SITUATION AND BACKGROUND

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Item Number 10.1

BOARD04/2013 Tayside NHS Board 28February 2013

CEL 01 (2012), HEALTH PROMOTING HEALTH SERVICE: ACTION IN HOSPITAL SETTINGS

SITUATION AND BACKGROUND

The Health Promoting Health Service (HPHS) concept is that “every healthcare contact is a health improvement opportunity”.

The programme of activities for NHS Boards is designed to ensure that healthcare encounters with patients in acute settings include targeted action to improve patients’ health and prevent future ill- health. Given the proportionately greater use of acute services by patients from deprived

communities, health promotion in acute settings offers an opportunity to reduce health inequalities.

CEL 01 (2012) tasks Medical Directors and Directors of Public Health to jointly support and encourage all hospital Clinical Directors to take account of involvement in health improvement actions through the annual appraisal cycle for hospital consultants.

The HPHS ethos and principles of equity, participation, empowerment and sustainability are central to the Quality Ambitions for both ‘person-centered’ and ‘effective care’ set out in the NHS Scotland Quality Strategy. Embedding health improvement advice and support into everyday practice will go some of the way towards achieving these ambitions. The Improving Population Health Action Group (IPHAG) which is part of the Effective Delivery Strand of the Quality Strategy will oversee the development of CEL 01 (2012). Monitoring will be through the national monitoring and

evaluation framework (Appendix 1) which was issued to Boards in December 2012; first report due April 2013.

CEL 01 (2012) sets eight topic/setting actions:

• Smoking

• Alcohol

• Breastfeeding

• Food and health

• Healthy Working Lives

• Sexual health

• Physical activity

• Active travel.

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There is a requirement for Boards to encompass a wider variety of health promoting activities and settings in the innovative and emergent practice section of the framework.

ASSESSMENT

Local governance for CEL 01 is assured through reporting annually to Tayside NHS Board (presented to the Executive Team prior to the Board meeting) and the Improvement and Quality Committee (via Clinical Quality Forum). A HPHS report appears in the Director of Public Health’s Annual Report. Bi-annual reports are taken to the Executive Management Team and the Health Scotland HPHS Network.

NHS Tayside’s Directorate of Public Health provides strategic leadership for public health, health equity and health improvement, specialist health improvement advice, local training, resources and facilitates multi-disciplinary action for health improvement to progress HPHS. A HPHS Steering Group - comprising staff from the Directorate of Public Health, patient and public involvement, catering and training - co-ordinates the implementation of CEL 01 (2012) actions with a wide range of NHS Tayside staff. A HPHS Small Grants Scheme helps facilitate action within the hospital setting.

NHS Health Scotland provides support for learning and development such as, training on the HPHS framework and ‘Promoting Health – Developing Effective Practice’. They host a national network of HPHS facilitators and provide links to the World Health Organisation (WHO) Health Promoting Hospitals and Health Services network. NHS Health Scotland’s programmes support specific work on smoking, alcohol, and food and health. The Scottish Centre for Healthy Working Lives (HWL) within NHS Health Scotland promotes the HWL award scheme.

This paper is presented to the Board for assurance of progress against the CEL 01 (2012) actions using the national monitoring and evaluation framework. Below is a flavour of the work; it is a compilation of updates from the various topic leads. The required data will be collated at 31 March 2013 for the final report.

CEL 01 (2012) actions, outcomes and performance measures:

Each of the CEL 01 (2012) actions includes objective and quantifiable measures of progress which are aligned with the Quality Measurement Framework. Where relevant, data to measure progress are consistent with that required for associated HEAT targets. This will allow Boards to reflect the annual report in their self assessment for annual accountability reviews with Scottish Ministers.

1. Smoking Actions

Ensure dedicated specialist smoking cessation support is available within the hospital/acute setting which is integrated with community-based cessation services; and commit to the development and implementation of more comprehensive organisational tobacco policies.

Smoking outcomes

Increased availability of specialist smoking cessation support by hospital patients who are motivated to quit smoking.

An increase in the number of NHS premises moving towards becoming completely smoke-free.

