The aim of this DVD is to show good practice
and demonstrate the very significant progress which NHS Scotland has made
over the years in developing a Health Promoting Health Service
and most recently
since the publication of the Chief Executive letter
on the Health Promoting Health Service back in March 2008.
In 2007 in this very room something happened
which made me determined to keep pushing
the Health Promoting Health Service approach.
A patient came to my haematology clinic
with a relatively minor blood problem.
However, her GP had been concerned that she'd also lost a lot of weight
over the previous six months.
When I chatted to her it became clear that she'd done this deliberately
because she'd been diagnosed with type 2 diabetes
and had quite sensibly decided to lose some weight
to improve her health.
It also became clear during the consultation
that she was a very heavy smoker.
So I had the usual conversation that I have with all smokers
about the need to stop if at all possible,
asked her if she'd ever tried to stop before
and pointed her in the direction of her GP practice
for smoking cessation services.
As she left the room she turned back and looked at me and said,
'Doctor, you're the first person who has ever told me
that it would be a good idea to give up smoking'.
I'm sure most of you listening, like me, will find this almost incredible.
It may be that she had indeed been told to stop smoking at some point
by a health care professional,
but clearly the message had not been conveyed strongly enough
and had not registered with her as something important.
It made me think that we might achieve much more
if we had a more strategic and structured approach
which got real buy-in from senior management and clinical staff,
tapping into the enormous numbers of NHS Scotland staff
who are perfectly capable not only of treating illness
but also of giving health improvement messages
to both patients and their relatives.
And that's where the aspiration of 'every health care contact
is a health improvement opportunity' comes from.
What follows in this DVD are examples of local practice
which provide very encouraging evidence
that delivering a Health Promoting Health Service
is beginning to be seen as the responsibility
of everyone who works for NHS Scotland.
What we have done is set up, as part of the diabetes services,
a smoking cessation clinic within the diabetic clinic
and I think that this will allow us
to roll patients straight on to the smoking cessation people.
I think if the patients come back into the diabetic clinic
which they've often been coming to for years,
it'll make them feel more comfortable
rather than being handed a piece of paper or a sheet or a card
saying please could you make a phone call to Fresh Air.
It allows us also to identify those patients
that we think are sufficiently motivated to give up smoking
because there's no point in us referring people on who say,
'Well, I think I want to stop smoking'.
We need to know those who particularly want to stop smoking.
It is a resource that's out there
and I think it needs to be aimed at people that are motivated,
want to do it.
And by taking advantage of the smoking cessation
and the motivation with the patients,
hopefully we can reduce the number of patients who smoke in the clinic.
A recent audit suggested that at least 30% of our patients
who come to the diabetic clinic smoke,
which is a heck of a lot.
I think the big advantage in having the smoking cessation clinic
within the diabetes clinic
is that means anyone from pediatrist, to dietician to nurse to doctor
can refer the patient on to the service.
I think it's important the fact that the patients come along here anyway
to deal with their diabetes
and so this can be an extra add-on which is included in the service
because if a patient's getting the right support
and the right treatment,
they're four times more likely to stop than doing it on their own.
(So the odds are in their favour straight away
Patients who have chronic diseases and have complications
are much more motivated to stop smoking
than so-called healthy smokers.
And I think that's very important.
These people who've got problems with diabetes, they've got eye problems,
they've got macro vascular disease, they probably are much more motivated
than any smoker you meet on the streets.
And my concern would be that very quickly we overwhelm the service
but I think that would be a good thing
and I think we should be encouraged by that
because it means it's working.
So the project here is the REAL Project
which is Real Education Active Lives
and it's a social enterprise that's based in a high school in Inverness
and we've been working with them to have this fruit and vegetable stall
in the hospital for four hours a week
so that staff and visitors have got improved access
to great fruit and veg.
The visitors and staff liked it
because it was access to really good fruit and vegetables
and they could buy all their ordinary stuff
but they could also get things that were in season
and things that were a bit different.
So strawberries and purple sprouting broccoli and kohlrabi.
The management team liked it because it was a really good example
of the Health Promoting Health Service in action.
Also it's a great opportunity for a local employer
to support a social enterprise that brings benefits to the community.
You went along to training for a good few months
and then you got trained up and you learnt about food miles,
cash handling, handling customers and all different stuff like that.
If you look back at the stall there,
about 85% of it is from within 30 miles of here.
It hasn't travelled halfway round the world.
It's local food, it's good food, it's healthy food
and it's that whole range,
it's offered there conveniently at a workplace
or for the folks that visit the hospital
as they're passing through to the wards and so on.
It's there just for buying as they pass.
We get the stuff from the school farm which we sell,
or some of it's from that but if we can't grow it ourselves
we get it from local suppliers.
What I think is a real benefit about this project
is that it's clearly a Health Promoting Health Service.
People walk in and see all this fantastic,
colourful fruit and vegetables and it makes it accessible.
It's all about improving the whole setting for health
and making health an easy choice.
The specific remit of the Alcohol Liaison nurses
is to look at providing a specialist consultancy service
to accident and emergency
but to also look at an upscaling of the general hospital staff
in the way that they care for people with alcohol problems.
So in general, that's my rule.
What we're looking at is getting early intervention
so that we can tackle this, change the culture in Scotland,
and you're really wanting to get people assistance
before it gets to the point where they're dependent drinkers
and it's affecting not just them but the wider society,
impacting family members.
The service has been welcomed with open arms by the general hospital.
Initially it was only Crosshouse who got the service,
it was a pilot at Crosshouse but quite quickly Ayr wanted some input
that went to two days a week then five days a week.
We now provide that service to both of the general hospitals
seven days a week and we've extended our hours to seven o'clock at night.
It's about tackling alcohol-related ill health.
So it's about the people who present with physical health problems
that are probably related to the misuse of alcohol.
So now what we're able to do for the general hospital
is to go up and offer advice and offer them support
and signpost these people into services.
So the general hospital very much see us as being part of their team.
I set up a training programme for the general hospital
and today over 300 staff have attended
and it's not just about the way that they care for people.
It's about their attitudes towards people.
A couple of reasons why I do the job:
obviously alcohol is something that impacts in everybody's life.
I think it would be fair to say that nobody would want to be an alcoholic
or to be somebody who was dependent on alcohol
because of the impact it would have on their life.
It's about providing a service to people where there is a gap.
The big gap that I was always aware of was within the general hospital.
Yes, they would be cared for,
they would get the treatment for their physical health problems
but for the alcohol it was a case of treated and put out the door.
That doesn't happen any more in Ayrshire and Arran.