08 - 2025-06-18 IJB - Public Health Annual Report - Appendix 1
North Lanarkshire Council · 18 June 2025
Back to Health and Social Care Integration Joint Board — 18 June 2025 and its agenda
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1 Director of Public Health Annual Report 2024 NHS Lanarkshire
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NHS Lanarkshire | Director of Public Health Annual Report 2024 2 Acknowledgements I am grateful to all my staff within the Directorate of Public Health for their excellent work over the years. I am also grateful to the Health Improvement Team for their outstanding efforts and thank you to everyone across NHS Lanarkshire, partners and stakeholders who contribute to Public Health Priorities, your ongoing commitment is hugely appreciated. This includes North Lanarkshire Council, South Lanarkshire Council, North Lanarkshire University Health and Social Care Partnership and South Lanarkshire University Health and Social Care Partnership. I would like to thank all the contributors to this report within the Directorate of Public Health, the Health Improvement Department and colleagues across NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. Thank you to the members of the editorial team: Alana McGlynn, Mairead Doyle, Mark Kay, Ruth Mellor, Karen Lorenzetti, Alison Stanley, Alison Smith-Palmer, Albert Yeung, Linda Brown, Karen McGuigan, and in particular Derek York for designing the report, Inga Allan for producing the child-friendly video version, and Lorraine Dick for her communications support. Thank you to all the Lanarkshire children who contributed artwork and told us what they believe they need to be healthy, which were considered, and a selection included in this report. Finally, I would like to extend my thanks to all organisations who work with NHS Lanarkshire to protect, maintain and improve the health of the public. You can contact us by emailing publichealthannualreport@lanarkshire.scot.nhs.uk The Directorate of Public Health NHS Lanarkshire Headquarters Kirklands Fallside Road Bothwell G71 8BB Telephone: 01698 752952 www.nhslanarkshire.scot.nhs.uk © Lanarkshire NHS Board Published March 2025 We encourage the use by others of information and data contained in this publication. Brief extracts may be reproduced provided the source is fully acknowledged. Proposals for reproduction of large extracts should be sent to the address above. ISBN 978-0-905453-47-7 Cover image: Drawing by a pupil from Willowbank School, Airdrie, North Lanarkshire. Other artwork and quotes within the report were contributed by pupils from Aitkenhead Primary, Carbrain Primary, Greenfaulds High, Holy Cross Primary, Holy Family Primary, Kildrum Primary, New Monkland Primary, and Townhead Primary.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 3 Contents Acknowledgements 2 Contents 3 List of Abbreviations 4 Foreword 5 Reflection on the last 12 months (We said, We did) 7 1. Health of the People of Lanarkshire 10 1.1 Population Profile 10 1.2 Key Child Health Measures 17 2. Health Protection 18 2.1 Pertussis (Whooping Cough): Maternal and Childhood Vaccinations 18 2.2 Childhood Vaccination 22 3. Children & Young People 26 3.1 Children’s Voices 26 3.2 The United Nations Convention on the Rights of the Child 28 3.3 Child Poverty 30 3.4 Breastfeeding 33 3.5 Child Healthy Weight – Child Weight Management 37 3.6 The Child Health Programme 40 3.7 Keeping ‘The Promise’ for Care Experienced Children and Young People 43 3.8 Pregnancy and Newborn Screening Programme 46 3.9 Children and Young People’s Mental Health and Resilience 50 3.10 Young People and Vaping in Lanarkshire 53 3.11 Oral Health Status of Children 56 3.12 Raising Mouth Cancer Awareness Among Young People 58 4. Healthcare Public Health 60 4.1 Population Screening 60 Staff in the Public Health Directorate: January 2024 – February 2025 65 Statistical Appendix 67
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NHS Lanarkshire | Director of Public Health Annual Report 2024 4 List of Abbreviations BBV Blood-borne viruses BFF Becoming Breastfeeding Friendly Scotland BFS Breastfeeding Friendly Scotland BMI Body Mass Index CAMHS Child and Adolescent mental health Services CBRs Community Benefit Requirements CHD Coronary Heart Disease CHP Child Health Programme COVID-19 Corona Virus 2019 CWB Community Wealth Building DWP Department for Work and Pensions ECOSS Electronic Communication of Surveillance Scotland EQIA Equality and Diversity Impact Assessment ESRA Employment Related Services Association FAS Foetal Anomaly Scan FASP Foetal Anomaly Screening Programme FOQ Family Origin Questionnaire GIRFEC Getting it Right For Every Child GOALS Getting Our Active Lifestyle Started GP General Practitioner HEYS Health in Early Years Hib Haemophilus type b HIV Human Immunodeficiency Virus HPT Health Protection Team HPV Human Papilloma Virus HPZone Records management system used by Health Protection Team HSCP Health and Social Care Partnerships ID Identification Document KPI Key Performance Indicators LANDED Lanarkshire Drug Education LCPAR Local Child Poverty Action Report LGHP Lanarkshire Green Health Partnerships LWMS Lanarkshire Healthy Lifestyle & Weight Management Service MMR Measles, Mumps and Rubella MRP Monklands Replacement Project NDIP National Dental Inspection Programme NHS National Health Service NHSL National Health Service Lanarkshire NIPT Non Invasive Prenatal Testing NLC North Lanarkshire Council NRS National Records of Scotland P1 Primary 1 P7 Primary 7 PCV Pneumococcal conjugate vaccine PCVb Pneumococcal conjugate vaccine booster PHAcT Public Health Action Teams PHIL Public Health Information Lanarkshire PHS Public Health Scotland PNBS Pregnancy and New Born Screening S2 Secondary 2 SAPE Small area population estimates SIMD Scottish Index of Multiple Deprivation SLC South Lanarkshire Council SMR Standardised mortality ratios UNCRC The United Nations Convention on the Rights of the Child UNHS Universal Newborn Hearing Screening WHO The World Health Organization
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NHS Lanarkshire | Director of Public Health Annual Report 2024 5 Foreword Welcome to the 2024 Director of Public Health Annual Report. It is an honour and privilege once again, to have served the population of Lanarkshire alongside my colleagues within NHS Lanarkshire, the Health and Social Care Partnerships, Community Planning Partnerships and wider stakeholders. This year the main focus of the report is the health of Infants, Children and Young People. It will explore some of the usual public health themes, through a child health lens. I have also included an update on the actions identified as priorities in last year’s report, which focussed on the theme of NHS as an anchor organisation. I am pleased to report that we are making good progress across many areas on the Anchor Action Plan, however, there is lot more work to do to improve population health and address inequalities. “History will judge us by the difference we make in the everyday lives of children.” – Nelson Mandela 2024 was a landmark year for our children, with The United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Act 2024 coming into effect and ensuring all those under 18 have their rights protected by law. It recognises that childhood is a special time in people’s lives. Child health has always been, and will remain, a key priority for public health within Lanarkshire. We want to build a good foundation for future generations, by ensuring that every child has an opportunity to be healthy and flourish into adulthood. There are many examples of excellent practice across all our partners that demonstrate an ongoing commitment to child health and whole systems working. However, we know that there are some challenges facing us, addressing mental health, child poverty and inequalities are particular areas of focus. Whilst the population of Lanarkshire is aging, we still have 19.5% of the population aged 0–17 years in 2022, and 6,121 live births registered among NHS Lanarkshire residents in 2023. Our children of today are our adults of the future and it’s vitally important to ensure a focus on prevention in this important stage of the life course. Investing in children’s health is extremely important to improve the health of our population both for current and future generations. We are delighted that South Lanarkshire Council is successful as one of the areas for Collaboration for Health Equity in Scotland. This initiative which focuses on actions against child poverty is very welcome and will strengthen our plans and efforts to work towards reaching our targets. It should also help us to amplify and accelerate our efforts to improve population health not just in South Lanarkshire but across Lanarkshire as a whole. Our Child Health Commissioner has an important role across Lanarkshire advocating for and progressing children’s rights and working with all our partners and key stakeholders to improve child health as we move forward over the coming years. The artwork included in this report was created by Lanarkshire children and you will also see some of their views presented. This year, for the first time, we have a child friendly version of the report available in a video format. I would like to sincerely thank all the children and young people who
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NHS Lanarkshire | Director of Public Health Annual Report 2024 6 contributed. I would also like to thank the editorial team for their brilliant efforts in the production of this year’s report. I hope you find the report informative and helpful. I would welcome any feedback you have including any ideas for future reports. Prof S. Josephine Pravinkumar, Director of Public Health & Health Policy Email: josephine.pravinkumar@lanarkshire.scot.nhs.uk
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NHS Lanarkshire | Director of Public Health Annual Report 2024 7 Reflection on the last 12 months (We said, We did) Key population health priorities highlighted in the 2022/23 Annual Report We continue to report on the progress made on the key priorities highlighted in last year’s report and the table below summarises all the work taken forward to establish NHS Lanarkshire as an Anchor organisation. We have also provided key updates on the work we undertake with our strategic partners to strengthen our collective role as anchor organisations through the community wealth building commission. Chapters within this year’s report also cover updates on key priorities including health of the population, cervical audit and vaccination work in care homes. The Lanarkshire BBV Prevention and Care Network continues to lead and coordinate efforts to deliver Hepatitis C Elimination. This includes the dissemination of the findings from the Lanarkshire Love Your Liver events; continued improvements and expansion of BBV testing to new groups and new settings and the delivery of phase 2 of the Hepatitis C RECAST Project. Topic: NHS Lanarkshire as an Anchor Organisation We Said We Did Being an Exemplar Anchor • Leadership, ownership and support from across all services within NHS Lanarkshire. • Communications to raise awareness • Investing time to build on the local partnerships already in place • Scottish Government metrics incorporated into programme governance for 2024/25. • Awareness raising presentations and communications plan developed and delivered. • Partnership working with both local authorities and Glasgow City Region, including around community wealth building and Living wage. • Steering group and governance routes in place. Performance against the Scottish Government metrics for 2023/24 demonstrates improvement across many measures with increased employability and apprenticeship placements and increased spend on local businesses and with small and medium sized enterprises. Widening Access and Employability Opportunities • Provide paid placements and work experience for individuals facing barriers to employment or those facing poverty. • Provide outreach activities to our local community to promote NHS Lanarkshire as an exemplar employer • A 5% increase in paid work placements has been realised from last year and new paid work placements for school pupils was piloted in Summer 2024. • 36 participants started on the NHS Demonstrator 3 programme October 2024 • NHSL reached the National final for ESRA (Employability) awards in the category for Collaboration and Partnership with Routes to Work North Lanarkshire
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NHS Lanarkshire | Director of Public Health Annual Report 2024 8 Topic: NHS Lanarkshire as an Anchor Organisation We Said We Did Community Wealth Building (South Lanarkshire) • Work together to strengthen the collective role of key anchor organisations who deliver services across the area, in order to bring wealth into the area and generate real change across South Lanarkshire. • Develop opportunities to share expertise and learning between local anchor organisations. • Develop joint CWB indicators of progress and monitor these over time. • The Community Wealth Building Commission brings together key anchor organisations 4 times a year. • Briefings, presentations and reports have been provided by a range of anchor organisations, including VASLan, Business Gateway, NHS Lanarkshire, and community representatives. • Noting NHS Scotland’s anchor metrics approach, work on a potential suite of joint indicators will be undertaken in 2025. Community Wealth Building (North Lanarkshire) • Continued consultation and engagement on the approach, with adoption by the North Lanarkshire Strategic Leadership Board and partners by late summer 2024. • North Lanarkshire Partnership endorsed a multi-agency Community Wealth Building statement in December 2024. Work is now underway to develop a Partnership Implementation Plan. Monklands Replacement Project (MRP) and Community Benefits • Develop the delivery plan. • Develop the supporting communication plan. • Establish the progress monitoring tool and reporting arrangements. • Specific Community Benefit Requirements (CBRs) have been developed, included under contract and will be implemented during the project. • Regular communications are in place with the growing network of stakeholders, forming part of the projects overall Communications and Engagement Strategy. • Delivery on a number of CBR’s has commenced and in addition, NHS Lanarkshire has commenced delivery of Community Benefits beyond the scope of the contract, monitored through the MRP Governance routes. Service Design and Delivery • Supporting patients and staff with cost of living issues through a variety of actions, including addressing child poverty, is a key component of our anchor plan. • Continue to ensure that integrated EQIA’s are carried out and our services are designed to reach and support our most disadvantaged communities. • We have communicated with staff and patients on support for the cost of living, via a range of mediums including training, awareness raising and social media. • We continue to prioritise actions to tackle child poverty locally, by contributing to both the North and South Lanarkshire Local Child Poverty Action Reports. • All Committee papers have a section where leads must note if integrated EQIAs have been completed.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 9 Topic: NHS Lanarkshire as an Anchor Organisation We Said We Did Lanarkshire Green Health Partnership (LGHP) • Raise awareness and share the benefits of engaging with green health and promote engagement with activity. • Support and build partnerships to inspire projects that help people connect to nature and be active outdoors. • Empower health & social care and third sector staff to be confident to connect people to green health opportunities as appropriate. • Seek and secure funding to enable contribution and continuation of evidence based practice. • LGHP communication plan continues to promote local green health activities and events, as well as national campaigns, via a range of mediums. • Contribution to third sector interfaces continues to increase reach and build a network of stakeholders and green health opportunities. • Referral tools are promoted, these include The Nature Prescription, The Physical Activity Prescription and Active Health. Relevant training modules have been shared to encourage learning on green health topics. • New funding has been secured to continue the ongoing delivery of the NHS estate Therapeutic Garden Project.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 10 1. Health of the People of Lanarkshire 1.1 Population Profile Background This year has been an exciting year for population health intelligence. • Further 2022 Census findings were published, a snapshot of them is included below. • The National Population Health Framework will be published shortly, the Directorate has been involved in preparatory work for the arrival of this document, including responding to the consultation, and presenting information at an NHS Board Vision Session. Going forwards the Population Health Framework will influence our strategic priorities. • South Lanarkshire was successful in becoming one of three Marmot places in Scotland. The directorate is working with council, Public Health Scotland, and the Institute of Health (part of University College London) colleagues, on this work. • ‘PHIL: Public Health Information Lanarkshire’, a pan-Lanarkshire resource providing health intelligence and signposting to data, organised by public health themes, is under development. This site is aimed at decision-makers: the Board, Service Managers, etc., in NHS Lanarkshire, North and South HSCPs, North and South Councils, and the Third sector. The aim is to make it easier for them to find Lanarkshire specific data or intelligence, to aid their decision making. This chapter describes the population of NHS Lanarkshire, and how it is projected to change over the next 20 years. The number of births and deaths registered in 2023, and data on life expectancy are reported. Mortality information for specific diseases is presented. Detailed information on each area is included in the relevant section of the Statistical Appendix which readers are referred to; the appendices also include data on health protection, dental health and cancer registration. Snapshot of the population of Lanarkshire The Lanarkshire population is diverse (figure 1.1.1), but the majority of the population report themselves as White Scottish (North Lanarkshire 88.79%, South Lanarkshire 87.32%); heterosexual/straight (North Lanarkshire 89.7%, South Lanarkshire 89.4%). There are a range of faiths and religions reported, but the most frequently reported single group (if keeping different Christian faith categories separate) was no religion: North Lanarkshire 38.2%, South Lanarkshire 45.37%.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 11 South Lanarkshire 327,460 North Lanarkshire 340,920 Figure 1.1.1: Snapshot of the Lanarkshire population Ethnic Groups North Lanarkshire South Lanarkshire White: Scottish 88.79% 87.32% White: Other British 3.60% 5.47% White: Gypsy Traveller 0.04% 0.05% White: Other 3.54% 2.91% Mixed or Multiple Ethnic Group 0.62% 0.75% Asian 2.44% 2.48% Black, Caribbean or African 0.61% 0.62% Other Ethnic Groups 0.36% 0.40% Sexual Orientation North Lanarkshire South Lanarkshire Heterosexual/Straight 89.7% 89.4% Gay or Lesbian 1.5% 1.5% Bisexual 1.1% 1.1% Other Sexual Orientation 0.3% 0.3% Not Answered 7.5% 7.7% Sources: Population (2022) Mid-Year Population Estimates, National Records of Scotland. https://www.nrscotland.gov.uk/publications/mid-2022-population-estimates/ Ethnic group, sexual orientation, faith & religion, Scotland’s Census 2022. [Accessed 22/05/24], trans or has a trans history - Scotland’s Census 2022. [Accessed 16/01/25]. Religious Faith ☬ ⛤ North Lanarkshire South Lanarkshire Church of Scotland 20.50% 22.96% Roman Catholic 29.92% 19.30% Other Christian 3.21% 3.91% Buddhist 0.12% 0.14% Hindu 0.11% 0.27% Jewish 0.02% 0.07% Muslim 1.62% 1.44% Sikh 0.20% 0.19% Pagan 0.23% 0.25% Other religion 0.14% 0.17% No religion 38.20% 45.37% Religion not stated 5.73% 5.94% Trans or has a trans history North Lanarkshire South Lanarkshire 0.3% 0.3% (2022 – people aged 16yrs +)
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NHS Lanarkshire | Director of Public Health Annual Report 2024 12 Population and projected population(1-3) The estimated population of the NHS Lanarkshire area on 30 June 2022 was 668,380. This is a 0.3% increase from 2021 (which had a population of 666,670), and a 2.4% increase from 2012 estimate of 652,760. The median age of the population was 43, the same for Scotland as a whole. Seventeen percent of Lanarkshire residents were aged less than 16, 65% were of working age (aged 16 to 65 years), and 18% were of pensionable able (aged 66 years and over). This was similar to Scotland. There were 20,252 (6.2%) more women than men. North Lanarkshire Council Area: estimated population of 340,920, a 0.1% decrease since 2021. South Lanarkshire Council Area: estimated population of 327,460, a 0.6% increase since 2021. Figure 1.1.2 shows the population pyramid of the Lanarkshire population by age and sex for 2022, and the population projections for 2032 and 2043. Lanarkshire’s population is projected to decrease slightly by 0.1% by 2032, with a further 0.3% decrease by 2042. The biggest increase is predicted to be in those aged 75 and over, with 25.6% increase in the ten years from 2022 to 2032, and overall increase of 58.4% from 2022 to 2042 (Figure 1.1.2). Figure 1.1.2: Population pyramid: population of NHS Lanarkshire by 5-year age bands and sex, based on Small Area Population Estimates 2022 (SAPE); Population Projections for 2032 & 2042 Source: The statistics in this section were obtained from local analysis of data supplied by NRS or directly from NRS published online at https://www.nrscotland.gov.uk [Accessed 10 February 2025].
