Mike Massara

Alison McCallum

Yvonne Dalziel

Diane Devlin

Colin Cooper

David Ewart

Carl Bickler

Roy Robertson

John Budd

Catriona Morton

Wilf Treasure

Ian McKee

Penny Watson

Ewen Stewart

Lesley Boyd

Duncan Miller

Action

1.

Minutes

Accepted for accuracy

Matters Arising

John reported back on the Health For All Planning Day.  He highlighted several recommendations from the committee’s work plan including the priorities to look at sustainable funding for proven effective interventions, the need to address resource reallocation based on need and the need to extend action in  clinical health services to address Health Inequalities.

(2)

Community Based Alcohol Service Proposal

John updated the Group on this.  He is working with Euan Macleay, acting Manager NW APS, to produce this and hope to have the first draft to circulate for comments/suggestions by end of next week. 

John

Mike confirmed that the new alcohol money has come through.  Some discussion followed about whether this proposal was a pilot project, in terms of innovation, or rather a “path funding” proposal to work out a more definitive model of care.  It was generally felt that this was a proposal to ground an alcohol service within the Primary Care Team, to offer support and training for other members of the Primary Care Team, liaise with non- stat agencies and more specialised treatment services, and offer clinical input with more involved courses of brief interactions for more complex cases and community detoxification.

Jane suggested a bringing together of APS and CDPS, with  CDPS workers getting more involved with treating alcohol problems.

Alison wondered about the issues in general practice with regard to patients with alcohol problems.  Colin sited the advantage of primary cares’s ongoing  longer term involvement with patients and their families, regardless of whether they DNA appointments or not.  This advantage of ongoing engagement means that Primary Care is the optimum place to deal with alcohol problems, as withy other chronic diseases.

Alison suggested one means to improve efficient management of alcohol problems was to use a single shared assessment tool for primary care, social work, alcohol problems service and non-stat agencies.  

Mike informed the group that there was already a group with Fiona Watson working on developing such a tool.

John aimed to submit the proposal to the DAAT in the next few weeks, following circulation to the group and other stakeholders.

John

3.

Lothian Health’s Strategy for addressing Health Inequalities

Alison articulated the need for Lothian Health to develop an inequalities strategy with specific goals and measurable outcomes along with a time table for achieving this.  At present this is not in existence, however, as a means to generating this she identified the upcoming Health Inequalities Conference as being central.

Alison highlighted several areas that she was keen to take action on in an attempt to address inequalities.  She was keen to get health to be considered as an integral part of the planning process for new building developments and for the physical environment’s impact on health to be recognised and considered from housing and the local environment developments. 

Other areas that she was interested in included constructive involvement with food manufacturers to promote healthier food and dialogue with local authorities over health implications of alcohol licensing hours.

Alison identified the need for an array of service responses in addressing inequalities.  Some responses need to be universal, others enhanced in certain settings with others being targeted on specific areas of need.  She very much saw primary care as a central part of Lothian Health’s response to health inequalities drawing on its advantages of local knowledge and accessibility.    

Alison also touched on the need to evaluate interventions and the difficulties  involved with this, along with the problems of  monitoring performance against set targets for reducing inequalities.

Lively discussion ensued with the need for redistribution of resources based on need rather than demand surfacing as a recurrent theme.    How to use any redistributed resources effectively to address inequalities proved rather  contentious.

Hall 4 and the potential redistributing of Health Visitors was discussed.  Yvonne and Diane felt that unless Health Visitors were not only reallocated, but also made to work in a radically different way - with them focusing on group work or a community development role - then there would be no real benefit.

Others felt that there was no evidence for this and that  with the increase in numbers of Health Visitors in more disadvantaged communities then they could be a significant factor for improving  health outcomes.

Some time was spent debating the respective merits of the social model and medical model of health.  All were agreed on the need for change within the current health service response and for that change to be focused on need with ensuing redistribution of health resources.

4.

Health Inequalities Conference

The proposed Health Inequalities Conference in February 06 could offer a useful forum to explore the differing and complimentary roles that social and medical approaches to health could afford in tackling inequalities in health.  DIG has been asked to provide a representative for the organising committee for the conference.  Anyone interested to contact John.

Members

5.

AOB

(i)

Colin informed the Group of a LMC organised Hall 4 meeting on Wednesday 24 September at which it would be good to have DIG representation.

(ii)

Diane circulated details of the Bridgend Farm Community Gardening & Health Project.  See John for details.

(iii)

John informed the group of a committee he is involved with to organise Hepatitis C Outreach Clinics  focusing on Drug Users.  The aim is to pilot outreach clinics in different Primary care settings, including the Homeless Practice, CDPS, Prison and a regular GP Practice – to attempt to address the significant access problems drug users have in engaging with specialist services. 

6.

Next Meeting

Wednesday 5 October 7.30 Deaconess – Room 2.  We hope to have Linda Irvine with us to update us on the Mental Health Strategy.