Public Health 2011 / 12 - NHS Lanarkshire

Public Health 2011 / 12
The Annual Report of the
Director of Public Health

Public Health 2011 /12
The Annual Report of the
Director of Public Health
The Department of Public Health
NHS Lanarkshire

Acknowledgements
I am grateful to the staff within the Department of Public Health for their
hard work over the year. I am also grateful for their continued commitment, and
the commitment of other NHS Lanarkshire and non-NHS staff, to public health
in Lanarkshire.
In particular, I would like to thank all the contributors to this report and the
members of the Editorial Team (Lee Baird, Irene Campbell, John Logan, Catriona
Milošević, Brian O Suilleabhain, Derek Roseburgh, Martin Stirling and Albert Yeung).
Thanks also to Derek York for designing the report.
Finally, I would like to extend my thanks to all the organisations who work in
partnership with NHS Lanarkshire to protect and improve the health of the public,
particularly North Lanarkshire Council and South Lanarkshire Council.
The Department of Public Health
NHS Lanarkshire Headquarters
Kirklands
Fallside Road
Bothwell
G71 8BB
Telephone: 01698 858232
Fax: 01698 858283
www.nhslanarkshire.org.uk/Services/PublicHealth/
© Lanarkshire NHS Board
Published October 2012
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 978-0-905453-35-4
Printed on recycled material
Cover photo:
The cover photograph was taken by Don Perry from the Healthy n Happy
Development Trust at the unveiling of the mural Everyday People in Burnhill,
South Lanarkshire. The mural was designed and developed by the Burnhill
Children’s Group and depicts positive images of the Burnhill community from the
children’s own perspective.

Contents
Foreword 1
1 Health of the People of Lanarkshire
1.1 Population Profile 3
1.2 The Health Impact of Alcohol in Lanarkshire 7
2 Health Protection
2.1 Health Protection Update 13
2.2 Tuberculosis in Lanarkshire 15
2.3 The Lanarkshire Blood-borne Viruses Networks 18
2.4 The Hamilton Park Racecourse Food Poisoning Outbreak 20
2.5 Screening Programmes – Cancer 22
2.6 Screening Programmes – Pregnancy, Newborn and Pre-school 24
3 Health Improvement
3.1 Poverty and its Impact on Health 27
3.2 Tackling Poverty in South Lanarkshire – an Asset-based Approach 29
3.3 Welfare Reform – a Multi-agency Approach 31
3.4 Well Connected 33
3.5 Lanarkshire Tobacco Control Strategy 35
4 Oral Health
4.1 Improving Oral Health and Nutrition in the Early Years 39
4.2 The Oral Health Needs of Homeless People 42
5 Health Services
5.1 Overcoming Barriers to Accessing Healthcare Services –
the Keep Well Pilot 45
5.2 Dementia Services in Lanarkshire 47
5.3 Salus 50
Statistical Appendix 53
Staff in Public Health 72

Falkirk
North
Livingston
Glasgow
Coatbridge
Airdrie
Cambuslang/
Rutherglen
Bellshill
Motherwell
Wishaw
Hamilton
L a n a r k s h i r e
East Kilbride
Clydesdale

Foreword
It was with great sadness that I heard of Ken Corsar’s death in May. As the
Chairman of Lanarkshire NHS Board, he was an indefatigable champion
for the people of Lanarkshire, for education and for healthcare. Ken
would want us to redouble our efforts to improve the health of people in
Lanarkshire and to reduce health inequalities.
August 2012 saw the launch of NHS Lanarkshire’s strategic health planning
framework A Healthier Future and, importantly, the population’s health is the first of its four
key strategic aims which are:
1 to reduce health inequalities and improve health and healthy life expectancy
2 to support people to live independently at home through integrated health and social
care working
3 for hospital day case treatment to be the norm, avoiding inpatient admissions where
possible
4 to improve palliative care and supported end of life services.
These aims, together with the three national quality ambitions of providing personcentred,
safe and effective health care, and the need for improved efficiency and financial
sustainability, will be used to test any future service developments or changes in services
provided by NHS Lanarkshire.
It is in this context that I want to report on progress on some of the issues from last year’s
annual report.
The future trend of cancer in Lanarkshire section is being used in the development of the
Lanarkshire Cancer Strategy, work on which is underway. In health protection, work to raise
awareness of the importance of early booking in pregnancy has been successful with more
women being able to access the full range of screening tests and advice from their midwife
on having a healthy pregnancy. There was concerted action to improve the staff influenza
vaccine uptake last autumn and efforts on this will be reinforced this year.
Vitamin D supplementation is being reviewed following the CMO letter on the topic.
In South Lanarkshire, looked after children and young people were consulted on the
development of the new Integrated Children’s Services Plan. Improvement planning
(including improvement in health) for these children and young people has been
highlighted through the self-evaluation process in corporate parenting. In the child healthy
weight programme, work is ongoing to move from Healthy Life coach-led to class teacherled
interventions as an integral part of the curriculum. Women in the antenatal and
postnatal periods now have the benefit of staff specifically trained to help women who are
overweight, and, for babies, the national and infant nutrition framework will be developed
locally through the Best Possible Start Programme. The Gender-based Violence Action Plan
is being implemented with routine enquiry now being undertaken in sexual health services.
Finally, the Den Youth Health and Wellbeing Initiative is now part of the Cambuslang and
Rutherglen Community Health Initiative and its peer educators are now constituted as Den
Directions.
Foreword
1

Oral health of older people has seen the Mouth Matters Programme established in many
care homes, clear referral protocols to access dental services are in place, and a significant
number of oral health champions have been trained among care home staff.
Turning to this year’s report, the chapter on the health of people in Lanarkshire notes trends
previously described about the population increase, the ageing population, increasing life
expectancy, and deaths due to the so-called ‘big killer’ diseases of cancer, coronary heart
disease and stroke. There is a section on the health impact of alcohol, reviewing alcohol
consumption, and alcohol-related illness and deaths in Lanarkshire. This highlights the
immense harm that alcohol inflicts on individuals, communities and society, with people in
deprived areas being disproportionately affected. It notes the need to undertake prevention
activities (including alcohol minimum pricing) and provide appropriate services.
Health protection issues covered include:
• tuberculosis which emphasises the importance of tackling this disease which never
completely disappeared from Scotland and is increasing in incidence
• the work of the Blood-borne Viruses Networks covering treatment and prevention
• an outbreak of food poisoning at Hamilton Park Racecourse
• information on the cancer screening programmes, and the pregnancy, newborn and preschool
screening programmes.
The chapter on health improvement has the theme of poverty and health. It describes the
effects of poverty on health, the use of an asset-based approach to improving health, and
the negative impact of the UK welfare reform on many individuals and families. There are
also sections on social prescribing in mental health improvement which uses a community
asset-based approach, and the Lanarkshire Tobacco Control Strategy which underlines the
fact that smoking remains a significant cause of ill health, disability and early death.
The oral health chapter emphasises the issues of improving oral health and nutrition in early
years, and the oral health needs of homeless people.
The chapter on health services describes how the Keep Well project has helped overcome
barriers to accessing health care, the progress on services for people with dementia, and the
vital work of Salus, the Lanarkshire Occupational Health, Safety and Return to Work Service.
As ever, I trust you will find the report of interest and I welcome any comments or requests
for further information.
Dr Harpreet S Kohli
Director of Public Health
September 2012
Email: harpreet.kohli@lanarkshire.scot.nhs.uk
Telephone: 01698 858241
2 Public Health 2011/12

Health of the People
of Lanarkshire
1.1 Population Profile
Chapter
1
This section provides information on the
current population of Lanarkshire and
looks at how the population is projected
to change over the next twenty years.
The number of births and deaths in
Lanarkshire during 2011 is reported
in addition to information on life
expectancy, including trends. Readers
are also referred to the appropriate
sections in the Statistical Appendix for
further detailed information.
Population estimates and
projections
The estimated population of the NHS
Lanarkshire area on 30 June 2011 was
563,185, a small increase of 708 (0.1%)
on the previous year’s figure. The
population has increased annually since
2002 and is now at its highest level
since 1986. However, the rate of increase
has reduced over the last four years.
Between 2001 and 2011, the population
in Lanarkshire has increased by just
over 10,000 (1.8%). Within Lanarkshire,
there has been a greater increase in
South Lanarkshire (3.4%) than in North
Lanarkshire (1.7%), mainly due to higher
levels of people moving into the area,
rather than natural change as the result
of births and deaths.
The latest projections of Lanarkshire’s
future population are based on 2010
estimates and show that the population
will continue to rise at a gradual rate
over the next 20 years. The projected
change in the age structure of
Lanarkshire’s population between 2011
and 2031 is shown in Figure 1.1.1.
Figure 1.1.1
Projected change in the age structure of Lanarkshire’s population, 2011–2031
90%
70%
66%
% change
50%
30%
10%
32%
-10%
-30%
-3%
-6% -6%
-17%

Significant components in the changing
Lanarkshire population are as follows:
• An increase of 27% in the population
aged 75 and over is projected by 2021
and a further increase of 39% by
2031. Overall this means a projected
increase of 66% by 2031 resulting in
27,000 more people aged 75 and over.
• The largest fall in population will be
in age range 45–59, with a projected
decrease of 17% by 2031. It is projected
that there will be 21,000 fewer people
aged 45–59 by 2031.
More details on population estimates
and projections for Lanarkshire are
provided in tables A2 and A3 in the
Statistical Appendix.
Births
There were 6,502 live births in
Lanarkshire in 2011, 57 (1%) more than in
2010 and the first increase in three years.
The birth rate in Lanarkshire now stands
at 58.2 births per 1,000 women of childbearing
age and continues to be higher
than the Scottish birth rate of 56.4. The
number of stillbirths in Lanarkshire
decreased from 36 in 2010 to 29 in 2011,
the lowest number in 10 years.
Over the three-year period 2009–2011,
99.6% of all babies born alive in
Lanarkshire survived their first year,
a level similar to 10 years ago and an
increase from 99.2% 20 years ago. There
were 26 infant deaths under the age of
one in Lanarkshire in 2011: 16 in the first
week, four in the next three weeks and
six in the next 11 months. These figures
show some fluctuation from one year to
the next. Further information on births
is shown in tables A4 and A5 in the
Statistical Appendix.
Life expectancy
Life expectancy continues to increase
in Lanarkshire. In the 10 years between
1998–2000 and 2008–2010, average
life expectancy increased by 2.7 years
for males (from 72.3 to 75 years) and
by 1.7 years for females (from 77.7 to
79.4 years). Since the early 1980s, life
expectancy has increased by 6.2 years
for males and 4.7 for females (see
Figure 1.1.2). However, life expectancy
is still below national levels; people in
Lanarkshire live on average a year less
than others in Scotland. Compared to
the UK as a whole, men in Lanarkshire
die 3.1 years earlier and women 2.7
Figure 1.1.2
Change in life expectancy in Lanarkshire and Scotland
Life expectancy at birth (years)
82
80
78
76
74
72
70
68
66
1981–1983
75.5
74.7
69.3
68.8
1984–1986
1987–1989
1990–1992
Females
Males
1993–1995
1996–1998
1999–2001
2002–2004
2005–2007
80.4
79.4
75.8
75.0
2008–2010
Scotland
Lanarkshire
Source: National Records of Scotland
4 Public Health 2011/12

years. Within Lanarkshire, life expectancy
in South Lanarkshire is significantly
higher than in North Lanarkshire; men
in the South live 1.4 years longer on
average than those in the North and
women live 1.5 years longer.
Further information on life expectancy is
shown in A12 in the Statistical Appendix.
Deaths
There were 5,852 deaths in Lanarkshire
in 2011, a decrease of 64 (1.1%) on 2010.
Overall standardised mortality ratios
(SMRs) in Lanarkshire remain well above
the Scottish average for men and women
and for those under 75 years and 75 years
and over. Lanarkshire’s SMR has ranged
between 7.5% (in 2002) and 12.1% (in
2007) above the Scottish rate over the
last 10 years, and in 2011 was 9.2%
above. The relative difference between
Lanarkshire and Scotland is showing a
steady trend.
More than half of all deaths in
Lanarkshire in 2011 were due to the
so-called ‘big killer’ diseases of cancer
(28.2% of all deaths), coronary heart
disease (14.3%) and stroke (8.5%).
Overall, these three diseases accounted
for more than half (51%) of all deaths
in 2011. Over the past 10 years, this
proportion has decreased by 7% (from
58% in 2001), mostly as the result of a
decrease in deaths from coronary heart
disease. More detailed information
on mortality is provided in the tables
and charts in A6–A11 in the Statistical
Appendix.
Key Points
• Lanarkshire’s population continues to increase and is now at its highest level
since 1986.
• Population projections for Lanarkshire indicate that there will be 27,000 more
people aged 75 and over by 2031, an increase of 66%.
• The number of live births in Lanarkshire has increased for the first time in
three years. The birth rate remains above the Scottish average.
• Life expectancy continues to increase in Lanarkshire but is still, on average, a
year less than the rest of Scotland.
• More than half of all deaths in Lanarkshire in 2011 were due to the so-called
‘big killer’ diseases of cancer, coronary heart disease and stroke.
The statistics in this section were obtained from local analysis of data supplied by
National Records of Scotland (NRS) or directly from NRS information published online
at www.gro-scotland.gov.uk/statistics/index.html.
Derek Roseburgh
Public Health Information Analyst
Email: derek.roseburgh@lanarkshire.scot.nhs.uk
Telephone: 01698 858217
Health of the People of Lanarkshire
5