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NHS Lanarkshire | Director of Public Health Annual Report 2024 13 Life expectancy(4–6) There is a decrease in life expectancy at birth for both males and females in Lanarkshire from 2011–2013 to 2021–2023. This decrease is 1.0 year for males (from 76.6 to 75.6 years) and 1.3 years for females (from 80.8 to 79.5 years). Over the same time period, Scotland life expectancy has stabilised. Life expectancy in the UK had been increasing, but started to decrease (there is currently no data at UK level for 2021-2023 to compare). Females in Lanarkshire live on average 3.9 years longer than males. This gap between male and female life expectancy is similar to that for Scotland (4.0 years). Life expectancy is below national levels; people in Lanarkshire live on average 1.3 years less than others in Scotland (males 1.2 years and females 1.4 years less). Within Lanarkshire, life expectancy in South Lanarkshire is higher than in North Lanarkshire; in the South males live 1.4 years longer and females 1.6 years longer on average than those in the North. Life expectancy by SIMD Males living in the most deprived areas of Lanarkshire live on average 11.3 years less than males living in the least deprived areas. For females, life expectancy is 8.5 years less in the most deprived areas compared to the least deprived areas. Births(7) There were 6,121 live births registered among NHS Lanarkshire residents in 2023, a decrease from 2022 of 3.0%. The number of stillbirths decreased from 28 in 2022 to 22 in 2023. The overall live birth rate per 1,000 women aged 15-44 was 50.0 for Lanarkshire, higher than the Scottish rate of 44.8. Deaths(7) There were 8,086 deaths registered in Lanarkshire in 2023, an increase of 392 (5.1%) from 2022. Standardised mortality ratios (SMRs) were calculated for deaths in Lanarkshire, using Scotland as the standard population. SMRs show whether the number of deaths are higher or lower in Lanarkshire than would be expected based on Scotland’s mortality rates. Overall SMRs in Lanarkshire remain above the Scottish average for both sexes, both for mortality in those aged under 75 years and mortality in those aged 75 years and over. There is wide variation in SMRs between the different localities in Lanarkshire. From one locality with an SMR 20.2% below the Scottish rate for females aged less than 75 years, to another locality with an SMR 71.8% above the Scottish rate for females aged less than 75 years. There is a continuing reduction in the combined proportion of all deaths due to cancer, coronary heart disease (CHD) and stroke. Since 2012, they have accounted for less than 50% of all deaths and, in 2023, the proportion was 41.9%. Deaths from cancer increased slightly this year, whilst for CHD and stroke they remained relatively stable compared to previous years. In 2023, the ‘big killer’ diseases accounted for 3,386 deaths: individually cancer, CHD and stroke were responsible for 25.9%, 10.6% and 5.4% of all deaths in Lanarkshire, respectively. Respiratory disease had been decreasing, but increased in 2023. This was a significant cause of mortality in 2023, accounting for 11.4% of all deaths in Lanarkshire. Another major cause of death in 2023 was dementia and Alzheimer’s disease, accounting for 9.7% of deaths. More detailed information on mortality is provided in the tables and charts in A6–A11 of the Statistical Appendix.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 14 Scottish health survey(8,9) A sample of households across Scotland are invited to participate in the Scottish Health Survey each year(8). Figure 1.1.3 shows key results comparing Lanarkshire to Scotland, where we have worse results for each measure, except hazardous/harmful drinking. The data included here comes from surveys from 2019- 2023 (excluding 2020), compared with the 2018-2022 (excluding 2020) data, there has been an increase in number of people worried about running out of food, from 11% to 17% in Lanarkshire, but lower reporting of hazardous/harmful drinking from 23% to 20%(9). Figure 1.1.3: Scottish Health Survey Infographic (9) Source: Created from data on the Scottish Health Survey dashboard. Scottish Government. https://scotland.shinyapps.io/sg-scottish-health-survey/ [Accessed 12 February 2025]. Key Points • The estimated population of Lanarkshire mid-year 2022 was 668,380, a 2.4% increase since 2012. • Population projections continue to show an aging population. • Life expectancy is lower in Lanarkshire than in Scotland overall and life expectancy is lower in North Lanarkshire than South Lanarkshire. • There were 8,086 deaths registered in Lanarkshire in 2023, an increase of 5.1% from 2022. • Overall standardised mortality ratios (SMRs) in Lanarkshire remain above the Scottish average and there is a wide variation in SMRs between the different localities in Lanarkshire.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 15 • In 2023, the following accounted for a large proportion of deaths in Lanarkshire: cancer (25.9% of all deaths), respiratory diseases (11.4%), coronary heart disease (10.6%), stroke (5.4%), dementia (5.4%), and Alzheimer’s (4.3%). • The Scottish Health Survey Lanarkshire data describe that over 1 in 3 people experience a limiting long-term illness and nearly 1 in 4 people experience mental health symptoms, and 1 in 6 reporting they were worried about running out of food – so experiencing money worries. Therefore, it is essential that we have system wide evidence-based approaches to tackle the wider determinants of health. Priorities for Action • Creation and launch of ‘PHIL’ – Public Health Information Lanarkshire • Work with partners to make the most of the 2-year Marmot place opportunity. • The Scottish Health Survey highlights there are areas for health improvement in the Lanarkshire population, and the increase in money worries is particularly stark. Tackling these require a multidisciplinary, whole system working, with initiatives such as the Anchor Plan, Obesity PHAcT being examples of taking action. References (1) National Records of Scotland (NRS). Mid-2022 population estimates; 26 March 2024. Available from: https://www.nrscotland.gov.uk/publications/mid-2022-population-estimates/ [Accessed 13th February 2025]. (2) National Records of Scotland (NRS). Rebased population estimates, Scotland, mid-2011 to mid-2021; 21 January 2025. Available from: https://www.nrscotland.gov.uk/publications/rebased-population-estimates-scotland-mid- 2011-to-mid-2021/ [Accessed 13th February 2025]. (3) National Records of Scotland (NRS). Population Projections for Scottish Areas 2018-based; 24 March 2020. Available from: https://www.nrscotland.gov.uk/publications/population- projections-for-scottish-areas-2018-based/ [Accessed 25th February 2025]. (4) National Records of Scotland (NRS). Life Expectancy in Scotland 2021-2023; 23 October 2024. Available from: https://www.nrscotland.gov.uk/publications/life-expectancy-in- scotland-2021-2023/ [Accessed 25th February 2025]. (5) Office for National Statistics (ONS). National life tables – life expectancy in the UK. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpe ctancies/bulletins/nationallifetablesunitedkingdom/2020to2022 [Accessed 25th February 2025]. (6) Public Health Scotland. ScotPHO Online Profiles Tool. Public Health Scotland. Website. https://scotland.shinyapps.io/ScotPHO_profiles_tool/ [Accessed 25th February 2025]. (7) The statistics in this section were obtained from local analysis of data supplied by NRS or directly from NRS published online at https://www.nrscotland.gov.uk [Accessed 25th February 2025]. (8) Scottish Government. The Scottish Health Survey 2022 – volume 1: main report. Edinburgh: Scottish Government; December 2023. https://www.gov.scot/publications/scottish-health-survey-2022-volume-1-main- report/documents [Accessed 15 December 2023]. (9) Scottish Government. Scottish Health Survey dashboard. Scottish Government. Website. https://scotland.shinyapps.io/sg-scottish-health-survey/ [Accessed 12 February 2025].
