewiderpopulation.Inparticular, Homeless peoplehaveworsehealth,anddie particular concernfortheNHS. their ownright,thehealthofhomelessisa homelessness drawn upanactionplantotacklehealthand and itspartneragenciesinthisfi to nationalguidanceonthisissue,NHSGrampian I amthereforepleasedtoreportthatinresponse accidental injury. are morepronetobehaviouraldisturbanceand and infection,sufferdelayeddevelopment, indicates thattheyhavehigherlevelsofillness the childrenofhomelessfamilies.Evidence Of particularconcernmustbethehealthof accommodation. of varioustypestemporary shared bythoselivinginthepoorconditions not confi Evidence alsoshowsthatthispoorerhealthis factors areimportantinfl qualifi majority ofhomelesspeoplehavenoeducational showthatthe the ‘socialjustice’agenda.Surveys addressing homelessnessisanessentialelementof among themostdisadvantagedinsociety, homelessness. Giventhatthehomelessare areaofScotlandfacestheblight Every Health andHomelessness remains amatterofconcern. inGrampian The availabilityofNHSdentistry disappointed attheslowprogressonthisissue. !

cations andarenotinwork.Whilethese

ned topeoplesleepingrough,butis RECOMMENDATION: these priorities. discuss proposedlocalhealth priorities,fullyinvolvingthepublic,beforeformallyadopting 17 . Thisincludesworktogather

uences onhealthin

eld have

Partnerpublichealthorganisations inGrampianshoulddebateand and theavailableresources. problems, solutions,themobilisationofeffort, partners. We needtomakeconnectionsbetween build effectiverelationshipswithawiderangeof partnership requiresthepublichealthsystemto organisation’s agendatoorganisationsworkingin problem solving.Shiftingthefocusfromasingle issues, whichrequireaholisticapproachto Public policyistacklingcomplex,cross-boundary Social Inclusion annual report. progress inimplementingthisplanmynext tobeingablereportonmeaningful forward gearedtoneeds.Ilook developing services as wellimprovingaccesstohealthcareand evidence aroundhomelessnessinGrampian, Moray Youthstart Great NorthernSocialInclusionPartnership,and planning frameworksof,forexample,Aberdeen’s and monitoringmechanismswithinthestrategic range ofhealthindicators,measurementtools, the CommunityPlanningpartners)toincludea partnerships, (whichmaybecurrentlyoutwith authority area.Thiswillentailinfl Joint HealthImprovementPlansineachlocal is refl social inclusionforNHSGrampian-andthatthis Action Plan-withinanagreedframeworkfor an integratedHealthInequalitiesStrategyand development, implementationandevaluationof However, inthecomingyearIamkeentosee areaccessibletoall. ensuring thathealthservices Grampian toachievehealthgainthrough I amencouragedbythecommitmentofNHS protection ofhealthaslocal priorities. adopt mentalhealth,dentalhealthandthe NHS Grampiananditspartnersshouldformally that, inadditionaltonationalprioritiesforhealth, years. Giventheavailableevidence,myviewis - ofcommunitiesinGrampianoverthenextfew the lifecircumstances -andthereforethehealth social structurewillhaveasignifi In conclusion,thechangesinpopulationand Conclusion

ected intheGrampianHealthPlan 19 .

cant effecton

uencing specifi 18 and

c life circumstances forlocalpeople through Community PlanningPartnerships canimprove health, wellbeingandeconomicproductivity. provide amulti-facetedstrategytoimproveits the needsofindividualcommunityand and wellbeingofcommunitiesinwaysthatmeet provides themechanismtoimprovehealth the variousnaturalcommunitiesofGrampian.It role toplayinimprovinghealthandwell-being I believethatCommunityPlanninghasacrucial improvement. efforts oftheircommunitiestobringabouthealth citizenship’, withpeopleactivelyengagedinthe about improvements.Itneedstofoster‘active their ownhealth,andtoworktogetherbring communities totakesharedresponsibilityfor encourage, supportandenableindividuals to needs tobuildonworkalreadyunderway NHS Grampian,togetherwithitspartners, ...through CommunityPlanning MAKING ITHAPPEN... inGrampian. everybody andbevisibleto health services, improvement tohealth,enhance change whichwillbringamarked simply to‘makeithappen’,deliver NHS Grampiananditspartnersis One ofthebiggestchallengesfacing CHALLENGES SECTION THREE initiatives andsolutionsthemselves. support communitiestobe involved indeveloping change. Ideally, wewishtoempowerand have aroleinshapingactionanddelivering that peopleandcommunitiesareinvolved of organisationsworkinginpartnership,and this commitmentisnotlostinthecomplexity importantthat health improvement.Itisvery resources availableforhealthcare,including diffi very (physical, socialandmental)butalsointhe communities inallaspectsofnotonlyhealth to engagingwith,andinvolving,people see uscontinuethestronglocalcommitment that thisopportunityisgrasped.Iwouldliketo Itisimportant those providingtheservice. togetherwith community receivingtheservice, strong opportunitytoincludeviewsfromthe The CommunityPlanningprocessgivesa circumstances ofthemembersthatcommunity. can, together, makeanimpacttoimprovethelife a broad,multi-agencyviewofcommunity, we factors thatcontributetoinequality. Bytaking and leisurefacilities,poorhousingother action toaddresspoverty, lackofphysicalactivity communities. CommunityPlanningcansupport have animpactonthehealthandwellbeingof all facilities andawiderangeofpublicservices Housing, transport,employment,recreational addressing them. and ensuringanintegratedapproachto establishing sharedprioritiesforlocalcommunities