1.2
The Health Impact of Alcohol in Lanarkshire
Introduction
The World Health Organisation (WHO)
report on the global burden of disease
highlighted alcohol-related death and
disability as accounting for 4% of the
world total and alcohol was ranked as
the fifth most detrimental risk factor of
26 examined. 1 In developed countries,
alcohol was the third most detrimental
factor accounting for 9.2% of the burden
of disease. Medical, social, legal and
human problems can occur following
excessive consumption – that is drinking
too much too often. In practice ‘too
much too often’ may simply be getting
drunk once and then driving; or ‘too
much’ may be repeated and excessive
consumption over many years leading
to illness and family disharmony. For the
individuals concerned, alcohol misuse
can lead to relationship breakdown,
unemployment, poverty, physical health
problems, mental ill health and social
isolation. Alcohol problems do not affect
a single body system and there is no
single solution to them. The cost of the
wide-ranging consequences of alcohol
misuse is huge with the most recently
available estimate for Scotland at just
over £3.5 billion, of which £268 million is
estimated to be borne by the NHS. 2
Consumption
Table 1.2.1 shows nationally
recommended sensible drinking limits.
One unit is 10ml of pure alcohol. There
are 2.8 units in a pint of 5% beer and
1.5 units in a small glass of wine.
Table 1.2.1 Current nationally
recommended sensible drinking limits
Men Women
Daily
3–4 units,
with at least
2 alcoholfree
days
per week
2–3 units,
with at least
2 alcoholfree
days
per week
Weekly 21 units 14 units
The most recent information on selfreported
alcohol consumption by adults
aged 16 and over from the Scottish
Health Survey shows that in Lanarkshire,
as in Scotland, around two-thirds of
adults are classed as moderate drinkers
with weekly consumption within the
nationally recommended range (Figure
1.2.1). However, one in four adults in
Lanarkshire exceed the recommended
weekly consumption and around one in
20 adults have a weekly consumption
that is classed as harmful to health.
Figure 1.2.1 Weekly alcohol consumption, adults aged 16+, Lanarkshire and
Scotland, 2008/09
70%
60%
50%
40%
30%
Scotland
Lanarkshire
20%
10%
0%
Never drunk
alcohol
Ex-drinker
Source: Scottish Health Survey
Moderate
M 35 units
6 Public Health 2011/12

The Scottish Schools Adolescent Lifestyle
and Substance Use Survey (SALSUS)
provides figures for self-reported
alcohol use in 13- and 15-year-olds at
three discrete intervals: 2002, 2006 and
2010. Figure 1.2.2 shows that in 2010
around 40% of Lanarkshire 15-year-
olds and around 20% of 13-year-olds
reported alcohol consumption in the
last week. Lanarkshire figures are similar
to the Scottish average and the trend
since 2002 shows a steady decrease in
self-reported alcohol use in these age
groups.
Figure 1.2.2 Alcohol consumption in the last week, 13- and 15-year-olds, North/
South Lanarkshire and Scotland
60%
50%
40%
30%
20%
Age 15
Age 13
Scotland
North
Lanarkshire
South
Lanarkshire
10%
0%
Source: SALSUS
2002 2006 2010
As with all data, but particularly selfreported
alcohol data, they require to be
interpreted and understood in context.
In 2008, NHS Health Scotland undertook
a study to assess the validity of Scottish
national survey data on alcohol
consumption. The study concluded that
self-reported surveys may underestimate
alcohol consumption compared to
alcohol sales data by as much as 50%. 3
It also recommended that survey
methods be regularly updated to
provide more accurate consumption
trends. While there appears to be some
downward trajectory or flattening of
the trends regarding self-reported
alcohol consumption, there is a need
for a reduction in alcohol consumption
by all drinkers. Therefore, actions to
limit alcohol consumption such as
minimum pricing of alcohol and
enforcement of existing alcohol
legislation remain important.
Alcohol-related hospital
discharges
Hospital discharges with an alcoholrelated
diagnosis cover a range of
conditions including acute intoxication,
harmful use, alcohol dependence
syndrome, alcohol psychosis, liver
cirrhosis and unspecified alcoholic
liver disease. In 2010/11 in Lanarkshire,
there were 3,695 episodes of people
treated for an alcohol-related condition
(2,622 males and 1,073 females). Figure
1.2.3 shows that, over the last decade,
the trend in alcohol-related hospital
discharges has been mainly flat overall
with a small peak in 2007/08 followed
by a fall. The hospital discharge rates
in North Lanarkshire are similar to the
Scottish average but the rates in South
Lanarkshire are lower.
Health of the People of Lanarkshire
7

Figure 1.2.3 Inpatient and day case discharges with an alcohol-related diagnosis
(general acute and psychiatric)
European age-standardised rate per 100,000 population (EASR)
1,000
800
General acute
Scotland
EASR
600
400
200
Psychiatric
Lanarkshire
North
Lanarkshire
South
Lanarkshire
0
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
Source: SMR01 and SMR04, ISD Scotland
Alcohol-related deaths
In Lanarkshire in 2011, there were 281
alcohol-related deaths (183 males and 98
females). Figure 1.2.4 shows an overall
increasing trend in alcohol-related
deaths among males in Lanarkshire
and Scotland since 1996–1998 with a
slight fall in the last few years. The rate
of alcohol-related deaths in females is
less than half that for males and the
trend since 1996–1998 in females has
been largely flat. There is also a marked
disparity in male alcohol-related deaths
rates between North Lanarkshire, which
is well above the Scottish rate, and South
Lanarkshire, which is slightly below the
Scottish rate.
Figure 1.2.4 Alcohol-related deaths, by sex
European age-standardised rate per 100,000 population (EASR)
90
EASR (3-year moving average)
80
70
60
50
40
30
20
10
0
1996–1998
Males
Females
1997–1999
1998–2000
1999–2001
2000–2002
2001–2003
2002–2004
2003–2005
2004–2006
2005–2007
2006–2008
2007–2009
2008–2010
2009–2011
Scotland
Lanarkshire
North
Lanarkshire
South
Lanarkshire
Source: National Records of Scotland
8 Public Health 2011/12

Figure 1.2.5 Alcohol-related deaths in NHS Lanarkshire by age group
Standardised mortality ratio (SMR)
160
SMR (Scotland=100)
140
120
100
80

As previous Annual Reports have
highlighted, national and local initiatives
are vital to address these problems and
reduce the overall harms experienced by
individuals, families and communities
in Lanarkshire. A central plank of this
approach includes national changes
to the Licensing (Scotland) Act 2005,
the introduction of minimal pricing
and social marketing campaigns. At a
local level, the continued prioritisation
of population-based screening by
the Lanarkshire Alcohol and Drug
Partnership (LADP) for alcohol-related
problems and the delivery of alcohol
brief interventions within accident
and emergency departments, primary
care and antenatal settings is vital. It
is also important to prioritise the local
provision of early intervention and
treatment services which promote longterm
recovery, particularly within our
most deprived communities and with
our most vulnerable families.
Key Points
• Patterns of self-reported alcohol consumption in the adult population
in Lanarkshire are broadly similar to Scotland. Self-reported regular
consumption in 13 and 15-year-olds has decreased steadily over the last
decade and is broadly similar in North Lanarkshire, South Lanarkshire and
Scotland. However, there is evidence to show that alcohol sales significantly
exceed levels of self-reported consumption by a factor of two or more in
many cases.
• The rates of alcohol-related hospital discharges have remained flat over the
last decade. The rate in North Lanarkshire is similar to Scotland but the South
Lanarkshire rate is lower.
• Alcohol-related deaths in Lanarkshire and Scotland have slightly increased
over the last 15 years but the trend has levelled off in recent years. The
increase is mainly in men and in those under the age of 60. There is a
stark inequality in alcohol-related deaths between those living in the most
deprived areas and those living in the least deprived areas in Lanarkshire
and Scotland.
Priorities for Action
• Implementation of a population-based approach to alcohol screening and
brief interventions.
• Provision of high quality evidence-based services for young people, adults
and their families affected by alcohol problems in each of the major
townships of Lanarkshire.
• Expansion of services which support vulnerable families affected by parental
substance misuse within local schools and communities in Lanarkshire.
• Targeted social marketing campaigns aimed at young men, middle-aged
women and older adults, highlighting the dangers of harmful and hazardous
drinking.
10 Public Health 2011/12

References
1 World Health Organisation (WHO). The World Health Report 2002 – Reducing Risks, Promoting
Healthy Life. Geneva: WHO, 2002. www.who.int/whr/2002/en (accessed 15 August 2012).
2 York Health Economics Consortium, University of York. The Societal Cost of Alcohol Misuse in
Scotland for 2007. Edinburgh: Scottish Government, 2010.
www.scotland.gov.uk/Publications/2009/12/29122804/0 (accessed 15 August 2012).
3 Public Health Observatory Division, NHS Health Scotland. How much are people in Scotland really
drinking? Edinburgh: NHS Health Scotland, 2008.
www.healthscotland.com/documents/2612.aspx (accessed 15 August 2012).
Dr Brian O Suilleabhain
Consultant in Public Health Medicine
Email: brian.osuilleabhain@lanarkshire.scot.nhs.uk
Telephone: 01698 858218
Derek Roseburgh
Public Health Information Analyst
Email: derek.roseburgh@lanarkshire.scot.nhs.uk
Telephone: 01698 858217
Health of the People of Lanarkshire
11

12 Public Health 2011/12

2.1
Health Protection
Health Protection Update
The health protection remit of NHS
boards is set out in a Chief Medical
Officer letter and the main legislation
which supports health protection work
is the Public Health etc. (Scotland) Act
2008. 1–2
The NHS Lanarkshire Health Protection
Team works closely in partnership
with others in NHS Lanarkshire and in
other parts of NHS Scotland, and with
other organisations to prevent health
protection-related incidents, where
possible, to prepare for incidents and to
respond to them when they do occur.
The other organisations include North
and South Lanarkshire Councils, Scottish
Water, SEPA, Animal Health, Health
Protection Scotland and the Health
Protection Agency.
In 2011, enquiries were received
regarding a wide range of
communicable disease and
environmental health issues including
meningococcal infection, MRSA
(methicillin-resistant Staphylococcus
aureus), blood-borne viruses,
gastroenteritis, vaccination, respiratory
disease including tuberculosis, and
infection control.
Incidents and outbreaks
During 2011, there were 78 outbreaks
of diarrhoeal and/or vomiting illnesses
reported in both acute and community
healthcare settings. In 22 of these
incidents, norovirus was identified as
the causative organism. In addition,
seven community outbreaks were
notified including scabies outbreaks
in three care homes and a school, and
outbreaks of conjunctivitis, chickenpox
and scarlet fever in three Lanarkshire
nurseries.
The Lanarkshire Tuberculosis Contact
Tracing Service managed a family
outbreak of tuberculosis (TB). This
included contact tracing of hospital
patients and staff who had contact with
one of the cases and screening, as a
precautionary measure, of children and
staff who were contacts of another one
of the cases who worked in a nursery.
Members of the Health Protection Team
were also involved in:
• the assessment of health risks
associated with land which has some
residual post-industrial contamination
• the investigation of drinking water
quality situations
• the investigation and control of cases
of Clostridium difficile at Lockhart
Hospital
• the management of E.coli O157 cases
who were part of a Glasgow outbreak
• an outbreak of Staphylococcus aureus
food poisoning, associated with the
consumption of panna cotta dessert
• the management of a case of TB
at Dungavel Immigration Removal
Centre
• cases of cryptosporidiosis associated
with a school visit to a farm
• investigation of cases of Legionnaires’
disease including cases of Legionella
longbeacheae.
Chapter
2
Guidance requires regular review
and updating, and members of the
Health Protection Team were involved
in the development and revision of
the following guidance – Pandemic
Influenza Plan (in line with the UK
strategy), Major Emergency Plan,
Control of Infection Manual, the Scottish
Waterborne Hazard Plan, and Scottish
guidance of the management of public
health incidents. 3
Health Protection
13

Exercises are an important part of
preparation for incidents. During
2011, exercises took place that covered
drinking water incidents, waste water
incidents and a nuclear convoy accident.
Learning points were identified from the
preparation and conduct phases of each
of these exercises.
A report of the Scottish Government
stocktake of health protection is due to
be published in 2012 and work has been
progressing at national level to develop
a Scottish health protection information
management system.
Key Points
• Delivering a high quality health protection service remains a top priority for
NHS Lanarkshire.
• Joint working between health protection partners is essential in order to
deliver an effective and efficient health protection service.
• The Health Protection Team investigated and controlled several significant
and varied local incidents and outbreaks, and contributed to the
management of some national outbreaks.
Priorities for Action
• Contribute to the further development of Scottish health protection networks
of expertise and effectiveness.
• Implement the Scottish Government’s stocktake of health protection.
References
1 Scottish Executive Health Department. SEHD/CMO (2007) 2. NHS Boards’ Health Protection Remit.
www.sehd.scot.nhs.uk/details.asp?PublicationID=2145 (accessed 15 August 2012).
2 Scottish Government Public Health Act web page.
www.scotland.gov.uk/Topics/Health/NHS-Scotland/publicact/ (accessed 15 August 2012).
3 Scottish Government. Management of Public Health Incidents: Guidance on the Roles and
Responsibilities of NHS led Incident Management Teams [Online] 2011.
www.scotland.gov.uk/Publications/2011/11/09091844/0 (accessed 15 August 2012).
Dr John Logan
Consultant in Public Health Medicine
Email: john.logan@lanarkshire.scot.nhs.uk
Telephone: 01698 858241
Health Protection Team
Email: healthprotection@lanarkshire.scot.nhs.uk
14 Public Health 2011/12

2.2
Tuberculosis in Lanarkshire
Introduction
Tuberculosis (TB) remains one of the
leading causes of human illness and
premature death in the world.
TB is an infection caused by a
bacterium (Mycobacterium tuberculosis,
MTB). It usually affects the lungs
(pulmonary TB), but can affect
other parts of the body. TB is usually
transmitted when someone with
infection coughs, however it requires
close prolonged contact to acquire
infection. Symptoms vary depending on
which part of the body is infected and
include fever, night sweats, weight loss,
loss of appetite and lethargy.
This section provides information on
the epidemiology of TB in Lanarkshire,
current services for TB, and important
developments and progress with regard
to the TB Action Plan for Scotland. 1
Epidemiology
There were 8,963 cases of TB reported
in the UK in 2011, a rate of 14.4 per
100,000 population. 2 In Scotland, 429
notifications were reported in 2010, a
rate of 8.2 per 100,000.
During 2011, 37 notifications were
received for the NHS Lanarkshire area in
comparison to 27 notifications received
during 2010.
TB continues to disproportionately
affect those in hard to reach and
vulnerable groups, such as immigrants,
homeless people, problem drug users
and prisoners.
Figure 2.2.1 demonstrates the Scottish
picture for TB. 3
Figure 2.2.1 Numbers of tuberculosis cases and incidence in Scotland, 2000–2010
Number of cases
700
600
500
400
300
200
100
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
10
8
6
4
2
0
Incidence per 100,000 population
Number of cases
Incidence and 95% confidence intervals
Data for 2008–2010 are provisional and may be subject to change
Source: Health Protection Scotland (HPS)
Health Protection
15

