Programme for Government

Introduction

Our overall priority to improve public health focuses on:

Overview

Our general health record is not good. Death rates from coronary heart disease and some cancers are amongst the highest in Western Europe. So too, for example, are our teenage pregnancy rates. Overall, our life expectancy is lower than many other developed countries. Further, there is clear evidence that levels of ill-health are closely linked to social disadvantage - long-term sickness rates are 3 times greater in some districts than others. Finally, in the services we provide to treat illness we fall behind Great Britain - for example, we have a higher proportion (18%) of patients on hospital waiting lists for 12 months or longer.

Tackling the causes of ill-health

Too many of our community die early or suffer ill-health as a result of preventable disease. If we are to tackle these problems effectively it is essential that we focus on their causes and ensure that our policies and programmes strike at these. A range of factors, including low income; the environment; poor housing and community infrastructure; and inadequate working conditions impact adversely on health and well-being status. Family breakdown, domestic violence and levels of disability have also an impact, as do lifestyle factors such as smoking, inappropriate diet and a lack of physical activity. Smoking alone is responsible for some 3,000 deaths each year.

Providing timely and effective treatment

We all will need health care or support from the care system during our lifetimes. A major focus of the Executive will be on the quality of care and to ensure that it can be provided in the most effective and timely way to meet individual need.

Caring in the Community

Personal social and health care services provide vital services to many physically disabled people, older people, people with a mental illness and those with a learning disability. There are at present in excess of 15,000 people receiving intensive community health and social care support services. Despite increased provision in recent years, there are some 4,000 people waiting for support and demographic changes will place increasing pressure on resources.

The Well-being of our Children

We have one of the youngest populations in the EU, but an unacceptable proportion live in conditions of poverty. Over a quarter of children come from households dependent on Jobseeker's Allowance or Income Support. There is a close relationship between family poverty and higher infant mortality, poor levels of general health and increased risk of social problems. The Executive Programme Fund for Children will be a source of support for children in need.

Children in the worst-off families have a 20% higher death rate in the first years of life, and people of working age in the poorest socio-economic groups are more than twice as likely to die prematurely as those in the highest group. The number of children in care is significantly higher than in England and there is a need for a very substantial increase in the number of residential child-care places with a range of specialised facilities. There is continuing concern about road safety, particularly the levels of road accident casualties and deaths, and emphasis will continue to be placed on improving road safety through education, engineering and enforcement in an effort to reduce these levels.

We will work to reduce preventable disease, ill-health and health inequalities.

An effective strategy to improve our poor health status is one which must involve North/South and cross-departmental activity, focusing on the causes of ill-health and injury in a way that makes transparent the contributions and responsibilities of different sectors and policy areas. The actions and targets set out in the other priority areas for action of this Programme for Government - in relation to the community, education, skills and the economy - are fundamental in tackling the root causes of ill-health and injury. The measures set out in relation to working together and developing relationships on a North/South, East/West and international level will support and underpin the action needed. Together, they will help to create the social and economic conditions needed for good health.

Actions

We will take the following actions:

• by April 2001, after full public consultation, develop a cross-cutting public health strategy which maximises, across all sectors, our efforts to improve health and well being and reduce health inequalities;
• produce detailed cross-departmental plans for securing reductions in the main causes of ill-health with the objective of achieving a level of health and well being that is at least as good as the best of our European neighbours;
• take specific measures, underpinned by challenging targets, on a cross-Departmental basis to:
  • reduce the proportion of the population who smoke
  • increase physical activity
  • reduce unplanned births to mothers under 20
  • improve diet
  • increase uptake rate for primary immunisations
  • reduce the number of deaths from accidents
  • reduce the misuse of drugs and alcohol;

• ensure a cross-departmental response to the drugs strategy which is aimed particularly at reducing drug misuse among young people; involving local committees in addressing drug misuse; giving treatment for drug users; and reducing the availability of drugs;
• by 2001, ensure that Health and Social Services Boards implement New TSN Action Plans which include measures for tackling inequalities in areas of accidents, cancers, circulatory diseases, diabetes, immunisation, infant mortality, nutrition, smoking, physical activity and alcohol consumption;
• over a 3 year period, implement the agreed recommendations of the Capitation Formula Review Group to ensure more equitable distribution of resources to Health & Social Services Boards;
• early in 2001, launch a new road safety strategy for the next decade, identifying measures which will contribute to a reduction in road traffic casualties, including improvements in road safety education, increasing the number of road safety officers and the level of promotional activity;
• take steps to improve tobacco control including bringing forward measures to ban tobacco advertising;
• by August 2001, publish an Approved Code of Practice on passive smoking;
• by December 2001, in co-operation with District Councils, develop a strategy for improving health and well-being through participation in culture and leisure activities and increase health-related physical activity by increasing opportunities for participation in sport, especially by young people, women and people with disabilities;
• by April 2003, develop an Occupational Health strategy for Northern Ireland; and
• take forward work in the North South Ministerial Council, giving immediate priority to cancer research, health promotion, accident and emergency planning, major emergencies and co-operation on high technology equipment.