Smoking performance measures

Increased quit attempts and successful quits amongst hospital in-patients, out-patients, day

surgery and pregnancy. Community-based quit attempts and quit successes following a referral, or delivery of brief interventions and referrals, from a hospital setting;

Evidence of existence and application of Integrated Care Pathways for smoking cessation in

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Evidence of appropriate training and/ or support in the delivery of brief advice for smoking cessation in secondary care;

Evidence of specialist smoking cessation support (or Health Behaviour Change equivalent) available within (or to) secondary care sites within Boards.

Implement more comprehensive organisational tobacco policies with specific timescales to enable progress to be measured. For example, evidence could include a statement of existing smoke-free policies plus proposals or updates (e.g. within Board papers, action plans, local tobacco action, monitoring reports and so on) with timescales that would indicate the extent and type of progress made or planned against relevant indicators, such as no smoking in hospital grounds, removal of smoking rooms in existing exempted premises or a wide range of other steps towards smoke-free.

What has been achieved

NHS Tayside has 2 w.t.e. smoking cessation staff based at Ninewells delivering cessation to patients and staff in acute settings in Tayside and linking to community-based cessation services.

In addition, staff at the Health Shop at PRI and Ninewells offer advice on cessation and local services.

A care pathway for smoking cessation is established for both acute and community settings and training is delivered to ward staff to enable implementation. The smoking care pathway has been adopted by diabetes and respiratory MCNs. Training on brief advice and/or pathways is provided in conjunction with the Health Behaviour Change Co-ordinator to clinical staff and students.

The Hospital Smoke Free Service saw 359 patients from April to December 2012, 185 were referred onto community support (including group, pharmacy, one-to-one). An audit in 2011 showed 28% will attend their first appointment for community cessation support. The number of referrals from Pre-Assessment’s ‘Stop Before Your Op’ to community support is unavailable at this present time, but will be included in the 31 March monitoring report.

Number of quits recorded from the hospital setting (including staff) on the national database for January to December 2012 totalled 416. This will be under-recorded due to measures to avoid multiple Minimum Data Set (MDS) quit forms being recorded for same patient. (The hospital MDS form is overwritten by the community MDS form if the patient is seen in hospital then attends community support).

NHS Tayside has a comprehensive smoking policy which bans smoking in all NHS Tayside buildings and grounds. A Smoking Liaison Officer enforces and monitors the smoking policy at acute sites, mainly Ninewells.

What will happen next

We plan a roll-out of the existing pre-assessment clinic cessation work within the Assisted Conception Unit. We will work with the stroke MCN to embed the smoking cessations care pathway. The Smoking Policy is being refreshed and its scope broadened to encompass banning the use of e-cigarettes in all NHS Tayside sites.

2. Alcohol Actions

Opportunistically screen patients attending Accident and Emergency (A&E) departments and wider acute settings. For patients identified with harmful or hazardous drinking (screening positive), offer and deliver a brief intervention in accordance with the SIGN 74 Guideline. For patients identified as dependent drinkers, and those with harmful or hazardous drinking patterns who request further help, direct to an appropriate support service (including health, social services, local authority and voluntary).

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Alcohol outcomes

Improved, consistent and embedded screening (in line with the Alcohol Brief Intervention (ABI) HEAT standard for 2012-13 and the SIGN74 Guideline) and appropriate referral, ensures that the most appropriate treatments, interventions, support and services are available at the right time to everyone who will benefit.

Alcohol performance measures

The number of A&E attendances who are screened opportunistically for alcohol misuse, as a % of total attendances;

The number of A&E attendances screened (using a validated screening tool) for harmful or hazardous drinking and the % screening positive ( i) with % eligible for ABI and ii) % eligible for referral to treatment services;

The number of alcohol brief interventions delivered in accordance with the HEAT Standard Guidance 2012/13.

What we have achieved

Area Setting

Number of alcohol brief interventions Apr-June 2012 July-Sep 2012

Tayside Keep Well 11 18

Angus Forensic 9 14

Dundee Forensic 53 67

Perth & Kinross Forensic 20 12

Dundee DHLI 42 39

Tayside Sexual Health Data unavailable Data unavailable

Angus Primary Care 57 70

Dundee Primary Care 539 519

Perth & Kinross Primary Care 121 126

Tayside A&E 25 40

Tayside Acute wards 30 37

Angus Montrose MIU 15 25

Angus Brechin MIU 1 11

Angus Arbroath MIU 12 47

Angus Forfar MIU 16 21

Perth & Kinross Auchterarder MIU 2 0

Perth & Kinross Pitlochry MIU 0 0

Perth & Kinross Blairgowrie MIU 0 Data unavailable

Tayside Antenatal 0 238 (TBC)

Total 953 1284

Table 1: Summary of ABI delivery April-Sep 2012, by source

Delivery of ABI in MIU in Perth and Kinross has not been established and further work is required in these settings. Valuable learning may be gained from sharing the experience of MIU in Angus.

