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For most of us, for most of our lives, the NHS is a reassuring presence and a service we can call on. Some of us rely heavily on the NHS, and the next section of this Plan looks at some specific needs. Each of us needs the NHS most at the beginning of our lives and as we grow older and may become more frail and dependent. We want to make the health of children and older people a new priority for the NHS.
Children and young people
Our children are our future. We want every child in Scotland to get the best possible start in life. This commitment is reflected across the work of the Scottish Executive, for example in our policies to create social justice, to improve early education and to provide childcare, as well as in our health policies. The early years of development, particularly from conception to age three, influence learning, behaviour and health throughout life. Tragically, children who do not get the best start can show clear differences in both health and development by age three compared to those who do. The life circumstances of the expectant mother and young child influence the chances of developing cardiovascular diseases, diabetes, obesity, cancer and mental health problems in later life. Too often, poverty is the underlying cause.
Action must also be taken before birth to make sure that all children have a healthy start to life. Breastfeeding, nutrition, dental health and accident prevention are major focuses for health improvement.
Yet we will not improve the health of our infants without also looking to support parents. Every child deserves to be wanted by parents who themselves feel valued and supported, to be born safely and to be nurtured from the very beginning. Special measures are needed to support the most vulnerable families.
Preparing for healthy pregnancies
Pregnancy is a normal process for women, but it is also a significant life experience and this must be reflected in the way that women are cared for during pregnancy, childbirth and postnatally. Pregnancy is not an illness.
Services must be women and family-centred, providing a whole package of care throughout the pregnancy. Women and their families must be allowed to make fully informed choices about their care and be given the opportunity to choose the location in which they give birth. Choice in childbirth should not be the preserve of the privileged - it should be the standard for every woman.
Parenting is demanding. Parental influences and choices are key to children's development.
Good nutrition is vital for a healthy start to life. Our target is that by 2005 50% of mothers should be breastfeeding at six weeks. To promote breastfeeding we will:
IT'S HAPPENING ALREADY...
North Lanarkshire Social Inclusion Partnership's award-winning "You can't get better than a breastfed nipper" campaign is giving practical help for mothers to continue breastfeeding, and promoting breastfeeding as the normal choice. Trained members of the Wishaw initiative offer practical help to support mothers with babysitting, ironing and equipment lending services.
Health in early life
Very young children can of course be vulnerable to disease. So we must tailor services to their needs. One in five patients in Scotland is a child. But they should not be treated as small adults. Early identification of health problems is especially important for very young children.
"OUR CHILDREN ARE OUR FUTURE. WE WANT EVERY CHILD IN SCOTLAND TO GET THE BEST POSSIBLE START IN LIFE"
Joint working between the NHS in Scotland and other agencies is essential if we are to provide all children and their families with integrated services. This will require inter-agency strategic planning and investment in children's services in Children's Service Plans and Local Health Plans. At all levels we will ensure that parents and children are wholly involved in service design and delivery.
"My boys suffer from bed wetting, no-one thinks this is a problem. All I'm asking for is a plastic cover for the mattresses."
Child health services
We recognise the need for a long term strategy to promote improved, combined and integrated children's services.
The template will be used to monitor and drive up standards and will ensure that children's services are prioritised throughout the NHS in Scotland.
The template will provide a platform for the development of a National Child Health Information Plan.
Local Healthcare Co-operatives play a pivotal role in the co-ordination of children's services, and we will ensure that their plans are fully integrated with community services planning. Across child health services as a whole, the development of child and adolescent mental health services must be a priority.
When children are seriously ill and require hospital treatment, their needs are different from those of adults. We must ensure that care they receive is appropriate to children's needs, in both specialist and general hospital environments.
Being separated from parents adds to the trauma of illness for children. Parents must be considered a vital part of the care and treatment provided to children in a clinical environment. They must be given the opportunity to be with their child during a hospital stay. They must be given the information they need to participate fully in decisions about their child's care.
"JOINT WORKING BETWEEN THE NHS IN SCOTLAND AND OTHER AGENCIES IS ESSENTIAL"
We will continue to develop provision for children in line with the recommendation of the Acute Services Review.