Current services
The Lanarkshire Tuberculosis Contact
Tracing Service leads in the planning
and delivery of care for individuals in
Lanarkshire who are infected with or
affected by TB as well as their carers and
contacts.
Current developments are in place to
improve the control of TB through joint
working, improved communication,
resource management, audit, research
and through representation on national
groups and clinical guideline review
groups.
TB Action Plan for Scotland
In 2011, in collaboration with Health
Protection Scotland (HPS), a Scottish
Government TB Action Plan was
published with the aim of ensuring
that Scotland provides the best quality
clinical, laboratory and public health
services in relation to TB. In Lanarkshire,
the TB Work Plan has been developed to
implement the Action Plan.
Some of the key recommendations
relate to:
• Diagnostic services: Access to
routine use of liquid culture method
for diagnosing TB. This will enhance
the clinical management, reduce
infectivity and disease progression,
avoid drug toxicity, reduce delays in
the recognition of drug-resistant TB
and facilitate contact tracing.
• New entrant screening: Review of
new entrant screening arrangements
have been identified as priority in the
NHS Lanarkshire TB Work Plan. This
would include all immigrants from
countries with an incidence greater
than 40 per 100,000 population per
year, including refugees and asylum
seekers.
• Multidisciplinary team
approach: This approach is a key
recommendation, which would
encompass specialist clinical review,
investigations, advice, guidance,
education and assessment in relation
to contact screening.
• Neonatal BCG (Bacillus Calmette-
Guérin): A new central neonatal BCG
immunisation clinic was launched
in April 2011, which has several
advantages including provision
of a consistent service, improve
identification of high risk infants and
raise awareness among parents and
health care providers.
Image credit: Joloei / 123RF Stock Photo
16 Public Health 2011/12

Key Points
• The recent increasing trends in TB have led the Scottish Government, in
collaboration with HPS, to produce a TB Action Plan for Scotland.
• The NHS Lanarkshire TB Work Plan reflects this and is focused on achieving
better outcomes for patients diagnosed with TB and prevent transmission of
disease.
• The TB Contact Tracing Service provides a centralised neonatal BCG clinic
and is currently undertaking work to develop a single, multidisciplinary TB
clinic service for Lanarkshire.
Priorities for Action
• TB is both a national and local priority and requires continued efforts to
tackle this.
• Reduce transmission of TB in NHS Lanarkshire through a multidisciplinary
approach.
• Improve arrangements for new entrant screening.
References
1 Scottish Government. A TB Action Plan for Scotland [online] 2011.
www.scotland.gov.uk/Publications/2011/03/18095603/0 (accessed 3 August 2012).
2 Health Protection Agency. TB in the UK: 2012 Report [online] 2012.
www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317134916916
(accessed 3 August 2012).
3 Health Protection Scotland. Enhanced Surveillance of Mycobacterial Infections (ESMI) in Scotland:
2011 tuberculosis annual report for Scotland [online] 2011. www.hps.scot.nhs.uk/pubs/index.aspx
(accessed 3 August 2012).
Dr S Josephine Pravinkumar
Consultant in Public Health Medicine
Email: josephine.pravinkumar@lanarkshire.scot.nhs.uk
Telephone: 01698 858235
Health Protection
17

2.3
The Lanarkshire Blood-borne Viruses Networks
A partnership and multi-agency
approach has been the key to delivering
the objectives of the Lanarkshire Bloodborne
Viruses (BBV) Networks.
Hepatitis C
In 2011, 170 Lanarkshire residents were
diagnosed as hepatitis C antibody
positive, a 20% increase compared to
2010. Most of these infections were
acquired through injecting drug use.
HIV
In 2011, 25 Lanarkshire
residents were newly
diagnosed with HIV
infection, and 212
attended HIV services
with 79% receiving
drug treatment. Those
most at risk of HIV
are men who have
sex with men, and people from African
countries with a high prevalence of HIV.
Major challenges for HIV services are
persisting stigma and discrimination
associated with HIV, the normalisation
of HIV testing, and the need to diagnose
HIV infection early to reduce HIV-related
morbidity and mortality.
BBV prevention and education
Key BBV prevention and education
interventions being delivered are:
• Injecting equipment provision and
a peer education project aimed at
current injecting drug users.
• The Lanarkshire Condom
Distribution Scheme, World AIDS Day
(1 December) activities and promotion
of the Lanarkshire Sexual Health
Website by the BBV and Sexual Health
Promotion Team.
• The Lanarkshire BBV Educational
Resource Pack has been distributed to
all GPs and consultants in Lanarkshire.
• Learning sessions for junior doctors
highlighting BBV service and clinical
developments.
BBV screening and testing
BBV antenatal testing rates remained
high during 2011 with an uptake rate of
99.3% for HIV and 99.6% for hepatitis B.
A protocol is being developed to
support appropriate antenatal testing
for hepatitis C. NHS Lanarkshire’s Harm
Reduction Team
continues to lead the
provision of dried
blood spot testing
for hepatitis C across
Lanarkshire – a new
approach that has
enabled more people,
often injecting drug
users, to be diagnosed.
A BBV Local Enhanced Service for GPs
led to increased awareness within
primary care of service and clinical
developments in viral hepatitis and HIV
and to increased testing.
BBV clinical services
A number of key clinical service
developments have taken place
including the establishment of a
hepatitis C treatment service at
Hairmyres Hospital and the recruitment
of a specialist BBV psychologist and a
BBV dietician.
BBV care and support
Enhancing care and support for
individuals affected by a BBV is being
improved by the Lanarkshire BBV
Social Work Development Project, in
partnership with North and South
Lanarkshire Social Work Departments
and the Positive Support project.
18 Public Health 2011/12

Key Points
• HIV is increasingly being viewed and managed as a long-term condition.
• Stigma and discrimination remain key issues and challenges for hepatitis C
and HIV services.
• Implementation of the Lanarkshire BBV Testing Strategy will lead to earlier
diagnosis of BBVs with better clinical outcomes and enhance prevention of
the spread of infection.
Priorities for Action
• Development of a Lanarkshire Sexual Health and BBV Delivery Plan for 2012
to 2015.
• Further assessment of the needs of Lanarkshire residents in relation to
the Scottish Government’s Sexual Health and BBV Framework and further
redesign and commissioning of services.
• Development of a public BBV website, online educational tools and
training plan.
References
1 Scottish Government. The Sexual health and Blood Borne Virus Framework 2011–2015. Edinburgh:
Scottish Government, 2011. www.scotland.gov.uk/Topics/Health/health/sexualhealth/framework
(accessed 20 June 2012).
Dr John Logan
Consultant in Public Health Medicine
Email: john.logan@lanarkshire.scot.nhs.uk
Telephone: 01698 858241
Trish Tougher
BBV Networks Manager
Email: trish.tougher@lanarkshire.scot.nhs.uk
Telephone: 01698 858239
Health Protection
19

2.4
The Hamilton Park Racecourse
Food Poisoning Outbreak
On Monday 22 August 2011, 11 people
became unwell at a race meeting
at Hamilton Park Racecourse. Their
symptoms were predominantly of
vomiting and severe abdominal pain.
Five adults needed ambulance transfer to
hospital, three of whom were admitted
overnight. All had been previously well
and all had dined at the racecourse.
Hairmyres Accident
and Emergency
(A&E) Department
notified public
health of their
suspicions that
these patients were
suffering from food
poisoning, probably
due to a toxin
forming bacteria
(which causes rapid onset of illness),
rather than by a bacteria needing time
to incubate. The severity of symptoms,
the speed of arrival of patients, the
potential of more patients and ongoing
A&E pressures almost precipitated a
major incident declaration at the A&E
department.
Initial clinical and environmental
health investigations included taking
samples of the vomitus for microbiology
and enquiring about the catering
arrangements, food sources and menu.
A key step of the investigation was to
use the available evidence and assess
risk to determine if it was likely that the
cases were linked and, if so, take actions
to find the cause and prevent or reduce
the risk of others becoming unwell. A
consultant in public health medicine
and an environmental health officer
obtained detailed records of as many
people as possible who had dined at the
racecourse. This informed an outbreak
control team meeting which was led
by public health and involved A&E,
microbiology, South Lanarkshire Council
environmental health, Health Protection
Scotland and the Food Standards
Agency (Scotland).
In this situation, it is vital to interview
all those who attended the function,
rather than just
those who were
unwell, to determine
the likely food
source. Other key
information included
the assessment
from environmental
health officers
comprising previous
environmental
health assessments,
evidence of good practice such as
hygiene practices, reviewing food
records (temperature records) and
obtaining residual food samples (if
possible).
The outbreak control team met a further
three times. A total of 45 people were
interviewed, of whom 18 were cases.
Statistical analysis compared the risk
of being a case against each of the
menu items. Panna cotta dessert was
the likeliest culprit with a result that
was highly statistically significant.
Someone who ate panna cotta was
16 times more likely to have become
unwell than someone who did not. The
panna cotta was supplied by an external
manufacturer to the caterers hosting
the event.
The microbiological tests confirmed the
presence of the bacteria Staphylococcus
aureus in five of the cases. These
organisms were microbiologically very
20 Public Health 2011/12

similar and had common types of toxin.
Samples of panna cotta discarded by the
caterers and retrieved by environmental
health also grew Staphylococcus aureus
similar to that seen in the cases. Six
samples of panna cotta obtained by
the Food Standards Agency from the
manufacturer (which were from the
same batch as those for the race event)
showed high levels of Staphylococcus
aureus.
The outbreak control team investigation
also identified two cases in the
Manchester area on 6 August after
eating panna cotta – 16 days before the
Hamilton Park Racecourse outbreak.
Panna cotta linked to those cases, again
from the same batch, had tested positive
for Staphylococcus aureus on 12 August.
The manufacturer subsequently
detected Staphylococcus aureus from
the same batch after the outbreak was
announced.
The conclusion was that it was most
likely that contamination occurred
during production and the affected
batch had been prepared on 1 August.
The production process was reviewed
in detail by environmental health in
Manchester and was not permitted to
resume until satisfactory. On 25 August
the manufacturer recalled all supplies
of its panna cotta distributed between
1 and 23 August.
Key Points
• Staphylococcus aureus contamination of panna cotta was responsible for a
food poisoning outbreak at Hamilton Park Racecourse in August 2011. Some
people required hospital admission.
• Subsequent investigations showed a problem with the production process of
the panna cotta manufacturer.
• Multi-agency working with local, Scottish and UK public health bodies
ensured that the source was identified and rectified, protecting the public
from further harm.
Priority for Action
• Ensure good communications and working arrangements are maintained
and developed with clinicians, local authority staff and staff at national
organisations to effect prompt identification, investigation and actions in
food poisoning outbreaks.
Dr David Cromie
Consultant in Public Health Medicine
Email: david.cromie@lanarkshire.scot.nhs.uk
Telephone: 01698 858117
Health Protection
21

2.5
Screening Programmes – Cancer
NHS Lanarkshire provides a range of
cancer screening programmes. Review
of performance of some of these
programmes is a requirement of the
relevant NHS Quality Improvement
Scotland (QIS) standards (Healthcare
Improvement Scotland took over
the responsibilities of NHS Quality
Improvement Scotland on 1 April 2011).
Table 2.5.1 provides a brief overview of
some of the key performance indicators
for each programme.
Table 2.5.1 Cancer screening programmes in Lanarkshire
Screening
programme
Cervical
screening
Bowel
screening
Breast
screening
Target
population
All eligible
Lanarkshire
women aged
20–60 years
All
Lanarkshire
residents
aged 50–74
years
All eligible
Lanarkshire
women aged
50–70 years
Denominator
and time frame
1 April 2010 to
31 March 2011
1 August 2009
to 30 April 2011
6th Round: 29
January 2007 to
3 March 2010
Standards Uptake Outcomes
NHS QIS 1 2(a)3:
A minimum
of 80% of
women aged
20–60 years are
screened at least
once every 5
years
NHS QIS 2 2b3:
A minimum of
60% of invited
individuals
respond to an
invitation to
participate in the
bowel screening
programme and
complete the
test
NHS QIS 3
2(b)1: target
of 70% uptake
(essential),
80% uptake
(desirable)
156,145
eligible
women,
38,872
smears
performed
– an uptake
of 80.0%
157,396
invitations
to
screening
sent, 73,912
completed
test kits
returned –
an uptake
of 47.0%
73,509
eligible
women,
52,542
women
accepted
screening
invitation –
an uptake
of 71.5%

Key Points
• Uptake remains high for cervical screening but the uptake rate for bowel
screening remains lower than the national target. An awareness campaign is
planned for later this year to encourage participation in screening.
• The cervical screening programme is designed to detect pre-cancerous
changes in the majority of women and so the number of actual cancers
detected is low. However, the number of abnormalities which are detected
at an early stage is much higher allowing women to receive preventative
treatment at colposcopy.
• A new development in the form of human papilloma virus (HPV) testing was
integrated into the cervical screening programme in April 2012 for women
who received treatment at colposcopy. This means that they can return to
routine 3-yearly recall much earlier than previously.
• In addition to the 97 cancers detected by the bowel screening programme, a
much larger number of men and women were diagnosed with polyps which
were then removed at the time of colonoscopy. These polyps would have
been at risk of developing into bowel cancer in the future but will now be
prevented from doing so by regular surveillance follow up.
The NHS Lanarkshire Adult Learning
Disability Service has created a resource
for people with learning disability
covering many different types of medical
treatments. It can be accessed at
www.healthelanarkshire.co.uk. The
website contains health information
created with the active participation of
adults with learning disability and can
be accessed by anyone. The following
resources can be reviewed – Breast selfexamination,
Going for a mammogram,
Going for a cervical smear and Bowel
screening. The videos and leaflets are
written in simple language with clear
pictures and will be useful for everyone.
Contact Jean Howieson on 01698 855628
for further information.
References
1 NHS Quality Improvement Scotland (NHS QIS). Local Report – NHS Lanarkshire Cervical Screening
Service. Edinburgh: NHS QIS, 2003.
2 NHS Quality Improvement Scotland (NHS QIS). Bowel Screening Programme Clinical Standards.
Edinburgh: NHS QIS, 2007. www.healthcareimprovementscotland.org/previous_resources/
standards/bowel_screening_programme_clin.aspx (accessed 3 August 2012).
3 Clinical Standards Board for Scotland (CSBS). Breast Screening Clinical Standards. Edinburgh:
CSBS, 2002. www.healthcareimprovementscotland.org/previous_resources/standards/breast_
screening_standard_2002.aspx (accessed 3 August 2012).
Dr Margaret Morris
Public Health Specialist
Email: margaret.morris4@lanarkshire.scot.nhs.uk
Telephone: 01698 858222
Health Protection
23

