Moving Towards a Healthier : Newsletter for the public health function, October 2000

Introduction Welcome to the first newsletter from the Scottish Executive on the drive to improve public health. Developments in the implementation of the public health agenda are happening apace. The commitment made in “Towards a Healthier Scotland” to bring together the NHS with local authorities, voluntary and community organisations to tackle health inequalities is being met through new developments such as the Healthy Scotland Convention, the White Paper Demonstration Projects and targeting of the Tobacco Tax Health Improvement Fund. Implementation of the Public Health Function Review is well under way with the establishment of a Public Health Institute for Scotland, and ongoing work around public health standards, training and networks. The outcome of the Review of Nurses’ Contributions to Improving the Public’s Health is keenly awaited, and is expected to report shortly.

This newsletter is intended to provide an overview of progress to date. It is the first stage in communicating developments to a wide audience and aims to ensure that anyone with an interest in public health in Scotland is kept informed.

Implementation Group Following the launch of the Review of the Public Health Function in Scotland in December 1999 an implementation plan was prepared to take the Review forward on a national basis. A Public Health Function Review Implementation Group was formed with a remit to oversee implementation of the Review of the Public Health Function in Scotland, and to liaise with all key stakeholders in the development of the public health function as outlined in the Review.

Membership of the Group consists of :-

• Chief Medical Officer (Chair): (previously) Sir David Carter, • Chief Nursing Officer: Ms Anne Jarvie, • Deputy Chief Medical Officer, Public Health: Dr Andrew Fraser, • Head of Health Gain Division: Mr Hector McKenzie, • COSLA representative: Ms Oonagh Aitken/ Mr David Henderson, • Health Board General Manager/Health Board Chairman representative: Mr Neil McConachie, • Director of Public Health representative: Dr Lesley Wilkie/ Dr Dorothy Moir, • Dental Public Health Representative: to be confirmed, • Director of Scottish Consumer Council: Mr Martyn Evans, • Director of SCIEH: Dr Ian Jones, • Health Promotion representative: Dr Carol Tannahill, • Academic representative: Professor Raj Bhopal, • Director of Queens’ Nursing Institute: Ms Lis Cook, • Chief Executive, Primary Care Trust representative: Mr A Wells, • Chief Executive, HEBS: Professor Andrew Tannahill, • Chair of Scottish Affairs Committee, Faculty of Public Health Medicine: Dr John Wrench, • Chief Executive, Local Authority: Mr S Watson. Four meetings have already taken place, with the next meeting to take place in February 2001.

A Public Health Institute for Scotland One of the main recommendations in the Review of the Public Health Function was the establishment of a Public Health Institute for Scotland which will bring added coherence, energy and expertise to our public health endeavours. The Institute will be located as an arm of the Common Service Agency and based in Clifton House, . Running costs of £1m a year will be provided by the Scottish Executive and the recruitment process is being taken forward by the Common Services Agency. Recruitment of core staff has begun with Professor Phil Hanlon being recruited as Director to take up post in January 2001.

A Partner’s Council for the Public Health Institute has been formed in order to develop the Institute’s strategic role and agree its work programme. Some Council members were drawn from the Public Health Function Implementation Group to provide representation from Health Board Management, Health Promotion, Local Authorities, Academic Departments and the Scottish Consumer Council with additional representation from the Voluntary Sector, Community Health, Scottish Centre for Infection and Environmental Health and the Information and Statistics Division.

Healthy Scotland Convention The inaugural gathering of a planned annual Healthy Scotland Convention took place on 3 July, in Glasgow. Bringing together key partners in the drive to improve Scotland’s public health, the Convention provides a forum for reviewing progress in the implementation of the public health agenda – as set out in “Towards a Healthier Scotland” – and for working through the challenges and opportunities that lie ahead. Enabling participants from varied professional and geographical backgrounds to exchange experiences and views is one of the Convention’s key functions.

The NHS, local authorities, other statutory bodies, voluntary/community organisations, business and trades unions were all represented at this year’s event. Reflecting the Scottish Executive’s commitment to the cross-cutting public health agenda, it was opened by Jim Wallace (Deputy First Minister) and attended by Ministers and (Health and Community Care), , and (Education and Children) and Jackie Bailie (Communities).

“Delivering Together” was this year’s theme and, through a series of presentations, workshops and feedback sessions, participants focused on the practicalities of delivering health improvement through partnership working. There was an opportunity to hear about how the demonstration project, “Starting Well”, would apply a multi-agency approach to improving child health. And following the Scottish Executive’s decision to devote £26m from additional tobacco taxation to health improvement, participants were invited to give views on investment priorities. Ms Deacon took the opportunity to announce that some of these resources would be used to establish the Public Health Institute in Scotland.

The next meeting of the Convention will be on 1 June 2001. Demonstration Projects Towards a Healthier Scotland established four demonstration projects which were selected on the basis of bids received from across Scotland; Starting Well, Healthy Respect, Heart of Scotland and The Cancer Challenge.

