Targets & Strategies

Single Outcome Agreement (SOA) 2013

Glasgow’s new ten year Single Outcome Agreement (SOA) 2013 will be agreed by CPP partners by Summer 2013. It will focus on three key priority areas where Community planning partners in the city believe that they can achieve better outcomes for residents by working more collaboratively and integrating services.

The priorities are: alcohol, youth employment and vulnerable people. A further focus for the new SOA will be to tackle persistent inequalities within specific targeted neighbourhoods in the city.

The new SOA for Glasgow will be accompanied by a Performance Management Framework that will set out how the CPP will track the difference being made over time through a series of performance measures. Glasgow City Council's Strategic plan: 2012 to 2017 sets out the Council's priorities for the next 5 years.  It is focused on economic growth and resilience for the city and its communities.

Glasgow Health Commission recommendations  (2009)
The Glasgow Health Commission concluded its investigation into the city's health with the release of 20 key recommendations in 2009, and progress in these areas will continue to be monitored, in part using the information gathered on the Understanding Glasgow website.

Recommendations with a focus on children include:

• The city's partners should have a key goal at the heart of all their thinking for Glasgow: to be a child-friendly city… with a greater concentration of resources and effort on supporting parents and children in the early years, from pregnancy to primary school.
• In focusing  even more effort on tackling violence, drugs and alcohol-related harm, the Health Commission recommends that partners:

- focus on prioritising the early years

- invest greater resources in tackling tobacco and alcohol use during  pregnancy

- support young people away from gang membership and into more positive forms of participation  in  group activities – with a major focus on addressing the different needs of young men and women who are caught up in gangs or at risk of doing so.

• The introduction of mandatory 20mph zones in residential areas, especially those near schools.
• In making greater use of licensing powers to tackle alcohol-related harm, ensure that there are clear messages in bars and off-sales to advise against pregnant women drinking alcohol.
• A stronger role for the city in exercising its powers in relation to the school lunchtime, encouraging pupils to stay on the school  premises at lunchtime, where they are more likely to eat a healthy lunch, as well as gaining access to other  opportunities. The Health Commission also wishes to see the Council explore its licensing powers to either prevent unhealthy mobile food outlets siting next to schools or to shift their products towards much healthier options.
• All of the city's partners should increase the focus of their services on the early years.
• Developing a new model of support for children and families, influenced by systems successfully adopted in other EU countries which train experts specifically to support families and children from their first years of life. For instance, this model should focus very strongly on the months during pregnancy as much as on the initial years of infancy and childhood to help parents to get a good start in life for their child

This approach should support parents during pregnancy to improve birth weight

A key element of this model would be that all families and those involved in ‘parenting’ can access appropriate, sensitive and meaningful parenting support through parenting programmes and advice.

NHS Greater Glasgow and Clyde Director of Public Health Report 2011-13 “Keeping Health in Mind”
The report’s theme is mental health, and chapters on Early Years and on Children and Young People are included, with recommendations emphasising the importance of parenting programmes and other preventive and early intervention programmes (including whole school work on health and wellbeing as envisaged in the Curriculum for Excellence), and a commitment toward strengthening the roles of health visitors, midwives and of other key frontline workers across services in detecting and supporting those with mental health problems, with strong links to specialist and wider support resources to ensure appropriate and timely responses.  There are specific recommendations regarding reductions in smoking and alcohol consumption during pregnancy, and ensuring that the review of school nursing considers how best to work with partners to identify and support the health needs of young carers. Finally, there is a commitment to “communicate with children, young people, their parents and carers on mental health themes using approaches such as social media and involving young people as partners, to ensure a well-informed population, to challenge stigma and discrimination and to lower the barriers to seeking help and support.”

Scottish Government - Performance Framework
Fifteen National Outcomes describe what the Government wants to achieve over the next ten years. Health-related national outcomes include:

Our children have the best start in life and are ready to succeed (5)

• We live longer, healthier lives (6)
• We have tackled the significant inequalities in Scottish society (7)
• We have improved the life chances for children, young people and families at risk (8)

Specific policies relating to the health of children and young people include:

Getting It Right for Every Child (2006)
The Government established a commitment to ensure that every child gets the help they need, when they need it, emphasising co-operation and coordination between agencies. To fully assess a child's circumstances when a concern has been identified, the Getting it right approach has led to the development of an assessment and planning tool known as the national practice model.