2.6
Screening Programmes –
Pregnancy, Newborn and Pre-school
Table 2.6.1 Pregnancy, newborn and pre-school screening programmes in
Lanarkshire
Screening programme
Universal newborn hearing
screening
Newborn bloodspot test
Screens for the metabolic
conditions congenital
hypothyroidism (CH),
phenylketonuria (PKU),
cystic fibrosis (CF) and from
October 2010 medium chain
acyl-CoA dehydrogenase
deficiency (MCADD) and
sickle cell disease (SCD)
Pre-school orthoptic vision
screening (POVS)
Down’s syndrome
screening in pregnancy
Denominator and
time frame
Jan–Dec 2011
6,628 newborn
babies
April 2011–March
2012
6,490 births to
Lanarkshire residents
August 2010–June
2011
6,749 pre-school
children
April 2011–March
2012
5,464 bookings
Uptake
experienced
6,532 (98.5%)
of babies
completed the
hearing screen
by 10 weeks
Uptake of
programme
99.95%
Outcomes
6 moderate to severe hearing
loss detected through
screening
(4 of these have been
referred for cochlear
implants)
Referred 7 babies with CH
Referred

Key Points
• Uptake remains high for newborn bloodspot screening, newborn hearing
screening and pre-school vision screening. The uptake quoted for Down’s
syndrome screening is lower but unlike the other screening programmes,
there is no recommended uptake for this test. It is very much dependent on a
woman’s own views and beliefs.
• A number of babies have been identified as having one of the screening
conditions. This has allowed early management of the condition which will
improve outcomes. For example, four babies received cochlear implants.
• Biochemical screening (via a blood test) is no longer carried out for neural
tube defects in the second trimester. This has been replaced by a detailed
fetal anomaly scan for all women. Uptake figures are currently unavailable
but have been reported as being high (>95%). An audit of the first year of
the fetal anomaly scanning programme is underway and will report shortly,
giving details of the numbers and types of fetal anomalies detected.
• Following work by Maternity Services to encourage women to book early, the
average gestation at time of booking has now fallen, which enables women
to have greater choice and access to the new pregnancy screening services,
some of which are carried out relatively early in pregnancy.
Reference
1 Information Services Division, NHS National Services Scotland. Scottish Perinatal and Infant
Mortality Report (SPIMMR). CSBS: Edinburgh, 2002. www.isdscotland.org/Health-Topics/
Maternity-and-Births/Stillbirth-and-Infant-Deaths/ (accessed 7 August 2012).
Dr Tasmin Sommerfield
Consultant in Public Health Medicine
Email: tasmin.sommerfield@lanarkshire.scot.nhs.uk
Telephone: 01698 858227
Health Protection
25

26 Public Health 2011/12

3.1
Health Improvement
Poverty and its Impact on Health
Chapter
3
The term ‘relative poverty’ is frequently
used to quantify levels of poverty and
is defined in basic terms as a person
or family not having the resources
(financial/social) to take part in ordinary
living patterns or customs which are
prevalent within their social sphere. Both
the Scottish and UK Governments deem
that a person is living in relative poverty
when he or she is living in a household
whose equivalised income (i.e. adjusted
for household size and composition) is
below 60% of UK median income in the
same year. 1
Poverty can be a cause and a
consequence of poor health. The
negative impact of poverty on social,
physical and mental wellbeing has
been well documented. 2 The Scottish
Government has outlined a range of
policy commitments to assist those
living in poverty and to tackle the root
causes of poverty. 3–6 The UK Government
introduced the Child Poverty Act 2010 7
with an overarching aim to increase
efforts to eradicate child poverty. With
the introduction of the Welfare Reform
Act 2012, 8 the UK Government is seeking
to lift 900,000 people out of poverty.
The UK Government, however, does not
have an overarching strategy to tackle
poverty.
Between 2002 and 2008, relative
poverty rates in both North and South
Lanarkshire were close to the Scottish
average with around one in five
households living in relative poverty. 9
One major contributory factor to poverty
is worklessness. In this context, the term
worklessness refers to adults who are
economically inactive. This includes
people who are not in employment,
looking after a home, retired, long-term
sick or injured, and students. In North
Lanarkshire, the number of residents
claiming Jobseeker’s Allowance has risen
from 5,090 in May 2008 to 11,855 in May
2012. 10 In South Lanarkshire, the figure
rose from 3,829 to 9,202 over the same
period. 11
The impact of the Welfare Reform Act
2012, which will see changes to the
range and administration of a number
of benefits, including Income Support,
Housing Benefit and Tax Credits, cannot
be quantified until the reforms are
implemented. However, initial estimates
suggest that thousands of people in
both North and South Lanarkshire will
be adversely affected by having their
incomes reduced.
There has been considerable debate
with regard to the effectiveness of
person- or place-based policies to tackle
poverty. A review of the evidence was
inconclusive. 12 However, both types of
approach would have greater impact
when programmes:
• deliver tailored support to the most
disadvantaged people with minimal
complexity
• reflect local needs and priorities
• were shaped through active
engagement with stakeholders
including service users.
Within the context of the current
economic climate, future economic
uncertainty and the impending
implementation of welfare reforms, both
North and South Lanarkshire have to
continue to pursue poverty prevention
and support those who are living in
poverty.
Health Improvement
27

Key Points
• Approximately one in five households in Lanarkshire lives in relative poverty.
• The rise in unemployment and the reforms in welfare are likely to result in
poorer health for many individuals and their families.
Priorities for Action
• Community planning partnerships of both North and South Lanarkshire to
continue to pursue poverty prevention programmes and provide support to
those living in poverty.
• Person- or place-based programmes to address poverty are valid providing
that the approach is targeted, simple and fully engages with people.
References
1 Scottish Government. Poverty and income equality in Scotland: 2010–11 [online] 2012.
www.scotland.gov.uk/Publications/2012/06/7976/0 (accessed 9 July 2012).
2 World Health Organization website. Health topics – Poverty. www.who.int/topics/poverty/en/
(accessed 9 July 2012).
3 Scottish Government. Achieving Our Potential: A Framework to tackle poverty and income inequality
in Scotland. Edinburgh: Scottish Government, 2008.
4 Scottish Government. The Early Years Framework. Edinburgh: Scottish Government, 2008.
5 Scottish Government. Equally Well: Report of the Ministerial Task Force on Health Inequalities.
Edinburgh: Scottish Government, 2008.
6 Scottish Government. Child Poverty Strategy for Scotland. Edinburgh: Scottish Government, 2011.
7 Great Britain. Child Poverty Act 2010 (c.9). Norwich: The Stationery Office, 2010.
8 Great Britain. Welfare Reform Act 2012 (c.5). Norwich: The Stationery Office, 2012.
9 Scottish Government. Relative poverty across Scottish Local Authorities [online] 2010.
www.scotland.gov.uk/Publications/2010/08/26155956/0 (accessed 9 July 2012).
10 Official labour market statistics website. Total Jobseeker’s Allowance claimants – times series
(North Lanarkshire).
www.nomisweb.co.uk/reports/lmp/la/2038432142/subreports/jsa_time_series/report.aspx
(assessed 9 July 2012).
11 Official labour market statistics website. Total Jobseeker’s Allowance claimants – times series
(South Lanarkshire).
www.nomisweb.co.uk/reports/lmp/la/2038432149/subreports/jsa_time_series/report.aspx
(assessed 9 July 2012).
12 Griggs J, Whitworth A, Walker R, McLennan D, Noble M. Person- or place-based policies to tackle
disadvantage? Not knowing what works. York: Joseph Rowntree Foundation, 2008.
Gabe Docherty
Health Promotion Manager
Email: gabe.docherty@lanarkshire.scot.nhs.uk
Telephone: 01698 858121
28 Public Health 2011/12

3.2
Tackling Poverty in South Lanarkshire –
an Asset-based Approach
Collaboration and partnership between
stakeholders can make a real difference.
This was highlighted by the recent
Christie Commission Report on the
Future Delivery of Public Services which
suggests that approaches that are
characterised by collaboration between
organisations and partnerships with
people and communities should become
the norm. 1
An example of this is a programme
of work that has been taken forward
in Burnhill in South Lanarkshire. This
community lies within the 5% most
deprived in Scotland and the inequalities
between this area and the more affluent
neighbouring communities are stark,
with high unemployment levels,
high smoking levels, high levels of
prescriptions for medication for anxiety
and depression, and 42.3% of children in
the area living in poverty. 2
Over the past year, community
consultation work has been ongoing,
driven by South Lanarkshire Council’s
Tackling Poverty team and conducted
by a local third sector organisation,
Rutherglen and Cambuslang
Community Health Initiative, in
partnership with the local community.
Using an asset-based approach, the
aim of this work was to engage with
residents, increase levels of community
involvement and community spirit,
which were very low, and connect
residents to services and opportunities.
This approach, instead of concentrating
on what is lacking in a community,
focuses on the positive attributes
of a community, for example, the
skills, knowledge and enthusiasm of
individuals and groups. Sir Harry Burns,
Chief Medical Officer for Scotland,
advocates this way of working with
communities rather than health and
local authority
staff doing
things to
communities. 3
Trained local
researchers
visited every
household
in the area
and 55% of
households
were engaged
in discussions.
Community events and information
fliers were used to promote the research
and follow-up visits and support to
individual households is ongoing to
encourage and support action.
From this work, those interested in
becoming more involved in Burnhill have
been supported to establish themselves
as a local action group. This new group
has helped to establish new local youth
clubs, a drop in cafe, employment
notice board, community clean ups, a
big lunch event and improvements to
the local leisure centre. Central to the
Health Improvement
29

success of the group is the consistent
support from key community health
initiative and council staff, helping to
link the group to local services and
council departments, and providing
the necessary encouragement and
motivation.
The next stage is for public service
providers, including NHS Lanarkshire,
to reconsider how to make best use of
the ever tightening resources available
to deliver more appropriate services
and supports. It is understood that
building the capacity of the community
will be a necessary component of this
process to ensure that they can play
a significant role in turning around
the area’s outcomes and sharing the
responsibilities.
Key Points
• Partnerships and collaborative working with communities continue to be a
key factor for success in tackling poverty.
• Asset-based approaches build on existing strengths and resources within
communities.
• Statutory services must work differently in order to engage with hard to
reach communities.
Priorities for Action
• Continue to work with key partner agencies and the local community to
improve health outcomes in the area.
• Monitor and evaluate both process and outcome data for all activities.
References
1 Christie C. Commission on the Future Delivery of Public Services. Edinburgh: Scottish Government,
2011.
2 South Lanarkshire Council website. Occasional Report, Children in Relative Poverty in South
Lanarkshire. www.southlanarkshire.gov.uk/improve/download/111/children_in_relative_poverty
(accessed 9 July 2012).
3 Scottish Government. Annual Report of the Chief Medical Officer 2010. Edinburgh: Scottish
Government, 2011.
Karen McGuigan
Health Improvement Co-ordinator
Email: karen.mcguigan@lanarkshire.scot.nhs.uk
Telephone: 01698 377645
30 Public Health 2011/12

3.3
Welfare Reform – a Multi-agency Approach
The Welfare Reform Act 2012 1 has brought
about the biggest change to the welfare
system for over 60 years. The Act aims
to make the benefit system fairer, more
affordable and better able to tackle
poverty, welfare dependency and
worklessness. In this context, the term
worklessness refers to adults who are
economically inactive. This includes
people who are not in employment,
looking after a home, retired and longterm
sick or injured. The benefits system
will be simplified and changes made to
the entitlement and assessment process.
A new Universal Credit will replace most
existing benefits, including Housing
Benefits. In April 2013, the Personal
Independence
Payment will
be introduced
to replace the
Disability Living
Allowance. The
changes will
affect thousands
of individuals
and families across Lanarkshire,
including those in work and out of work.
The focus on helping individuals move
into and progress in work should be
welcomed as there is evidence that,
in general, employment has a positive
impact on health. 2 However, many
individuals, including those with health
conditions, often face barriers to finding
and maintaining meaningful, paid
employment. The welfare reforms may
result in a significant reduction in the
household income of many individuals
and families. Financial insecurity
undermines health and wellbeing
and could result in a rise in stress and
anxiety. Such an adverse impact on
health and wellbeing will lead to an
increase on the demand for health
services. Nor should we forget the
potential impact on public service staff
themselves, e.g. those who work parttime,
and ensure there is information,
advice and support for them.
In view of the welfare reform changes,
agencies have come together in
both North and South Lanarkshire to
formulate a joint approach to monitor
and assess the impact of the changes
and to develop and deliver a multiagency
response. NHS Lanarkshire is
actively involved in the development
and delivery of an action plan, including
both public communication campaigns
and staff training programmes. Health
service staff will play an important
role in identifying those most at risk
of financial exclusion, in supporting
the appeals process and signposting
patients to relevant support services.
One of the ways that NHS Lanarkshire
can support individuals and families
is through the Well Connected
Programme. Well Connected is a social
prescribing programme which provides
a direct link to local initiatives designed
to help people deal with problems such
as money worries and unemployment
and to help people cope with stress and
find positive solutions.
Health Improvement
31

Key Points
• The welfare reform changes, while benefiting some people, will leave many
individuals and families worse off.
• An increase in poverty will impact adversely on health and wellbeing and will
exacerbate health inequalities.
• There will be an impact on the demand for health services.
Priorities for Action
• Continue to support and strengthen inter-agency activities between health,
financial inclusion and employability services.
• Develop and deliver communication and training programmes to ensure that
staff can provide support and information to patients where they are best
placed and signposted to appropriate local services via the Well Connected
Programme.
• Monitor the potential impact of the welfare reform changes on staff
themselves.
References
1 Great Britain. Welfare Reform Act 2012 (c.5). Norwich: The Stationery Office, 2012.
2 Black C. Working for a healthier tomorrow – Dame Carol Black’s Review of the health of Britain’s
working age population 2008. London: The Stationery Office, 2008.
Janice Scouller
Health Improvement Team Lead (North West Unit)
Email: janice.scouller@lanarkshire.scot.nhs.uk
Telephone: 01236 771063
32 Public Health 2011/12

