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Appendix 1

APPENDIX 1: PROGRESS AGAINST PRIORITIES FOR ACTION IN DPH REPORT 2007 - 2009

The 2007-2009 DPH Report identified a number of priorities for action. Here we report on progress against a number of these priorities. A more comprehensive review is available online at NHS Greater Glasgow and Clyde.(128)

Priority for Action 2007: Action on smoking

“We need a comprehensive strategy to address public health challenges.”

What have we achieved? Strategic Planning on Smoking
The Glasgow Tobacco Strategy, the vehicle for delivering Glasgow City Council’s Single Outcome Agreement (129) on tobacco, has been produced. All Glasgow CH(C)Ps are developing local action plans to contribute to its delivery. All other local authority areas have tobacco action plans in place or are being developed with structures to oversee implementation.

Stop Smoking Services
SmokeFree Services (130) (0800 84 84 84) was launched in 2008, with the aim of reducing the impact of tobacco by providing one single, easy-to-use source of help for smokers who want to give up. This service is available to all adults in every area of Greater Glasgow and Clyde where strategies have been developed to focus on reducing health inequalities caused by tobacco use. The development of comprehensive, integrated, evidence-based stop smoking services continues across a range of settings including pharmacy, maternity, acute and community:

  • In 2008-09, 5,082 quit attempts were made (one of top three NHS Boards), an increase of 0.5% on 2007 – 08, with 33% of these still smoke free at one month (nationally 38% smokefree)
  • We have the top three CH(C)Ps in terms of service uptake in Scotland (East, South East and East Dunbartonshire).
  • 55% of quits in NHSGGC were from SIMD 9 and 10, reflecting appropriate targeting of services
  • 25% of pregnant smokers attempting to quit using NHS services – highest of any Board area
  • Despite improvement in activity, NHSGGC has achieved only 82% of the HEAT6 target (131)

Prevention and protection from smoking

  • A programme of activity is being delivered based on the National Smoking Prevention Action Plan,(132) addressing the issue of second-hand smoke in the home. In addition, with local authority partners, we deliver a smoking prevention programme in all secondary schools and primary schools in Glasgow and Clyde.
  • East Glasgow CH(C)P has focused on young people and families through their Smoke Free Homes & Zones (133) Project prevention initiative.
  • West Glasgow CH(C)P’s Tobacco Action Group is using a community development.  Sessional staff from the South Asian and Chinese community have made contacts with and empowered community and faith leaders to raise awareness of tobacco issues and undertake a local needs assessment of the barriers to accessing smoking cessation groups.

Priority for Action 2007: Delivering health protection programmes

“Health protection programmes must be evidence based; positively target services; involve primary care.”

What have we achieved?
All Health protection programmes are based on national guidance or initiatives that are rooted in evidence or professional consensus.

Screening Services - NHSGGC Public Health Screening (134)

  • Screening programmes are evidence based, have robust quality control and failsafe mechanisms in place and follow a systematic population approach.
  • Specific initiatives are in place to offer screening programmes to disadvantaged groups; people with learning disabilities, ethnic minorities, travellers, homeless and prisoners.
  • The NHSGGC Bowel Screening Communications Action Plan is in place which aims to identify initiatives to increase uptake in harder to reach communities/groups. Each CH(C)P’s Health Improvement team is targeting local priority groups through local action plans.

Immunisation - NHSGGC Public Health Protection Unit (135)

  • Human Papilloma Virus (HPV) immunisation programme, which aims to protect girls from developing cervical cancer in later life, has been rolled out across the NHSGGC area.  The overall uptake in NHSGGC is higher than the Scottish average.
  • The Primary Care setting is crucial in delivering health protection services and ensuring uptake is high in immunisation and screening programmes. The Public Health Protection Unit supports Primary Care in this by provision of on-going training for staff and expert advice.

Priority for Action 2007: Health inequalities are increasing

The 2007-09 report identified the complex and multiple causes and consequences of inequality and identified four key areas for public health action. Each area is listed below showing what has been achieved and an example of current action.

1. “Local and national economic strategies, employment plans, taxation, benefits and education policies must be influenced to attain a more equitable distribution of wealth in our population.”

What have we achieved?
We have made progress on a range of determinants of inequality including employability, financial inclusion and child poverty where NHSGGC has developed frameworks for action along with other partners.