Glasgow Healthy City Partnership is taking forward the Starting Well project which aims to demonstrate that child health can be improved by a programme of activities that both supports families and provides families with access to enhanced community based resources. The project will be implemented through a programme of intensive home-based health visiting, lay worker support and community development. Starting Well will be based within two communities in Glasgow and will, over a three year period, receive £3 million in funding.

The Healthy Respect project has been awarded to a multi-sectoral partnership that includes Lothian Health, the local authority, SIPS, youth projects and voluntary organisations. This project will foster responsible sexual behaviour on the part of young people, with emphasis on the avoidance on unwanted teenage pregnancies and sexually transmitted diseases. As well as area wide work, developments will focus on two recognised areas of deprivation. Healthy Respect will receive up to £3 million funding over a period of 3 years.

The Heart of Scotland project has been awarded to Have a Heart Paisley, a multi-sectoral partnership that includes Paisley LHCC, community initiatives, the local authority, partnership forums, academic organisations, Argyll and Clyde Acute Trust and Argyle and Clyde Health Board. It will build on established initiatives to improve the life circumstances of people living in Paisley’s more deprived neighbourhoods, develop area wide strategies to address health related behaviours and offer secondary prevention interventions. Have a Heart Paisley will receive up to £6 million funding over 3 years.

Cancer Challenge was assigned to Grampian, Tayside and Fife Health Boards who are taking forward the Scottish arm of the UK Colorectal Screening pilot. The aim of the pilot, which commenced in early April 2000, is to assess the feasibility of introducing a national colorectal cancer screening programme and will target men and women aged 50 - 69 in the three Health Board areas. This demonstration project will receive up to £2.5 m over a 2 year period.

The demonstration projects will act as test beds for action, and a teaching resource for the rest of Scotland. Project teams for each of the projects are now in place, a national co-ordinator has been appointed and independent evaluation of the projects has been commissioned by the Chief Scientist’s Office. A multi-sectoral national Steering Group is being established and a website will be developed in early 2001. The Minister for Health & Community Care officially launched the 3 projects over a 6-week period between October and November.

The Review of Nurses’ Contributions to improving the Public’s Health Work on the review of nurses’ contributions to improving the public’s health commenced in September 1999. It has been led by Anne Jarvie, the Chief Nursing Officer for Scotland and arose from the White paper Towards a Healthier Scotland. The Review has three aims;  To identify the implications of current Scottish, UK and European policy on the roles of nurses, midwives and health visitors in relation to public health  To identify and describe current practice in the field of public health nursing, including both routine and innovative practice  To make recommendations on the future development of the contribution of nurses, midwives and health visitors to improving the public’s health at three levels: Individuals and their families; Communities; and Public Health Strategy and Leadership.

The nursing groups covered by the review were: health visitors, school nurses, practice nurses, district nurses, community psychiatric nurses, learning disability nurses, midwives, infection control nurses and occupational health nurses. The role of the wider nursing constituency, particularly nurse education was also included.

The review employed a comprehensive and inclusive consultation process throughout Scotland with input from a wide range of stakeholder groups from statutory, voluntary, and community organisations as well as the academic and private sectors. Initial results from the policy review identified recurrent themes as being multi-sectoral working, consumer involvement, social exclusion, marrying top-down and bottom-up approaches and taking a lifespan approach to health improvement. In addition, the literature review has suggested that focussed, evidence based, multi-sectoral, community based projects are in the majority of cases the most likely to be effective.

The consultation period ended on 25 August, with the final review paper currently being finalised.

Development of multi-disciplinary public health standards A key feature of the CMO’s Review of the Public Health Function was the priority given to increasing the range of skills available to public health practice at all levels in order to develop a specialist public health multidisciplinary workforce. Emphasis was given to national collaboration in specialist public health training and the need for formulating standards for public health practice. In addition, the CNO’s review (described above) highlighted the need for public health training to be relevant and accessible to practitioners within LHCCs.

Since 1999 the four UK health departments have supported a three-year project which seeks to develop an integrated programme for establishing standards, accreditation, career and service development in public health. Healthwork UK, the National Training Organisation for the Health Sector, facilitates the project. In Scotland, a Steering Group was established as a sub-group of the Public Health Function Review Implementation Group to oversee the Scottish component of the UK programme. Practitioners are closely involved in the process of developing the standards which includes describing the key functions carried out by specialist public health practitioners (a functional map), and defining occupational standards which specify what practitioners need to achieve in the key functions relevant to their job. The Healthwork UK pilot sites in Scotland are Lanarkshire Health Board and LHCCs in Springburn (Glasgow), Southeast Edinburgh and Castle Douglas. The pilots are due to finish by February 2001 and a full report will be made available.

For more information on any aspect of the newsletter, please contact Fiona Neep, email address: [email protected]