3.4
Well Connected
Mental health improvement is a public
health priority in Scotland. Mental ill
health accounts for 20% of the total
burden of diseases in the UK. 1 Mental
health problems affect approximately
one in four people, equating to over
140,000 people in Lanarkshire. However,
those who experience material and
relative deprivation, low educational
attainment, unemployment, poor
housing, violence, adverse life events or
poor support networks have a significant
increased risk of developing mental
health problems. 2
The Scottish Government’s Towards
a Mentally Flourishing Scotland Policy
highlighted the need for preventing
common mental health problems and
promoting mentally health communities
by addressing the
wider determinants
of health and
wellbeing. 3 To
address this, and
to support NHS
Lanarkshire’s
targets of stabilising
the increase in
antidepressant
prescribing and increasing the
someone you know:
access to psychological therapies,
• Volunteering
• Employment
a comprehensive social prescribing
programme was developed.
Well Connected
Social prescribing aims to strengthen
Well Informed
the access to socio-economic solutions
to mental health problems, linking
people with non-medical sources
of support within the community. 4
Well Connected is Lanarkshire’s social
prescribing programme for mental
health. The programme was developed
by a multi-agency steering group with
the aim to make it easier for people to
take part in and benefit from activities
Making it easier to take part in activities and services in Lanarkshire that
improve our well-being (how we feel about ourselves and our lives).
There are eight Well Connected areas – choose one or more for yourself or
• Physical activity and leisure opportunities
• Arts and culture
• Benefits, welfare and debt advice
• Learning opportunities
and services that can improve wellbeing.
The programme took a community
asset-based approach 5 by focusing
on existing community support but
defining a single point of access.
There are eight Well Connected areas for
people to access:
• physical activity and leisure
• volunteering
• employment
• arts and culture
• welfare, benefit and debt advice
• lifelong learning
• healthy reading and self-help
information in libraries
• stress control classes.
To support the delivery of the Well
Connected Programme, an extensive
training programme
was available to staff
working in all the
above areas including
online mental
health awareness
training, face-to-face
briefings and Scottish
Mental Health First
Aid training. Each
area also signed the See Me pledge,
committing to tackle the stigma of
mental ill health.
Initial results
• Healthy Reading and self-help information in libraries
• Stress Control classes in communities
Further information
Visit www.elament.org.uk (Self-Help section) or call:
North Lanarkshire: 0800 073 0918 South Lanarkshire: 01698 366 930
The Well Connected Programme was
launched in February 2012. A minimum
data set is in place to evaluate the
programme with results to be published
in due course.
Stress Control
Seven stress control courses took place
between April and June 2012, in local
community facilities. The evening
classes were the most popular in terms
of attendance with an average of
Health Improvement
33

45 bookings per course along with an
average of 33 for the afternoon courses
and 17 for the morning ones.
Healthy Reading
The Healthy Reading Programme was
the first stage of the Well Connected
Programme which was launched in
2009. During 2011/12, a total of 4,209
mental health and wellbeing related
resources were issued and 13,976 since
the launch.
Further information on the Well
Connected Programme can be found at
www.elament.org.uk.
Key Points
• Development of population mental health and wellbeing approaches with
communities to increase mental health promotion capacity and resilience is
important.
• Multi-agency working is crucial to develop the most effective and efficient
services and approaches possible.
Priorities for Action
• Evaluate the Well Connected Programme to develop it further.
• Embed the Well Connected Programme across all Lanarkshire communities to
support existing community assets.
References
1 Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (eds). Global Burden of Disease and Risk
Factors. Washington DC: The World Bank, 2006.
2 Melzer D, Fryers T, Jenkins R (eds). Social Inequalities and the Distribution of the Common Mental
Disorders. Hove: Psychology Press, 2004.
3 Scottish Government. Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009–2011.
Edinburgh: Scottish Government, 2009.
4 Scottish Development Centre for Mental Health (SDC). Developing Social Prescribing and
Community Referrals for Mental Health in Scotland. Edinburgh: SDC, 2007.
5 Sigerson D, Gruer L. Asset-based Approaches to Health Improvement. Edinburgh: NHS Health
Scotland, 2011.
Kevin O’Neill
Public Mental Health and Wellbeing Development Manager
Email: kevin.oneill@lanarkshire.scot.nhs.uk
Telephone: 01698 366750
Avril Thomson
Senior Health Promotion Officer
Email: avril.thomson@lanarkshire.scot.nhs.uk
Telephone: 01698 377626
Acknowledgement: Well Connected Implementation Group
34 Public Health 2011/12

3.5
Lanarkshire Tobacco Control Strategy
Tobacco smoking remains a significant
cause of ill health, disability and early
death in Scotland. 1 Lanarkshire has the
second highest smoking prevalence
of all NHS boards, with 28% of adults
estimated to smoke. 2 Smoking is linked
to health inequalities, with prevalence
higher in areas of deprivation and
among vulnerable groups.
and policies to support increased
legislative control and investment in
smoking prevention and cessation
programmes. 5–9 This includes a new
inequalities-focused smoking cessation
target for NHS boards for 2011–2014 with
60% of quits at one month to come from
the 40% most deprived communities. 10
Tackling tobacco-related harm
in Lanarkshire
The multi-agency Lanarkshire Tobacco
Control Strategy and Action Plan
2012–2015 adopts an outcome-focused
approach and outlines the actions that
are being taken by all partners, including
statutory and voluntary agencies, to
reduce smoking prevalence and reduce
tobacco-related harm.
The strategy will contribute to achieving
the health improvement aims of the
joint community plans developed in
partnership with North and South
Lanarkshire Councils and other
community planning partners.
As well as the impact of smoking on
health, there is also conclusive evidence
that secondhand exposure to tobacco
smoke (‘passive smoking’) causes death
and disease. 3
Evidence shows tackling smoking
requires a multistranded approach using
a range of public health interventions to
tackle the individual, social and cultural
influences on smoking behaviour. 4
The Scottish Government has recognised
the importance of a comprehensive
approach to tobacco control and
has published a number of strategies
The overall aim of the strategy is to
reduce tobacco-related morbidity and
mortality and reduce health inequalities
by:
• reducing initiation and uptake of
smoking
• reducing rates and frequency of
smoking
• reducing smoking in deprived and
vulnerable groups
• reducing smoking in pregnancy
• reducing exposure to secondhand
smoke and the wider harm associated
with smoking
• enforcing legislation relevant to the
sale and use of tobacco products.
Following a review of the evidence
base and local activity, outcomes were
agreed and 13 workstreams developed as
outlined in Table 3.5.1.
Health Improvement
35

Table 3.5.1 Workstreams in reducing smoking
Smoking prevention Smoking cessation Reducing tobaccorelated
harm to others
Youth involvement and
peer education
Campaigns and
communications
Engaging smokers:
• brief interventions
• referrals from general
practitioners
• communications.
Secondhand smoke
programmes
Enforcement of the
smoke-free legislation
Curriculum development
Prevention programmes
for priority groups
Training and resource
development
Smoke-free policies
Enforcement and control
of tobacco sales
Delivery of cessation services
targeted to priority groups
and settings including:
• young people
• pregnant smokers
• mental health patients
• acute patients
• areas of deprivation
• workplaces
• other target population
groups.
Service standards,
monitoring and evaluation
Fire prevention
Progress so far
There have been many achievements
and developments to date in line with
the workstreams and outcomes set
including:
• achievement of the HEAT smoking
cessation target trajectory for 2011/12
• development of a tobacco resource
for schools in line with Curriculum for
Excellence
• delivery of smoking cessation training
for youth workers and dentists
• implementation of a Varenicline
Patient Group Direction for the
Lanarkshire Stop Smoking Service
• development of a pilot Integrated
Care Pathway for patients who smoke
coming into hospital
• implementation of a smokefree
homes programme through
Lanarkshire Healthy Living Centres.
36 Public Health 2011/12

Key Points
• The strategy outlines a coordinated approach to reducing smoking
prevalence and the harmful effects of tobacco within communities, with a
focus on areas of deprivation and vulnerable groups.
• The strategy focuses on smoking prevention among young people, provision
of cessation support, and reducing tobacco-related harm to others.
• Progress to date includes an online tobacco learning resource for primary and
secondary schools, training for youth workers and dentists, and development
of a smoke-free homes programme.
Priorities for Action
• Develop prevention and cessation programmes for 16–24-year-olds.
• Raise public awareness of secondhand smoke through communication
campaigns.
• Further develop cessation support for pregnant smokers.
References
1 Marryat, L. Chapter 4: Smoking. In: Bromley C, Given L (eds). The 2010 Scottish Health Survey –
Volume 1: Main Report. Edinburgh: Scottish Government, 2011.
2 Scottish Public Health Observatory website. Tobacco use: adult smoking by NHS board.
www.scotpho.org.uk/behaviour/tobacco-use/data/adults-by-nhs-board (accessed 24 May 2012).
3 NHS Health Scotland, ISD Scotland, ASH Scotland. An Atlas of Tobacco Smoking in Scotland: A
report presenting estimated smoking prevalence and smoking attributable deaths within Scotland.
Edinburgh: NHS Health Scotland, 2007.
4 Taulbut M, Gordon D, McKenzie K. Tobacco smoking in Scotland: an epidemiology briefing.
Edinburgh: NHS Health Scotland and Scottish Public Health Observatory, 2008.
5 Scottish Executive. A Breath of Fresh Air for Scotland – Improving Scotland’s Health: The Challenge –
Tobacco Control Action Plan. Edinburgh: Scottish Executive, 2004.
6 Scottish Government. Scotland’s Future is Smoke Free: A Smoking Prevention Action Plan. Edinburgh:
Scottish Government, 2008.
7 Great Britain: Scottish Parliament. Tobacco and Primary Medical Services (Scotland) Act 2010 (asp 3).
Norwich: The Stationery Office, 2010.
8 Scottish Government. Equally Well: Report of the Ministerial Task Force on Health Inequalities.
Edinburgh: Scottish Government, 2008.
9 NHS Health Scotland, ASH Scotland. A guide to smoking cessation in Scotland 2010: Planning and
providing specialist smoking cessation services. Edinburgh: Health Scotland, 2010.
10 Scottish Government. Scotland Performs: Smoking Cessation website.
www.scotland.gov.uk/About/scotPerforms/partnerstories/NHSScotlandperformance/
smokingcessation (accessed 24 May 2012).
Elspeth Russell
Assistant Health Promotion Manager
Email: elspeth.russell@lanarkshire.scot.nhs.uk
Telephone: 01698 377622
Health Improvement
37

38 Public Health 2011/12

Oral Health
Chapter
4
4.1 Improving Oral Health and Nutrition in the Early Years
Poor diet and nutrition increases the risk
of poor health outcomes for children,
such as tooth decay, obesity and chronic
disease. Intervention in the earliest years
is vital to improve the health behaviours
and outcomes of young children, now
and in later years. 1, 2 Only 15% of Scottish
children (2–4 years) consume five or
more portions of fruit and vegetables
per day. 3 Twenty-six per cent of children
(2–6 years) are overweight, with 10.9%
obese. 3 Around 40% of children in
primary 1 in Lanarkshire schools have
evidence of tooth decay. 4
Tackling the problem
The diet, nutrition and health of young
1, 5–7
children is a national priority.
NHS Lanarkshire delivers a programme
of activity to improve the nutrition and
oral health of children in the early years. 8
This includes:
• The delivery of nutrition and oral
health training to childcare providers
to support the guidance pack –
Nutrition and Oral Health: Strategy into
Practice in the Early Years. 9
• Use of the training for trainers
approach to support the delivery of
both weaning and practical cooking
and nutrition workshops to 107 staff
in the NHS and 63 staff from local
authorities and the third sector.
In addition, a number of partnership
initiatives exist, including the provision
of free fruit to children under five in
nursery, and increasing the knowledge
and skills of parents and carers in
relation to healthy eating, toothbrushing
and cooking skills.
Training for childcare providers
and other staff
Nutrition and oral health training was
delivered to 424 childcare providers
and professionals who support families.
Changes in knowledge and practice
were evaluated using three participant
questionnaires: pre-training, posttraining
and three months post-training.
Improvements in knowledge were
apparent across a number of areas as
outlined in Table 4.1.1.
Table 4.1.1 Examples from the training evaluation results
Number and proportion aware of guidance
Pre-training
(n=424)
Post-training
(n=424)
Follow-up
(n=51*)
Recommended fluoride
224 (53%) 361 (86%) 37 (72%)
concentration for children’s
toothpaste
Recommended period of exclusive 274 (65%) 311 (74%) 39 (76%)
breastfeeding (6 months)
Classification of high sugar
29 (7%) 309 (73%) 16 (31%)
(>15g of sugar per 100g)
Tomato sauce is high in salt 254 (60%) 327 (78%) 38 (75%)
* 12% response rate to follow-up questionnaire
Oral Health
39

A number of changes to practice
were noted in organisations following
training. This included provision of more
chopped vegetables as
snacks and a reduction
in the fizzy juice, raisins,
sweets and biscuits
provided. Many were
already aware that sugary
foods and drinks should
be kept to mealtimes and
gave children fresh fruit
daily.
Evaluation of weaning
and practical cooking and
nutrition training is in
its infancy. Weaning workshops will be
evaluated using participant evaluations
and by monitoring the number of infants
weaned before 17 weeks using the
Community Infant Feeding Pathway.
The practical cooking
and nutrition training
was positively received;
participants noted that
the practical information,
skills and lesson plan
ideas provided a strong
foundation to deliver
similar sessions in their
own area of work. Fifty
per cent of participants
who completed a followup
evaluation (n=12) have
since held their own local
sessions. It was, however, recognised
that delivering practical workshops relies
heavily on the availability of funding.
Key Points
• Improving nutrition and oral health in the early years remains a priority and a
multi-agency approach should continue.
• Knowledge and skills of existing staff and partners have been improved
in relation to delivery of nutrition, oral health, weaning and practical
cooking skills.
Priorities for Action
• Development of free online nutrition and oral health training based on the
above programme.
• Robust evaluation of weaning interventions.
• Establish a network of well-trained facilitators and sustainable practical
cooking sessions to ensure parents and carers can be easily signposted to the
support available.
References
1 Scottish Government. Improving Maternal and Infant Nutrition: A Framework for Action. Edinburgh:
Scottish Government, 2011.
2 National Institute for Health and Clinical Excellence (NICE). NICE public health guidance 11:
Improving the nutrition of pregnant and breastfeeding mothers and children in low-income
households. London: NICE, 2008.
3 Scottish Government. The Scottish Health Survey 2010. Edinburgh: Scottish Government, 2011.
40 Public Health 2011/12

4 MacPherson LM, Conway DI, Goold S, Jones CM, McCall DR, Merrett MC, Pitts NB. National
Dental Inspection Programme of Scotland. Report of the 2010 Survey of P1 Children. Scottish Dental
Epidemiological Co-ordinating Committee, 2010.
5 Scottish Government. Healthy Eating, Active Living: An action plan to improve diet, increase physical
activity and tackle obesity (2008–2011). Edinburgh: Scottish Government, 2008.
6 Scottish Government. Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy
Weight. Edinburgh: Scottish Government, 2010.
7 Scottish Executive. An Action Plan for Improving Oral Health and Modernising NHS Dental Services in
Scotland. Edinburgh: Scottish Executive, 2005.
8 Public Health and Health Improvement Directorate, Scottish Government. CEL 36 (2008). Nutrition
of women of childbearing age, pregnant women and children under five in disadvantaged areas.
www.sehd.scot.nhs.uk/details.asp?PublicationID=2702 (accessed 5 May 2012).
9 NHS Lanarkshire. Nutrition and Oral Health: Strategy into Practice in the Early Years. Lanarkshire:
NHS Lanarkshire, 2010.
Ashley Goodfellow
Public Health Nutritionist – Maternal, Infant and Children’s Nutrition
Email: ashley.goodfellow@lanarkshire.scot.nhs.uk
Telephone: 01698 377631
Celia Watt
Senior Health Improvement Officer – Oral Health
Email: celia.watt@lanarkshire.scot.nhs.uk
Telephone: 01698 377625
Oral Health
41