Example of a strategic approach to financial Inclusion
An action plan has been developed which will deliver a programme of activity as an NHS response to financial inclusion across primary and secondary care. A copy of this can be found at the Equalities in Health website (136)

2. “Health service provision can increase health inequalities since those with most need are least likely to take up services.”
The Primary Care Strategy Framework is being developed which aims to deliver effective and high quality health services, to act to improve the health of our population and to do everything we can to address the wider social determinants of health which cause health inequalities.

Example of a settings based initiative
The Inequalities Sensitive Practice Initiative (137) carried out qualitative research with women using maternity services which showed that many women felt that their social identity led to differential and negative treatment by health staff. However, where health staff took time to take women’s wider social circumstances into account this had a beneficial effect on their lives.

3. “A focus on addressing social determinants of health with our community planning partnerships must be maintained to reduce worklessness, improve educational attainment and enhance the local environment.”

What have we achieved?
Example of an initiative
An outcome-focused Planning Toolkit has been developed to support the development of East Renfrewshire Single Outcome Agreement (138) and to facilitate the allocation of Fairer Scotland Fund Resources(139)

4. “There must be a programme of health impact assessment of all strategies and plans that can influence health and inequalities.”

What have we achieved?
The Joint Health Improvement Officers Group has supported a Health Impact Assessment of the Commonwealth Games. This looked at the potential impact of the games on health through the opportunities it could create for employment, physical regeneration and social cohesion. The HIA has informed the Commonwealth Games Legacy Plan. Community engagement was key to the process.

Example of joint initiative
A literature review of inequalities in screening and treatment in Colorectal (Bowel) Cancer has been carried out to inform the NHSGGC Patient Experience Programme. The review has been able to identify several factors which contribute to poorer outcomes for several inequality groups and across the complex interrelationship of different forms of inequality.

Priority for Action 2007: Our least healthy communities are unlike our healthy communities in every way

“Resources need to be moved to early years, including early education, childcare and support for vulnerable families and young people; a higher priority must be given to parenting support.”

What have we achieved?
NHS, councils and partnerships have worked together in order to improve the experience of our most unhealthy communities. The focus of intervention is on early years and young people.

Examples of these initiatives are:

  • Adoption of the new Infant Feeding Strategy. (140)
  • Expansion of Parents and Children Together (PACT) (141) teams in each NHSGGC CH(C)P
  • The Ten Goals of an Inequalities Sensitive Practice Approach (142) was introduced to East Renfrewshire Children Services Core Group as part of the process of developing East Renfrewshire Children’s Service Plan 2009-2012
  • A new NHSGGC Parenting Support Framework (143) is being implemented with the aim of improving outcomes for children through the provision of co-ordinated, evidence based support for parents
  • Girl Power is a 12-week programme which provides learning opportunities for 13 - 18 year old girls in Inverclyde. The programme was developed and is delivered in partnership by Inverclyde Council’s Community Learning and Development Team and Inverclyde CHP. A variety of issues are explored, including healthy relationships, sexual health, self-esteem and confidence building and a team building activity trip is included. The programme targets inequalities by encouraging girls from disadvantaged areas to participate. One of the aims is to change attitudes and encourage girls to respect themselves and others
  • As part of the planning of a new youth health drop-in service, East Dunbartonshire CHP has recruited a group of young people to undertake peer research. The aim of the research is to gather young people’s views about health and assess their health needs.  The findings will influence the service development and the young people will have the opportunity to become involved in the service, as volunteers or mentors
  • In Renfrewshire CHP a community led health event was organised, in conjunction with the local authority and local health initiative, to discuss how to get communities involved. The community asked for a number of actions and, through the local area committee structure, have secured funding for:- 
    • Cooking classes
    • Setting up allotments
    • Production of mental health directory
    • Staging an Age-Fest

Priority for Action 2007: The obesity epidemic needs to be taken seriously

“In order to reverse the obesity trend, the population as a whole has to consume less food energy.”

