Walking Towards a Healthier Scotland

Guest blog by Ian McCall – Senior Development Officer at Paths for All

PFA_Logo_Blue_Box_cmykGetting active through walking is the easiest path to better health and longer healthy lives and will take pressure off our hard pressed health and social care services.

Walking is such an outstanding opportunity for effective preventative spending that we must bring it back into our daily lives and put it at the heart of our health service.

What support do we need in Scotland to live healthier lives?

One of the most effective ways to improve the health of our population is to increase physical activity levels – and walking has been proven to be the most popular, accessible and effective way of doing this.

We need to help people be more active by making walking part of all our daily lives – with walking for health and travel being seen as the social norm. This needs to be supported by an environment that is conducive, safe and welcoming. Community led, effective, local walking opportunities are also an important way to get people active.

The National Walking Strategy and Long-term Vision for Active Travel in Scotland should deliver this.


What areas of health and social care matter most to you?

Getting people active through walking is a great way to support better health and longer healthy lives – taking pressure off health and social care services. This is an important opportunity for effective preventative spend as recommended by the Christie Commission and is particularly important in a time of increasing pressure on budgets, reduced resources and an ageing population. It is also important to support self-management of long term conditions – including enabling people to keep active.

The economic benefits associated with increased physical activity levels far outweigh the costs. Cost Benefit Ratios for walking developments show significant value for money. Social Return on Investment (SROI) evidence shows a return of approximately £8 for every £1 invested in health walk and path development projects.


Thinking about the future of health and social care services, where should our focus be?

Walking should be at the heart of our health and social care services and we should focus on providing opportunities, signposting activities and informing Health & Social Care Professionals. Avenues that should be explored are including the provision of physical activity advice in GP contracts and on relevant content in undergraduate courses.

The importance of preventative spending and the need for sustained funding for walking as part of that cannot be overemphasised. The work of Paths for All and our partners can play an important role in getting people walking more – which will bring multiple health benefits over the longer term. Supporting older adults to be active must be a priority.


The National Walking Strategy

Increasing physical activity is crucially important for the mental and physical health of our country. Big health gains come from getting inactive people more active, particularly in the outdoors, and the easiest way for most of us is through walking more.

Walking is cheap, accessible and fun – almost everyone can do it – and has been described as the “magic pill” for health.

The National Walking Strategy makes the links between getting active and health and has three strategic aims:

  • Create a culture of walking
  • Better walking environments throughout Scotland
  • Ensure easy, convenient independent mobility for all

Paths for All is a Scottish charity founded in 1996. We champion everyday walking as the way to a happier, healthier Scotland. We want to get Scotland walking: everyone, everyday, everywhere.

Our aim is to significantly increase the number of people who choose to walk in Scotland – whether that’s for leisure or walking to work, school, the shops or to a nearby public transport hub. We want to create a happier, healthier Scotland where increased physical activity improves quality of life and wellbeing for all. We work to develop more opportunities and better environments not just for walking, but also for cycling and other activities, to help make Scotland a more active, more prosperous, greener country.

Our work supports the delivery of the Scottish Government’s National Walking Strategy (NWS) and the Long-term Vision for Active Travel in Scotland, community and workplace health walking, path network development and active travel policy development. We are a partnership organisation with 28 national partners. Our funders include the Scottish Government, Transport Scotland, Scottish Natural Heritage, Macmillan, The Life Changes Trust, Forestry Commission Scotland and Awards for All.

Paths for All and our partners are involved in a number of key areas of work that support the National Walking Strategy and plans for a healthier Scotland. We are very keen to engage more with the health and social care sector to share our experience and raise awareness of the opportunities.

  • Health walks – local walking projects across Scotland – training, resources and support
  • Strength and Balance – for example in care homes – training, resources and support
  • Step count challenge – workplace team walking challenges
  • Workplace – training, resources and support
  • The Alliance – promoting walking for staff and patients in Links/Deep End GP practices and for people with long term conditions
  • Medal Routes and app – including hubs in health care settings
  • World Walking and app
  • Macmillan – promoting walking for people affected by cancer
  • Dementia Friendly Walking Project – training, resources and support – funded by the Life Changes Trust
  • Community paths – training, resources and support to create active environments
  • Active travel – including the Smarter Choices Smarter Places Fund – encouraging travel behaviour change
  • Walking football – supporting the development of local Walking Football opportunities across Scotland
  • Working with NHS Health Scotland in developing the Exemplar Physical Activity Employer Award
  • Cobranded research project into increasing the activity of dog walkers on the National Forest Estate in Scotland.
  • The Big Fit Walk takes place annually in June and aims to inspire communities across Scotland to come together for a short walk to celebrate the benefits of being active.