4.2
The Oral Health Needs of Homeless People
Homeless people have been identified
as one of the key priority groups in An
Action Plan for Improving Oral Health
and Modernising NHS Dental Services in
Scotland. 1 Many homeless people are
coping with a variety of very urgent and
immediate issues. Health care and dental
care can slip down their list of priorities,
only becoming important when the
problem becomes acute and the need
for attention is urgent. 2
In 2007, a successful proposal to
improve the oral health of homeless
people was submitted to the Scottish
Government. The Smile4life proposal,
which was submitted by a consortium
of seven NHS boards including NHS
Lanarkshire, aimed to facilitate the
development of an evidence-based
oral health preventive programme for
homeless people in Scotland. In 2008–
2009, an oral health needs assessment
for homeless people was conducted as
an initial phase of the Smile4life project.
A full report of the findings of the oral
health needs assessment is available
from www.dundee.ac.uk/dhsru/news/
smile4life.htm.*
In Lanarkshire, participants of the oral
health needs assessment were recruited
from hostels and soup kitchens. They
were asked to complete a questionnaire
which was used to assess their general
health, oral health and behaviours such
as tobacco use and dental attendance.
An oral examination was offered to each
participant.
A total of 102 homeless people in
the NHS Lanarkshire area took part,
including 76 men and 26 women.
The majority (74%) lived in hostels
or temporary accommodation. Most
participants (79%) reported to be
smokers, 39% drank alcohol on most
days, and 25% admitted to using drugs.
The findings of the oral examination
indicated that the homeless population
in Lanarkshire has poor oral health. The
obvious decay experience (Table 4.2.1)
was measured by the total number of
decayed (D 3
), missing (extracted due to
decay) (M) and filled (F) teeth. The sum
is known as the DMFT index (D 3
MFT).
Individual scores were averaged to give
a mean score for this population. The
number of missing teeth was double
that of filled teeth, suggesting that these
participants had their decayed teeth
extracted rather than filled.
Forty-five per cent had not visited a
dentist for two or more years. The
percentage of participants with a recent
visit to a dentist, at 38%, is much lower
than reported in the general population
(Table 4.2.2).
Table 4.2.1 Obvious decay experience of Lanarkshire participants
Obvious decay experience Mean score Percentage
Decayed teeth (D 3
) 4.46 31
Missing teeth (M) 6.85 48
Filled teeth (F) 3.02 21
D 3
MFT 14.33 100
42 Public Health 2011/12

Table 4.2.2 Length of time since last visit to dentist
Length of time
Homeless
participants (%)
General
population 3 (%)
Less than 1 year 38 69
More than 1 year, up to 2 years 16 10
More than 2 years, up to 5 years 26 8
More than 5 years 19 12
The poor oral health in the homeless
population was highlighted as having
an impact on their quality of life. 4
Seventeen per cent stated that they were
very often handicapped by oral health
issues making their life less satisfying.
This compares to only 1% of UK adults. 5
More information on Lanarkshire’s local
findings is available from
http://content.yudu.com/Library/
A1vmn9/ScottishDentalMagazi/
resources/46.htm.
“Until the opportunity of dental
treatment came my way I was resigned
to a life of constant pain. When I
was homeless I would sleep rough in
bridges suspended over the River Clyde.
There was no possibility
of dental care, to get
access to treatment you
need an address or photo
ID – a sleeping bag in a
girder didn’t qualify.”
– Barry Greenan
Key Points
• An oral health needs assessment for homeless people in Lanarkshire was
carried out.
• The findings of the oral examination indicated that the participants have poor
oral health.
• The proportion of participants with a recent visit to a dentist is much lower
than reported in the general population in Scotland.
Priorities for Action
• Use a multi-agency approach and ensure information is available at hostels
and drop-in centres on how to prevent oral disease and access dental
services.
• Streamline referral of homeless people for dental treatment.
• Maintain a list of dental practices within Lanarkshire willing to register
homeless people.
Oral Health
43

References
1 Scottish Executive. An Action Plan for Improving Oral Health and Modernising NHS Dental Services in
Scotland. Edinburgh: Scottish Executive, 2005.
2 Cole E, Edwards M, Elliot GM, Freeman R, Heffernan A, Moore A. Smile4life: The Oral Health of
Homeless People Across Scotland. Dundee: University of Dundee, 2011.
3 Dobbie F. Dental Health. In: Bromley C, Given L, Ormston R (eds). The 2009 Scottish Health Survey
Volume 1: Main Report. Edinburgh: Scottish Government, 2010.
4 Slade GD. Deprivation and validation of a short-form oral health impact profile. Community
Dentistry and Oral Epidemiology 1997;25:284-290.
5 Walker A, Cooper I (eds). Adult Dental Health Survey: Oral Health in the United Kingdom 1998.
London: The Stationery Office, 2000.
Albert Yeung
Consultant in Dental Public Health
Email: albert.yeung@lanarkshire.scot.nhs.uk
Telephone: 01698 858214
44 Public Health 2011/12

Chapter
5
Health Services
5.1 Overcoming Barriers to Accessing Healthcare
Services – the Keep Well Pilot
Inequalities in access to NHS services
were first described by Dr Julian Tudor
Hart in the 1970s. 1 He postulated the
inverse care law to describe the situation
where ‘the availability of good medical
care tends to vary inversely with the
need for it in the population served’.
Keep Well is a national pilot funded by
the Scottish Government that aims to
address the inverse care law in areas of
socio-economic deprivation. The goals
are to identify people most at risk of
developing heart disease or stroke in
deprived areas, and to offer help with
quitting smoking and/or losing weight,
and medication to lower cholesterol
and blood pressure. Keep Well also
links people to mainstream services
for mental health, employment advice,
benefits advice and social work support
where appropriate.
The Lanarkshire Keep Well service
includes some innovative service
delivery approaches that aim to address
barriers to accessing healthcare in
deprived areas. People in the Keep Well
target population (aged 45–64 years)
that fail to respond to a postal invitation
are followed up by telephone or home
visits. During a home visit, the outreach
workers can have a discussion about
health issues and can arrange a Keep
Well appointment.
Up to January 2011, the Keep Well
outreach service in Lanarkshire managed
to recruit over 5,000 people to the
service at an average cost of just over
£60 per person recruited. The people
recruited through outreach were
statistically more likely to be male, more
likely to smoke and more likely to live in
an area of socio-economic deprivation;
these are all factors that are associated
with a higher risk of cardiovascular
disease and other health problems.
Some in-depth local qualitative research
has shown that most of the people
recruited to Keep Well through outreach
required little by way of persuasion
to make and attend an appointment.
Rather, they required a little extra effort
over and above routine letters and
phone calls.
The Keep Well service in Lanarkshire
has now been mainstreamed within the
community nursing as was originally
described in the NHS Lanarkshire Long
Term Conditions Strategy. The outreach
team has been retained as a parallel
service to support people to attend the
community nursing treatment room
service, from where Keep Well health
checks are now delivered.
Health Services
45

Key Points
• Outreach workers have been employed through Keep Well in Lanarkshire to
support people in overcoming barriers to accessing preventive healthcare
services.
• The people recruited to Keep Well appointments through outreach had
characteristics that are associated with a higher risk of cardiovascular disease
and other health problems.
• Most people welcomed the intervention of outreach workers and many only
needed a little extra support to make and keep their Keep Well appointment.
Priorities for Action
• The ongoing work of the outreach team should be supported to help embed
the anticipatory care ethos of Keep Well within the NHS Lanarkshire treatment
room service.
• By its nature, outreach is an individually-targeted approach to engagement.
Other community-based approaches to Keep Well engagement should be
considered in the future to complement the outreach work, particularly if the
target community can be well defined.
• Further refinements to the Keep Well service model in Lanarkshire should be
considered once the findings from the national evaluation emerge over the
next few years.
References
1 Hart JT. The Inverse Care Law. The Lancet 1971;1(7696):405-12.
Dr Brian O Suilleabhain
Consultant in Public Health Medicine
Email: brian.osuilleabhain@lanarkshire.scot.nhs.uk
Telephone: 01698 858218
46 Public Health 2011/12

5.2
Dementia Services in Lanarkshire
The Annual Report of the Director of
Public Health for Lanarkshire 2010/11
made clear that dementia is a key
public health priority. 1 Since last year’s
report, the multi-agency Lanarkshire
Dementia Strategy Implementation
Group has continued to co-ordinate
the development and improvement of
services for people with dementia by
implementing Scotland’s National
Dementia Strategy. 2
Prevalence
Alzheimer Scotland estimates that
there are over 9,250 people living with
dementia in Lanarkshire, and that this
will double over the next 25 years. 3 All
GP practices in Lanarkshire
have a dementia register,
with over 4,093 people
registered, exceeding
the Scottish Government
performance target for
dementia diagnosis in
2010/11.
Progress
A mapping exercise has
been undertaken across
Lanarkshire to benchmark
all services against the
Standards of Care for Dementia in
Scotland, and the resultant action plan
will assist comprehensive improvement. 4
Work is ongoing to increase public
understanding of dementia and to
reduce the associated fear of the
diagnosis. A Worried About Your
Memory Campaign was launched in
Lanarkshire in June 2012, providing
first point information and advice
in collaboration with the Dementia
Helpline.
Helping people ‘live well with dementia’
requires a much wider community
approach. Examples of actions include
a pilot programme in Motherwell to
support the town centre to become
a ‘dementia friendly community’
promoting awareness, access and
support, and, in collaboration with
Sport Relief and Motherwell Football
Club, a ‘football reminiscence’
programme using sporting heritage to
improve the quality of life for people
with dementia.
Post-diagnostic support for people
living with dementia is a priority, with
local actions including dementia cafés
and a pilot post-diagnostic support
programme in the Wishaw
locality supported via the
North Lanarkshire Dementia
Demonstrator Site.
The Scottish Government’s
Change Programme
continues to assist the
redesign of services and to
develop integrated health
and social care with a focus
on older people, including
those with dementia.
Around 400 people living with dementia
in Lanarkshire are estimated to be under
65 years of age, 3 and the Young Onset
Dementia Team has been expanded to
become multidisciplinary and includes
staff from nursing, occupational therapy,
psychology and psychiatry.
An extensive programme of workforce
development is underway, utilising
Promoting Excellence as the competency
framework to ensure the Lanarkshire
workforce has the skills and knowledge
to provide quality care for people with
dementia. 5
Health Services
47

Nine Dementia Champions are
supporting a wide range of action
to improve the care of people with
dementia in acute settings, along with
an Acute Liaison Psychiatrist and Nurse
Consultant for Dementia.
Good progress has been made in
Lanarkshire in increasing public
awareness to care and treatment and
improving primary care, community and
acute services. However, there remains
much to do.
Key Points
• It is estimated that 9,250 people in Lanarkshire have dementia.
• The number of people with dementia is expected to double over the next
25 years.
• Productive and co-ordinated partnerships are essential to the development
and delivery of services for people with dementia.
Priorities for Action
• Continue to focus on support for reducing risk while also developing services
for people with dementia.
• Continue work to address stigma and discrimination.
• Continue to promote understanding of dementia among the population and
dementia friendly and capable communities.
References
1 Department of Public Health, NHS Lanarkshire. Public Health 2010/11. The Annual Report of the
Director of Public Health. Bothwell: Lanarkshire NHS Board, 2011. www.nhslanarkshire.org.uk/
Services/PublicHealth/Directors-Annual-Report-2010-2011/Pages/default.aspx
(accessed 16 June 2012).
2 Scottish Government. Scotland’s National Dementia Strategy. Edinburgh: Scottish Government,
2010. www.scotland.gov.uk/Publications/2010/09/10151751/0 (accessed 16 June 2012).
3 Alzheimer Scotland website statistics: Number of people with dementia in Scotland 2012.
www.dementiascotland.org/news/statistics-number-of-people-with-dementia-in-scotland/2012/
(accessed 16 June 2012).
4 Scottish Government. Standards of Care for Dementia in Scotland. Edinburgh: Scottish
Government, 2011. www.scotland.gov.uk/Publications/2011/05/31085414/0
(accessed 16 June 2012).
5 Scottish Government. Promoting Excellence. Edinburgh: Scottish Government, 2011.
www.scotland.gov.uk/Publications/2011/05/31085332/0 (accessed 16 June 2012).
48 Public Health 2011/12

Dr John Logan
Consultant in Public Health Medicine
Email: john.logan@lanarkshire.scot.nhs.uk
Telephone: 01698 858241
Kevin O’Neill
Public Mental Health & Wellbeing Development Manager
Email: kevin.oneill@lanarkshire.scot.nhs.uk
Telephone: 01698 366750
Dr Jennifer Borthwick
Clinical Director – Old Age Psychiatry
Email: jennifer.borthwick@nhs.net
Telephone: 01698 210021
Jim Wright
Mental Health & Learning Disabilities Unit General Manager
Email: jim.wright@lanarkshire.scot.nhs.uk
Telephone: 01698 366690
Acknowledgement: Lanarkshire Dementia Strategy Implementation Group
Health Services
49

5.3
Salus
NHS Lanarkshire’s Occupational Health,
Safety and Return to Work service
(known as Salus) has headquarters
in Beckford Street, Hamilton and
departments at all three acute hospitals
across Lanarkshire.
Broadly, occupational health is about the
interaction between work and health.
Evidence abounds that work is good for
physical/mental health and wellbeing.
Conversely, unemployment is associated
with poorer wellbeing. 1 Occupational
health seeks to maximise individuals’
opportunities to benefit from healthy
and rewarding work while not putting
themselves or others at risk. 2 The Scottish
Government recognises the importance
of this and set a standard for NHS staff
absenteeism in 2009.
Early Access to Support for You
(EASY) service
A HEAT target was set by the Scottish
Government for NHS boards to achieve
an annual sickness absence rate of
4% from March 2009. A concerted
effort has been made by human
resources, occupational health, local
and senior management, and staff side
representation to achieve this sickness
absence rate within NHS Lanarkshire.
The EASY service provides early,
targeted support to employees and their
managers during sickness absence. EASY
adopts a holistic approach known as
the bio-psycho-social model of health as
recommended in the report Working for
a healthier tomorrow. 3
Salus is committed to quality
management. It has been accredited
with ISO 9001:2008 for over ten years
and has completed its submission for the
recently introduced Safe Effective Quality
Occupational Health Service (SEQOHS)
accreditation, which it expects to
receive soon.
The big picture
In addition to work for NHS Lanarkshire,
Salus provides its services to public,
private and third sector organisations.
This also includes vocational
rehabilitation services to a diverse
range of clients including those absent
from work, those employed and at
risk of absence, and those who are
unemployed and seeking work. The
multidisciplinary team at Salus has now
grown to over 150 staff, with offices
in Lanarkshire, Glasgow, Ayrshire and
Fleetwood in Lancashire.
EASY signposts the employee to
appropriate support services,
including counselling, physiotherapy,
occupational health, human resources
and occupational therapy. Figure 5.3.1
shows the percentage of working hours
lost to sickness over each of the last
five years. This shows that, following
the introduction of EASY in 2009, there
has been a sustained reduction in
sickness absence.
50 Public Health 2011/12