We will work to ensure that the environment supports healthy living and the safe production of food

We will work to ensure the improvement of air, land and water quality. We will not only fulfil our EU obligations but also seek to ensure that development takes place in a sustainable way. Ensuring the highest standards of animal health and building confidence in the safety of local food products are also important public health considerations. We will ensure that our people continue to have access to high quality recreational facilities.

Actions

We will implement the following actions:

• support the work of the Food Standards Agency and the North/South Food Safety Promotion Board to ensure the safety of food and foster confidence in the local food supply;
• by March 2001, finalise arrangements for formal co-operation on animal health on the island of Ireland;
• by March 2002, develop joint strategies for the improvement of animal health on both sides of the border;
• by March 2002, make progress towards the eradication of scrapie in sheep;
• by April 2001, prepare a Sustainable Development Strategy for Northern Ireland incorporating a set of indicators of progress including health-related measures;
• progressively eliminate the backlog in transposing and implementing EC Directives on air, land and water quality;
• by March 2003, achieve a 20% reduction on the 1996 level in the number of high and medium severity water pollution incidents; and
• by end 2002, have in place a policy and legislative framework to deliver our contribution to the targets in the UK Air Quality Strategy.

We will modernise and improve hospital and primary care services to ensure more timely and effective care and treatment for patients

Everyone has a right to timely quality care based on clinical and social need. The health and social care system must be able to respond to assessed individual needs and provide modern flexible services which will make full use of new technologies. At the same time the users of these services must use them with consideration in order that scarce resources are not wasted. We will therefore develop proposals for a modern acute hospital service and take steps where possible to maintain safe and effective services at smaller hospitals.

Actions

We will also implement the following actions:

• work to reduce waiting lists and to ensure improved capacity to meet winter pressures by increasing high dependency beds, implementing a range of new management arrangements and recruiting additional nursing and other front-line staff;
• finalise a strategy for the development of the ambulance services and begin the implementation of an investment programme which will be targeted initially at essential fleet replacement;
• provide some 40-50 extra specialist medical, nursing and other staff to improve provision in services for breast, lung and colorectal cancers to consolidate progress made on the implementation of the cancer strategy;
• continue the major capital redevelopment programmes at the Royal Victoria Hospital and Altnagelvin hospital sites, accelerate the development of ICT systems based on a new ICT strategy and aim to reduce the backlog in essential health and safety/Firecode work;
• finalise a strategy which will replace the GP Fundholding Scheme with fairer, less bureaucratic arrangements in primary care designed to strengthen structures for delivering high quality primary care services in local communities;
• review cardiac services to assess efficiency and effectiveness and develop best practice;
• review the implementation of the community care policy, paying particular attention to hospital admissions and discharge arrangements;
• put in place a framework to raise the quality of services provided to the community, and tackle issues of poor performance; and
• maximise the resources going to front-line care.

We will work to enable those suffering from disability or chronic, mental or terminal illness to live normal lives and contribute to society.

We need to support those with chronic and mental illness, disability or terminal illness to live independently, supporting them and their carers, wherever possible in their own homes and communities. Effective social care should be available to those who have not the means or other resources to get the help they need.

Actions

We will implement the following actions:

• enhance the provision of high quality care for those waiting in the community for suitable care packages by the provision of an additional 230 community care packages;
• provide for enhanced community teams which will facilitate the resettlement of some 35 long-stay patients from hospitals;
• establish a Northern Ireland Social Care Council to regulate the personal social services workforce and raise standards of practice;
• by 2001, develop a Carers' Strategy which will seek to address properly the needs of this group; and
• by May 2001, implement a programme to improve accessibility to culture and leisure facilities in particular for people with disabilities.

We will protect and promote the health and social development of children.

A healthy start to life is the necessary preparation for a healthy life. We need to reduce infant mortality and take steps to break the cycle of deprivation through early sustained measures to promote healthy social and emotional development. In particular, we need to improve provision for children in care and support for families. We also need to recognise the important role of play in promoting the health and social development of children and ensure that play facilities are given appropriate priority.

Actions

We will implement the following actions:

• increase coverage of the Sure Start programme targeted at children under 4 in areas of social disadvantage from 11,000 children to 16,000;
• by December 2001, provide some 12 additional residential care places;
• issue new Child Protection guidance, introduce legislation which will put the Pre-employment Consultancy Service register on a statutory footing in line with the Protection of Children Act 1999 and extend the new provisions to cover vulnerable adults;
• introduce legislation to help young people move from care into independent living;
• by December 2001, provide 10 additional child and adolescent inpatient psychiatric beds;
• develop, by December 2001, a strategy for establishing state of the art community play facilities in collaboration with the District Councils and the community and voluntary sector; and
• by 2002, revise the curriculum for schools to enhance the status and impact of health education.

The departments with the main involvement are :

Department of Health, Social Services and Public Safety
Department of Environment.
Department for Social Development.
Department of Enterprise, Trade and Investment
Department of Agriculture and Rural Development.
Department of Culture, Arts and Leisure
Department of Education