What have we achieved?
Examples of service development and initiatives

  • Healthy vending: In Glasgow City Council (GCC), steps have been made to promote healthier vending choices within public buildings including GCC leisure centres. It is expected that the Joint Staff Health Action Plan will further address this issue. NHSGGC will implement a 50% healthier vending policy to roll out across all five CH(C)P sites
  • The forthcoming GCC Healthy Weight Action Plan has an action to increase the availability of healthier food options in GCC cafés. In schools, the plan aims to develop a healthy inhouse tuck policy to cover all educational settings, including all ‘after-school clubs’ 116
  • Supporting the development of food co-operatives
  • A scoping study is being carried out to assess current and potential supply of and demand for fruit and vegetables amongst community and voluntary organisations and produce options for future collaborative action
  • Adoption of the Healthy Living Award (144): all NHSGGC sites will soon have obtained this award. NHSGGC has developed a child healthy weight programme known as ACES: Active Children Eat Smart. The programme is designed as a community based healthy weight intervention programme for obese children and is delivered by all CH(C)P areas.  Facilitated by ‘coaches’ employed by CSG. Local CH(C)P groups created to assist groups and promote partnership working
  • East Renfrewshire CH(C)P has been successful in gaining national pilot projects on Smarter Choices: Smarter Places (145) and Healthy Weight Communities (146) in partnership with planning and transport departments
  • In response to local need, East Dunbartonshire CHP commissioned a feasibility study of a volunteer-led food co-op initiative. Based on the findings, the CH(C)P will deliver a volunteer food co-op project starting in 2010. The project will aim to improve access to fresh fruit and vegetables and provide employability opportunities in disadvantaged communities
  • As part of Renfrewshire CHP effort to improve staff health, a healthy breakfast has been provided with healthy eating messages for staff and their families

Priority for Action 2007: Alcohol is an increasing problem

“Greater commitment to tackling alcohol problems will be needed from all public sector organisations and people with alcohol problems will need to be better identified and managed.”

What have we achieved?
Examples of local initiatives
All CH(C)Ps are planning and implementing alcohol brief interventions

  • East Renfrewshire CH(C)P identified alcohol as a local priority and has supported the development of East Renfrewshire Joint Alcohol Policy Statement. The joint policy is now being taken forward as a significant strand of East Renfrewshire CH(C)P Development plan and contribution to the local Single Outcome Agreement (147)
  • As part of East Renfrewshire CH(C)P Learning and Development plan, staff have taken part in a pilot training programme to address attitudes, knowledge and skills around alcohol and harmful drinking behaviours, to help them develop skills to facilitate conversation around alcohol consumption and offer brief interventions
  • East Glasgow CH(C)P are developing an East Strategic Addictions Group which will use the NHSGGC prevention and education model as a focus to agree a coordinated action plan for addictions work across the East. A key feature of this plan will be our East Tobacco Control Plan and a priority over the next year will be integrating tobacco into the wider addictions agenda
  • Inverclyde CHP has piloted the role of the primary care alcohol nurse through Keep Well funding as a forerunner to the new integrated alcohol service. The client groups are those who are thought to be drinking in a harmful, hazardous or risky fashion and are referred from the primary care team including GPs, practice nurses and other primary care staff. A brief intervention is an evidence-based structured, non-confrontational way that seeks to motivate and support the person to think or plan behaviour change. This post has allowed quicker assessment; referral pathways to be established to a range of alcohol services as
    required; and in addition, access referral pathways to a range of other services which can support the clients e.g. money matters; stress management etc
  • In Renfrewshire CHP a programme of staff training is on-going to support the screening for alcohol problems and brief interventions
  • In West Glasgow CH(C)P, local teenagers, aged 11-18 years produced a DVD on the effect of alcohol on their lives, on families and their communities, based on real life experiences. The DVD will be used as a resource pack to support and empower individuals, families and communities to reduce alcohol-related harm

Priority for Action 2007:

Sustainability should become a more explicit consideration

“Partnership work through community planning should focus on improving public health; all public sector organisations in NHSGGC area should adopt a leadership role in promoting sustainability.”

What have we achieved?
A Planning and Implementation Group (PIG) has been established to develop a comprehensive NHSGGC response to the sustainability agenda. CH(C)Ps are represented on the PIG. An action plan has been drawn up using the key priority headings from the 2007-2008 DPH report.  A Glasgow Climate Change Partnership – an extension of Glasgow City Council’s strategy has been established. This will enable a fuller public sector response on climate change and carbon emissions. NHSGGC will sign up to this partnership.