The data for 2012/13 will be collated and presented fully in the final monitoring report.

3. Breastfeeding action

Continue to implement the UNICEF Baby Friendly Initiative in all maternity units.

Breastfeeding outcome

An increase in the number of women exclusively breastfeeding at first visit and at 6-8 week review.

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Breastfeeding performance measures

Achievement and maintenance of UNICEF Baby Friendly Initiative in all maternity units.

All mothers are signposted to available breastfeeding support programmes in the community.

Those with additional needs who are least likely to breastfeed, or breastfeed only for a short time, are supported to access and engage with services through an appropriate referral process.

Develop and establish pathways to maintain support and continuity of breastfeeding in the community, including measures aimed at reducing attrition rates of those initiating lactation.

All women returning to work from maternity leave are advised of the breastfeeding support policy 4-6 weeks prior to returning to work.

All maternity units in Tayside have achieved Baby Friendly. All women are referred to community nursing services at the point of discharge from midwifery services. In Tayside all women receive information on breastfeeding groups and national support networks at discharge from hospital.

Annual breastfeeding rates at day 5 are collated from Guthrie data by place of birth.

In Dundee, women who are breastfeeding at discharge are offered support from a Breastfeeding Support Worker; so far in 2012/13 66% of eligible women received support.

All pregnant women employed by NHS Tayside receive a copy of NHS Tayside Breastfeeding and return to work policy via HR and line manager.

We will work to ensure maintenance of UNICEF Baby Friendly. We will increase the application of asset-based approaches by NHS and partner agencies. We plan to develop an i-Phone app., which will give information to patients/public on the availability and location of local infant and maternal nutrition services.

4. Food and Health Actions

To develop a consistent approach to healthy eating for all food service providers across the NHS.

This will require private and voluntary sector operators to follow the lead of NHS caterers, 97% of whom have already achieved the Healthy living Award.

Caterers will be required to follow Healthy living Award criteria at the point of contract

(re)negotiation. If no contract exists, an implementation plan for the caterer's registration to the Healthy living Award should be agreed.

Retailers will be required to join the Scottish Grocers’ Federation Healthy living Programme and meet their Gold Standard criteria at the point of contract (re)negotiation.

NHS Boards to continue to encourage and support food co-operatives and other social enterprises selling healthy produce. NHS Boards may wish to support the sustainability of community food initiatives by encouraging retailers to source healthier, local produce from them.

Food and Heath outcomes

Access for staff, patients and visitors in hospitals to a wide range of affordable healthier options from all food outlets across NHS sites.

An increase in access to healthy drinks and a reduction in access to drinks with high sugar content.

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Food and Health performance measures

Number of sites with hospital caterers from all sectors with Healthy Living Award (or Healthy Living Award Plus for those caterers who have already achieved the Healthy Living Award) as a

proportion of total sector delivery units.

Number of units with retailers in the Healthy Living Programme as a proportion of total sector delivery units.

Number of sites with community food co-ops and other social enterprises selling predominantly healthier produce.

Number of sites with healthy options within vending machines in place as a proportion of total sector vending machines.

In addition, NHS Boards should continue to implement the actions to remove sugary drinks from vending machines on NHS sites outlined in CEL 14 (2008) and provide details of progress in their annual report.

All 11 catering units that NHS Tayside operates have the Healthy Living Award Plus.

We are working with NHS Tayside Head of Site/Support Services to discuss engagement and contractual issues with the retailers identified so that they can comply with the Healthy Living Programme. They are; WH Smith (Ninewells), DUSA shop (Ninewells), WRVS (PRI), WRVS trolley services, Lippen Care (Whitehills).

A fruit and vegetable stall operated by the charity, Transform, was sited in the Fresh Air Garden at Ninewells every Tuesday from June until 25 September 2012. Although sales during this period were down on previous years, it was the view of Transform that the stall was a worthwhile way of letting the public see what the charity is doing in the city. They would be keen to operate the stall again during 2013.