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NHS Lanarkshire | Director of Public Health Annual Report 2024 16 Karen Lorenzetti, Principal Public Health Information Analyst Email: karen.lorenzetti@lanarkshire.scot.nhs.uk Lisa Maria Neil, Public Health Information Analyst Email: lisamaria.neil@lanarkshire.scot.nhs.uk Dr Ruth Mellor, Consultant in Public Health Email: ruth.mellor@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights By monitoring data, we can work with children, families and professionals in a timely manner, protecting and progressing UNCRC article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 17 1.2 Key Child Health Measures Population 130,220 Children and young people aged 0–17 years1 6,121 Live Births: Lanarkshire2 Ethnicity (Lanarkshire schools)3 White Scottish: 86.2% White, Other British: 4.6% Minority Ethnic group: 7.4% Not known/disclosed: 1.8% Child Weight Overweight: Lanarkshire: 9.3%, : 8.5%; Obese: Lanarkshire: 3.9%, : 3.7%; Severely obese: Lanarkshire: 3.5%, : 3.2% (Primary 1) 4 Oral Health No obvious decay Lanarkshire: 75.9% : 73.2% (P1 children)5 1 2022, National Records of Scotland 2 2023, National Records of Scotland 3 2023, Summary statistics for schools in Scotland. www.gov.scot 4 Percentage of Primary 1 children measured, 2022/23 Primary 1 Body Mass Index (BMI) statistics Scotland - School year 2022 to 2023 - Public Health Scotland Tobacco/Vaping 2nd hand smoke North: 7%, South: 5.7% Exposure at first health visit Pregnant smokers North: 13.4%, South: 9.9% : 12% (all ages) “Yes, I vape” 12.9% of 11–15 year olds: North: 16.3% South: 10.0% 6 Health service use Under 15 years: Lanarkshire: 666.5 : 689.9 15–24s: Lanarkshire: 469.7 : 483.7 Emergency Hospital admissions rate for unintended injuries7 Immunisation North: 96.1%, South: 95.8% : 94.8% 6-in-1 immunisation8 5 2023/24, National Dental Inspection Programme 6 Vaping Survey Report 2024 (landed.info) 7 2023/24, rate per 100,000 population Overview - Accident and emergency - Urgent and unscheduled care - Public Health Scotland 8 Uptake by 12 months. Scottish Immunisation and Recall System (SIRS), PHS 9 At least one delay identified in 27–30-month review. Early Breastfeeding North: 30.4%, South: 38.2% Babies breastfed at 6–8 weeks Developmental Concerns 19.3% of children at 27–30 months 9 Child Poverty North: 26.9%, South: 23.6% Children in households in relative poverty10 Teenage Pregnancy rate North: 31.0, South: 25.8 : 27.111 Positive Destinations/ Attainment12 North: 94.7%, South: 96.9% child development statistics - Scotland 2022 to 2023 - Public Health Scotland 10 2022/23, End Child Poverty Coalition, Local Child Poverty Statistics 21/22 11 Rate per 1,000 women, 2022. NRS birth registrations & Termination of Pregnancy Submissions Scotland, PHS 12 School leavers: going to an initial positive destination, Scottish Government
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NHS Lanarkshire | Director of Public Health Annual Report 2024 18 2. Health Protection 2.1 Pertussis (Whooping Cough): Maternal and Childhood Vaccinations Public Health and Pertussis NHS board health protection teams provide support and advice on: • infectious diseases • infection control • environmental health hazards Under the Public Health etc. (Scotland) Act 2008(1) NHS Lanarkshire are made aware of Laboratory confirmed cases of notifiable infectious diseases. The Health Protection Team follow these up in several ways including offering; advice to cases, contacts or health care professionals, guidance on isolation, advice on vaccinations or contact tracing as required on case by case and situation management. Pertussis is one of these notifiable infectious diseases. Pertussis (or whooping cough) is an acute bacterial disease of the respiratory tract, resulting from infection with Bordetella pertussis. Pertussis is a highly contagious infectious disease that can spread rapidly from person-to person through contact with airborne droplets. Severity of disease is closely associated to age. Infants under one year have the highest mortality rate and are most likely to be hospitalised. Infection is generally milder in adults and teenagers (2-6). Background In early 2024, an increasing number of laboratory-confirmed cases of pertussis were being reported in Scotland (figure 2.1.1). There would be a significant volume of cases self-managed by patients therefore the true number will not be known. Increased numbers of pertussis cases generally occur in 3 to 4-year cycles, however, before 2024, the last significant outbreak in Scotland was in 2012 and 2013. At the last quarter of 2023, laboratory confirmed pertussis case numbers in Scotland were more than 10 fold higher than in the preceding 3 years(4). Figure 2.1.1: Number of laboratory reports of Bordetella pertussis in Scotland by month, January 2015 to 31 August 2024 Source: PHS
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NHS Lanarkshire | Director of Public Health Annual Report 2024 19 Figure 2.1.2: Lanarkshire Laboratory Case Data Source: ECOSS data Pertussis cases in infants under the age of 3 months is of particular concern as these infants are at greatest risk of severe disease and are too young to benefit from the complete vaccination programme. Vaccination Programmes A safe and highly effective maternal pertussis vaccination programme was first introduced in October 2012, with the aim of providing passive immunity from a pregnant woman to her unborn baby to afford protection in the first few weeks of life before the infant becomes eligible to begin their immunisation course. UK studies demonstrated maternal pertussis vaccination offers around 90% vaccine effectiveness against confirmed disease and 97% protection against death from pertussis in infants under 3 months of age. Vaccination in pregnancy is highly effective. Estimated maternal uptake in Scotland (April 23-March 24) is 82.3%. Every effort should be made by midwives and other health professionals to signpost and encourage pregnant women to take up the offer of pertussis vaccination. This early protection further progresses the child's right to the best possible health (in line with the United Nations Convention on the Rights of the Child)(1, 2, 4, 7). Pertussis vaccine is included in the routine national childhood immunisation schedule, with three doses administered at 8, 12 and 16 weeks of age, and one dose as a pre-school booster.(8) In 2023 in Lanarkshire uptake of the primary course of pertussis containing vaccine was 95.0% by 12 months of age, and 89.6% for the pre-school booster by 5 years of age. These figures represent a gradual decline in uptake, in keeping with other vaccination programmes Over the past decade this has reduced from 97.4% by 12 months of age, and 94.2% for the pre-school booster by age 5 years in 2014(1, 2, 4). Key Points • After a significant rise in early 2024, laboratory confirmed cases of Pertussis within Scotland and Lanarkshire are now falling. Increased rates of pertussis placed additional burden on the NHS within acute services and primary care.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 20 • Vaccine uptake levels across the UK including Lanarkshire have steadily fallen in pregnant women, babies and young children. • Pertussis can affect people of all ages and while it can be a very unpleasant illness for older vaccinated adolescents and adults, infants who are too young to be fully protected through vaccination are at greatest risk of serious complications or, rarely, death. A large proportion of infants who develop symptoms of pertussis will require hospitalisation. Priorities for Action • Midwives, Obstetricians, other Clinicians and Health Care Professionals are strongly encouraged to promote uptake of maternal vaccinations, including pertussis. Women in pregnancy will typically be offered a pertussis-containing vaccination between 20 and 32 weeks gestation but can receive it as early as week 16. Women should be vaccinated in each pregnancy. • Clinicians should encourage and bolster vaccination uptake through routine Health Visitor childhood vaccination programmes. • Every effort should be made to identify and offer vaccination to un-immunised and under- immunised individuals in NHS Lanarkshire. • NHS Lanarkshire will continue to adopt a proactive assessment approach to our vaccination programmes and uptake levels to encourage all those eligible to be fully protected and vaccinated. References (1) Public Health Scotland etc. (Scotland) Act 2008 https://www.legislation.gov.uk/asp/2008/5/schedules/2022-09- 01 (accessed 31st December 2024) (2) UKHSA (2024) Pertussis: the Green book, chapter 24 https://www.gov.uk/government/publications/pertussis- the-green-book-chapter-24 (accessed 31st December 2024) (3) NES training resources: Immunisation, Pertussis (whooping cough): https://learn.nes.nhs.scot/14726/immunisation/pertussis-whooping-cough (accessed 31st December 2024) (4) Public Health Scotland (2024), Guidelines for the Public Health Management of Pertussis, https://publichealthscotland.scot/publications/guidelines-for-the-public-health-management-of- pertussis/guidelines-for-the-public-health-management-of-pertussis-version-3/ (accessed 31st December 2024) (5) Public Health Scotland (2021), Pertussis enhanced surveillance form for infants aged under one year: https://publichealthscotland.scot/publications/surveillance-form-pertussis-incident-form-for-infants-under-one- year/surveillance-form-pertussis-incident-form-for-infants-under-one-year-december-2021/ (accessed 31st December 2024) (6) UK Health Security Agency - Guidance on the management of cases of pertussis in England during the re- emergence of pertussis in 2024; Update: August 2024: https://www.gov.uk/government/publications/pertussis- guidelines-for-public-health-management (accessed 31st December 2024) (7) NHS Inform, Whooping cough: causes, symptoms, treatment and when to seek help : https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/whooping-cough/ (accessed 31st December 2024) (8) Public Health Scotland (2025), Baby and Child Immunisations. https://publichealthscotland.scot/population-health/health-protection/immunisation-vaccine-and-preventable- disease/immunisations-by-group/baby-and-child/ (accessed 4th Feb 2025) Further useful links: NHS Inform information on pertussis vaccination in pregnancy: • https://www.nhsinform.scot/healthy-living/immunisation/vaccines/whooping-cough-vaccine/,
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NHS Lanarkshire | Director of Public Health Annual Report 2024 21 • https://www.nhsinform.scot/translations/languages/british-sign-language-bsl/immunisation/whooping- cough-vaccine-bsl/ and • https://www.nhsinform.scot/translations/formats/audio/immunisations/help-protect-your-baby-from- whooping-cough-audio/ (accessed 31st December 2024) Caroline Thomson, Health Protection Nurse Consultant Email: caroline.thomson2@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights Promotion of the vaccine in pregnant women ensures early protection for babies, further progressing article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 22 2.2 Childhood Vaccination Background NHS Lanarkshire is responsible for the delivery of all childhood vaccination programmes. The primary vaccination service is delivered by the health visitor and school nursing teams split between North and South. Figure 2.2.1 shows the routine schedule for childhood vaccinations in Scotland. Figure 2.2.1: Immunisation – Routine schedule in Scotland Data Source: NHS Inform, illustrated by Claire Cameron Public Health Scotland Uptake Public health Scotland (PHS) (1) reports the success of the immunisation programme with high uptake rates; however, emphasis has been made on the need to halt the current decline. Despite the decline of uptake rates for all immunisations over the past 10 years, Lanarkshire remains high in comparison to the Scottish average. In the year ending 2024, Lanarkshire uptake for many of the immunisations remain above The World Health Organization (WHO) (2) recommended coverage rate of 95% for the prevention of outbreaks (see Figure 2.2.2), with the exception of Rotavirus, which PHS (3) reports to be under the recommended threshold by 1.7%, and the 4-in-1 immunisation that is also under by 2.5%. The Measles, Mumps and Rubella (MMR) uptake rates for the first and second dose are also under the advised threshold, except for the MMR1 immunisation at age 5, which is 95.3%. Uptake remains better in South Lanarkshire in comparison to North Lanarkshire with the exception of the age 5 immunisation uptake (4) (See Appendix 18).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 23 Figure 2.2.2: Summary of immunisation uptake rate in Lanarkshire in comparison to Scotland end of financial year 2024 Data source: Public Health Scotland (PHS). The WHO(2) highlights that low vaccination coverage for MMR vaccinations and measles outbreaks across 103 countries are being reported, however, encouragingly Scotland is amongst the 91 countries with good uptake rates. Vaccine apathy is defined by Wood et al(5) as a general disinterest in vaccination and highlights the little time people spend considering vaccination. Kamloops(6) states this is due to the success of past immunisation campaigns in eradicating or greatly reducing diseases such as Smallpox and Polio, and with lower occurrence of these and other diseases, parents see less need for vaccination. The WHO(7) highlights vaccine apathy as a main contributor of low vaccine uptake, inconvenience in accessing vaccines, complacency, and lack of confidence are all noted as some of the key reasons for hesitancy. NHS Lanarkshire Public Health Directorate work closely with the vaccination service to provide guidance and support to staff and service leads. Higher vaccination uptake in Lanarkshire can be accredited to the vaccination teams’ sound knowledge base and close working partnerships with children and families Assessing maturity and understanding, listening to the voices of children and providing them with the correct information in a format they can understand, allows children under 16 to make an informed choice in line with Gillick competence and Fraser guidelines(8), This provides an accessible service that children and parents can be confident in and use in the future and also supports the progression of children’s rights. NHS Lanarkshire Public Health has put in place key measures within the service to develop strategies for pre-school children, school age children and targeted groups (including groups within the population that may have lower vaccination uptake than the general population for various reasons). Low uptake has been identified by the Scottish Public Health Observatory(9) to be linked with factors such as in single parenthood, area deprivation, high birth order and family size. The Identification of geographical areas in Lanarkshire with disproportionately low uptake of vaccination will be key to reducing disparities and meeting the needs of Lanarkshire’s population, 88% 89% 90% 91% 92% 93% 94% 95% 96% 97% 98% 6-in-1 PCV Rotavirus Meningitis B 6-in-1 MMR1 Hib/Menc PCVB Meb B (Booster) MMR1 Hib/Men C 4-in-1 MMR2 MMR1 4-in-1 MMR2 Primary immunisations by 12 months Primary and booster immunisation by 24 months Primary and booster immunisation by age 5 years of age Primary and booster immunisation by age 6 years of age % Immunisation Coverage Childhood Immunisation Uptake Rate, by financial year 2023-2024 Uptake For Lanarkshire Uptake for Scotland Immunisation Target rate of 95%
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NHS Lanarkshire | Director of Public Health Annual Report 2024 24 increasing uptake of vaccination and working towards a preventative approach to enhance health outcomes. Annual Flu and HPV vaccination to Children and Young People Flu vaccinations are offered to all primary and secondary children from September to December. NHS Lanarkshire work closely in collaboration with schools to provide updated guidance and resources to ensure high uptake rates. Figure 2.2.3: Coverage of Human Papilloma Virus (HPV) Immunisation (single dose) by the end of the school year 2023/24, by Board of school; Pupils in S2 Data Source: Public Health Scotland (PHS) HPV vaccines were previously offered to school children as a three-dose schedule. As of the 1st of January 2023, children aged 15 will be offered one dose. Disparity in figure 2.2.3 has been reported by PHS(10), noting a higher uptake rate in females than in males. However, male uptake rates in Lanarkshire for 2023/2024 in S2 pupils is the highest in Scotland with the least difference in rates between male and female groups. The graph also shows Lanarkshire to have the second highest uptake rates in Scotland overall for this cohort. Key Points • Vaccination uptake above 95% is essential to prevent infectious diseases across the population. Targeting areas of low uptake and identifying barriers will improve health outcomes for the population of Lanarkshire and at national level. • Investment is vital to ensure immunisation teams have the resources and staffing to continue to maintain and improve vaccination rates across the population. • Focused work to remove barriers and factors contributing vaccine apathy and hesitancy is vital. Priorities for Action • A comprehensive ongoing analysis of all available vaccination related data will be required. • A joined-up review of all relevant aspects of vaccination services to identify what systemic changes are required to turn around the decline and maintain uptake levels above 95%. • We will continue working closely with children and young people, ensuring their voice is heard and information is given to them in a way they can understand, in line with the United Nations Convention on the Rights of the Child (UNCRC).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 25 References (1) Public Health Scotland (2024) Protecting the population of Scotland from Vaccine preventable diseases: Vaccination and Immunisation Report, Public Health Scotland Publishes First Annual Vaccination and Immunisation Report 2023 - News - Public Health Scotland., accessed 22/10/2024 (2) World Health Organization (2023) Global childhood immunization levels stalled in 2023. Leave many without life-saving protection, Global childhood immunization levels stalled in 2023, leaving many without life-saving protection,. accessed 23/10/2024 (3) Public Health Scotland (2023) Childhood immunisation statistics Scotland annual uptake rates by deprivation, Childhood immunisation statistics Scotland - Quarter ending 30 September 2024 - Childhood immunisation statistics Scotland - Publications - Public Health Scotland,. accessed 07/01/2025 (4) Public Health Scotland (2024) Childhood Immunisation Statistics Scotland Quarterly uptake rates by NHS Board of Treatment, Childhood immunisation statistics Scotland - Quarter ending 30 June 2024 - Childhood immunisation statistics Scotland - Publications - Public Health Scotland,. accessed 22/10/2024 (5) Wood S, Schulman K. JAMA: The Journal of the American Medical Association. 2021; 22/29 Volume 325 (24): 2435 – 2436. When Vaccine Apathy, Not Hesitancy, Drives Vaccine Disinterest | Shared Decision Making and Communication | JAMA | JAMA Network,. accessed 06/01/2024 (6) Vaccine apathy a health threat. Kamloops Daily News. 2013 Nov 27: Available from: Open Athens / Sign in (Internet). Proquest.com. 2025 (cited 2025 Jan 7). https://www.proquest.com/docview/1462170435?sourcetype=Newspapers,.accessed 06/01/2024 (7) World Health Organization (2019) Ten threats to global health in 2019, Ten threats to global health in 2019,. accessed 23/10/2024 (8) National Society for the Prevention of Cruelty to children (2022) Gillick competency and Fraser guidelines Gillick competence and Fraser guidelines | NSPCC Learning,. accessed 04/11/2024 (9) Public Health Information for Scotland (2024) The Scottish Public Health Observatory, Children - ScotPHO,. accessed 23/10/2024 (10) Public Health Scotland (2022/23) HPV Immunisation Statistics Scotland School year 2022/23: A National Statistics release for Scotland, HPV Immunisation Statistics Scotland. accessed 07/01/2025 Aileen O’Neill, Public Health Programme Manager Email: Aileen.oneill2@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights Listening to the voices of children and young people and providing them with information in a format they understand, allows them to make an informed choice and put them at ease. This supports the progression of children’s rights, in particular UNCRC article 12 (voice of the child) and UNCRC article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 26 3. Children & Young People 3.1 Children’s Voices Introduction Children have a right to have their voices heard, and this is now protected by the law. We asked children and young people within our schools to get involved in this year’s Director of Public Health Annual Report. They were invited to draw a picture and tell us what they believe they need to be healthy. You will see some of the amazing designs within the report. We had 433 entries from Primary, Secondary and Additional Support Needs schools. Choosing which pictures to include was a very difficult task. Within NHS Lanarkshire, we want to ensure that children’s voices are heard and that we engage with them. Findings The majority of younger children highlighted one or two of the key themes below, the most frequently cited themes in this age group were eating a healthy diet and being active, both in sports or being outside in nature. As the children got older, they tended to report a more holistic understanding of health and highlighted a broader range of themes, including a focus on mental health. • Having a healthy diet, drinking water and getting enough sleep. • Less screen time (phones and TV), no junk food, sweets, fizzy drinks, alcohol or smoking. • Being active, playing, getting fresh air and sunshine in nature and participating in sports. • Reading, listening to music and going to school. • Vaccinations, medicine, hand washing and brushing your teeth. • Looking after your mental health. Mental health was interpreted in several ways: - friendship - happiness - not listening to negative comments - having a positive mindset - positive self-talk - sense of community - being okay with your feelings and body - opening up to people if you’re having a difficult time. The healthy foods mentioned were strawberry, banana, blueberry, watermelon, apple, tomato, onion, carrot and broccoli. It was great to note that many of the young people also mentioned that protein was an important factor in a healthy diet. The activities that were mentioned were playing, walking, running, scootering, trampolining, cycling, dancing, gymnastics, netball, basketball, football, yoga, meditation, horse riding, swimming, Tae-kwon-do and going to the gym.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 27 Key Points • Article 12 within the ‘The United Nations Convention on the Rights of the Child’ (UNCRC) Act outlines the importance of children being able to have a say in all matters that affect them. • The response and quality of entries from children across all ages and schools was heartening and a great start in improving health for our children and young people • We wanted to find out what children in Lanarkshire felt they need to be healthy. It showed us that there is a really good understanding of health and wellbeing across children of various age groups in Lanarkshire. Priorities for Action • Continue to increase understanding of and capacity for participation and engagement of children and young people within NHS Lanarkshire. • Review how we incorporate findings / themes in our plans and policies to improve services and opportunities for children and young people to lead a healthy life. • Work with partners where possible to reduce duplication and focus efforts around children’s voice. Alana McGlynn, Public Health Programme Manager Email: alana.mcglynn@lanarkshire.scot.nhs.uk ‘Don’t listen to negative comments or let others’ thoughts hurt you’. ‘It is important we speak to people and open up about our emotions for positive mental health, it’s ok not to be ok’. ‘You need water, fruit, sleep, exercise and most important being HAPPY! ‘I think you need to get a lot of exercise and have nutritious foods (so don’t have junk food all the time)…meditation and stay hydrated’ ‘To be healthy you need to wash your hands and do that after the bathroom or anything that is gross that is not yours’ ‘I believe you need lots of water, sunshine, exercise, good sleep, less screen time and more playing outside’ ‘Taking my dolly for a walk to the park’ ‘riding a bike in the sun’ ‘water and sunshine’ ‘I need blueberries and other fruit’ ‘eat a lot of broccoli, play with the ball and get sleep’ ‘I like to eat lots of vegetables because they are good for you. I like to read books because when you are upset it makes me feel better’ ‘be smart’ ‘To be healthy, there are 3 main things, healthy eating, lots of sleeping (I don’t sleep in though!) and loads of exercise, make sure you do this on a regular basis and you could become really healthy!’