A Refreshed Framework for Maternity Care in Scotland (2011), which outlines the principles which govern maternity services from pre-conception, through pregnancy, childbirth and postnatal care and into parenthood in Scotland. One of the key drivers for refreshing te framework was the need to reduce inequalities in maternal and infant health outcomes at birth and across the life course.

 Improving Maternal and Infant Nutrition: A Framework for Action (2011). This outlines actions which can be taken by NHS Boards, local authorities and others to improve the nutrition of pregnant women, babies and young children in Scotland. The framework stresses the importance of nutrition in the earliest years for long-term health and wellbeing, but also provides case studies demonstrating some of the good practice already in place across Scotland. The detrimental effect of health inequalities on maternal and infant nutrition is recognised, resulting in the recommendation of targeted support to those most in need to ensure that health outcomes for children are maximised and the gap between the most and least healthy is reduced.

The Early Years Framework (2009)
Single outcome agreements and the community planning process will be the key local mechanisms for putting this framework into practice. In doing so, the focus will remain on outcomes rather than inputs, and we will work to develop better indicators of outcomes from early years policies and services.”

Equally Well – the national health inequalities strategy (2008)
Key points from this strategy include:

• Health inequalities remain a significant challenge in Scotland..
• Tackling health inequalities requires action from national and local government and from other agencies including the NHS, schools, employers and Third Sector.
• Priority areas are children, particularly in the early years, "killer diseases" such as heart disease, mental health and the harm caused by drugs, alcohol and violence.

Key recommendations include:

• NHS Boards should improve the capacity of ante-natal services to reach higher risk groups and identify and manage risks during pregnancy.
• The Government should lead the development of support services for families with very young children at risk of poor health and other poor outcomes.
• The Government should develop a community-based integrated school health team approach, increasing the nursing staff and other professionals supporting schools.
• Physical environments that promote healthy lifestyles for children, including opportunities for play, physical activity and healthy eating, should be a priority for local authorities and other public services.

Health for All Children (4^th Edition 2003, followed by guidance for implementation in Scotland, 2005)
The UK Royal College of Paediatrics and Child Health commissioned a 4th review of evidence and resulting recommendations regarding the universal child health programme, including child health surveillance (such as the health visitor first visit, the 6-8 week review, and the proposed 24-30 month review), screening (such as newborn hearing screening and pre-school vision screening) and health promotion.

The Scottish Government produced updated guidance in 2011

Better Health, Better Care Action Plan (2007) includes three main components of health improvement, tackling health inequality and improving the quality of health care.

Good Places, Better Health for Scotland’s Children (2011) considered four health challenges facing children in Scotland: Obesity, Asthma, Unintentional Injury and Mental Health and Wellbeing. An independent expert evaluation group considered the question "What is needed to deliver places that nurture good health for children?"

The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care (2005) was developed to assist all agencies with planning and delivering integrated approaches to children and young people's mental health.

Delivering a Healthy Future: An Action Framework for Children and Young People's Health in Scotland (2007) sets out a structured programme of actions, drawn primarily from existing policy initiatives and commitments, to improve services for children and young people in Scotland.

HEAT Targets are one element of performance-monitoring contributing towards delivery of the Scottish Government's Purpose and National Outcomes; and NHSScotland's Quality Ambitions. The HEAT targets are grouped into 4 priorities:

• Health Improvement for the people of Scotland - improving life expectancy and healthy life expectancy;
• Efficiency and Governance Improvements - continually improve the efficiency and effectiveness of the NHS;
• Access to Services - recognising patients' need for quicker and easier use of NHS services; and
• Treatment Appropriate to Individuals - ensure patients receive high quality services that meet their needs.

HEAT targets of very specific relevance to children and young people have been, and are, few:

• 33 per cent of newborn children across Scotland exclusively breastfed at six to eight weeks in 2010/11 - delivering a 25 per cent increase on baseline performance across all Boards by 2010/11
• 80 per cent of all three to five year olds to be registered with an NHS dentist by 2010/11.
• at least 60 per cent of 3 and 4 year old children in each Scottish Index of Multiple Deprivation (SIMD) quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014.
• achieve 6,317 completed child healthy weight interventions in total across Scotland over the three years to the end of March 2011, then streamline the range of interventions delivered, with new requirement that at least 40% of child healthy weight interventions are delivered to children/families in the two most deprived SIMD quintiles by local SIMD datazone. The number of interventions to be delivered across the NHS Greater Glasgow and Clyde area in the three years to 2013/14 is 3,389.