cult decisionsaroundthelimited 21

ANNUAL REPORT of the Director of Public Health 2002/2003 22

ANNUAL REPORT of the Director of Public Health 2002/2003 the challenge The policydocument of ourlocalworkforce. Iampleasedthatthere possible, butalsotothetraininganddevelopment as only tothepublicwhowantaslocalaservice likely tobelostbothareas.Thisisalossnot clinical networksbetweenthetwo,theyare arecombinedasmanaged unless someservices between facilitiesinDundeeandAberdeen,and, example, therearecriticalinterdependencies of Scotlandandbeyondformanythese.For patients willhavetotravelthecentralbelt intheNorth,and of thesespecialistservices together, wewillnotsucceedinsustainingsome commitment betweentheboardstowork these issues.However, unlessthereisagenuine Shetland) presentsanopportunitytotackle Highland, Tayside, Orkney, Western Isles,and which makeuptheNorthofScotland,(Grampian, Regional planningacrossthesixNHSboards staff toworkinremoteandruralareas. makes itevenmorediffi andthis professionals inmanyspecialisedservices, is anationalshortageofappropriately-trained benefi partnership withourtwouniversities,forthe the NorthofScotland.Itisvitalwedothis,in across some ofourspecialisthealthcareservices The othersignifi ...and planningacross theNorthofScotland three localauthorityareas. Community HealthPartnershipsineachofour this inGrampian,withthehelpofdeveloping We centres andothercommunity-basedinitiatives. Social InclusionPartnerships(SIPs),healthyliving health improvingpotentialofcommunityplans, authority partnerstoensurethatwemaximisethe area, willhaveagreedprocesseswiththeirlocal framework), togetherwitheachlocalNHSBoard Planning Partnerships(astheoverarching needtocontinueworktowardsachieving ! !

t of the communities we serve. There t ofthecommunitiesweserve. 2 statesthatbymid2004Community population. capacity oftheirhealthprotection functionsremainappropriatetotherisksfacedby the local RECOMMENDATION: sustainable. inawaythatmakesthem on aNorthofScotlandbasis,tocombinespecialistservices RECOMMENDATION:

cant challengeissustaining Improving HealthinScotland:

cult torecruitandretain NHSBoardsintheNorthofScotlandmustrapidlymake decisions, NHS Grampianandpartnerlocal authoritiesshouldensurethatthe resources. Grampian anditspartnersinthefaceofscarce the hardchoiceswhichhavetobemadebyNHS In previousreportsIhaveraisedthesubjectof Resources as necessary. refreshing clinicalskillsanddevelopingnewones variant CJDandSARS.Thisraisesissuesabout TB andtheappearanceofnewdiseasessuchas re-emergence of‘old’threatstohealthsuchas way thathadnotbeenanticipated.We facethe diseases andthereappearanceofothersina about theemergenceofnewcommunicable rising professional,politicalandpublicconcern protection. Overthepastyearwehaveseen improvement, butparticularlyinrelationtohealth ‘business’, notonlyforhealthcareandhealth in awaythatensureswecontinueourdaily enthusiasm, itisimportantthatwemanage changewith While Iwelcomethisnecessary ‘change’. what isrequired,andalsothecapacitytomanage its partnersneedtohavethecapacitydeliver people’s healthexperience.NHSGrampianand expect somethingdifferenttohappenintermsof cannot continueasweareinGrampianand quite radicallyoverthecomingmonths.We NHSGrampianwillneedtochange services, improvement andenhancedqualityhealthcare To Fit forpurpose have totravelmuchfurther. Scotland inthefuture,orpatientswillfuture intheNorthof to secureaccesssuchservices and actedon.We mustaddresstheseissuesnow centres intheNorthmaynotbebeingrecognised I amconcernedthatinterdependenciesbetween children’s healthcareoverthepastyear. However, in relationtosomeofthespecialisedaspects has beengoodprogressintacklingtheseissues contributetoachievingastep-changeinhealth • • • • • • • • • References the sameatpopulationlevel.ThoseleadingNHS individual level,Ibelievewemuststrivetoachieve so importantasafundamentalethicalprincipleat In anerawhere‘informedconsent’hasbecome shouldbeprovided. services and to decidehowmuchofwhichinterventions additional demands.Thiswillmakeitevenharder mean thattherewillbelittleextramoneyfor care andoutcomesforpatients.Thisdoeshowever further improvingworkpractices,thequalityof investment issuchthatitoffersgreatscopefor and almostallotherNHSstaff.Thescaleofthis contracts ofemploymentforGPs,consultants go specifi there willbesignifi recent yearsparticularly2002/2003).Although position (havingspenttoomuchmoneyover of NHSGrampianhavingtorecoveritsfi over comingyears.Thisworkisinthecontext the localprioritiesare,andwhatwillbeprovided toagreewhat engaging withthepublicitserves and information.NHSGrampianiscommittedto advance oftechnologyandgreaterawareness their healthandhealthcare,fuelledbytherapid people ofGrampianhavegrowingexpectations within itsallocatedbudget.Year onyear, the forGrampianresidents and mustsecureservices The NHScannotspendmoneyithasnotgot, Edinburgh: ScottishExecutive1998 Oxford UniversityPress2003. Aberdeen: NHSGrampian Edinburgh: ScottishExecutive.2003 Scotland Aberdeen: NHSGrampian2001 Scottish Executive,2003 Aberdeen 2000 Aberdeen: DepartmentofPublicHealth, Universityof Community Plan 9 8 7 6 5 4 3 2 1 Scottish Executive Hall DMBandEllimanD. NHS Grampian. NHS Grampian. Scottish Executive. Scottish Executive. The Way -FrameworkforEconomic Developmentin Forward W Aberdeen CityCouncil. ilson B&HinksS, !