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NHS Lanarkshire | Director of Public Health Annual Report 2024 28 3.2 The United Nations Convention on the Rights of the Child Background The United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Act 2024(1) came into effect on 16 July 2024. This landmark legislation ensures that all children and young people in Scotland, under the age of 18, have their rights protected. Under this new law, NHS Lanarkshire and all other public bodies are required to take proactive steps to ensure the protection of children’s rights in their decision-making and service delivery. This responsibility extends to our commissioned services and independent contractors. The United Nations Convention on the Rights of the Child (UNCRC) outlines 42 rights, known as articles. The new legislation impacts all NHS Lanarkshire services and decisions affecting children and young people, whether directly or indirectly. It builds upon the excellent work of Getting It Right for every Child (GIRFEC). Implementation NHS Lanarkshire’s Implementation Plan for UNCRC (January-December 2024) is focused around 8 themes, with an overarching focus on children and young people who are more likely to have their rights breached. Theme 1: Leadership, Corporate Commitment and Planning Theme 2: Accountability, Reporting and Measuring Progress on Children’s Rights Theme 3: Participation and Empowerment of Children and Young People Theme 4: Child Friendly Complaints Procedure Theme 5: Training, Awareness Raising and Improving Practice – Tools and Resources to support you work Theme 6: Publishing Child Friendly Information Theme 7: Children’s Rights Budgeting Theme 8: Non-discrimination/Rights at Risk We are required to report to Scottish Government every 3 years, however a yearly internal monitoring exercise will take place to track progress. Examples of work taken place includes: • Development of “How to Guides” to support our staff, around topics such as participation and engagement, best interests, compatibility assessments and developing child friendly information. • Awareness raising sessions, communications and specialist workshops, including senior leaders within the organisation. • Integration within Equality and Diversity Impact Assessment. • Increased promotion of Care Opinion Bear and other ways of gathering feedback, particularly within adult services who also treat children, for example the Emergency Department, outpatients and day surgery.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 29 Figure 3.2.1: Care Opinion Bear Poster Key Points • The United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Act 2024 came into effect on 16 July 2024. This landmark legislation ensures that all children and young people in Scotland, under the age of 18, have their rights protected. • UNCRC outlines 42 rights, known as articles, that all children and young people in Scotland are entitled to. • NHS Lanarkshire is taking active steps to ensure that we are complying with this legislation and that children’s rights are advanced across our system. Priorities for Action • Continue to work with directorates across the system to increase awareness and ensure compatibility with the UNCRC legislation. • Progress with local NHS Lanarkshire implementation plan for UNCRC. • Increase understanding of and capacity for participation and engagement of children and young people across NHS Lanarkshire decision making and service delivery. • Incorporate introduction of a new child friendly complaints process. References (1) United Nations Convention on the Rights of the Child Act 2024. Available at: https://www.legislation.gov.uk/asp/2024/1/contents (accessed 30 December 2024) Alana McGlynn, Public Health Programme Manager Email: alana.mcglynn@lanarkshire.scot.nhs.uk
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NHS Lanarkshire | Director of Public Health Annual Report 2024 30 3.3 Child Poverty Background The Child Poverty (Scotland) Act 2017(1) places a duty on local authorities and health boards to co-produce a Local Child Poverty Action Report (LCPAR) each year. These can be found on the Improvement Service website.(2) These reports describe work that has been done, and actions that are planned to tackle child poverty at a local level. NHS Lanarkshire contributes to both the North and South Lanarkshire reports. Official Scottish Government statistics, published in March 2024(3) show that 24.2% of all children in Scotland are living in poverty (from the period 2020-2023). The most recent Lanarkshire figures for 2022-2023(4) of children living in households in relative poverty, after housing costs, are 23.6% in South Lanarkshire and 26.9% in North Lanarkshire. This data, and trends across previous years, are presented in the graph in Figure 3.3.1. Figure 3.3.1: Proportion of children who are living in relative poverty, after housing costs Please note that the overall Scotland figure is taken from three-year averaged estimates, based on data from the Family Resources Survey and published by Scottish Government(3). Latest estimates are however only for a two-year period, with data from April 2020-March 2021 removed due to quality issues related to the pandemic. The local authority figures are calculated from DWP data, published annually by the End Child Poverty Coalition and the Centre for Research in Social Policy at Loughborough University(4). In 2023, Public Health Scotland identified four key areas where NHS boards across Scotland could maximise their contribution to reducing child poverty. Table 3.3.1 details examples over the 2023-2024 financial year of NHS Lanarkshire contributions to tackling child poverty, against each of these key areas. 0% 5% 10% 15% 20% 25% 30% 2018/19 2019/20 2020/21 2021/22 2022/23 (Local Authority uses DWP data, Scotland uses Scottish Government analysis of the Family Resources Survey) Year groupings for Scotland data differs, the groupings are: 2016-19, 2017-20 Performance North Lanarkshire Performance South Lanarkshire Performance Scotland (year groupings differ) Target by 2024 Target by 2030 Lower is better
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NHS Lanarkshire | Director of Public Health Annual Report 2024 31 Table 3.3.1: NHS Lanarkshire activities to reduce child poverty against 4 key areas Key Area Example of Activity 1. Ensure tackling child poverty is prioritised at a senior level The Director of Public Health presented at the joint North Lanarkshire Tackling Poverty conference in April 2024, alongside key local and national speakers, to around 150 delegates. 2. Implement an Anchor Organisation approach, ensuring that reducing child poverty and the priority families are a priority outcome NHS Lanarkshire supported 38 unemployed or low earning parents to enter placements within our organisation as part of the demonstrator 2 programme(5). 71% have gone onto positive destinations, securing employment or joining the Staff Bank. 3. Supporting and sustaining income maximisation services/pathways NHS Lanarkshire are one of 4 Boards chosen to be part of a Public Health Scotland led project “Deep Dive into Income Maximisation in Health” into the barriers and enablers of this work, to help inform future development. NHS Lanarkshire were also successful in a partnership bid to the Scottish Government Child Poverty Accelerator fund which will support 10 local families with disabled children access more intensive support to help them to improve their financial situation. 4. Increasing awareness and understanding across frontline NHS Staff. Key awareness raising periods in the year, including Challenge Poverty Week and Talk Money Week are promoted widely across the organisation via various platforms. Key Points • Child poverty remains high in Scotland and in Lanarkshire. • NHS Lanarkshire work alongside local partners to deliver actions and help mitigate the impacts of child poverty. This is recorded via the Local Child Poverty Action Reports. • We ensured the rights of the child were respected throughout this work, in line with UNCRC. Priorities for Action • Continue to utilise national NHS and Local Authority networks, where best practice in tackling child poverty is shared. • Engage with new and existing services across the organisation to implement routine enquiry of finances and staff training. • Engage in the Public Health Scotland Deep Dive into Income Maximisation in Health Project to help inform future developments. References (1) Child Poverty (Scotland) Act 2017 (https://www.legislation.gov.uk/asp/2017/6/contents/enacted), accessed 07/10/2024 (2) Improvement Service website, Local Child Poverty Action Reports (https://www.improvementservice.org.uk/products-and-services/inequality-economy-and-climate-change/local- child-poverty-action-reports), accessed 10/01/2025
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NHS Lanarkshire | Director of Public Health Annual Report 2024 32 (3) Scottish Government, Poverty and income Inequality in Scotland 2020-2023, (https://data.gov.scot/poverty/), accessed 07/10/2024 (4) End Child Poverty Coalition, Local Child Poverty Statistics 2022-2023, (https://endchildpoverty.org.uk/child- poverty-2024/), accessed 07/10/2024 (5) NHS Lanarkshire, The Pulse “Celebrating NHS demonstrator programme” (https://www.nhslanarkshire.scot.nhs.uk/pulse-celebrating-nhs-demonstrator-programme/), accessed 13/11/2024 Johann Duffy, Senior Health Improvement Officer Email: jo.duffy@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights This work progresses several children’s rights, including article 26 (if my family need it, they should get money to help bring me up) and article 27 (I have the right to have a proper home, food and clothing). Listening to lived experience is also key for service design and delivery (article 12, voice of the child).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 33 3.4 Breastfeeding Background Exclusive breastfeeding goes a long way toward cancelling out the health difference between being born into poverty and being born into affluence. It is a natural “safety net” against the worst effects of poverty almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.(1) Figure 3.4.1: Illustration demonstrating the need for culture change Created at NHS Lanarkshire Breastfeeding Conference, Credit: Graham Ogilvie Design NHS Lanarkshire breastfeeding rates are among the lowest in the UK. There has been some improvement over time, but there are still barriers. Living in a predominantly bottle-feeding culture makes breastfeeding more difficult. Often the support network around new parents lacks knowledge and confidence in breastfeeding and normal infant behaviour.(2) Looking critically at how we supported infant feeding as an organisation, we recognised that to really change culture requires a whole system approach to creating an environment that is supportive and enabling of normalising breastfeeding. NHS Lanarkshire has had Baby Friendly Accreditation for many years, we successfully achieved our “Achieving Sustainability Gold Award” (Figure 3.4.2) in this year, recognising the whole systems approach to supporting parents in our communities and putting the wellbeing of babies at the heart of everything we do. Baby Friendly Standards(3) complement the United Nations Convention on the Rights of the Child(4), e.g. Article 9 - children should not be separated from their parents unless it is in their best interests and Article 3 - the best interests of the child must be a top priority in all decisions and actions that affect children, including continued breastfeeding wherever possible.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 34 Figure 3.4.2: Achieving Sustainability Gold Award Changing a Culture The Becoming Breastfeeding Friendly Scotland (BFF) report(5) makes recommendations for change and whole systems working. Figure 3.4.3: BBF Scotland Recommendations In partnership with Scottish Government, Maternal and Infant Nutrition colleagues and North Lanarkshire Council (NLC), developed and piloted the Breastfeeding Friendly Scotland (BFS) Local Authority Scheme and in February 2024, NLC were awarded Gold (Figure 3.4.4). A first for Scotland! Specifically, the council has implemented a number of changes including: • Significantly improved employer support through the introduction of a corporate breastfeeding policy with workplaces facilitating continued breastfeeding/expressing when returning to work. • Established nine community breastfeeding champions of mixed gender, working with health colleagues in communities to promote and support breastfeeding. • All Early Learning establishments achieved BFS Early Learning award and 80% of all school establishments achieved the BFS Schools award. This includes NHS breastfeeding awareness training, embedding breastfeeding in the curriculum. Play environments in nurseries and early years have been redesigned promoting an environment where breastfeeding is seen as the biological normal way to feed infant. • All new-build facilities including community hubs have breastfeeding facilities designed in at the planning stage. • Foster carers completed NHS training on responsive feeding and social work staff trained on infant nutrition and benefits of breastfeeding. • Libraries, leisure and sport facilities providing warm welcome spaces and facilities for breastfeeding on site (Figure 3.4.5). • Road signage, public buildings and fleet vehicles having BFS signage in place.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 35 Figure 3.4.4: NLC BFS award presentation Figure 3.4.5: NLC BFS Gold award in place at a community venue in North Lanarkshire Impact is demonstrated in our local data (Figure 3.4.6), particularly in SIMD 1 and 2 and in mothers under 20(6). South Lanarkshire are working to embed this approach. Figure 3.4.6: Data charts for overall breastfeeding at first visit by age group and at 6-8 weeks by deprivation table Source: Public Health Scotland, Infant feeding statistics 2024 The Voice of the Babies We also consulted with breastfeeding mothers and families at two successful events in this year, our 5th Breastfeeding Conference in September 2024 and our Community Mothers 21st Birthday celebration event .