Figure 5.3.1 Sickness absence rates in NHS Lanarkshire before and after the
introduction of EASY
7%
% of working hours lost to sickness
6%
5%
4%
Pre-EASY 2007/08
Post-EASY 2008/09
Post-EASY 2009/10
Post-EASY 2010/11
Post-EASY 2011/12
HEAT standard
3%
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
Source: Scottish Workforce Information Standard System (SWISS)
Staff influenza vaccination
programme
2010/11 saw an uptake of 33% for NHS
Lanarkshire staff flu immunisation.
While this represents a 3% improvement
in uptake on last year, and an 18–23%
increase in uptake from previous
years, it remains short of the Scottish
Government 40% uptake target.
Figure 5.3.2 shows vaccination uptake by
staff group. When broken down in this
way, uptake is noted to be very high in
managers while frontline medical/dental
and nursing staff have lower uptake
rates of 36.4% and 27.8% respectively.
Staff flu immunisation, and in particular
improving uptake in frontline clinical
staff, will continue to be a priority in the
coming year.
Figure 5.3.2 Uptake of influenza vaccination by staff in NHS Lanarkshire, by staff
group, 2011/12
100%
Percentage uptake
80%
60%
40%
20%
0%
Managers
Assoc. health prof.
Health science
Medical & dental
Support services
Admin. & clerical
Nursing & midwifery
Other therapeutic
Source: Salus
Health Services
51

Key Points
• Salus Occupational Health, Safety and Return to Work service is part of NHS
Lanarkshire.
• EASY has played a significant role in reducing staff sickness absence levels.
• Overall staff influenza vaccination rates increased to 33% in 2011, but further
work is required to boost uptake in specific subgroups such as doctors and
nurses.
Priorities for Action
• Continue to assist NHS Lanarkshire in reducing staff sickness absence.
• Increase staff influenza vaccination uptake, particularly in frontline medical
and nursing staff.
• Achieve SEQOHS accreditation.
References
1 Waddell G. and Burton K. Is Work good for your Health and Wellbeing. London: The Stationary
Office, 2006.
2 Faculty of Occupational Medicine website. www.fom.ac.uk (accessed 1 May 2012).
3 Black C. Working for a healthier tomorrow. London: The Stationary Office, 2008.
Dr Imran Ghafur
Clinical Director
Occupational Health and Safety
Email: imran.ghafur@lanarkshire.scot.nhs.uk
Telephone: 01698 206348
52 Public Health 2011/12

Statistical Appendix
List of tables
A1 Sociodemographic summary: by locality/CHP
A2 Estimated population: by age group and locality/CHP
A3 Projected population: by age group and sex
A4 Births: by year
A5 Births, perinatal deaths, neonatal deaths and infant deaths: by CHP
A6 Deaths from all causes: by sex, age group and year
A7 Deaths from all causes: by sex, age group and locality/CHP
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/CHP and site
A16 Notifiable diseases – confirmed notifications: by year
A17 Dental registrations and participation. Dental health of children*
A18 Primary and booster immunisation uptake rates: by locality/CHP
General notes:
• Lanarkshire has two Community Health Partnerships (CHPs) – North Lanarkshire and South
Lanarkshire. The CHPs cover the same geographical areas as North Lanarkshire Council and
South Lanarkshire Council. There are ten localities within the CHPs – six in North Lanarkshire
(Airdrie, Coatbridge, North, Bellshill, Motherwell and Wishaw) and four in South Lanarkshire
(Cambuslang/Rutherglen, East Kilbride, Clydesdale and Hamilton). The geographical area covered
by NHS Lanarkshire is smaller than the combined CHP areas as Cambuslang/Rutherglen locality
and part of the North locality (the Northern Corridor) lie within NHS Greater Glasgow and Clyde.
Therefore people living in Cambuslang, Rutherglen and the Northern Corridor are residents of
the NHS Greater Glasgow and Clyde area but have some of their health services delivered by NHS
Lanarkshire through the CHPs. The tables in the Statistical Appendix indicate whether information
relates to the Lanarkshire CHPs or NHS Lanarkshire.
• Populations shown and used in rates calculations are, for NHS Lanarkshire, the CHPs 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.
• Standardised ratios are standardised by age and sex to the European standard population.
* This replaces the usual table showing information on sexually transmitted infections (STIs). Due to
problems in the implementation of the National Sexual Health System (NaSH) complicated by the
integration of sexual health services in Scotland, recent data on STIs are not available. Further details
are available at www.isdscotland.org/Health-Topics/Sexual-Health/STIs/.
Derek Roseburgh
Public Health Information Analyst
Statistical Appendix 53

A1
A1
Sociodemographic summary
by locality/CHP
A1
Sociodemographic summary
by locality/CHP
Locality
Airdrie Coatbridge North Bellshill Motherwell Wishaw Cambuslang/ East Clydesdale Hamilton North South
Rutherglen Kilbride
CHP
Lanarkshire
CHPs
NHS
Lanarkshire
Scotland
Estimated population, 2011 No. 56276 46922 82634 48072 39844 52932 58487 87482 61718 104973 326680 312660 639340 563185 5254800
Estimated population
by age group, 2011
Under
5-14
15-24
25-44
45-64
65-74
75 and
5
over
%
%
%
%
%
%
%
6.2
12.2
12.8
27.0
26.9
8.7
6.2
6.4
11.9
12.6
27.5
26.4
8.3
7.0
6.1
12.2
12.4
26.2
28.0
8.9
6.2
6.0
11.9
13.1
26.7
28.2
8.2
6.0
6.6
11.7
12.2
28.0
25.2
9.1
7.1
6.1
11.2
12.6
26.2
27.0
9.0
7.9
6.2
10.8
11.9
27.1
27.8
8.5
7.6
5.4
11.6
12.9
24.4
28.5
9.0
8.3
5.5
10.8
11.7
24.1
30.0
9.9
8.1
5.9
11.3
12.1
26.2
27.8
9.4
7.3
6.2
11.9
12.6
26.8
27.1
8.7
6.7
5.7
11.2
12.2
25.5
28.4
9.2
7.8
6.0
11.5
12.4
26.2
27.7
9.0
7.2
5.9
11.6
12.5
26.0
27.8
9.0
7.2
5.7
10.6
13.0
26.4
27.3
9.1
7.9
Proportion of data zones in the
15% most deprived data zones
in Scotland, 2009 1 % 25.4 40.0 2.8 23.4 22.9 26.1 29.6 0.0 7.5 23.7 21.3 14.6 18.0 17.4 15.0
Population of data zones in the
15% most deprived data zones
in Scotland, 2011 1,2 No. 13422 17294 1937 11292 7716 12560 15388 0 4880 23275 64221 43543 107764 92376 745407
Housing tenure, March 2012 3
Owner occupied % 66.8 58.1 75.0 62.8 51.6 55.3 67.2 76.2 69.7 65.5 63.5 69.7 66.5 66.2 63.7
Rented % 33.2 41.9 25.0 37.2 48.4 44.7 32.8 23.8 30.3 34.5 36.5 30.3 33.5 33.8 36.3
Unemployment, April 2012 No. 2142 1928 2273 1896 1587 2222 2016 2058 1519 3612 12048 9205 21253 18934 144345
% 4 5.8 6.3 4.2 5.9 6.2 6.5 5.2 3.7 3.8 5.3 5.6 4.5 5.1 5.1 4.2
Long-term unemployment No. 585 515 445 490 430 615 465 440 380 925 3080 2210 5290 4775 34835
(1 year plus), April 2012 % 4 1.6 1.7 0.8 1.5 1.7 1.8 1.2 0.8 1.0 1.4 1.4 1.1 1.3 1.3 1.0
1 The 15% most deprived data zones in Scotland are from the Scottish Index of Multiple Deprivation (SIMD) 2009. Sources: National Records of Scotland, SIMD, Scottish Government,
2 Populations are mid-2011 Small Area Population Estimates (SAPE) from National Records of Scotland. North Lanarkshire Council, South Lanarkshire Council
3 Housing tenure figures for Scotland are for March 2010.
4 Numbers claiming Jobseeker's Allowance as a percentage of the population aged 16-64.
54
Public Health 2011/12

A2
A2
Estimated population
by age group and locality/CHP: 2011
A2
Estimated population
by age group and locality/CHP: 2011
Age group Locality
Airdrie Coatbridge North Bellshill Motherwell Wishaw Cambuslang/ East Clydesdale Hamilton North South Male Female Total
Rutherglen Kilbride
CHP
Lanarkshire
CHPs
NHS Lanarkshire
Under 5 3510 3024 5031 2861 2625 3242 3644 4695 3378 6155 20293 17872 38165 17001 16341 33342
5-9 3373 2821 5009 2832 2372 2874 3179 4691 3195 6014 19281 17079 36360 16254 15702 31956
10-14 3486 2751 5076 2902 2297 3034 3166 5429 3484 5798 19548 17877 37425 16894 16336 33230
15-19 3612 2849 5259 3006 2380 3142 3395 5821 3736 6218 20246 19170 39416 18089 16917 35006
20-24 3596 3055 4996 3304 2490 3503 3566 5500 3468 6536 20944 19070 40014 18365 17090 35455
25-29 3644 3150 4964 3192 2613 3617 3807 5094 3330 6800 21180 19031 40211 17983 17425 35408
30-34 3472 2944 4748 2789 2581 2975 3884 4555 3147 6052 19509 17638 37147 15698 16383 32081
35-39 3704 3200 5342 3014 2770 3303 3878 4884 3662 6702 21333 19126 40459 16642 18661 35303
40-44 4367 3592 6627 3819 3186 3995 4305 6830 4721 7985 25586 23841 49427 20716 22828 43544
45-49 4451 3734 6566 3868 3128 4019 4341 7649 4962 7865 25766 24817 50583 21332 23475 44807
50-54 3863 3351 5914 3650 2613 3795 4396 6844 4809 7644 23186 23693 46879 19688 21563 41251
55-59 3513 2786 5399 3107 2166 3242 3956 5479 4411 6913 20213 20759 40972 17215 18693 35908
60-64 3290 2501 5229 2933 2149 3254 3561 4951 4349 6726 19356 19587 38943 16534 17807 34341
65-69 2664 2092 4046 2158 1888 2616 2729 4109 3340 5455 15464 15633 31097 12779 14795 27574
70-74 2252 1795 3334 1765 1749 2141 2229 3729 2755 4438 13036 13151 26187 10367 12950 23317
75-79 1637 1437 2474 1289 1222 1952 1963 3131 2080 3505 10011 10679 20690 7701 10613 18314
80-84 1029 1018 1460 872 902 1269 1401 2243 1546 2254 6550 7444 13994 4710 7588 12298
85 and over 813 822 1160 711 713 959 1087 1848 1345 1913 5178 6193 11371 3115 6935 10050
All ages 56276 46922 82634 48072 39844 52932 58487 87482 61718 104973 326680 312660 639340 271083 292102 563185
Source: National Records of Scotland
Statistical Appendix 55

A3
A3
Projected population
NHS Lanarkshire residents by age group and and sex: sex: 2021 2021 and and 2031 2031 (2010-based)
Age group
2021
2031
Male Female
Both sexes
Male Female
Both sexes
No. % change
No. % change
from 2011
from 2011
Under 5
16656 15801
32457
-2.7
15787 14972
30759
-7.7
5-9
17172 16145
33317
4.3
16373 15380
31753
-0.6
10-14
17340 16596
33936
2.1
16895 16007
32902
-1.0
15-19
16350 15743
32093
-8.3
17236 16213
33449
-4.4
20-24
16825 16044
32869
-7.3
17302 16280
33582
-5.3
25-29
18283 16906
35189
-0.6
16487 15707
32194
-9.1
30-34
18666 17502
36168
12.7
16919 16242
33161
3.4
35-39
18130 17731
35861
1.6
18231 17074
35305
0.0
40-44
15717 16595
32312
-25.8
18454 17658
36112
-17.1
45-49
16373 18641
35014
-21.9
17704 17694
35398
-21.0
50-54
20120 22570
42690
3.5
15390 16458
31848
-22.8
55-59
20337 22766
43103
20.0
15712 18235
33947
-5.5
60-64
18031 20324
38355
11.7
18656 21469
40125
16.8
65-69
14859 17077
31936
15.8
18068 21038
39106
41.8
70-74
13288 15486
28774
23.4
15061 18061
33122
42.1
75-79
9237 12002
21239
16.0
11298 14267
25565
39.6
80-84
6301
9226
15527
26.3
8693 11586
20279
64.9
85 and over 5392 9667 15059 49.8 8225 13443 21668 115.6
All ages
279077 296822
575899
2.3
282491 297784
580275
3.0
Source: National Records of Scotland
56
Public Health 2011/12

A4
A4
Births
NHS Lanarkshire residents by by year: year: 2002–2011 2002–2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Live births
5992 6045 6497 6283 6584 6548 6848 6575 6445 6502
Stillbirths
29
45
35
33
38
32
36
44
36
29
All births (live and still) 6021 6090 6532 6316 6622 6580 6884 6619 6481 6531
General fertility rate (GFR) – live births per 1,000 women aged 15–44
80
70
60
60.1
50
55.2 56.8 56.8
58.4 58.2 59.5
53.8
50.4 51.2
40
30
Rate
20
10
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: National Records of Scotland
Statistical Appendix 57