Let’s Talk About Palliative Care

Guest Blog by Professor Craig White – Divisional Clinical Lead of the Quality and Planning Division of the Healthcare Quality and Strategy Directorate at the Scottish Government and Honorary Professor in the College of Medicine, Veterinary and Life Sciences at the University of Glasgow

Assets and Expertise

As a society we are facing a growing need for appropriate care in the face of ageing, life limiting illness and death. Although the scale and complexity of this makes this challenging – we have substantial assets and expertise within Scotland with which to respond to this need.cw1

In 2014 the World Health Assembly – the governing body of the World Health Organisation – passed a resolution requiring all governments to recognise palliative care and to make provision for it in their national health policies.

The Strategic Framework for Action on Palliative and End of Life Care is the Scottish Government’s response to that call (http://www.gov.scot/Publications/2015/12/4053/downloads).

Health and Sports Committee

The Health and Sport Committee of the Scottish Parliament has published its report entitled:

‘We Need to Talk About Palliative Care”

(http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Reports/HSS042015R15.pdf ). The Scottish Government have responded to this

(http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Inquiries/20160121-SG_Response.pdf )

and recently welcomed the opportunity to provide evidence to MSPs on progress and future plans


cw2The Framework outlines the vision that by 2021 everyone who needs access to palliative care will have access to it.

Surely everyone in Scotland currently has access to palliative care – after all most people have a GP and everyone who has been diagnosed with a progressive, incurable and/or life-limiting illness has been in touch with a Consultant ?

Theoretically yes, but the vision is for access to the sort of palliative care that the World Health Assembly refers to, where there is “:…palliation across the continuum of care, especially at the primary care level, recognizing that inadequate integration of palliative care into health and social care systems is a major contributing factor to the lack of equitable access to such care.”

This is the vision for what this means for Scotland.

We were fortunate to be able to appoint Professor David Clark as the Consulting Editor for the Framework, ensuring that all of the views received throughout the engagement process were considered objectively against the best available international evidence and expert opinion.

The publication of the Framework and supporting evidence has been welcomed internationally (http://endoflifestudies.academicblogs.co.uk/scottish-government-launches-its-strategic-framework-for-action-on-palliative-and-end-of-life-care/).  As with any change on the scale of that envisaged in a national strategic framework, there are a wide range of ideas and views on how this might be achieved.


The Scottish Government has outlined it’s commitment to supporting changes required to support access to palliative and end of life care being available to all who can benefit from it, regardless of age, gender, diagnosis, social group or location.cw3.png

It has been recognized that people, their families and carers will need to have timely and focused conversations with appropriately skilled professionals to plan their care and support towards the end of life, and to ensure this accords with their needs and preferences.

This will in turn require that a wider range of communities, groups and organisations understand the importance of good palliative and end of life care to the well-being of society.

The health and social care system will be increasingly configured to maximize the changes that people receive health and social care that supports their wellbeing, irrespective of their diagnosis, age, socio-economic background, care setting or proximity to death.  Many more people will have more opportunities to discuss and plan for future possible decline in health, preferably before a crisis occurs, and will be supported to retain independence for as long as possible.   People will need to know how to help and support each other at times of increased health need and in bereavement, recognising the importance of families and communities working alongside formal services.

All of this will be supported by a culture, through resources, systems and processes within health and social care services that empower staff to exercise their skills and provide high quality person-centred care.

Enhanced contribution

All of this can be achieved through improved identification of people who may benefit from palliative and end of life care, supported by an enhanced contribution of  a  wider  range  of  health  and  care  staff.

cw4There must be a stronger sense among staff of feeling adequately trained and supported to provide the palliative and end of life care that is needed, including a better understanding of how people’s health literacy needs can be addressed.

This is likely to be helped through a greater openness about death, dying and bereavement in Scotland – which will in turn be enabled through the recognition of wider sources of support within communities that enable people to live and die well.