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NHS Lanarkshire | Director of Public Health Annual Report 2024 36 Key Points • NHS Lanarkshire recognises the rights of the child must be a top priority in all decisions and actions that affect children, including continued breastfeeding wherever possible • All maternity and children’s services are accredited as a Gold Baby Friendly service by Unicef UK • Taking a whole systems approach in North Lanarkshire has impacted positively on breastfeeding rates and created a supportive, enabling environment for breastfeeding. Priorities for Action • Implement the whole system approach and embed throughout NHS Lanarkshire acute services and South Lanarkshire Council • Collaborative working with local communities and working with partners to change the culture around breastfeeding • Continue to develop innovation to maintain Baby Friendly Standards and Gold Accreditation. References (1) UNICEF. The benefits of breastfeeding - Baby Friendly Initiative [Internet]. Baby Friendly Initiative. UNICEF; 2016. Available from: https://www.unicef.org.uk/babyfriendly/about/benefits-of-breastfeeding/ (2) Pérez-Escamilla R, Tomori C, Hernández-Cordero S, Baker P, Barros AJD, Bégin F, et al. Breastfeeding: Crucially important, but Increasingly Challenged in a market-driven World. The Lancet [Internet]. 2023 Feb 7;401(10375) pg 472-485. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(22)01932-8/fulltext (3) Achieving Sustainability: Standards and Guidance [Internet]. Baby Friendly Initiative. Available from: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/achieving- sustainability-standards-guidance/ (4) UNICEF. Convention on the Rights of the Child [Internet]. 1989. Available from: https://www.unicef.org/media/52626/file (5) Becoming Breastfeeding Friendly Scotland: report [Internet].2019 Scottish Government www.gov.scot. Available from: https://www.gov.scot/publications/becoming-breastfeeding-friendly-scotland-report/ (6) Public Health Scotland. Dashboard - Infant feeding statistics - Financial year 2023 to 2024 - Infant feeding statistics - Publications - Public Health Scotland [Internet]. Publichealthscotland.scot. 2024. Available from: https://publichealthscotland.scot/publications/infant-feeding-statistics/infant-feeding-statistics-financial-year- 2023-to-2024/ Susan Short, Public Health Nutritionist & Maternal and Infant Nutrition Lead Email: Susan.Short@lanarkshire.scot.nhs.uk AnneMarie Bruce, Infant Feeding Development Midwife Email: AnneMarie.Bruce@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights The range of breastfeeding work undertaken is a great example of how we are progressing many children’s rights. UNCRC article 12 (voice of the child) is progressed through engagement with mums and families, utilising UNCRC article 5 (my family should help me use my rights). Supporting mums to continue breastfeeding in various settings supports UNCRC Article 9 (children should not be separated from their parents unless it is in their best interests) and UNCRC Article 3 (best interests of the child).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 37 3.5 Child Healthy Weight – Child Weight Management Background In Lanarkshire, many children are overweight or obese (Table 3.5.1), which shows that there is a need to help them manage their weight. The Lanarkshire Healthy Lifestyle & Weight Management Service (LWMS) offers different programmes and services for people of all ages. This includes special programmes to help children, young people, and their families. Table 3.5.1: Primary 1, 2022–23; clinical categories Overweight Obese Severely Obese Lanarkshire 9.5% 4.3% 3.2% Scotland 8.8% 3.8% 3.1% Source: Primary 1 Body Mass Index (BMI) statistics Scotland. Public Health Scotland (published 10/12/24) Child Weight Management has a tiered model, (Figure 3.5.1). Within these tiers, these are the main programmes; Healthy Schools, Getting Our Active Lifestyle Started (GOALS) Groups & Full of Beans, and GOALS 1-1. Figure 3.5.1: Tiered Model of Child Weight Management Support Healthy Schools The Healthy Schools framework helps teachers plan and track health and wellbeing in schools. It uses the Curriculum for Excellence's Health & Wellbeing Experiences & Outcomes and connects them to the Wellbeing Indicators. This helps pupils move smoothly from Nursery through to Secondary School. The framework also gives teachers ideas for activities, extra resources, websites with more information, and useful physical materials. Healthy Schools is flexible and works well with other resources, helping teachers build on what pupils already know to teach health and wellbeing. GOALS 1-1 Tier 3 -Clinical referrals for specialist paediatric dietetic weight management GOALS Groups & Full of Beans Tier 2 -Targetted healthy lifestyle & healthy weight programmes Healthy Schools Tier 1 -Universal health & wellbeing within education setting
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NHS Lanarkshire | Director of Public Health Annual Report 2024 38 82.9% of all North Lanarkshire Schools and 67.9% of all South Lanarkshire Schools are using the Healthy Schools website (Table 3.5.2.). Table 3.5.2: Healthy Schools usage figures Primary School usage High School usage Additional Support Needs School usage Registered teachers NLC 118 of 119 (99.2%) 18 of 23 (78.3%) 10 of 14 (71.4%) 1119 SLC 107 of 125 (85.6%) 17 of 20 (85%) 3 of 9 (33.3%) 882 Source: Healthy Schools website analytics 2024 Full of Beans The Full of Beans programme is a fun activity for families with children aged 18 months to 5 years old. It is run by healthy lifestyle coaches in partnership with North Lanarkshire Council and South Lanarkshire Leisure and Culture. Families can join in activities while learning helpful tips on things like healthy eating, exercise, play, screen time, and sleep. Families can sign up for Full of Beans on their own, or they may be referred by Health Visitors, School Nurses, or GPs for extra support with weight management. Before joining, a Paediatric Dietitian checks each child. There are 8 Full of Beans groups that meet every week in different places across Lanarkshire all year long. GOALS (Getting Our Active Lifestyle Started) GOALS is a family-based healthy lifestyle programme that helps school-aged children, young people, and their families in Lanarkshire. It is run by specialist dietitians and physical activity experts. The goal of the programme is to help families reach a healthy weight and live a more active and healthy life. To join, families need a referral from a doctor. GOALS groups are part of a community programme that helps families make healthy changes, like improving their diet, being more active, and reducing screen time. For families with more complex needs, GOALS 1-1 offers extra support, with more help from staff and regular check-ins by a medical team. Key Points • Lanarkshire P1 data shows Child Overweight, Obese, and Severely Obese as above the national average. • Child Weight Management has a tiered model providing several key targeted programmes to support children and their families. • 82.9% of all North Lanarkshire Schools and 67.9% of all South Lanarkshire Schools are using Healthy Schools website. Priorities for Action • Utilise universal Child Health Surveillance at the 27-30 months and P1 review points to identify severely clinically obese children.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 39 • A Short Life Working Group has been set up to coordinate improvement actions around identification and referral during the 27-30 month child health review. • Raise the issue with families and encourage them to accept referrals into the LWMS. References (1) Healthy Schools, Healthy Schools website: https://healthyschools.scot/ (2) NHS Lanarkshire, Getting Our Active Lifestyle Started (GOALS) – early years, Getting Our Active Lifestyle Started (GOALS) – Early Years | NHS Lanarkshire (3) PHS (2024) Primary 1 Body Mass Index (BMI) statistics Scotland, Primary 1 Body Mass Index (BMI) statistics Scotland. Public Health Scotland publications 2023-24 Jonathan Cavana, Senior Health Improvement Manager, Healthy Lifestyle & Weight Management Service Email: jonathan.cavana@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights Leading on efforts to support a healthy weight in children progresses and protects UNCRC article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 40 3.6 The Child Health Programme Background The Child Health Programme (CHP) is an evidence-based intervention which is delivered in Scotland by Health Visiting staff. During a universally offered schedule of home visits, Health Visitors engage with parents/carers and babies/children to ensure they have the best start in life through the provision of health promotion and parenting support, early identification of physical and developmental issues, delivery of early and effective interventions and provision of support to children and families that need it most. Outputs from the CHP are reported on through the Health in the Early Years in Scotland (HEYS) Dashboard. This Public Health Scotland platform is updated on a quarterly basis and covers child development among other outcomes. The information is drawn from routine child health review appointments. Outcomes of the 13–15 month, 27–30 month or 4–5 years review are displayed as below for NHS Lanarkshire. Child Health Surveillance Data The graphs below show data extracted from the Health in the Early Years dashboard (1) in January 2025 showing the July – September 2024. The use of a pre - pandemic median allows us to compare usual levels of concerns, as during and after the COVID-19 pandemic we saw some fluctuation in recording and reporting of developmental concerns. In Lanarkshire at the 13–15 month review the percentage of children with one or more developmental concerns saw a recent decrease to 14.85% since January from March 2024 (16.77%) (figure 3.6.1). During the same time period, at the 27–30 month review, the percentage of children with one or more developmental concerns recorded has been below the pre-pandemic median to 16.33% (figure 3.6.2). For the 4–5 year age group, the percentage of children with one or more developmental concerns recorded has shown an uptick to 17.4% and remains above the pre-pandemic median (figure 3.6.3). Figure 3.6.1: Percentage of children with one or more developmental concerns recorded at the 13–15 month review
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NHS Lanarkshire | Director of Public Health Annual Report 2024 41 Figure 3.6.2: Percentage of children with one or more developmental concerns recorded at the 27–30 month review Figure 3.6.3: Percentage of children with one or more developmental concerns recorded at the 4– 5 year review Source: https://scotland.shinyapps.io/phs-health-in-the-early-years-in-scotland/ Support for children and families Close monitoring of the above trends has led to senior staff and their wider teams recognising the need to understand these data further and ensure that affected children and their families are receiving adequate support. An example of this work is within the neurodevelopmental pathway, where work with Health Visiting staff is helping to support them to recognise and respond to neurodevelopmental concerns that may be identified at child health reviews. Awareness raising via social media channels is also taking place which signposts to sources of support including neurodevelopmental workshops for both professionals and families.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 42 Key Points • The Child Health Programme is a universally accepted tool that helps to identify developmental concerns early and offer support to families. • Those children with one or more developmental concerns have been showing a recent decrease at 13-15 and 27-30 month reviews and increasing at 4-5 year old reviews in Lanarkshire. • Work continues to identify children with developmental concerns and to offer support to them and their families. Priorities for Action • Continue to robustly complete the Child Health Programme within appropriate timeframes. • Continue to work with families on appropriate, timely supports. • Monitor developmental concerns in the pre-5 population with an aim to reducing them to appropriate levels as indicated by the Scottish Government. References (1) PHS, Health in the Early Years in Scotland (HEYS) dashboard: https://scotland.shinyapps.io/phs-health-in- the-early-years-in-scotland/ Karen McGuigan, Consultant in Public Health/Child Health Commissioner Email: karen.mcguigan@lanarkshire.scot.nhs.uk Jill Irwin, Associate Nurse Director (Interim) Jill.irwin@lanarkshire.scot.nhs.uk Carrie McCulloch, Associate Nurse Director Carrie.McCulloch3@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights By monitoring data, we can work with children, families and professionals in a timely manner, protecting and progressing UNCRC article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 43 3.7 Keeping ‘The Promise’ for Care Experienced Children and Young People Background Scotland’s vision for our children is that they grow up loved, safe, respected and realise their full potential. The Independent Care Review was published in February 2020(1). It produced ‘The Promise’ Plan 21–24(2) which is built on five foundations of voice, family, care, people and scaffolding. Since then, Plan 24–30(3) has been published. Both of these are transformational plans which must be delivered over ten years in order to ‘Keep the Promise’ to care experienced children and young people. We recognise that for many care experienced children and young people, being in care has a protective effect, but for others this is not the case. Recently published data noted that children in the care system are more likely to have concerns about their development from an early age; nearly 40% of looked after children had concerns noted at 27–30 month health reviews, which was more than twice the rate for non-looked after children (18%) (4). Local data and Our Responsibilities The number of care experienced children and young people in Lanarkshire varies from year to year. The data below is from 2023 (5) Figure 3.7.1: North Lanarkshire looked after children on 31 July, 2018 to 2023, rate per 1,000 (0–17 population) Source: Scottish Government's Children's Social Work Statistics - www.gov.scot/collections/childrens-social-work/
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NHS Lanarkshire | Director of Public Health Annual Report 2024 44 Figure 3.7.2: South Lanarkshire looked after children on 31 July, 2018 to 2023, rate per 1,000 (0–17 population) Source: Scottish Government's Children's Social Work Statistics - www.gov.scot/collections/childrens-social-work/ NHS Lanarkshire, like our local authority partners, has responsibilities as ‘corporate parents’. It is important that children and young people feel the benefit of Scotland’s good parenting, including those who are care experienced. NHS Lanarkshire is committed to supporting care experienced children and young people who come in contact with our services. When children and young people become care experienced, the NHS has a responsibility to complete a health needs assessment with them. This is an opportunity to identify any areas that these individuals need support with. They also provide an opportunity for a yearly catch up with NHS services to monitor on-going health needs. A Throughcare and Aftercare Nursing service has been established within NHS Lanarkshire in recognition of a gap in service provision for young care leavers transitioning into adulthood. The foundations of The Promise facilitate the role of the Nurses to provide a caring and compassionate scaffold of support, advice and guidance to young people, aged 16-26 years. Support is provided to empower the young person to access universal, preventative and early intervention services relating to their health and wellbeing. The nationally produced Plan 24–30 offers NHS Lanarkshire an opportunity to refresh their commitment to care experienced children and young people to ensure they feel adequately supported as is the role of all good parents. Key Points • NHS Lanarkshire has a role as a ‘corporate parent’ to care experienced children and young people. • In some cases, the health of care experienced children and young people can be poorer than the general population. • We must offer support to our care experienced children and young people to achieve their full potential.