A5
A5
Births, perinatal deaths, deaths, neonatal neonatal deaths deaths and and infant infant deaths deaths
CHPs, Lanarkshire and Scotland: 2009–2011 (3-year (3-year average) average)
CHP
North South
Lanarkshire CHPs NHS Lanarkshire Scotland
Live births No. 3996 3462 7459 6507 58809
Rate 1 60.5 57.5 59.1 58.8 56.6
Stillbirths No. 25 16 41 36 302
Rate 2 6.2 4.5 5.4 5.6 5.1
All births (live and still) No. 4021 3478 7499 6544 59111
Rate 1 60.9 57.8 59.4 59.1 56.8
Perinatal deaths 3 No. 34 20 54 49 418
Rate 2 8.4 5.8 7.2 7.5 7.1
Neonatal deaths 4 No. 12 7 19 16 158
Rate 5 3.0 1.9 2.5 2.5 2.7
Infant deaths 6 No. 18 7 26 23 230
Rate 5 4.6 2.1 3.4 3.5 3.9
1 Rate per 1,000 women aged 15–44. Source: National Records of Scotland
2 Rate per 1,000 births.
3 Stillbirths and deaths in the first week of life.
4 Deaths at ages under 28 days.
5 Rate per 1,000 live births.
6 Deaths during first year of life.
58
Public Health 2011/12

A6
A6
Deaths from all causes
NHS Lanarkshire residents by sex, age group and year: 2002–2011
A6
Deaths from all causes
NHS Lanarkshire residents by sex, age group and year: 2002–2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Number
Males

A7
A7
Deaths from all causes
by sex, age group and locality/CHP: 2011
A7
Deaths from all causes
by sex, age group and locality/CHP: 2011
Locality
Airdrie Coatbridge North Bellshill Motherwell Wishaw Cambuslang/ East Clydesdale Hamilton North South
Rutherglen Kilbride
CHP
Lanarkshire
CHPs
NHS
Lanarkshire
Number
Males

A8
A8
Deaths from malignant neoplasms
NHS Lanarkshire residents by sex, age group and year: 2002–2011
A8
Deaths from malignant neoplasms
NHS Lanarkshire residents by sex, age group and year: 2002–2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Number
Males

A9
A9
Deaths from coronary heart disease
NHS Lanarkshire residents by sex, age group and year: 2002–2011
A9
Deaths from coronary heart disease
NHS Lanarkshire residents by sex, age group and year: 2002–2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Number
Males

A10
A10
Deaths from cerebrovascular disease
NHS Lanarkshire residents by sex, age group and year: 2002–2011
A10
Deaths from cerebrovascular disease
NHS Lanarkshire residents by sex, age group and year: 2002–2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Number
Males

A11
A11
Deaths from respiratory disease
NHS Lanarkshire residents by sex, age group and year: 2002–2011
A11
Deaths from respiratory disease
NHS Lanarkshire residents by sex, age group and year: 2002–2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Number
Males

A12
A12
Expectation of life 1
by age and sex: 2008–2010; trend by sex: 1998–2000 to 2008–2010
A12
Expectation of life 1
by age and sex: 2008–2010; trend by sex: 1998–2000 to 2008–2010
Males Females
North CHP South CHP NHS Scotland UK North CHP South CHP NHS Scotland UK
Lanarkshire Lanarkshire
2008–2010
Age
0
45
65
75
74.3
31.7
15.6
9.6
75.7
33.0
16.4
10.3
75.0
32.4
16.0
10.0
75.8
33.3
16.8
10.4
78.1
35.0
17.8
10.9
78.8
35.2
18.2
11.2
80.3
36.4
18.9
11.8
79.4
35.7
18.5
11.4
80.4
36.8
19.3
12.0
82.1
38.4
20.4
12.7
Life expectancy at birth - males Life expectancy at birth - females
85
80
75
70
78.1
75.7
75.8
75.0
75.0
74.3
72.8
71.8
72.3
72.9
85
82.1
80.3
80.4
79.4
79.9
80
78.8
77.3
77.9
78.4
77.7
75
70
Life expectancy (years)
Life expectancy (years)
65
North CHP South CHP NHS
Lanarkshire
Scotland UK
65
North CHP South CHP NHS
Lanarkshire
Scotland UK
1998–2000 2008-2010
1998–2000 2008-2010
1 Expectation of life is the average number of years left to a person of an exact age who is subject to the current mortality probabilities from birth. Sources: National Records of Scotland,
Office for National Statistics
Statistical Appendix 65

A13
A13
Cancer registrations 1,2
NHS Lanarkshire residents by sex, age group and year: 2001–2010
A13
Cancer registrations 1,2
NHS Lanarkshire residents by sex, age group and year: 2001–2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number
Males

A14
A14
A14
Cancer registrations 1 1
NHS Lanarkshire residents by by year year and and site: site: 2006–2010; standardised incidence incidence ratios ratios by sex, by age sex, group age and group site: and 2008–2010 site: 2008–2010
Trachea,
bronchus
and lung
Female
breast
Large
bowel
Prostate Bladder Stomach
Cervix
Number
2006
530
402
353
229
74
105
43
2007
532
407
395
226
88
81
34
2008
545
475
405
258
85
89
30
2009
545
419
409
300
74
97
56
2010
567
460
457
267
97
89
46
Standardised incidence ratio (2008 –2010) 2
Males

A15
A15
Cancer registrations 1
by locality/CHP and site: 2010; standardised incidence ratios by locality/CHP, site and age group: 2008–2010
A15
Cancer registrations 1
by locality/CHP and site: 2010; standardised incidence ratios by locality/CHP, site and age group: 2008–20
Age group Locality
Airdrie Coatbridge North Bellshill Motherwell Wishaw Cambuslang/ East Clydesdale Hamilton North South
Rutherglen Kilbride
CHP
Lanarkshire
CHPs
NHS
Lanarkshire
Number (2010)
Lung 59 52 81 55 41 62 56 76 57 103 350 292 642 567
Female breast 28 41 87 26 21 38 45 112 37 106 241 300 541 460
Large bowel 43 42 59 45 29 41 50 82 48 75 259 255 514 457
All cancers 2 360 320 604 358 277 426 449 746 460 807 2345 2462 4807 4196
Standardised incidence ratio (2008–2010) 3
Lung

A16
A16
Notifiable diseases – – confirmed notifications notifications 1,2,3 1,2,3
by year: 2007–2011
NHS Lanarkshire residents
Scotland
Number
Rate 4 Rate 4
2007 2008 2009 2010 2011 2011 2011
Anthrax 0 0 0 1 0 0.0 0.0
Brucellosis .. .. .. 0 1 0.2 0.0
Cholera 1 0 2 0 1 0.2 0.1
Measles 46 38 24 28 15 2.7 1.6
Meningococcal disease 20 26 22 12 21 3.7 2.0
Mumps 342 109 63 60 48 8.5 11.6
Necrotizing fasciitis .. .. .. 0 5 0.9 0.2
Pertussis (whooping cough) 17 18 13 5 7 1.2 1.6
Rubella 23 23 19 5 8 1.4 0.4
Tuberculosis (respiratory) 21 29 31 28 29 5.1 5.5
Tuberculosis (non-respiratory) 6 12 12 18 12 2.1 3.2
1 There were no notifications in Lanarkshire of the following diseases in the period shown: botulism, diphtheria, Source: Health Protection Scotland
haemolytic uraemic syndrome (HUS), Haemophilus influenzae type b (Hib), paratyphoid, plague, poliomyelitis, rabies,
SARS, smallpox, tetanus, tularemia, typhoid, viral haemorrhagic fevers, West Nile fever and yellow fever.
2 There were no notifications of clinical syndrome due to E.coli O157 infection. However, there were 39 cases of E.coli O157 infection
in Lanarkshire in 2011. Figures on E.coli O157 are incomplete for Scotland and therefore rates cannot be shown.
3 From 2010 the following are no longer notifiable diseases: bacillary dysentery, chickenpox, erysipelas, food poisoning, legionellosis,
leptospirosis, Lyme disease, malaria, puerperal fever, relapsing fever, scarlet fever, toxoplasmosis, typhus fever and viral hepatitis.
4 Rate per 100,000 population.
.. Not available as the disease only became notifiable from 2010.
Statistical Appendix 69

A17
A17
Dental registration and participation
Dental health of children
A17
Dental registrations and participation
Dental health of children
Age group

A18
A18
Primary and booster immunisation uptake rates by 5 years old 1
by locality/CHP: evaluation period 1 April 2010 to 31 March 2011
A18
Primary and booster immunisation uptake rates by 5 years old 1
by locality/CHP: evaluation period 1 April 2011 to 31 March 2012
Locality 2 CHP 2 Lanarkshire 3
Airdrie Bellshill Coatbridge North Motherwell Wishaw Clydesdale East Hamilton North South
Kilbride
Scotland
No. in cohort 436 565 606 810 472 634 604 944 1344 3523 2892 6763 57220
% completed primary course by 5 years
Diphtheria 97.9 99.1 99.3 98.6 97.0 99.2 99.0 98.9 99.5 98.6 99.2 98.8 98.6
Tetanus 97.9 99.1 99.3 98.6 97.0 99.2 99.0 98.9 99.5 98.6 99.2 98.8 98.6
Pertussis 97.9 99.1 99.3 98.6 97.0 99.2 99.0 98.9 99.5 98.6 99.2 98.8 98.6
Polio 97.7 99.1 98.7 98.6 97.0 99.1 99.0 98.8 99.3 98.5 99.1 98.7 98.5
Hib 4 97.5 98.9 98.5 98.5 96.2 98.7 98.8 98.7 98.9 98.2 98.8 98.4 97.9
MenC 5 95.6 97.0 95.4 96.3 93.0 96.1 97.5 96.1 96.4 95.7 96.5 96.0 94.6
MMR 6 95.0 96.8 96.9 96.9 94.1 97.6 97.2 96.9 97.1 96.4 97.1 96.6 96.6
% completed booster course by 5 years
Hib/MenC 4,5 92.7 97.5 95.9 95.9 94.7 97.8 95.9 96.7 95.2 95.9 95.9 95.6 95.1
PCVB 7 93.8 97.0 96.2 95.8 93.0 95.9 97.2 96.4 96.8 95.5 96.7 95.9 94.0
Diphtheria 89.9 92.4 95.5 89.4 93.0 96.8 94.7 93.3 93.2 92.8 93.5 93.0 91.9
Tetanus 89.9 92.4 95.5 89.4 93.0 96.8 94.7 93.3 93.2 92.8 93.5 93.0 91.9
Pertussis 89.9 92.4 95.5 89.4 93.0 96.8 94.7 93.3 93.2 92.8 93.5 93.0 91.9
Polio 89.7 92.4 95.5 89.4 93.2 96.7 94.7 93.3 93.1 92.8 93.5 93.0 91.9
MMR 6 87.6 90.6 92.9 87.8 90.5 94.8 93.2 90.6 90.6 90.7 91.1 90.7 90.2
1 Children reaching 5 years of age during the evaluation period 1 April 2011 to 31 March 2012 (i.e. born 1 April 2006 to 31 March 2007). Source: SIRS, ISD Scotland
2 GP practices in NHS Lanarkshire grouped into localities/CHPs. Children resident in NHS Lanarkshire only.
3 Children resident in NHS Lanarkshire immunised in any NHS board.
4 Haemophilus influenzae type b vaccine.
5 Meningococcal serogroup C conjugate vaccine.
6 Combined measles, mumps and rubella vaccine.
7 Pneumococcal conjugate vaccine booster.
Statistical Appendix 71

Staff in Public Health
Name Designation Email address
Anne Alexander Operational Support Manager anne.alexander@lanarkshire.scot.nhs.uk
Lee Baird Personal Assistant/Team Leader lee.baird@lanarkshire.scot.nhs.uk
Loretta Barr Medical Secretary loretta.barr@lanarkshire.scot.nhs.uk
Alison Buesnel BBV Networks Co-ordinator alison.buesnel@lanarkshire.scot.nhs.uk
Dr Charles Clark Consultant in Public Health Medicine Retired from NHS Lanarkshire in March 2012
Dr David Cromie Consultant in Public Health Medicine david.cromie@lanarkshire.scot.nhs.uk
Dr Jennifer
Consultant in Public Health Medicine jennifer.darnborough@lanarkshire.scot.nhs.uk
Darnborough
Louise Flanagan Specialty Registrar in Public Health louise.flanagan@lanarkshire.scot.nhs.uk
Patricia Houston Higher Clerical Officer (Health patricia.houston@lanarkshire.scot.nhs.uk
Protection)
Catherine Keachie Medical Secretary Left NHS Lanarkshire in November 2011
Jean Kerr
Senior Nursing Adviser (Infection jean.kerr@lanarkshire.scot.nhs.uk
Control)
Dr Harpreet Kohli Director of Public Health and Health harpreet.kohli@lanarkshire.scot.nhs.uk
Policy
Dr John Logan Consultant in Public Health Medicine john.logan@lanarkshire.scot.nhs.uk
Elizabeth Maitland Public Health Research Officer Fixed term from October 2011 to July 2012
Dr Catriona Specialty Registrar in Public Health catriona.milosevic@lanarkshire.scot.nhs.uk
Milošević
Medicine
Dr Margaret Morris Public Health Specialist margaret.morris2@nhs.net
Julie Muir
Higher Clerical Officer (Health julie.muir@lanarkshire.scot.nhs.uk
Protection)
Dr Brian O
Consultant in Public Health Medicine brian.osuilleabhain@lanarkshire.scot.nhs.uk
Suilleabhain
Dr Josephine Consultant in Public Health Medicine josephine.pravinkumar@lanarkshire.scot.nhs.uk
Pravinkumar
Lesley Ritchie TB Liaison Nurse lesley.ritchie2@lanarkshire.scot.nhs.uk
Alan Robertson Emergency Planning Officer alan.robertson@lanarkshire.scot.nhs.uk
Derek Roseburgh Public Health Information Analyst derek.roseburgh@lanarkshire.scot.nhs.uk
Evelyn Scott Medical Secretary evelyn.scott@lanarkshire.scot.nhs.uk
Dr Tasmin
Consultant in Public Health Medicine tasmin.sommerfield@lanarkshire.scot.nhs.uk
Sommerfield
Praveena
Public Health Research Officer praveena.symeonoglou@lanarkshire.scot.nhs.uk
Symeonoglou
Dr Rachel Thorpe Specialty Registrar in Public Health rachel.thorpe@lanarkshire.scot.nhs.uk
Medicine
Trish Tougher BBV Networks Manager trish.tougher@lanarkshire.scot.nhs.uk
Christine Weir Lead TB Liaison Nurse christine.weir@lanarkshire.scot.nhs.uk
Jim White Health Protection Nurse jim.white@lanarkshire.scot.nhs.uk
Albert Yeung Consultant in Dental Public Health albert.yeung@lanarkshire.scot.nhs.uk
72 Public Health 2011/12