All 60 cold drinks vending machines in NHS Tayside comply with the CEL 01 requirements due to the Drinks4Health’s initiative.

We will explore with NHS Tayside availability of an indoor site at Ninewells for the fruit and vegetable stall so that site users can access fresh produce throughout the year.

We will explore the options for healthy snack vending and it is hoped that NHS Tayside will negotiate with the food vending contractor to introduce healthy option to the machines.

We will work to support colleagues negotiating or renegotiating non-NHS catering contracts to ensure the requirement for Health Living Award is included in any contract.

5. Healthy Working Lives actions

Continue to work to attain Healthy Working Lives (HWL) awards for all acute services, working towards the Gold Award;

The attainment of the Healthy Working Lives Mental Health Commendation Award.

HWL outcomes

Improved health and wellbeing of staff, improved attendance, and enhanced productivity.

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HWL performance measures

NHS Boards commit to minimum achievements of a Bronze Healthy Working Lives Award by end of March 2013 and Silver by end of March 2015;

NHS Boards who already hold a Bronze Award should commit to attaining a Gold Healthy Working Lives Award by March 2015

NHS Boards should give consideration to self-monitoring of performance indicators. These should include, but are not limited to, monitoring of sickness absence.

Tayside NHS Board (Kings Cross, Maryfield and Corporate Staff at Ninewells), NHS Tayside Operational Unit (Ninewells, PRI and Stracathro), NHS Tayside Specialist Palliative Care and NHS Tayside Support Services (Ninewells and Dundee Dental Hospital) are all Gold Award Holders.

NHS Tayside Centre for Brain Injury Rehabilitation (Royal Victoria) has achieved Silver Standard.

Montrose Maternity Unit, Strathmore Unit Blairgowrie, Arbroath Infirmary have all registered for HWL but are not currently active. Some ad hoc participation has been undertaken with Brechin Infirmary.

NHS Tayside monitors sickness absence and encourages managers to implement the refreshed Promoting Attendance at Work Policy.

Within team resources we will encourage and facilitate more NHS Tayside units to participate in HWL programme and support those already registered to progress. Tayside NHS Board has recently piloted the new HWL Employee Survey Document and once the final version is available this survey will be undertaken in all NHS Tayside sites participating in the HWL programme as and when required.

6. Sexual Health actions

Ensure that, prior to discharge from maternity services, all women aged 16-50 are advised of their contraception options. In particular, vulnerable women at risk of poor sexual health outcomes should be offered effective methods of contraception, including long-acting reversible

contraception (LARC).

Prior to discharge from termination services, all women should be provided with an effective method of contraception, including LARC, where appropriate.

Sexual Health outcomes

An increase in the number of women using LARC methods; and a decrease in the number of unintended pregnancies, terminations and repeat terminations, particularly amongst vulnerable women who are at risk of poor sexual health outcomes

Sexual Health performance measures

The number of women who have contraception methods recorded.

The number of women (including teenagers and women with drug and alcohol problems) who are provided with longer lasting contraception prior to discharge.

The number of terminations and repeat terminations

The number of unintended pregnancies, particularly amongst teenagers and others at risk of poor sexual health.

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The HIS Standards for Sexual Health are reported on by the Sexual Health and Blood Borne Virus MCN and standard 6 directly relates to termination of pregnancy (TOP) services. The latest update from the MCN is a narrative as they are awaiting the figures from the updated database.

The Medicines Division and the MCN are working together to strengthen and integrate care pathways.

The review of TOP service provision and the patient pathway will inform a test of change intended to meet waiting time targets as well as strengthen the links to the Sexual and Reproductive Health Service. Some changes have already been implemented as a result of the review, including the introduction of Manual Vacuum Aspiration (MVA) and early discharge for medical TOP.

A new consultant was appointed in September 2012, which, along with changes to the senior nursing team will provide strengthened clinical leadership and support the modernisation of the TOP service.

The local clinical database has been reviewed and real time performance information is to be available from January 2013. The service aims to increase the clinic capacity based on the current performance and the data for the past year.

All women are offered and advised of contraception options prior to discharge but not all women accept.

All women are provided with an effective method of contraception including LARC. However, 'effective' contraception is very much dependant on compliance.

We record the chosen option of contraception (including those patients who decline contraception on more that one occasion) as the woman goes through the system.