I recently had the privilege of working with the Chief Medical Officer and some colleagues on her Annual Report for 2014/15 (http://www.gov.scot/Resource/0049/00492520.pdf).  This report included the suggestion that “Clinical leaders need to challenge their own thinking and ask themselves whether they have a growth mindset.

cw5.pngThis will mean an enhanced awareness of opportunity for self improvement, more engagement with challenge and a greater persistence in the face of obstacles.”  This is pertinent to all of the commitments outlined in the new Framework.

To achieve our vision many people, organisations and agencies will have to work together in a culture of collaboration – ensuring that there is a balance of constructive challenge and a recognition of the benefits of aligning support, engagement and delivery mechanisms for maximum benefit.

Much of the co-ordination, leadership and support for this work will come through the Health and Social Care Partnerships across Scotland.   The way in which these changes will be delivered may require significant changes in the way in which organisations approach the delivery of palliative care provision.

I would be delighted to hear from you, through this blog, email (craig.white@gov.scot) or on twitter  (@craigwhitephd) if you have an interest in this work.

The Strategic Framework for Action on Palliative Care and Supporting Evidence Summary are available at: http://www.gov.scot/Publications/2015/12/4053/downloads

Craig’s blog was originally previously featured on the Ayrshire Health website.


RoSPA contributes to the Healthier Scotland Conversation

RoSPA logo.jpgGuest blog by Jessica Munshaw – Community Safety Information and Support Officer, RoSPA

It is becoming increasingly evident that preventative services are extremely important for creating a healthier nation. While prevention is not a new topic, recent national conversations have been bringing it to the forefront. The Royal Society for the Prevention of Accidents have been promoting safety and the prevention of accidents in the UK for over 100 years. Accidents are the principal cause of premature, preventable death for children, youth and people up to the age of 60. Because accidents affect the young so much, they cast a very long shadow over the lives of those left behind. Therefore, we strongly believe that an emphasis on accident prevention will contribute greatly to a healthier Scotland.

Following two safety projects implemented by RoSPA, we have seen that for a relatively low cost, accident prevention can have a big impact on the health and lives of UK citizens. Scotland’s Home Safety Equipment Scheme involved a home safety visit, education package and free installation of safety equipment to approximately 1000 families. According to the National Institute for Health and Care Excellence (NICE), the cost of a non-fatal hospital treated home accident for children aged up to four years in the UK is £10,600. The cost of delivering the scheme was £142 for each child, far cheaper than the cost of treatment and rehabilitation.

Laundry capsule campaignRoSPA also worked on a liquid laundry capsule campaign with NHS Greater Glasgow and Clyde. Several children in Scotland have been admitted to the hospital for biting into liquid laundry capsules. Safety packs with information leaflets and cupboard catches were created and delivered by health visitors as part of their health visit to over 16,000 families. The cost of delivering the scheme was just £1.46 for each family.

These are just two examples of how effective a preventative approach can be at creating a healthier Scotland. Although they demonstrate that significant money can be saved through prevention, more importantly they show how easily the pain and suffering associated with accidents can be avoided.

A healthier Scotland will consist of strong, resilient and supportive communities. Accident prevention encourages resilience, resourcefulness and self-reliance. By providing people with these skills, we would be providing them with the ability to take responsibility for their own health and the health of their loved ones.

For more information: www.rospa.com

Email: jmunshaw@rospa.com

Telephone: 0131-449-9379

Health in the Workplace

Thinking about healthy living in different settings, our workplaces can have a huge impact on our health.

The workplace is where many people spend the largest proportion of their time and therefore can play a key role in contributing to health and wellbeing.

Many employers know the importance of having healthy employees as this can improve productivity. The Office for National Statistics estimated that 131 million working days were lost due to sickness absences in the UK in 2013/14.

NHS Scotland offers these tips on how to boost your health at work.


  • What can be done to improve our health and wellbeing through work?
  • What changes can we make in Scotland to ensure our future workplaces are healthy workplaces?


Scotland’s Natural Health Service

We know that the quality and accessibility of our natural environment is key to good physical and mental health. Evidence shows us that a population closer to nature is healthier and that health disparities between high and low income groups are much narrower in areas with ample greenspace (parks, walking routes etc.)

Having good quality greenspace which people regularly use could save the NHS as much as £94 million a year as people become fitter and healthier.