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 45 Priorities for Action • Raise awareness of roles and responsibilities around being a corporate parent within NHS Lanarkshire. • Examine locally available health data for care experienced children and young people. • Engage with care experienced children and young people to ensure their voice is heard in NHS Lanarkshire. References (1) The Promise Scotland (2020) Independent Care Review,www.carereview.scot (2) The Promise Scotland (2021) Plan 21-24 https://thepromise.scot/resources/2021/plan-21-24.pdf (3) The Promise Scotland: Plan 24-30 https://thepromise.scot/what-must-change/plan-24-30/ (4) MRC/CSO Social and Public Health Sciences Unit. Allik, M., Brown, D., Gedeon, E., Leyland, A. H. and Henderson, M. (2022) Children’s Health in Care Scotland (CHiCS) Main findings from population-wide research www.gla.ac.uk/media/Media_989673_smxx.pdf (5) Scottish Government. Children’s Social Work Statistics 2022-23 https://www.gov.scot/collections/childrens- social-work/ Karen McGuigan, Consultant in Public Health/Child Health Commissioner Email: karen.mcguigan@lanarkshire.scot.nhs.uk Jill Irwin, Associate Nurse Director (Interim) Jill.irwin@lanarkshire.scot.nhs.uk Carrie McCulloch, Associate Nurse Director Carrie.McCulloch3@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights Ensuring that dedicated health support is given to care experienced children and young people is an example of UNCRC article 2 (all children have these rights no matter what their differences are) in practice. Ultimately progressing article 24 (right to the best possible health). Listening to their voices to improve service delivery is also very important for us, progressing article 12 (voice of the child).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 46 3.8 Pregnancy and Newborn Screening Programme Pregnancy and newborn screening (PNBS) programmes aim to identify a range of conditions that may affect the health and wellbeing of the mother and newborn. This allows for early detection and timely management. The majority of those screened will not have these conditions. For the small number who do, early detection can make a significant difference in health outcomes. Background and Importance of PNBS Programmes NHS Lanarkshire provides all the national PNBS programmes available in Scotland. All pregnant women between 8 and 12 weeks of pregnancy are offered screening for infectious diseases and haemoglobinopathies. Infectious diseases screening involves testing for HIV, Hepatitis, and Syphilis. Haemoglobinopathies are genetic conditions that affect red blood cells e.g. Sickle Cell Disease. Trisomy (when baby has an extra chromosome) screening can be offered in both the first and second trimester. Informed patient choice is important. The conditions screened for are Down’s, Edwards’, and Patau’s Syndrome. First trimester screening is the preferred option and is a combination of an ultrasound measurement and blood testing. Women receiving a high-chance trisomy screening result are offered the non-invasive prenatal testing (NIPT), which can reduce the need for invasive procedures. The Foetal Anomaly Screening Programme (FASP) involves a detailed ultrasound scan between 18 and 20 weeks of pregnancy. Following birth, babies are offered hearing and bloodspot screening. The Universal Newborn Hearing Screening (UNHS) aims to detect significant permanent hearing loss in babies. It is offered within the first 4 weeks of life. The Newborn Bloodspot (using a heel prick blood test) Screening aims to assess babies for nine rare metabolic and genetic conditions. It is usually undertaken between four and five days after birth. Testing for all 9 conditions can still be done up until 8 weeks, and 8 of the 9 can be offered until 1 year of age. Figure 3.8.1: Pregnancy (antenatal) and Newborn Screening Timeline Before 10 weeks: Haemoglobinopathies - Sickle cell and Thalassaemia* Screening test: Family origin questionnaire and blood tests for higher risk 8 and 12 weeks: Infectious Diseases- Hepatitis B, HIV and Syphilis* Blood test 11 and 14 weeks: First Trimester screening for Trisomy (Down’s syndrome, Edwards’ syndrome and Patau’s syndrome) Ultrasound and blood tests 14 and 20 weeks: First Trimester Screening for Trisomy if missed during the first trimester. Blood test only 18 and 21 weeks: Mid-pregnancy screening ultrasound scan Foetal Anomaly Scan (FAS) Birth Birth to 4 weeks: Universal Newborn Hearing Screening (UNHS) Tests baby’s response to sounds Four to five completed days of birth: Newborn Bloodspot Screening Heel prick blood test
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NHS Lanarkshire | Director of Public Health Annual Report 2024 47 Table 3.8.1: Summary of PNBS Screening Programmes and Key Performance Indicators (KPIs) Screening Test Target Population Denominator / Time Frame Standard/KPI Uptake Outcomes Haemoglobinopathies Family Origin Questionnaire (FOQ) and blood test Pregnant women at antenatal booking 5946 (January – December 2023) No standard for uptake ≥95% completion of FOQ forms 99.5% 77.7% of FOQ forms were complete 974 (97.2%) blood tests requested following questionnaire. Blood testing: 12 required further investigation. 198 carrier/found to have trait 13 with Sickle Cell Disease or other haemaglobinopathy Infectious Diseases Screening Blood test for Hepatitis B, HIV and Syphilis Pregnant women offered testing (takes into account miscarriage and transfers) 5669 women (Year ending 31 December 2023) ≥ 95.0% coverage for Hepatitis B, HIV, and Syphilis testing. 99.5% Almost all women tested; <5 declined testing for each infection. Most women test negative Trisomy Screening First and Second Trimester Trisomy Screening Pregnant women undergoing trisomy screening 5,946 (Year ending 31 December 2023) No standard because acceptance is a matter of personal choice 86.9% 13.7% of screenings occurred in the second trimester (versus 15.3% for Scotland), showing improvement from 21.1% previous years 115 NIPT screens were carried out Mid-trimester/Detailed Ultrasound scan Foetal Anomaly Scan (FAS) All eligible pregnant women 5790 (April 2022 – March 2023) 90% of eligible pregnant women should have a FAS 87.1% 70 abnormal scans, of these 43 (61.4%) were live births
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NHS Lanarkshire | Director of Public Health Annual Report 2024 48 Screening Test Target Population Denominator / Time Frame Standard/KPI Uptake Outcomes Newborn screening Universal Newborn Hearing Screening (UNHS) All newborn babies born to Lanarkshire residents or moving into Lanarkshire under the age of 12 weeks 6024 (April 2022 – March 2023) 98% of babies should have completed the hearing screen by 10 weeks. 99.7% 5 babies detected with moderate to severe permanent hearing loss. All babies were referred on to audiology for further assessment. Newborn Bloodspot Screening All newborn babies born to Lanarkshire residents and babies with no bloodspot result moving into Lanarkshire before age 12 months 6438 (April 2023 – March 2024) 99.5% of infants should have a screening result or repeat test 6065 (94.2%) and Movers- in and declines accounted for 5.8% Avoidable repeat rate - 4.09% 5 suspected conditions referred for follow-up 41 carriers (found to have a genetic trait) of various childhood conditions screened for were identified.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 49 Key Points • Overall, the PNBS is performing well. Availability of high-quality data locally and nationally is a challenge. There is a need for consistency of recording of screening offers, completion of family origin questionnaires, and outcomes on the digital clinical system. • In NHS Lanarkshire, 92.5% are booked into maternity services by 12 weeks (standard is 90%). However, earlier booking allows for timely offer of screening tests. Quality improvement work over the next year will focus on further reducing the proportion of second trimester screening. • Bloodspot screening should be offered to all Movers-in to Lanarkshire. To improve uptake, an updated protocol is in place and additional awareness raising will be undertaken with health visitors. Priorities for Action • Improve the quality of recording in local digital clinical systems. Ensure staff consistently record pregnancy outcomes clearly and complete key forms e.g. family origin questionnaire. • Continue to engage nationally to increase use of linked data. This would support a national approach to reporting against standards and reduce issues with manual data entry. • Through the Screening Inequalities Action Plan, further engage with staff to provide comprehensive and accessible information, enabling all women, regardless of background or circumstances to make informed choices about screening and engage with maternity services as early as possible. Praveena Symeonoglou, Public Health Researcher Email: praveena.symeonoglou@lanarkshire.scot.nhs.uk Dr Cathy Johnman, Consultant in Public Health Medicine and Non Cancer Screening Programmes Coordinator Email: cathy.johnman@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights This work ensures that UNCRC article 3 (best interests of the child) and article 24 (right to the best possible health) are protected and progressed.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 50 3.9 Children and Young People’s Mental Health and Resilience Background In Scotland it has been suggested that children and young people have seen an increase in the incidence of mental health and wellbeing stressors. In addition to this many have experienced mental health stigma and discrimination(1). On the whole children and young people’s mental health and wellbeing has seen a decline in recent years(2). NHS Lanarkshire, along with partnerships across both North and South Lanarkshire local authorities set out priorities within both Children’s Services Plans(3, 4) and the Infant, Children and Young People’s Health Plan(5) to combat this and nurture positive changes for the children and young people of Lanarkshire. The following reports on a range of these developments and areas that have ensued to address this. Lanarkshire Wide Across both North (in March 2023), and South (in June 2022) Lanarkshire, there has been the introduction of Kooth. This is an online service and has provided a number of supports for the children and young people of Lanarkshire including self-help resources, community supports, and 1-1 support. Kooth offers 24/7 support with 71% of logins in North Lanarkshire, during the 12 months of June 2023–24 being outwith the standard hours of 9–5(6). In South Lanarkshire, Kooth had been accessed by 579 children and young people during the period of July 2023 – March 2024 further evidencing its success(7). Figure 3.9.1: Kooth image showing a brief overview of the service. Source: Kooth Website South Lanarkshire School Counselling in South Lanarkshire has seen 1411 children accessing the service in the period from July 2023 – March 2024(7). Of this 909 identified as female and 482 as male, (remaining children opting to not identify). Onward referrals made to a number of agencies including Child and Adolescent Mental Health Services (CAMHS), child protection, and third sector, totalling 91. A range of reasons for presenting came through; of these the highest were: Anxiety – 605, family issues – 385, relationship/ friendship – 223, and emotional/ behavioural difficulties – 203. In addition to this, Community mental health and wellbeing supports and services showed a total of 5007 children and young people accessing services and supports. North Lanarkshire The Scottish Government provides local authorities with funding each year to offer support for children and young people that is focused on improving mental health and wellbeing(8). In an 8- month period, support has been given to: 2602 children and young people, 1163 boys, 1384 girls and 55 people who selected another gender, 1189 primary aged pupils, 1223 secondary aged pupils and 190 care leavers, and 241 'whole' families received support. Using mental health and family wellbeing funding, 22 out of 2602 (less than 1%) of young people supported were referred onto crisis level supports (social work or CAMHS)(9).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 51 CAMHS in NHS Lanarkshire NHS Lanarkshire offer support for children and young people from 0-18 years old with moderate to severe mental health difficulties, by offering both interventions to reduce risk while also building upon resilience. In NHS Lanarkshire, Children and Young People come into CAMHS in one of two ways: during times of crisis or routine referrals. Referrals to Child and Adolescent Mental Health Service (CAMHS) have increased post the COVID-19 pandemic and show no signs of slowing (10- 11). This is true for presentations of depression, anxiety, eating disorders, suicidality and deliberate self-harm. it is essential that services and partners work together to meet the needs of our most vulnerable Children and Young People. Research has shown that identifying and intervening early with risk factors, while developing and building resilience is essential to making and maintaining change(12). During times of crisis, it is also essential that the development of coping strategies at this time are built upon to enhance the repertoire of skills available the next time the Child or Young Person feels distress, thus ensuring resilience is being developed. Key Points • Children and Young People’s Mental Health has seen a decline in recent years and referrals to CAMHS are increasing. • Across Lanarkshire, the provision of Kooth, the online platform that is accessible 24/7 has seen a large number of children and young people access this to address a number of concerns with the highest being around anxiety. • Decreasing risk, as well as building resilience is key. Early interventions through community support may be alleviating onward referral to more intensive level/crisis level supports such as CAMHS. Priorities for Action • Increase access to and utilisation of early intervention. • Working together to offer full supports to children and families. • Increasing access to 24/7 supports and improving resources is essential to support both early intervention and our most distressed Children and Young People who use ‘unscheduled’ services. References (1) Scottish Government Publication - Advice and guidance Mental health and wellbeing: whole school approach: framework. Aug 2021 https://www.gov.scot/publications/whole-school-approach-mental-health- wellbeing/pages/2/ accessed 25/10/2024 (2) Cristina Marini - Children and young people's mental health in Scotland. Mat 2022 https://digitalpublications.parliament.scot/ResearchBriefings/Report/2022/5/24/aa290f5c-f12a-4077-81ea- 4cc5c6151e34 accessed 25/10/2024 (3) North Lanarkshire Children’s Services Plan 2023-2026 North Lanarkshire Children’s Services Partnership: https://www.northlanarkshire.gov.uk/sites/default/files/2023- 11/CC_2023_00196%20NL%20Children%E2%80%99s%20Services%20Plan%202023- 2026%20and%20appendix%20%281%29.pdf accessed 25/10/2024 (4) South Lanarkshire Children’s Services Plan 2023-2026: www.southlanarkshire.gov.uk/cp/downloads/file/467/childrens_services_plan_2023-2026 accessed 25/10/2024
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NHS Lanarkshire | Director of Public Health Annual Report 2024 52 (5) The NHS Lanarkshire Infant, Children and Young People's Health Plan 2024-27 accessed 25/10/2024 https://www.nhslanarkshire.scot.nhs.uk/download/infant-children-and-young-peoples-health-plan-2024-2027/ (6) North Lanarkshire contract: Kooth Engagement Summary Quarter 4, Engagement Lead: Emily Johnston Months Covered: January to March 2024 (7) Children and Young People’s Mental Health Report July 2023 – March 2024 School Counselling and Community Mental Health and Wellbeing Supports and Services: accessed 25/10/2024 (8) North Lanarkshire Community Mental Health and Wellbeing Supports and Services Framework (CMHWB funding) for children & young people & counselling in schools funding report 2023-2024. https://sway.cloud.microsoft/KmUFTt621lRsn6de accessed 25/10/2024 (9) North Lanarkshire Children’s Services Plan Annual Report 2023-2024: https://www.northlanarkshire.gov.uk/sites/default/files/2024- 06/NL%20CS%20Plan%20Annual%20Report%202023%2024.pdf accessed 25/10/2024 (10) Huang HC, Ougrin D. Impact of the COVID-19 pandemic on child and adolescent mental health services. BJPsych Open. 2021; 7(5):e145. (11) Kauhanen L, Wan Mohd Yunus W, Lempinen L et al. A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatry. 2023; 32: 995–1013. (12) Mesman E, Vreeker A, Hillegers M. Resilience and mental health in children and adolescents: an update of the recent literature and future directions. Curr Opin Psychiatry. 2021; 34: 586-592. Mark Kay, Senior Health Promotion Officer: Children and Young People Email: mark.kay@lanarkshire.scot.nhs.uk Dr Yvonne Vance, Consultant Clinical Psychologist, Head of Psychology for CAMHS and the Neurodevelopmental Service Email: yvonne.vance@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights The CAMHS Service have a dedicated engagement officer within the service. This allows the children and young people to participate in making decisions about their care and actively influence the services they receive care from. It also gathers insights into barriers. This is an excellent example of UNCRC article 12 (voice of the child) in practice. ‘CAMHS saved my life. If I can help make the service better for other young people like me, I am hopeful for the future. Thank you for being there’