A questionnaire will be developed to identify any delays in the current pathway and explore with women the reasons for late presentation and repeat termination.

By the end of January figures of women who have been provided LARC prior to discharge will be available. We will also be able to provide figures on the number of women undergoing repeat terminations.

We do not ask (or record) patients if a pregnancy was 'unintended'. However, it could be incorporated into the assessment consultation document.

Plan to have contraception method identified and recorded for 100% of women (even those who decline).

7. Physical Activity actions

Increase opportunities for staff, visitors and patients to be physically active; and encourage and support them to be more active, including the provision of advice to staff and patients on the importance and benefits of physical activity.

Physical Activity outcomes

NHS staff routinely highlight the importance of physical activity for patients in hospitals as part of their rehabilitation and for prevention of future illness.

Increased opportunities for staff, patients and visitors to be more physically active are in place

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Physical Activity performance measures

Evidence of brief advice and/or brief interventions for the routine provision of information and advice to patients on physical activity. This should include defined pathways for the delivery of brief advice.

Increase opportunities for staff to be move active.

Increase uptake of opportunities to be more active by staff.

Evidence of the use of promotional and motivational posters and other materials to encourage staff and visitors to make more active choices.

Since September 2012 Nursing Documentation contains a brief advice and a pathway that is used to signpost patients to physical activity opportunities including Exercise Referral schemes, Green Exercise and Walking.

The Pre-assessment team in Ninewells are trained in Health Behaviour Change and the relevant aspects of delivering the physical activity brief advice/brief intervention pathway. Training is planned for Stracathro and Perth.

The Arboretum Green space development is complete at Ninewells. The Community Garden is in progress and offers a wide range of volunteering opportunities, rehabilitation programmes and a facility for community involvement e.g. work experience, West Fest venue, cultural events and health walks.

We have increased opportunities for staff, patients and visitors to be active through the completion of the cycle path’s linkage into the Green Circular route offering opportunities for Active Travel.

Cycle to Work schemes, corporate membership of leisure facilities and leisure facilities on site are promoted.

As part of the Active Travel Plan all sites have pool cars and Ninewells and Kings Cross sites have pool bikes. Numbers of staff using all of these facilities are recorded.

What will we do next

Continue to recruit volunteers for sustainability of Ninewells green space and roll out same model to other NHS acute sites. Engage with clinical staff to develop rehabilitation and recovery

programmes.

8. Active Travel action

Encourage staff and visitors to make more active, green travel choices.

Active Travel Outcome

Staff and visitors have increased awareness of the connection between travel choices and health and have better information about the alternative options available to them.

Active Travel performance measures

Evidence that NHS sites have developed and promoted an active travel plan.

Evidence that NHS Boards have made available promotional material to raise awareness of active travel options e.g. make leaflets available to all staff, patients and visitors.

Evidence of initiatives and infrastructure in place to support active travel, such as walking maps, cycle friendly employer, bike purchase I training schemes, stair walking.

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NHS Tayside promotes active travel through provision of pool cars, 333 link bus, cycle paths, cycle storage, cycle purchase schemes. Promotion of physical activity is also progressed via

the HWL programme.

We will work with colleagues to further develop local walking maps for staff to use during break periods and to promote car sharing for commuting.

RECOMMENDATION

The Board is requested to note the paper.

Dr D Walker Mr G Marr

Director of Public Health Chief Executive

Mrs L M Marley

Directorate Manager Public Health February 2013

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APPENDIX 1

CEL (1) 2012 Health Promoting Health Service: Action into Hospital Settings

Monitoring and Evaluation Framework:

Year 1 for submission March 31^st 2013

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – CORE ACTIONS

Action Monitoring and Evidence

1. Chief Executives are asked to delegate responsibility for implementation to the appropriate committee and governance structures and to provide a report to the Board on progress, at least annually, in each of the next 3 years.

2. The attainment of generic health improvement competences should be supported through provision of appropriate professional development programmes.

3. Local expertise on improvement methodology should be made available to jointly support all hospital and public health staff to test, adopt and spread good practice.

4. Patient Focus and Patient Involvement (PFPI) and patient experience leads should enable patient, carer and volunteer participation in developing and implementing the action plan.

5. Medical Directors and Directors of Public Health should jointly support and encourage all hospital Clinical Directors to take account of involvement in health improvement actions through the annual appraisal cycle for hospital consultants.