(Source: NHS Health Scotland – Costing the burden of ill health related to Physical Inactivity for Scotland – 2013)

  • Do you use greenspace to keep active?
  • What can be done in your area to help you?


If you are thinking about starting to get active outdoors and would like to meet new people too, then why not explore some of the these options that are suitable for all levels of fitness:

Medal Routes.

Medal Routes is a Scotland-wide initiative created by Ramblers Scotland to support people across the country to be more active and build walking into their daily lives. Medal Routes are short, circular walks lasting 15, 30 or 60 minutes from a hub location (such as a library, sports centre or café).

Doctors agree that the moderate exercise from regularly walking these medal routes helps protect the body from many illnesses and conditions, including heart disease and stroke, high blood pressure, osteoarthritis, obesity, the most common type of diabetes and many cancers. It’s also a great way to relieve stress and stay happy.

Visit the Take 30 website to find out more.

Green Gyms.

Green Gyms are fun and free outdoor sessions created and run by The Conservation Volunteers Scotland. TCV involve a range of practical activities such as planting trees, sowing meadows, looking after paths, and establishing wildlife ponds.

Unlike other conservation projects, the emphasis is very much on health and fitness – volunteers warm up and cool down in preparation for a range of light to vigorous activities to suit all abilities. In fact, almost a third more calories can be burnt in some Green Gym sessions than in an average aerobics class.

In addition to physical health benefits, green Gyms also enhance mental wellbeing through increased contact with nature, the social benefits of group activity and helping people contribute something positive to their community.

Visit the TCV website to find out more.


Paths for All.

Paths for All is a Scottish charity who champion everyday walking as the way to a happier, healthier Scotland. They aim to significantly increase the number of people who choose to walk in Scotland for leisure, for work, to school or to the shops.

Paths for All want to create a happier, healthier Scotland, where increased physical activity improves quality of life and wellbeing for all. They work to develop more opportunities and better environments not just for walking, but also for cycling and other activities, to help make Scotland a more active, more prosperous, greener country.

Visit the Paths for all website to find out more.

Population Health Improvement and National Conversation – Scene Setter

Over the next three weeks we’ll be exploring our next theme ‘Looking after my health’. Let’s start by setting the scene with some key facts and figures … and some questions to get the conversation started.

  • Our health in Scotland has changed since the NHS was founded in 1948. So has our society.
  • So many things have improved. We live longer. Around 1948, life expectancy in Scotland was 67. Today, it is 79.
  • And our lives are healthier. Twenty years ago, people in Scotland could expect to live to 57 in broadly good health. Today, it is 61.
  • But things have not improved equally for all of us. There are huge differences in how long we live, and how healthy our lives are, especially between our poorest people and our most well off.
  • And these differences – these inequalities – affect and hold back the health and prosperity of all of us. Scotland would be a healthier place if it was a more equal place.
  • There have been other changes – what makes us sick and what ends our lives has changed. Like many other countries, it is chronic disease – like heart disease, cancers, stroke and diabetes – more than infectious disease, that now affects our health and how long we live. Mental health problems are common.
  • And living longer can bring its own challenges. More of us are likely to have more than one health problem at the same time. As we live longer lives, our health needs are more complex.
  • Our health is related to our genetics, our lifestyles, our healthcare and our wider environment. Experts broadly agree our wider environment is particularly important.
  • This environment can be economic – our income and wealth, our jobs and workplaces; social – our family and friends, our communities and networks; and physical – our homes, our towns and cities.
  • Much of the ill health we now experience is related to our diet, our physical activity, to smoking and alcohol use. Our wider environment affects these behaviours. Improving this environment will help us address the causes of the causes of ill health.
  • We increasingly understand that many of the answers to improving our health lie outside our health system. From having the best start in life, to growing, living, working and ageing in a culture that creates and improves health right through our lives, many of the answers are in our daily settings.
  • But it is not just about preventing ill health or avoiding disease. Our daily environments as a population in Scotland – our culture – can create health and improve health.
  • We can take actions today in all these settings that that will create and improve health tomorrow, to help us all lead healthier and happier lives. We can ask ourselves, for example, what does a school that creates health look like? What does a workplace that creates health look like? What does a health creating home look like? And a health creating neighbourhood, community, town, city, etc?