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NHS Lanarkshire | Director of Public Health Annual Report 2024 53 3.10 Young People and Vaping in Lanarkshire Background The NHS Lanarkshire Health Improvement Alcohol and Other Substances Team commissioned LANDED Peer Education Service to conduct a Lanarkshire wide consultation into Youth Vaping. The consultation took place in 2023(1). The consultation aimed to gather local data on vaping prevalence, trends and attitudes. A range of methods were used to collect survey data. There were 6910 responses from young people in Lanarkshire, aged between 11 and 25. The majority of responses came from the 12 to 17 age group, because surveys were completed during vaping awareness assemblies in high schools. This chapter focusses on the results of the survey and the insight it gives into vape related habits and attitudes of young people in Lanarkshire. Background Figure 3.10.1: Answers to the question ‘Do you vape?’ While we understand the potential impact of nicotine, any negative long-term impacts of vaping are not yet clear. The best evidence available shows e-cigarettes are far less harmful than smoking. But because e-cigarettes are a relatively new product, there isn’t enough research yet into long-term use, or into their effects in people who have never smoked, including children and young people. (2) People who use electronic cigarettes have been shown to have unique microbial communities in their mouths, these communities may signal an increased risk of gum disease. (3) It appears that users of flavoured vapes could experience a 27% decrease in enamel hardness compared to unflavoured vape users. (4) Evidence also points to impaired blood vessel function, which may put vape users at increased risk for heart disease. (5) 18.6% of respondents said they vaped (figure 10.1.1). Of those 83% said they vape using a device that contains nicotine. Worryingly 88% of our young vape users had never smoked tobacco before they started vaping, and the average age at which they first tried a vape was 13. Around one-third (31.9%) of vape users said they were sold vapes without being asked for ID. Proxy purchasing was also identified as problematic, with 36% saying that they were given vapes by people they knew or had asked someone to buy them for them. When asked why they vape, the most popular response was that it was relaxing, followed by addiction then the flavour/taste. Other responses suggest that young people vape to suppress their appetite and manage stress. Some young people cited their mental health as a reason for vaping.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 54 When asked what influenced them to vape the most popular answers included flavours and/or new types of device. Figure 3.10.2: ‘Where would you go for help?’ Young people who said they used a vape were asked if they wanted to quit, 30% said ‘no’. Of the 43% who said they did want to quit, 14% said they didn’t know how to. We then asked the young people who said they wanted to quit if they knew where to get help, worryingly, 72% stated ‘no’. Those who answered ‘yes’ were asked where they would go for help. Figure 10.1.2. shows that more than half would ask a ‘trusted adult’ friend or family member. Young people told us that they are more regularly exposed to 2nd hand vape aerosol than second hand smoke in their home or family car, but more than double the number said that no one smoked or vaped around them. Key Points • Young people aged under 18 are able to obtain vapes easily, despite being below the legal age for purchase. They are susceptible to the advertising of both flavours and devices. • The majority of our young people did not know where to get cessation support and would rely on a “trusted adult” i.e. teacher or youth worker or a friend or family member for help to quit vaping. • Half of young vape users said vaping ‘helped them relax’. Priorities for Action • Work with partners in education, the third sector and parents to ensure ‘trusted adults’ have appropriate training to discuss vaping with young people. • Develop a plan to deliver a package of parental education. • Share findings from survey with partners to help develop bespoke information to raise awareness on the adverse impact of vaping in young people • Contribute to the Tobacco and Vaping programme plan. References (1) LANDED (2024) Lanarkshire vaping survey 2023/2024: report of findings, https://www.landed.info/_files/ugd/6c5a4e_ea8e79495eaf42ea883ad78f5e12fb6c.pdf Accessed 10/12/2024 (2) McNeill, A, Simonavičius, E, Brose, LS, Taylor, E, East, K, Zuikova, E, Calder, R and Robson, D (2022). Nicotine vaping in England: an evidence update including health risks and perceptions, September 2022. A report commissioned by the Office for Health Improvement and Disparities. London: Office for Health Improvement and Disparities https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update Accessed: 07/01/24 (3) Thomas SC, Xu F, Pushalkar S, Lin Z, Thakor N, Vardhan M, Flaminio Z, Khodadadi-Jamayran A, Vasconcelos R, Akapo A, Queiroz E, Bederoff M, Janal MN, Guo Y, Aguallo D, Gordon T, Corby PM, Kamer AR, Li X, Saxena D.(2022) Electronic Cigarette Use Promotes a Unique Periodontal Microbiome. mBio;13(1):e0007522. doi: 10.1128/mbio.00075-22. Epub 2022 Feb 22. PMID: 35189698; PMCID: PMC8903898. (4) Kim SA, Smith S, Beauchamp C, Song Y, Chiang M, Giuseppetti A, Frukhtbeyn S, Shaffer I, Wilhide J, Routkevitch D, Ondov JM, Kim JJ. (2018) Cariogenic potential of sweet flavors in electronic-cigarette liquids. PLoS One;13(9):e0203717. doi: 10.1371/journal.pone.0203717. PMID: 30192874; PMCID: PMC6128655.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 55 (5) Mohammadi L, Han DD, Xu F, Huang A, Derakhshandeh R, Rao P, Whitlatch A, Cheng J, Keith RJ, Hamburg NM, Ganz P, Hellman J, Schick SF, Springer ML.(2022) Chronic E-Cigarette Use Impairs Endothelial Function on the Physiological and Cellular Levels. Arterioscler Thromb Vasc Biol;42(11):1333-1350. doi: 10.1161/ATVBAHA.121.317749. Epub 2022 Oct 26. Erratum in: Arterioscler Thromb Vasc Biol. 2024 Sep;44(9):e242. doi: 10.1161/ATV.0000000000000176. PMID: 36288290; PMCID: PMC9625085. Alison Stanley, Health Improvement Senior, Alcohol, Vaping & Cannabis Email: Alison.Stanley@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights This is an excellent example of UNCRC article 12 (voice of the child) in practice, asking and listening to the voices of children and young people, to improve service design and delivery. Ultimately progressing article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 56 3.11 Oral Health Status of Children The National Dental Inspection Programme (NDIP) is carried out annually in Scotland and has two levels: • A basic inspection for all Primary 1 (P1) and Primary 7 (P7) children. • A detailed inspection of a representative sample, alternating between P1 and P7. Oral health of P1 children The NDIP report of detailed inspection of P1 children in school year 2023/24 showed significant improvements in oral health of children in Lanarkshire(1). This is due to the hard work and dedication of all branches of the dental profession, coupled with excellent integrated working with our social care and education partners. The main findings for Lanarkshire were as follows(1): • Percentage of children with no obvious dental decay experience in primary (baby) teeth in Lanarkshire was 75.9%. This represents a 3.9 percentage point increase from the last survey in 2020(2) and an impressive improvement from the first NDIP in 2003 (40.7%)(3). • For the first time, Lanarkshire is above the Scotland average (73.2%). • Percentage of children with no obvious dental decay experience in primary teeth in North Lanarkshire and South Lanarkshire was 73.8% and 78.1% respectively. Oral health of P7 children The main findings for Lanarkshire were as follows(4): • Percentage of children with no obvious dental decay experience in permanent teeth in Lanarkshire in 2023 was 77.6%. This represents a 0.8 percentage point decrease from the last survey in 2019. The decrease is likely due to the disruption of Childsmile programme during the COVID-19 pandemic. • Percentage of children with no obvious dental decay experience in permanent teeth in North Lanarkshire and South Lanarkshire was 77.3% and 78.1% respectively. Targets for oral health of children in Scotland and Lanarkshire National targets of oral health of Scotland’s children are(5): • 75% of P1 children with no signs of dental disease by 2024 • 80% of P7 children with no signs of dental disease by 2024. Targets for NHS Lanarkshire are(5): • 10% increase on 2014 (P1) NDIP result (67.8%) by 2024; i.e. 74.6% • 10% increase on 2015 (P7) NDIP result (68.1%) by 2024; i.e. 74.9%. NHS Lanarkshire has exceeded the targets for both P1 and P7. Further information on the trend of oral health of children is shown in Table A17 of the Statistical Appendix.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 57 Key Points • Oral health of children has improved steadily since 2003 and has exceeded the 2024 targets set by the Scottish Government. • For the first time, the Lanarkshire figure (75.9%) is above the Scotland average (73.2%) in P1 children in 2024. • The significant improvements in oral health of children in Lanarkshire are due to the hard work and dedication of all branches of the dental profession coupled with excellent integrated working with our social care and education partners. Priorities for Action • Identify the vulnerable families within our deprived communities who are at high risk of developing dental disease. • Re-focus our existing successful prevention programmes in a more targeted way to address the health inequalities gap. • Strengthen our existing links with our social care and education partners to provide an integrated approach to reducing the levels of dental disease in our child population. References (1) Public Health Scotland. National Dental Inspection Programme (NDIP) 2024: Report of the 2024 Detailed Inspection Programme of Primary 1 Children and the Basic Inspection of Primary 1 and Primary 7 Children. 29 October 2024. National dental inspection programme 2024 - National dental inspection programme - Publications - Public Health Scotland, accessed 22/01/2025 (2) Public Health Scotland. National Dental Inspection Programme (NDIP) 2020: Report of the 2020 Detailed Inspection Programme of Primary 1 Children and the Basic Inspection of Primary 1 and Primary 7 Children. 20 October 2020. National dental inspection programme - School year 2019 to 2020 - National dental inspection programme - Publications - Public Health Scotland, accessed 22/01/2025 (3) Scottish Dental Epidemiological Co-ordinating Committee. Scotland’s National Dental Inspection Programme 2003. https://ndip.scottishdental.org/wp-content/uploads/2014/07/ndip_scotland2003-P1.pdf, accessed 22/01/2025 (4) Public Health Scotland. National Dental Inspection Programme (NDIP) 2023: Report of the 2023 Detailed Inspection Programme of Primary 7 Children and the Basic Inspection of Primary 1 and Primary 7 Children. 24 October 2023. https://publichealthscotland.scot/publications/national-dental-inspection- programme/national-dental-inspection-programme-20222023, accessed 22/01/2025 (5) Letter from the Minister for Public Health and Women's Health to the Convener of the Health, Social Care and Sport Committee concerning the COVID-19 Committee inquiry into the recovery of NHS dental services.18 October 2023. www.parliament.scot/-/media/files/committees/health-social-care-and-sport- committee/correspondence/2023/minister-update-covid19-dental-services-inquiry.pdf, accessed 22/01/2025 Albert Yeung, Consultant in Dental Public Health Email: albert.yeung@lanarkshire.scot.nhs.uk Geraldeen Irving, Clinical Director of the Public Dental Service Email: geraldeen.irving@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights Focussing on addressing the health inequalities gap and those in more deprived areas ensures that children’s rights are progressed for all, an example of UNCRC article 2 (all children have these rights no matter what their differences are) in practice. Ultimately progressing article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 58 3.12 Raising Mouth Cancer Awareness Among Young People Mouth cancer can affect the gums, floor of mouth, palate, or inside the cheeks. In Scotland, 256 cases of mouth cancer were reported in 2022 of which 16% were diagnosed in Lanarkshire. In 2022, less than five cases were reported in young adults (25-29 years) in Scotland (1). In 2021, mouth cancer accounted for 62 deaths in Scotland of which 13% were in Lanarkshire (2). While all the deaths were in adults, mouth cancer can develop in younger adults. Around 90% of mouth cancer cases are linked to preventable causes such as smoking, alcohol and contracting the human papilloma virus (HPV)(3). HPV infection is thought to be linked with most cases of mouth cancer that happen in young people. A scoping exercise of mouth cancer prevention materials and outreach aimed at young people was conducted in NHS Lanarkshire in August 2018 and demonstrated a gap in resources. Subsequently, funding was obtained from the Ben Walton Scholarship and Development Grant to develop a short animation to raise awareness of mouth cancer among young people (4). Young people from North Lanarkshire worked together with professionals from a media company to write a script and develop graphics for the short animation. The sessions were facilitated by staff from North Lanarkshire Council’s Community Learning and Development Department. Educational input was provided by two dental trainees and health improvement staff from NHS Lanarkshire. The aims of the short animation were to: • Raise awareness of mouth cancer, including: signs, symptoms, associated risk factors and where to seek advice. • Target young people (13-19 years) using social media. It has been used by staff in education and health settings. • Promote responsible drinking, smoking cessation and a healthy lifestyle. • Raise awareness of the link between HPV and the increased risk of mouth cancer and the importance of HPV vaccination • Promote mouth self-examination to equip young people with the knowledge to carry out self-examination and to encourage early presentation to a healthcare professional. The young peer educators were instrumental in the development of the resource. They created the draft script, based on their own research and attendance at the educational sessions. They chose the colours and the characters and decided on the final music and graphics. The infomercial was kept short, under 60 seconds, to enable it to be shown on social media sites (Facebook, X, Instagram and YouTube) popular with young people. These ensured that the infomercial was relevant and appealing to young people and increase the reach with the target audience. Over 3000 people have viewed the infomercial. The infomercial can be viewed at www.nhslanarkshire.scot.nhs.uk/mouth-cancer-awareness. Key Points • Mouth cancer can occur in younger adults, but it’s thought that HPV infection may be responsible for the majority of cases that occur in young people.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 59 • A project involving young people was conducted to develop an animation on mouth cancer awareness. • An infomercial was created to raise awareness and launched on social media. Priorities for Action • Continue to refresh the media campaign especially during November which is Mouth Cancer Action Month. • Explore the opportunities and barriers for general dental practitioners and their practice staff for referring patients to stop smoking service. • Explore development of a video for dental teams on asking patients about stopping smoking. References (1) Public Health Scotland. Cancer Incidence of the Mouth (IARC definition). Data files - Cancer incidence in Scotland - to December 2022 - Cancer incidence in Scotland - Publications - Public Health Scotland, accessed 22/01/2025 (2) Public Health Scotland. Cancer Mortality of the Mouth (IARC definition). View the cancer mortality data files - Cancer mortality in Scotland - Annual update to 2021 - Cancer mortality - Publications - Public Health Scotland, accessed 22/01/2025 (3) Cancer Research UK. Men twice as likely to develop oral cancer. 29 November 2017. Men twice as likely to develop oral cancer - Cancer Research UK - Cancer News, accessed 22/01/2025 (4) Royal College of Physicians and Surgeons of Glasgow. Ben Walton Scholarship and Development Grant. Ben Walton Scholarship and Development Grant, accessed 22/01/2025 Albert Yeung, Consultant in Dental Public Health Email: albert.yeung@lanarkshire.scot.nhs.uk Susan M Lyttle, Health Improvement Manager for Health and Wellbeing of Asylum Seekers & Refugees/Homelessness Email: susan.lyttle2@lanarkshire.scot.nhs.uk Anne Muir, Senior Health Promotion Officer (Oral Health) Email: anne.muir2@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights This is an excellent example of designing materials and a campaign specifically for young people, progressing their rights around article 13 (right to find out and share information), article 17 (I have the right to get information in lots of ways) and article 24 (right to the best possible health).
