Director of Public Health Annual Report
Argyll and Bute Council · 31 January 2024
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 31 January 2024 and its agenda
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1 Date of Meeting: 31st January 2024 Title of Report: Director of Public Health Annual Report: Medication and Public Health – Do the Right Thing Presented by: Dr Tim Allison, Director of Public Health & Policy The Health and Social Care Partnership is asked to: ▪ Note ▪ Discuss 1. EXECUTIVE SUMMARY Directors of Public Health are required to produce an annual report concerning the state of health of their local population. There is no set format for the report and in recent years the reports have tended to focus on individual themes rather than acting as a repository for population health intelligence. The report for 2023 is presented to the Argyll and Bute Health and Social Care Partnership. 2. INTRODUCTION The Annual Report of the Director of Public Health for 2023 is presented. 3. DETAIL OF REPORT The theme for the report is medication and public health; the key discussion point is about doing the right thing. Public Health challenges cannot be solved simply by prescribing medication. There are areas of public health where medication plays a huge role in improving health but conversely it is important to be aware and take action where medication causes harm such as impacts on the environment. The report presents information about the health of the population of NHS Highland then gives examples of how medication affects public health. The areas selected for this report are not intended to provide a comprehensive picture of the relationship between medication and public health but rather serve as examples of wider themes. The report contains six chapters as follows:
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2 Chapter 1: Demography and health inequalities • Information on NHS Highland’s population is essential for planning health and care services across the life course. • An ageing population is increasing the demand on health and care services as more people are living with one or more long-term health conditions and with increasingly complex needs. • Population data from Scotland’s Census 2022 will provide a detailed picture of the characteristics of our people and communities, including information on: ethnic group, armed forces veterans, sexual orientation and trans status or history; health, disability and unpaid care. • Improving the health of our population requires a fundamental shift towards prevention and mitigating the underlying issues that can impact on health, such as poverty and deprivation. Chapter 2: The Environment: How medication can make our environment sicker • There is growing evidence of the negative effects of medicines on our environment. When medicines are excreted from our body or flushed down toilets or sinks, they can end up in our water environment and soils. They can have negative effects on aquatic organisms and end up in the crops we eat. • NHS Highland is at the forefront of research and action to reduce the impact of the medicines we use on the environment and is a co-founder of the One Health Breakthrough Partnership (www.https://ohbp.org). • There is something that everyone can do to help reduce pollution of our environment with medicines. Chapter 3: Hepatitis C: How medication is transforming treatment and prevention • Hepatitis C (HCV) is a blood borne virus (BBV) which can lead to cirrhosis of the liver and hepatocellular carcinoma. • The management of HCV has been revolutionised in recent years by the introduction of new therapies. This development has played a significant role in the increase in treatment initiatives and the potential across Scotland to achieve HCV elimination. • The availability of effective treatment that can be taken over a short period of time with few side effects should encourage more people to come forward for testing for Hepatitis C and provide a major step towards elimination of the virus. Chapter 4: Social Prescribing: How an alternative to medication can work • It is estimated that 20% of people visit their GP with non-medical needs and up to one fifth of GPs’ time is spent on issues related to social needs. • Social prescribing provides an evidence-based potential to complement management of a wide range of health conditions through providing a
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3 holistic person-centred model of care to improve health and wellbeing and reduce reliance on medication and health services. • The social determinants of health play an important role in the development of risk factors for a range of diseases and the health outcomes that people experience throughout life. Supporting people with wider social and environmental issues is important for improving health and wellbeing and reducing demand on health and care services. • There is promising evidence that social prescribing provides a positive return on investment from between £2.30 and £7.08 for every £1 invested. Chapter 5: Analgesics and Opioids: How medication can have long lasting effects on public health • There is little doubt that analgesics and opioid use can bring great benefits to individual but there are serious disadvantages as well. • There are negative impacts of opioid prescribing, particularly the management of chronic pain. Alternatives are available such as social prescribing programmes, psychologically based interventions and physical therapies. • Leadership and support for the continued implementation of the Medicines Assisted Treatment Standards, and in particular the use of Opioid Substitution Therapy, is vital in assisting individuals with problematic drug use to turn their lives around. Recommendations for action for Argyll and Bute Health and Social Care Partnership (and NHS Highland) NHS Highland and its partners should ensure that planning addresses the change in demography and ageing population. NHS Highland and it partners should prioritise tackling health inequalities and the causes of those inequalities. NHS Highland and those prescribing medicines should prioritise actions which will reduce the impact of medicines on the environment. Citizens should take up actions which will reduce the impact of medicines on the environment. NHS Highland work to eliminate Hepatitis C should promote the effectiveness of new medication and so encourage more people to be tested and successfully treated. NHS Highland should increase the number of health and social care staff who are aware of social prescribing by developing and promoting a social prescribing network and a Directory of Services and by creating targeted messaging through staff and service newsletters, bulletins and social media.
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4 NHS Highland and partners should improve the knowledge and skills of health and social care staff in relation to social prescribing by providing learning and development opportunities. NHS Highland and partners should improve the infrastructure and availability of social prescribing by embedding link workers in a range of health and social care services and increasing use of the community benefits gateway through public sector procurement and commissioning processes. Alcohol and Drug Partnership members should support further work relating to opioid and analgesic prescriptions, including needs assessment and development of alternative programmes for chronic pain. Alcohol and Drug Partnership members should continue to support the delivery of the Medicines Assisted Treatment standards and the increased choices offered to individuals through the Opioid Substitution Therapy programme. 4. RELEVANT DATA AND INDICATORS Relevant information is contained within the report. 5. CONTRIBUTION TO STRATEGIC PRIORITIES This report provides information that will contribute in some way to all of the Health and Social Care Partnerships strategic objectives but particularly to the priority to: • Promote health and wellbeing across all communities and age groups 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact There are no direct financial implications from the paper. A focus on prevention, for example, social prescribing, would incur costs, but net savings are possible from NHS budgets for many prevention initiatives. Some could also be cash releasing. Adherence to prescribing and therapeutic guidance should ensure effective and safe use of medicines. 6.2 Staff Governance There are no specific workforce implications from this paper. A focus on prevention such as social prescribing has the potential to improve the health of the workforce through job satisfaction and staff being recipients of interventions. 6.3 Clinical Governance Prevention, for example, social prescribing is an important part of both quality and patient care, and it is recommended that it is included in appropriate pathways. Argyll and Bute HSCP should continue supporting all staff in adhering to the principles of realistic medicine, and safe and effective prescribing.
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5 7. PROFESSIONAL ADVISORY This is an independent report from the Director of Public Health. 8. EQUALITY & DIVERSITY IMPLICATIONS The report addresses equality issues. The chapter on demography clearly outlines, for the Argyle and Bute populations, trends in health inequalities for selected health outcomes. This chapter also discusses the need for a fundamental shift towards prevention and mitigating the underlying issues that can impact on health such as poverty and deprivation. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE The report complies with NHS Highland data protection principles. 10. RISK ASSESSMENT Risks are managed in line with NHS Highland policy. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT The principles of public and user involvement and engagement are embedded in public health actions. This is an independent report from the Director of Public Health. 12. CONCLUSIONS Members are asked to note and comment on the report. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name: Dr Tim Allison, Director of Public health Email: Tim.Allison@nhs.scot