Evidence of Delivery

1. Local Governance and implementation structures submitted and evidence of Board reports/ minutes on progress achieved.

2. Submission of proportion of staff undertaking and completing generic health improvement professional development programmes.

3. Named Lead and description of what planned and/or operational improvement processes are in place

4. Details of how and what PFPI leads have influenced in the development and implementation of the local delivery plan.

5. Hospital consultants have demonstrated involvement in health improvement action.

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – ALCOHOL (ACTION 18.2)

Action Outcome Performance Measures Monitoring and Evidence

A. Opportunistically screen patients attending A&E

departments and wider acute settings. For patients identified with harmful or hazardous drinking (screening positive) to offer and deliver a brief intervention in accordance with the SIGN 74 Guideline.

B. For patients identified as dependent drinkers, and those with harmful or hazardous drinking patterns who request further help, to direct to an appropriate support service (including health, social services, local authority and voluntary).

Improved, consistent and embedded screening (in line with the Alcohol Brief Intervention (ABI) HEAT standard for 2012-13 and the SIGN74 Guideline) and appropriate referral, ensures that the most appropriate treatments, interventions, support and services are available at the right time to everyone who will benefit.

1. The number of A&E attendances who are screened opportunistically for alcohol misuse, as a % of total attendances;

2. The number of A&E attendances screened (using a validated screening tool) for harmful or hazardous drinking and the % screening positive ( i) with % eligible for ABI and ii) % eligible for referral to treatment services;

3. The number of alcohol brief interventions delivered in accordance with the HEAT Standard Guidance 2012/13.

Monitoring

Performance Measures 1-3 will be reported as part of revised Governance & Accountability arrangements for Alcohol & Drug Partnerships (ADPs) every 12 months. Other reporting as indicated.

The number of screenings for all services, including the number of A&E attendances screened, as part of the total number of A&E attendances (extracted from the ADP Governance

& Accountability dataset).

The number of alcohol brief interventions delivered in accordance with the HEAT Standard Guidance 2012/13.

The number of staff trained in both A&E and other acute settings (as part of wider settings) in ABI (extracted from required 6 monthly report)

Evidence of planning, delivery and/or evaluation of ABIs across the acute settings in accordance with the ABI HEAT standard guidance 2012-13.

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – BREASTFEEDING (ACTION 18.3)

Continued

implementation of the UNICEF Baby Friendly Initiative in all maternity units.

An increase in the number of women exclusively

breastfeeding at first visit and at 6-8 week review.

1. Achievement and maintenance of UNICEF Baby Friendly Initiative in all maternity units.

2. All mothers are signposted to available breastfeeding support programmes in the community. Those with additional needs who are least likely to breastfeed, or breastfeed only for a short time, are supported to access and engage with services through an appropriate referral process.

3. Develop and establish pathways to maintain support and continuity of breastfeeding in the community, including measures aimed at reducing attrition rates of those initiating lactation.

4. All women returning to work from maternity leave are advised of the breastfeeding support policy 4-6 weeks prior to returning to work.

Submission of evidence that confirms attainment or maintenance of UNICEF BFI Award.

Monitoring

Report on the proportion of breastfeeding women signposted to community support services at point of discharge through appropriate referral processes.

Proportion of women who access a breastfeeding clinic or a breastfeeding support worker.

Submission of local pathways for signposting to community breastfeeding support including feedback mechanism on breastfeeding rates at 5 days (from Improving Maternal and Infant Nutrition: A Framework for Action short-term outcomes)

Submission of staff breastfeeding support policy and details of how policy is communicated to women returning to work.

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – FOOD & HEALTH (ACTION 18.4)

A. To develop a consistent approach to healthy eating for all food service providers across the NHS. This will require private and voluntary sector operators to follow the lead of NHS caterers, 97% of whom have already achieved the Healthy living Award;

B. Caterers will be required to follow Healthy living Award criteria at the point of contract (re)negotiation. If no contract exists, an implementation plan for the caterer's registration to the Healthy living Award should be agreed;

C. Retailers will be required to join the Scottish Grocers’ Federation Healthy living Programme and meet their Gold Standard criteria at the point of contract

(re)negotiation; and

D. NHS Boards to continue to encourage and support food co-operatives and other social enterprises selling healthy produce. NHS Boards may wish to support the

sustainability of community food initiatives by encouraging retailers to source

healthier, local produce from them.