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NHS Lanarkshire | Director of Public Health Annual Report 2024 60 4. Healthcare Public Health 4.1 Population Screening Background NHS Lanarkshire provides all of the national population screening programmes available in Scotland. Figure 4.1.1 shows the number of people in the target population and uptake for each programme. It also includes a brief summary of our achievements against Healthcare Improvement Scotland standards. Screening Uptake Uptake rates for some screening programmes are improving (e.g. breast cancer screening) and others have levelled off (e.g. bowel and cervical cancer screening) over the last year. Uptake remains high in pregnancy and newborn screening programmes. Figure 4.1.1: Trend in cancer screening programme uptake in NHS Lanarkshire and Scotland, 2017-2023 Inequalities Activities to raise awareness of the benefits of screening and address the barriers to screening participation is coordinated through an updated 3-year Screening Inequalities Action Plan. Colleagues from Health Improvement, West of Scotland Breast Screening Service, and the former Jo’s Cervical Cancer Trust have been key partners in delivering these actions. Developments in the last year include: • the continuation of our assertive outreach work to provide cancer screening and sexual health services to those affected by homelessness. Nearly 300 referrals for support were made to this service in the last financial year. Support was provided to meet contraceptive
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NHS Lanarkshire | Director of Public Health Annual Report 2024 61 needs, sexual health screens, order bowel screening kits, arrange breast screening appointment and over 100 cervical smears were performed • the extension of our “maximising screening awareness through health contact opportunities” work. This included training of treatment room staff in GP practices and Quit Your Way staff to raise screening eligibility and increase awareness with their clients. • Completing of an arts-based community engagement project in Bellshill area and production of a video highlighting local barriers to cervical screening. This video will be used as a training resource with key stakeholders. National Cervical Exclusion Audit Following an incident in the national Scottish Cervical Screening Programme, an audit of patient records of those excluded from the programme was carried out. This was to review the appropriateness of any exclusion applied. Over 13,000 records were audited within NHS Lanarkshire and the audit is now complete. Five percent of the individuals whose records were reviewed were invited to colposcopy and 8% were invited to attend their GP practice. The audit required close partnership working with primary and secondary care in Lanarkshire. This was to ensure evidence was uploaded, reviewed and clinical management of patients, where appropriate, was in place.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 62 Table 4.1.1: Summary of Screening Programmes in Lanarkshire Screening programme Target population Denominator and time frame Standard Uptake Outcomes(1) Bowel screening Men and women aged 50-74 years 242,360(1) men and women May 2021 to Apr 2023 Nationally agreed Standard, including the target uptake of 60.0%. 63.1 % of target population Uptake varies across Scottish Index Multiple Deprivation (SIMD) quintiles from 54.4% in SIMD 1 (most deprived) to 73.0% in SIMD 5 (least deprived). 61.0% of men 65.2% of women Meets uptake standard for both sexes. Breast Cancer Screening Women aged 50-70 years 86,036(2) women Apr 2020 to Mar 2023 Nationally agreed standards including minimum uptake of 70.0%. 75.1% of target population Uptake varies across SIMD quintiles from 66.2% in SIMD 1 (most deprived) to 83.2% in SIMD 5 (least deprived). Meets all standards except round length, which is the length of time between invitations, time to issue results and time to assessment from first adequate screen. Across Apr 2022 to Mar 2023, 143 invasive cancers were detected in women following breast screening: 25 were detected at the first screen (women aged 50-52) and 118 were detected at subsequent screens in women 53-70 years old and referred for further investigations and treatment Cervical screening Women aged 25-64 years 176,872 women Data from Apr 2021 to Mar 2022. This is the most up to date published data by Public Health Scotland. Nationally agreed standards including the target uptake of 80.0% in each Scottish Index of Multiple Deprivation (SIMD) quintile. 71.1% of target population 25-49 year olds: 70.2% 50-64 year olds: 72.5% Uptake varies across SIMD quintiles from 63.7% in SIMD 1 (most deprived) to 79.0% in SIMD 5 (least deprived). Met all standards apart from uptake and laboratory turnaround times for cytology. Sample to routine colposcopy referral were challenging to meet while NHS Lanarkshire delivered the National Cervical Exclusion Audit. Universal Newborn Hearing Screening (UNHS) All newborn babies born to Lanarkshire residents or moving into Lanarkshire under the age of 12 weeks 6024 Apr 2022 to Mar 2023 98.0% of babies should have completed the hearing screen by 10 weeks. 99.7% of target population 5 babies with moderate to severe permanent hearing loss were detected through screening and referred for clinical follow up.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 63 Screening programme Target population Denominator and time frame Standard Uptake Outcomes(1) Newborn Bloodspot Screening All newborn babies born to Lanarkshire residents and babies with no bloodspot result moving into Lanarkshire before the age of 12 months 6438 Apr 2023 to Mar 2024 99.5% of infants who have undergone screening tests have a screening result available or are recalled for repeat testing by 20 days of age. 94.2% of all babies born to Lanarkshire residents 2023/2024 have undergone bloodspot screening and have a result available. 5 babies suspected of having one of the conditions were referred for follow up 41 carriers (found to have a genetic trait) of various childhood conditions screened for were identified. Pre-School Orthoptic Screening All children resident in Lanarkshire, aged between four and five years. 6,963 Aug 2022 to Jun 2023 N/A 88% Uptake varies across SIMD quintiles from 83.0% in SIMD 1 (most deprived) to 92.0% in SIMD 5 (least deprived). 23% of children tested were referred to the hospital based Orthoptic team for further assessment 4% of referred children tested required further follow-up with specialist services Diabetic Eye Screening Patients with diabetes aged 12 years and over 50,280 Apr 2023 to Mar 2024 Nationally agreed standard including minimum uptake of 80.0% uptake. 56.7% were successfully screened in 2023-24 Uptake varies across SIMD quintiles from 40.5% in SIMD 1 (most deprived) to 46.3% in SIMD 5 (least deprived). Improvements are underway to increase numbers successfully screened, including open booking and maintaining current increased capacity. 284 referrals were made to ophthalmology Abdominal Aortic Aneurysm Screening Men aged 65 years 4,178 men aged 65 years who became eligible in year ending 31 March 2024 Nationally agreed standard including minimum uptake of ≥75.0% uptake. Number and percentage of men offered screening before age 66 who were tested before age 66 and 3 months 82.1% for those invited for screening. Uptake varies across SIMD quintiles from 76.4% in SIMD 1 (most deprived) to 85.0 % in SIMD 5 (least deprived). Highest uptake is in SIMD 4 (88.9%) 11 large aneurysms detected and referred for assessment by a Vascular Specialist for consideration of appropriateness for intervention.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 64 Key Points • Screening can help prevent conditions (including cancers) developing. It can also detect conditions and cancers at an early stage, when treatment is more likely to be successful. Maximising uptake across the population, and targeting areas where uptake is lowest, will improve outcomes for individuals and our population. • Barriers to accessing services exist for screening programmes for our most disadvantaged populations. The screening programmes continue to focus on identifying and addressing these barriers. • Where members of the population make an informed choice not to participate in population screening programmes, awareness of the signs and symptoms of conditions is important to improve outcomes and detect conditions earlier. Priorities for Action • Monitor the performance of our screening programmes to ensure they continue to be safe, effective and patient-centred. This, along with national developments, informs the work programme for the coming year. • Continue efforts to encourage engagement with, and participation in, population screening programmes in our most disadvantaged populations and reduce inequalities in screening uptake. • Continue the work on the screening programmes and pathways, to maintain and maximise uptake and capacity. References (1) Public Health Scotland. Scottish Bowel Screening Programme Statistics - For the period of invitations from May 2021 to April 2023 [Internet]. 2024. Available from: https://publichealthscotland.scot/publications/scottish- bowel-screening-programme-statistics/scottish-bowel-screening-programme-statistics-for-the-period-of- invitations-from-may-2021-to-april-2023/ (2) Public Health Scotland. Scottish breast screening programme statistics - Annual update to 31 March 2023 [Internet]. 2024. Available from: https://publichealthscotland.scot/publications/scottish-breast-screening- programme-statistics/scottish-breast-screening-programme-statistics-annual-update-to-31-march-2023/. (3) Public Health Scotland. Scottish cervical screening programme statistics - Annual update to 31 March 2022 [Internet]. 2023. Available from: https://publichealthscotland.scot/publications/scottish-cervicalscreening- programme-statistics/scottish-cervical-screening-programme-statistics-annual-update-to31-march-2022/ (4) Public Health Scotland. Scottish Abdominal Aortic Aneurysm (AAA) screening programme statistics - Year ending 31 March 2023 [Internet]. 2024. Available from: https://publichealthscotland.scot/publications/scottish- abdominal-aortic-aneurysm-aaa-screening-programme-statistics/scottish-abdominal-aortic-aneurysm-aaa- screening-programme-statistics-year-ending-31-march-2023/ Dr Cathy Johnman, Consultant in Public Health Email: cathy.johnman@lanarkshire.scot.nhs.uk Celia Briffa-Watt, Consultant in Public Health Email: celia.watt@lanarkshire.scot.nhs.uk Morag Nicholson, Public Health Screening Programme Manager Email: morag.nicholson@lanarkshire.scot.nhs.uk Spotlight on Children’s Rights This work ensures that UNCRC article 3 (best interests of the child) and article 24 (right to the best possible health) are protected and progressed.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 65 Staff in the Public Health Directorate: January 2024 – February 2025 Name Designation Loretta Barr* PA to Executive Director Jill Bell Health Protection Nurse and acting Nurse Team Leader – Health Protection Susan Brennan Health Protection Nurse (HPN) Celia Briffa-Watt Consultant in Public Health (CPH) Linda Brown Management Team Secretary Sheila Bryce HPN Callum Buchanan* Senior Data Analyst Imogen Caird Programme Manager Megan Cameron* FY2 Health Protection/Microbiology Ruby Clafferty* FY2 Health Protection/Microbiology Mairead Doyle Clerical Assistant Kerri Duncan Management Team Secretary Sophie El-Nahas* Clinical Fellow - Health Protection Valerie Findlay Public Health Specialist Registrar Krysha Finlayson HPN Aoife Fortescue-Webb Public Health Specialty Registrar Claire Gordon* Nurse Specialist (Cervical Screening Audit) Martin Gordon Resilience Manager Fiona Hanlon* Admin Assistant Susan Hearty Operational Services Manager Roxanne Hendry Nurse Specialist (Cervical Screening Audit) & Health Protection Nurse Patricia Houston Health Protection (HP) Administrator Cathy Johnman Consultant in Public Health Medicine (CPHM) Joanne Kane* HPN Kalonde Kasengele* Public Health Specialty Registrar Jaimie Kelly Management Team Secretary Shannon Kemp Clinical Teaching Fellow - Obstetrics and Gynaecology Chris Kimber* Blood Borne Viruses (BBV) Development Officer Kirstin Lammie Management Team Secretary John Logan CPHM Karen Lorenzetti Principal PH Information Analyst Mary Louden* Operational Service Manager Alana McGlynn PH Programme Manager Karen McGuigan CPH Karen McLennan Nurse Team Leader - Health Protection David McMahon Clinical Fellow - Public Health Ruth Mellor CPH Joanna Miller HPN Angharad Morgan Resilience Officer Julie Muir HP Administrator
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NHS Lanarkshire | Director of Public Health Annual Report 2024 66 Lisa Maria Neil PH Information Analyst Paul Nelson CPHM Morag Nicholson Programme Manager - Screening Ruth Oluleke Clinical Fellow - Public Health Aileen O'Neill Nurse Team Leader (Cervical Screening Audit) / Public Health Programme Manager Femi Oshin CPHM Louise Pollock Communicable Diseases Specialist Midwife S. Josephine Pravinkumar Director of Public Health and Health Policy Henry Prempeh CPHM Josephine Reilly Quality Co-ordinator - Screening Nick Riches Public Health Specialist Registrar Alan Robertson Emergency Planning Officer Elspeth Russell CPH Evelyn Scott* Management Team Secretary - Dental Audit Angela Shaw Health Care Support Worker HP/TB Alison Smith-Palmer CPH/ Deputy Director of Public Health Carol Stewart CPH Praveena Symeonoglou Public Health Researcher/Programme Manager - Health Protection in Dentistry (National role) Caroline Thomson Nurse Consultant Elaine Tindle Management Team Secretary Jacqueline Tollan HPN Trish Tougher BBV Network Manager Alison Weir* Management Team Secretary Kirstin Weir Management Team Secretary Jean Wheatley BBV Occupational Health Nurse Specialist Julie Winters* Nurse Specialist (Cervical Screening Audit) Albert Yeung Consultant Dental Public Health (CDPH) *As of March 2025, these colleagues are no longer working with the Public Health Directorate – thank you for all your hard work.
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NHS Lanarkshire | Director of Public Health Annual Report 2024 67 Statistical Appendix List of tables (available in separate PDF download) A1 Sociodemographic summary: by locality/HSCP A2a Estimated population: by age group and locality/HSCP A2b Estimated population: children, by age group and locality/HSCP A3 Projected population: by age group and sex A4 Births: by year A5 Births, perinatal deaths, neonatal deaths and infant deaths: by HSCP A6 Deaths from all causes: by sex, age group and year A7 Deaths from all causes: by sex, age group and locality/HSCP A8 Deaths from malignant neoplasms: by sex, age group and year A9 Deaths from coronary heart disease: by sex, age group and year A10 Deaths from cerebrovascular disease: by sex, age group and year A11 Deaths from respiratory disease: by sex, age group and year A12 Expectation of life: by age and sex; trend by sex A13 Cancer registrations: by sex, age group and year A14 Cancer registrations: by year and site; standardised ratios by sex, age group and site A15 Cancer registrations: by locality/HSCP and site A16 Notifiable diseases – clinically notified cases: by year A17 Dental participation. Oral health of children: by Lanarkshire A18 Primary and booster immunisation uptake rates: by locality/HSCP General notes • Lanarkshire has two Health and Social Care Partnerships (HSCPs) – North Lanarkshire and South Lanarkshire. The HSCPs cover the same geographical areas as North Lanarkshire Council and South Lanarkshire Council. There are ten localities within the HSCPs – six in North Lanarkshire (Airdrie, Coatbridge, North, Bellshill, Motherwell and Wishaw) and four in South Lanarkshire (Cambuslang/Rutherglen, East Kilbride, Clydesdale and Hamilton) – see map on page 2. On 1 April 2014, changes to NHS board boundaries resulted in NHS Lanarkshire becoming coterminous with the HSCPs and local authorities. The tables in the Statistical Appendix indicate whether information relates to the old or new NHS Lanarkshire boundary, the exception being where all data relate to April 2014 onwards. On 1 April 2019, changes to the Lanarkshire and Greater Glasgow and Clyde boundary at Cardowan by Stepps resulted in the following postcodes now being part of North Lanarkshire and NHS Lanarkshire - G33 6GZ, G33 6GX, G33 6GS, G33 6GY, G33 6GW, G33 6GT, G33 6GU, G33 6NS. • Populations shown and used in rates calculations are, for NHS Lanarkshire, the HSCPs and Scotland, mid-year estimates produced by National Records of Scotland (NRS). Locality populations are from NRS small area population estimates at data zone level. Health Intelligence Team Email: karen.lorenzetti@lanarkshire.scot.nhs.uk
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