For many children, particularly in remote and rural areas distant from specialist children's services, the first contact with hospital services may be through Accident and Emergency Departments or other adult services.
Children with special needs
All children are special - but the NHS and partner agencies must work harder to support vulnerable children with special needs. We will ensure that children with special needs have access to multi-disciplinary medical, nursing, educational and social care.
Wherever possible and appropriate, we will deliver this care at home, under the direction of specially trained community children's nurses, or in schools rather than in other institutions.
These children will receive respite care, jointly commissioned by health and social care services, when they or their families need it.
IT'S HAPPENING ALREADY...
The Diana Princess of Wales initiative will provide training for up to 23 Community Children's nurses. These nurses will co-ordinate local packages of care, bringing together all relevant agencies to meet the complex needs of children and families.
The recent reviews of services for children and adults with learning disabilities recognise the need for better and more flexible health and social care services: services that are organised and delivered around the needs of the child. The emphasis must be on joined-up thinking and joined-up action, both nationally and locally, to deliver innovative services that promote inclusion.
As they grow, young people also begin to exercise greater personal choice. This means that many young school leavers, particularly in areas of disadvantage, become very hard to reach. Health-related services need to be attractive and accessible to meet the needs of these young people. We need to talk to young people about their health needs in a language they understand. And when they respond, we must show we are listening.
"As if you're even going to need to understand all these long names." (About sex education at school)
As they grow older, children who suffer from enduring illness are particularly vulnerable as they go through the often difficult transition from specialist children's services to those provided for adults.
Advice and information on sexual health and contraception is of
particular importance to young people.
IT'S HAPPENING ALREADY...
The Castlemilk health project contributes to the 'Health Spot', an information and advice service provided by and for young people. This provides a sexual health service for young people on an outreach basis.
We live in an ageing society. Today, one in five people in Scotland is over 60. Life expectancy continues to increase and in the next 20 years the number of people over 80 will increase significantly. To this Executive, that is a challenge to be met, not a burden to be endured.
We all have a responsibility to help older people lead full and independent lives: to add life to years as well as years to life. The Executive has demonstrated its determination to do this by placing older people at the heart of its social justice agenda.
We know there is still a clear feeling that the NHS in Scotland could do much better in the way it delivers services and cares for older people. Care of older people accounts for 40% of social work and 40% of health service budgets in Scotland. We need to ensure that these resources are managed effectively to deliver effective, integrated services. We need to demonstrate by our actions that people will get the care and treatment they need, when they need it and where they want it, irrespective of their age. There is no place for ageism -real or perceived - in any part of the NHS in Scotland.
"When my dad needed dialysis, he got it. The fact he was 79 did not matter."
Preparation for healthy older age should begin early in life. We must make sure that people have ready access to information and advice that helps them take informed decisions about their wellbeing.
Older people must have full access to modern services, skills and technology as and when they need them. Better care at home will help them stay there: living independently wherever possible, cared and supported at home, not in homes. And their special needs in acute hospital care, rehabilitation and support after hospital discharge must be met, by health and social work working better together.
This screening should be carried out in the home to ensure that it addresses the physical and social needs experienced by older people in their everyday lives. It must be carried out in a way which respects older people's needs and views on how care should be provided.
"THERE IS NO PLACE FOR AGEISM - REAL OR PERCEIVED - IN ANY PART OF THE NHS IN SCOTLAND"
We are providing Local Authorities with over £200 million additional funding over the next three years to deliver:
"PREPARATION FOR HEALTHY OLDER AGE SHOULD BEGIN EARLY IN LIFE"
Wherever care is provided, it should be of the highest possible standard.
When an older person needs continuing hospital care, it must be provided in an environment and in a way that promotes independence, choice, dignity and wellbeing. We recognise that too often old buildings and old-fashioned hospitals leave older people sharing ward areas with members of the opposite sex. New hospitals and targeted capital investment are providing modern facilities that recognise patients' feelings - as well as their clinical needs.
We will continue to develop our policies to meet the needs of older people both now and in the future.
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