Access for staff, patients and visitors in hospitals to a wide range of affordable healthier options from all food outlets across NHS sites; and an increase in access to healthy drinks and a reduction in access to drinks with high sugar content.

1. Number of sites with hospital caterers from all sectors with Healthy living Award (or Healthy living Award Plus for those caterers who have already achieved the Healthy Living Award) as a proportion of total sector delivery units.

2. Number of units with retailers in the Healthy living Programme as a proportion of total sector delivery units;

3. Number of sites with community food co-ops and other social enterprises selling predominantly healthier produce;

4. Number of sites with healthy options within vending machines in place as a proportion of total sector vending machines. In addition, NHS Boards should continue to implement the actions to remove sugary drinks from vending machines on NHS sites outlined in CEL 14 (2008) and provide details of progress in their annual report.

Monitoring

The Healthy Living Award and the SGF Healthy Living Programme will report quarterly on progress within the NHS setting identifying support required.

Evidence of delivery

Performance measures 1-4 will be reported on within results

contained within the annual report from each NHS board.

Performance measures 1-2 will be reported on specifically by the relevant national food & health project as part of their quarterly reporting.

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – HEALTHY WORKING LIVES (18.5)

Continue to work to attain Healthy Working Lives Awards for all acute services, working towards the Gold award.

Improved health and wellbeing of staff, improved attendance, and enhanced

productivity

1. NHS Boards commit to minimum achievements of a Bronze Healthy Working Lives Award by end of March 2013 and a Silver by end of March 2015;

2. NHS Boards who already hold a Bronze Award should commit to attaining a Gold Healthy Working Lives Award by March 2015 3. NHS Boards should give consideration to self-monitoring of performance indicators.

These should include, but are not limited to, monitoring of sickness absence.

Monitoring

NHS staff survey report includes questions on staff experience of workplace health support, employee satisfaction and employee engagement.

Inclusion of sickness absence rates.

NHS Boards to specify organisational hospital and community hospital services to enable progress to be captured on the NHS Health Scotland National HWL Database. NHS Boards to report on progress as part of their Annual Review process.

Submission of evidence that confirms attainment in all hospital and community hospital services elements of HWL Bronze Award by March 2013, and HWL Silver Award by March 2015.

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – PHYSICAL ACTIVITY (ACTION 18.7)

A. Encourage and support staff and patients to be more

physically active, including the provision of advice to staff and patients on the importance and benefits of physical activity.

B. Increase opportunities for staff, patients and visitors to be more physically active (e.g. stair use, walking paths, cycling infrastructure, walking groups, community/therap eutic garden, green spaces).

NHS staff routinely highlight the importance of physical activity for patients in hospitals as part of their rehabilitation and for prevention of future illness.

Increased

opportunities for staff, patients and visitors to be more physically active are in place

1. Evidence of brief advice and/or brief interventions for the routine provision of information and advice to patients on physical activity. This should include defined pathways for the delivery of brief advice.

2. Increase opportunities for staff to be move active

3. Increase uptake of opportunities to be more active by staff.

4. Evidence of the use of promotional and motivational posters and other materials to encourage staff and visitors to make more active choices.

Monitoring

The proportion of staff/ staff groups delivering brief advice and/or brief interventions within defined patients pathway and consistent with the National Physical Activity Pathway.

Evidence of adoption of National Physical Activity Pathway for Brief Advice & Intervention to Patients.

Staff Training Plan for employees responsible for the delivery of the Local Physical Activity Pathway for Brief Advice & Intervention to Patients.

Plans and/or Reports on Workplace Physical Activity Schemes.

Monitoring

Baseline data of staff physical activity scheme uptake.

Evidence describing the range of physical activity promoting and motivational tools in place for staff, visitors and/or patients.

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – ACTIVE TRAVEL (ACTION 18.8)

To encourage staff and visitors to make more active, green travel choices.

Staff and visitors have increased awareness of the connection between travel choices and health, and have better information about the alternative options available to them.

1. Evidence that NHS sites have developed and promoted an active travel plan.

2. Evidence that NHS Boards have made available promotional material to raise awareness of active travel options e.g. make leaflets available to all staff, patients and visitors.

3. Evidence of initiatives and infrastructure in place to support active travel, such as walking maps, cycle friendly employer, bike purchase I training schemes, stair walking.

