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Our National Health: A plan for action, a plan for change

• a new priority for the health of children and older people
• give children the best possible start in life by improving child health and children's services
• provide all children and their families with equal and easy access to comprehensive, combined and integrated services
• enable older people to maximise independence, dignity and good health
• provide older people with access to responsive, integrated services

Section 6: A lifetime of care

Core aims

• a new priority for the health of children and older people
• give children the best possible start in life by improving child health and children's services
• provide all children and their families with equal and easy access to comprehensive, combined and integrated services
• enable older people to maximise independence, dignity and good health
• provide older people with access to responsive, integrated services

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.

• we will offer information and support to all women of child-bearing age, and their partners, so that they can make the best choices about diet, alcohol, lifestyle, smoking and drugs to help them prepare for healthy pregnancy

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.

• in January 2001, we will publish a national Maternity Services Framework. It will ensure choices for women and their families_while recognising the need for clinical safety_and assist decision_taking on the design of maternity services across Scotland

Supporting parents

Parenting is demanding. Parental influences and choices are key to children's development.

• we will support parenting, by ensuring each NHS Board has in place effective, local antenatal and postnatal parent education and support programmes to make sure that women and their partners are well prepared for the emotional and physical changes that occur in pregnancy, childbirth and parenthood
• we will develop better parental support through initiatives such as Starting Well and Sure Start Scotland
• we will increase the health input into family centres, with links between LHCCs and Family Centres

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:

• support local NHS Board breast feeding strategies
• implement the joint WHO/UNICEF initiative on breastfeeding
• raise awareness of its benefits, by promoting support by professionals and peers
• enhance the opportunities for women to continue breastfeeding on their return to work.

• each local NHS Board will have systems to promote early detection, referral and treatment of postnatal depression, involving midwives, health visitors, GPs and other agencies
• we will develop guidelines to help health professionals recognise when women - whether mothers or not - are experiencing domestic violence and to ensure that they are given sensitive support and advice

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"

• the NHS in Scotland will refresh and update its screening programmes, focusing on the health of women and children
• we will seek to improve lifestyle education, raising awareness of the lifestyle issues that will affect children's future health. Health promotion and health education in schools, including HEBS campaigns, will help pupils to make healthy choices for themselves on alcohol, smoking and drugs
• we will revolutionise the school nursing service, building on the experience of nursing roles in New Community Schools to develop a service that focuses on identifying and addressing the health needs of the whole school community
• we will develop a new model of public health nursing, bringing health visitors and school nurses into a single discipline focused on addressing the health needs of communities

Joint working

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."

• the Scottish Executive will allocate over £70 million over 2002-04 to provide integrated children's services. We will expect the NHS at a local level to work closely with Local Authorities, voluntary sector and other partners to make best use of this resource

Child health services

We recognise the need for a long term strategy to promote improved, combined and integrated children's services.

• in early 2001, the Child Health Support Group (CHSG) will produce a Child Health Service Template that will provide a framework for all agencies involved in providing a combined, integrated and co-ordinated child health service

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"

• as part of the performance management arrangements put in place by this Plan, NHS Boards will have to demonstrate that the treatment and facilities they provide for children meet both clinical and emotional needs of the child and parents

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.

• we will require NHS Boards to ensure that they have appropriate training and systems in place to ensure that treatment given to children in the general hospital environment recognises and addresses their needs and those of families

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.

• the Executive is committed to improving the provision of services for children with special needs

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.

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.

• the Executive is acting on the recommendation of the Riddell Committee and reviewing how we provide speech and language and other therapies for children with learning disabilities
• the Executive will issue guidance on the education of children who are too ill to attend school
• by summer 2002, children, young people and adults with learning disabilities will have access to local area co-ordinators who will co-ordinate services to provide information, family support and funding

Young people

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)

• we will encourage the NHS to work with and listen to young people to make sure that local services are shaped in ways that effectively meet their needs
• we are investing £1 million from the Health Improvement Fund in the Walk the Talk initiative to underpin this work, developing a network of services to meet young people's health needs

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.

• We expect the NHS to work with partner agencies to ensure that this transition is managed sensitively and with attention to young people's needs.

Sexual health

Advice and information on sexual health and contraception is of

particular importance to young people.

• we are providing £3 million over three years for the 'Healthy Respect' national health demonstration project that seeks to develop and share best practice in the promotion of sexual health, prevention of unwanted teenage pregnancies and reduction of sexually transmitted diseases

• we will expect each local NHS Board to work in partnership with Local Authorities and voluntary sector organisations to ensure that young people have access to a range of sexual health support and services

Older people

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.

• the Health Education Board for Scotland (HEBS) is currently developing a campaign tailor-made to the health education needs of older people

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.

• the Chief Medical Officer will lead an Expert Group to improve the care of older people in NHS acute and primary care services. This will include action to reduce delays in discharging patients from hospital
• the Chief Medical Officer will be asked to produce proposals for more effective screening of older people's health needs

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.

• we will ensure that a single shared needs assessment is carried out by a health or social care professional to avoid duplication and additional burdens on older people

"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:

• a local service in every part of the country for shopping, laundry and minor household repairs, helping 10,000-15,000 people to preserve their independence at home
• fast, flexible rapid response teams in every part of Scotland to support up to 18,000 older people at home: for example, when a short period of help for an older person who falls ill might prevent hospital admission
• action to tackle delayed discharge from hospitals
• free home care support for people who need it for up to four weeks following discharge from hospital

In addition,

• older people in Scotland will be the first to benefit from joint resourcing and joint service management locally, from 2002
• by October 2001, we will introduce, in advance of other care groups, a single shared assessment for older people and people with dementia

"PREPARATION FOR HEALTHY OLDER AGE SHOULD BEGIN EARLY IN LIFE"

Wherever care is provided, it should be of the highest possible standard.

• by April 2002, we will set up a Commission for the Regulation of Care to regulate care homes and support services such as home care and day care in both the public and independent sector, to standards devised from the perspective of users of services themselves

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 are investing £4.8 million to make sure that mixed wards will be eradicated by April 2002.

We will continue to develop our policies to meet the needs of older people both now and in the future.

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