Wednesday, September 11, 2013

Scottish Health Budget

The Scottish Government has published its draft budget today for the next two years. The health budget continues to receive a  degree of protection from UK Government cuts. However, in real terms, inflation and other demand costs  are likely to keep up the financial pressure on services.

No such protection for local government that takes another big revenue hit.

Wednesday, September 4, 2013

The power of big business to undermine public health

Two recent health stories highlight the challenge for public health when sensible measures to tackle tobacco and alcohol abuse run up against the commercial interests of big business

A recent study by Cancer Research shows that almost 20,000 children in Scotland start smoking every year. They have called on the Scottish Government to act quickly on its pledge to introduce legislation on plain packaging for cigarettes. A similar move by the UK Government was put on hold earlier this year with a strong suspicion (subsequently denied) that Tory strategist Lynton Crosby influenced the decision on behalf of his commercial clients. 

The Scottish Government's recently published programme for government confirms that they are still committed to introducing this measure. However, for now, they are promising a consultation and legislation is not likely before 2014/15.

The public health benefits of this measure are clear. The research shows that packaging without branding is less appealing to children and would support other action to discourage young people from starting to smoke. Vicky Crichton said: “Smoking is a serious problem in Scotland with almost 20,000 children, tempted by glitzy, slickly designed packs, being lured into starting smoking every year. It is an addiction that is often life-long and kills more than 4,000 Scots annually. If the Scottish Government is serious about curbing the death toll caused by this lethal habit and meeting its goal for Scotland to become a nation free from tobacco by 2034, then swift action needs to be taken.”

The importance of tackling smoking amongst the young is highlighted by the statistic that  eight out of ten adult smokers start the habit by the age of 19. If the tobacco industry can catch them young, they are likely to have a customer for life. While the rest of us pick up the public health tab.

The second story covered the latest alcohol consumption statistics. Adults in Scotland are continuing to drink more heavily than those south of the Border. Beer, wine and cider sales are similar to England and Wales. However, Scots drink far more spirits, almost three litres per adult per year, compared to less than two litres in England and Wales. Vodka, not whisky is the tipple of preference. It should be said that the good news is that alcohol consumption overall is reducing. However, it remains to be seen if this is more about the economy than a long term shift in consumption. 

NHS Health Scotland also found two-thirds of alcohol sold in 2012 was below the proposed minimum price of 50p per unit. The Scottish Government has taken steps to reduce harmful drinking, with measures such as banning multi-buy discounts, and it wants to create a minimum price to eliminate cheap alcohol from the market. They believe the fact that a quarter of alcohol bought from off-sales in 2012 was below 40p per unit, and two-thirds below 50p, adds weight to its legislation to introduce a minimum price.

Public health minister Michael Matheson said: “We still drink around a fifth more than England and Wales. That is fuelling much higher levels of harm, which results in 100 alcohol-related hospital admissions a day and costs Scotland £3.6 billion each year – £900 for every adult in Scotland.”

And that brings us back to big business because the Scottish Government’s plans have been delayed by a legal challenge from the drinks industry. Even at EU level objections have come in from cheap wine producers. Campbell Evans of the Scotch Whisky Association said: “Minimum unit pricing is not the way to tackle misuse – it does not target the heaviest drinkers, it would be illegal and it would damage the Scotch whisky industry.”

You see it's not about profit, the measure just wouldn't be effective. A familiar refrain from big business to justify their actions over the years. In the case of tobacco and alcohol, a combination of lobbying and legal action is certainly delaying important public health measures.

Scottish Government health programme

The Scottish Government has published its programme for government for the coming year. The health section provides the predictable long list of achievements. While this is expected, it unsurprisingly ignores the very real pressures that real term budget cuts are having on the service. Everything in the garden is apparently rosy, when self evidently it isn't.

The paper does helpfully reiterate the Scottish Government's approach to health service delivery by contrasting their approach with the shambles in England. 

"Scottish Ministers have categorically ruled out the disruptive type of reforms and upheaval being put in place in NHS England, and are committed to continuing to provide high quality health and social care to the people of Scotland that reflects the true values of the people delivering health and social care services in Scotland. The internationally recognised successes Scotland’s health services have achieved have been earned through working in partnership across the Scottish Government, the wider public sector and with staff. Looking ahead, Scotland’s approach remains one of integration, collaboration, innovation, and a focus on outcomes."

There is one new Bill. The Mental Health and Adults with Incapacity Amendment Bill aims to improve the operation and efficiency of mental health legislation for service users and practitioners alike. It will implement recommendations from the McManus Review Group, which reviewed specific aspects of the Mental Health (Care & Treatment) (Scotland) Act 2003. The Bill will also introduce new powers in relation to a Mental Disordered Offenders (MDO) Victims Notification Regime and will amend the Adults with Incapacity (Scotland) Act 2000 to remove the requirement for a single statutory ethics committee to consider all research-related applications involving incapacitated adults.

In addition to legislation, the programme includes other measures the government intends to implement in the coming year. These include:

providing a whole system response to improve the patient pathway in order to reduce pressure on Accident & Emergency (A&E) departments;
develop their strategy for engaging and empowering their workforce, providing a response in Scotland to addressing many of the issues raised by the Mid- Staffordshire/Francis Inquiry, and equipping them to work in an integrated way which reflects the different needs of different people and different places across Scotland;
achieve a sustainable performance on 4-hour A&E waits by the end of December 2013;
implement the world’s first national multiagency early years quality improvement programme across partner organisations to give Scotland’s children the best start in life;
achieve a measurable increase in early detection of cancer across Scotland, particularly in deprived areas, resulting in better outcomes.

Scottish Ministers regret the UK Government’s decision not to proceed with legislation to introduce plain packaging for cigarettes and other tobacco products. They will consult on the issue in the coming months, with the intention of introducing legislation in 2014-15. Similarly, the Scottish Government remains committed to introducing minimum pricing
per unit of alcohol, in order to reduce the terrible impacts of over-consumption. They will defend the legislation against any subsequent appeals in the courts. 

As with other sections of the programme there is nothing remarkable or unexpected in the programme. The Scottish Government's focus is on the independence referendum and little else.