Monitoring

Submit baseline data of staff participating in employer active travel schemes.

Report on Performance Measures 1-3 will be provided.

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HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – SEXUAL HEALTH (18.6)

A. Prior to

discharge from maternity

services, all women aged 16- 50 are advised of their

contraception options.

B. Prior to

discharge from termination services all

women are

provide with an effective method of contraception including LARC, where

appropriate.

An increase in the number of women using LARC methods;

and a decrease in the number of unintended pregnancies,

terminations and repeat terminations, particularly amongst vulnerable women who are at risk of poor sexual health outcomes.

1. The number of women who have contraception methods recorded.

2. The number of women (including teenagers and women with drug and alcohol problems) who are provided with longer lasting contraception prior to discharge.

3. The number of terminations and repeat terminations

4. The number of unintended pregnancies, particularly amongst teenagers and others at risk of poor sexual health.

Monitoring

Percentage (n.) of all women aged 16-50 admitted to maternity and termination services who have contraceptive method recorded

Percentage of women offered effective contraceptive methods prior to discharge from maternity and Termination Services.

Percentage of women i) under 20 years old and ii) by SIMD for monitoring measures 1 and 2.

Proportion of reproductive age women using LARC Monitoring

The rate of terminations of pregnancy.

The rate of repeat terminations of pregnancy.

(21)

HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – SMOKING (ACTION 18.1)

A. To ensure dedicated specialist smoking cessation support is available within the

hospital/acute setting which is integrated with community- based cessation services.

B. To commit to the development (or

maintenance) and

implementation of

comprehensive organisational tobacco policies.

Increased availability of

specialist smoking cessation support by hospital patients who are motivated to quit smoking.

An

increase in the

number of NHS premises moving towards becoming completely smoke- free.

1. Increased quit attempts and successful quits amongst hospital in-patients, out-patients, day surgery and pregnancy. Community-based quit attempts and quit successes following a referral, or delivery of brief interventions and referrals, from a hospital setting;

2. Evidence of existence and application of Integrated Care Pathways for smoking cessation in secondary care (and for patient flows to and from primary care);

3. Evidence of appropriate training and/ or support in the delivery of brief advice for smoking cessation in secondary care;

4. Evidence of specialist smoking cessation support (or Health Behaviour Change equivalent) available within (or to) secondary care sites within Boards.

5. Implement more comprehensive organisational tobacco policies with specific timescales to enable progress to be measured. For example, evidence could include a statement of existing smoke-free policies plus proposals or updates (e.g. within Board papers, action plans, local tobacco action, monitoring reports and so on) with timescales that would indicate the extent and type of progress made or planned against relevant indicators, such as no smoking in hospital grounds, removal of smoking rooms in existing exempted premises or a wide range of other steps towards smoke-free.

Monitoring

Number of acute-setting referrals to Community Smoking Cessation Services

Number of acute setting referral to attend first SCS session/ group

Breakdown of Quit Attempts of Smoking Cessation Users referred from Hospital Setting

Submission of Local Integrated Care Pathway(s). Including details of:

i) pathway alignment with MCNs

ii) if opt-out scheme approach is in practice.

iii) approach to integrate with primary care Number of hospital staff by ward/setting trained in the effective delivery or brief advice or use of the Integrated Care Pathways.

Submission of outline of specialist smoking cessation support available within or to secondary care sites within Boards (or health behaviour change equivalent).

Submission of Local Tobacco Policy with update report on delivery. This would include;

• Details on how the policy is communicated to staff, patients and visitors.

• Details of Smoke Free Target Dates for Hospital Sites and plans for those yet to set target dates.

(22)

HEALTH PROMOTING HEALTH SERVICE CEL (1) 2012 – INNOVATIVE & EMERGING PRACTICE (PERFORMANCE MEASURES 16-18)

Boards are encouraged to broaden the scope of their health improvement activities to additional topic areas wherever possible.

The CEL interventions constitute a minimum set of action and boards are requested to more, including integrating separate activities into a whole-hospital approach.

Health improvement opportunities within acute care are maximised, with boards demonstrating integrated and innovative approaches through about clinical pathways.

1. Evidence of planning, delivery and/or evaluation to for health improvement within hospital and community hospital settings.

Completion of Innovative and Emerging Practice Pro-Forma (provided in the annual report template)