2000 cally intowagesandsalarieswithnew all theresources (includingfunding)availabletous. we continuetoimprovehealthandbuildaneffectivesystemwhichmakesbestuseof to engagewiththepublic,andtheirstaff,tacklethesediffi RECOMMENDATION: . Aberdeen:AberdeenCityCouncil 2001 Grampian BreastfeedingStrategy NHS GrampianHealthPlan2003/04

New CommunitySchoolsProspectus cant newinvestment,thiswill Improving HealthTheChallenge Partnership forCare Give KidsaChance-EvaluationReport Aberdeen Futures,City Health forallchildren . Edinburgh: NHSGrampiananditspartnersneedtodeveloprobustmechanisms

nancial . Oxford: . . . . , national movementforhealthimprovement.” improve theirownhealth.We willworktocreatea health -helpingthemunderstandhowtheycan “We willencouragepeopletocareabouttheirown in whichtoomanypeoplelive. unhealthy lifestylesandthecircumstances easy. We needtoworktogetherchangeourown cautioning that: • • • • • • • • • more eloquentlythan struggle topaintthechallengethatfacesusall the peopleofGrampianoverpastyear, I As Irefl The Way Forward January 2004 January Dr EricBaijal the limitedresources availabletous. effective healthimprovementandhealthcarewithin be abletotacklethesediffi partners. Ibelieveitisonlyinthiswaythatwewill asequal be madewiththecommunitiesweserve there canbematurediscussionofthechoicesto years. We needtorapidlyarriveatthepointwhere will havetobemadeovercomingmonthsand understand theissuesinvolvedinchoicesthat areinformed,and that thecommunitiestheyserve Grampian anditspartnerorganisationsmustensure 2002 Aberdeen: NHSGrampian 2003 Aberdeen: NHSGrampian2003 2003 2003 Meeting on7February for Scotland 2000-01 www.shaw.uk.com vision forGrampian’s health NHS Grampian2003 19 18 17 16 15 14 13 12 11 10 • Moray Youthstart www.youthstart.org NHS Grampian. NHS Grampian. Scottish Executive. Johnstone, L. Howie H. Offi Baijal, E. Population Census2001www.statistics.gov.uk Scotland’s HealthatWork Award Scheme,1996

ce forPublicManagement.

ect onthisbriefsketchofthehealth , AberdeenNHSGrampian2001 Annual ReportoftheDirectorPublicHealth . Edinburgh:ScottishExecutive AIDS ControlActReport2002-2003. ReporttoAberdeenCityAlcoholActionTeam “Tackling theseproblemswillnotbe

cult decisionstogether, sothat Grampian Health Plan 2003-04 Health &HomelessnessStrategy Eating forHealth-ADietActionPlan PartnershipforCare . Offi . Aberdeen:GrampianPolice

cult decisionstodeliver

ce ofPublicManagement HealthFit: creatingthe 1 does, Aberdeen , , 23

ANNUAL REPORT of the Director of Public Health 2002/2003 24

ANNUAL REPORT of the Director of Public Health 2002/2003