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Healthier, Wealthier Children(HWC) aims to contribute to reducing child poverty by  helping families with money worries. The project is working closely with antenatal and community child health services to target pregnant women and families with young children experiencing, or at risk of, child poverty, as costs increase and employment patterns change around the birth of a child.

The project offers income maximisation advice for families experiencing child poverty and will aim to prevent families from falling into child poverty by working with health and early years services to identify families at risk at an early stage. Consequently the main service groups targeted for providing referrals to Healthier, Wealthier Children income maximisation services will be, in the first instance, midwives and other antenatal service staff, health visitors, oral health and breastfeeding advisers, parenting support workers, and early education staff.The initiative has been running since October 2010. As of August 2020, financial gain is estimated at £36,462,342 from 26,687 referrals. Healthier Wealthier Children models are cited as a requirement of Scotland’s Child Poverty action plan and similar models have been developed in Australia, Sweden and Newham in East London

The principles of the initiative are being rolled out nationally. NHSGGC staff are linking with Health Scotland on this.

The initiative is cited in:

  • Equally Well Annual Reports
  • National Child Poverty Strategy
  • National Early Years Collaborative
Project Structure

Healthier Wealthier Children is a collaboration between NHS Greater Glasgow and Clyde, Local Authorities, Glasgow Centre for Population Health and Voluntary Sector Money Advice Services.

Almost half of the children in Greater Glasgow and Clyde live in low income households, ranging from 25% in East Renfrewshire to 69% in East Glasgow [1]. Addressing child poverty is a key Scottish Government strategy for improving children’s health and well-being and is supported by the strategies, Equally Well, Achieving Our Potential and the Early Years Framework. Maximising families’ income is one element of addressing child poverty and a practical action that health and social care service providers can offer with the right support. A collaboration between NHS Greater Glasgow and Clyde (NHSGGC), Glasgow City Council (GCC) and Glasgow Centre for Population Health (GCPH) with additional support from other council partners has been successful in attracting funding from the Scottish Government Social Inclusion Division for a Child Poverty and Financial Inclusion Project.

The funding of £1,058,375 was secured for 15 months from January 2010 to provide income maximisers and development officers for all Community Health (and Care) Partnerships across NHSGGC. It builds on actions taken by NHSGGC to meet the objectives outlined in the Scottish Government Health Directorates Chief Executive Letter (CEL) 36 for improving nutrition for families living in disadvantage. CEL 36 implementation included work to improve uptake of the UK-wide Healthy Start programme and through this identified a gap in financial service provision for families attending antenatal and postnatal health services.

Building on the Healthy Start work, the Project supports the development of expertise within financial inclusion services and health structures for addressing child poverty by targeting income maximisation advice to pregnant women and families with infants and young children. The main aims of the Project are to:

  •  Test out a partnership model of providing income maximisation advice at a local level; and
  •  Develop a strategic approach to linking this service provision with health and other services in the longer term.

The Project is implemented through all HSCPs across Greater Glasgow and Clyde. Income maximisers in HSCPs and development officers will be employed across the whole of NHSGGC to establish referral and information pathways between health and financial inclusion service structures. The Project targets families with children under 5 attending health and early years services although some exceptions will be allowed. For example, particular attention is paid to picking up families who face additional barriers to maximising their incomes such as in the case of kinship carers, or where affordable childcare is unavailable.

NHSGGC has a Financial Inclusion Group, which reports to NHSGGC Corporate Management Team. The Healthier Wealthier Children Project Steering Group reports to the NHSGGC Financial Inclusion group[1] Low income households are defined here as being in receipt of any benefits, out of work or in work (2006 data, GCPH analysis, 2009)

Definitions and Standards

What is financial inclusion?

Financial inclusion means that individuals have access to appropriate financial products and services. This includes people having the skills, knowledge and confidence to use these products and services

Financial Inclusion Guidance for staff

NHSGGC has developed Guidance for staff on money worries. This guidance includes working with patients and sources of support for staff who have money worries.

Health benefits of financial inclusion

Summary Report: The Health Benefits of Financial Inclusion

Addressing financial exclusion is a priority for health service providers because it has the potential to reduce health inequalities and tackle the social determinants of ill-health. People living with long term ill-health or disability are more likely to be living in poverty, a key factor in poorer health outcomes. The NHS has contact with people as part of their rehabilitation and self care pathway and therefore an opportunity to support people’s wider social needs.

To develop an inequalities sensitive health service NHSGGC wishes to skill health practitioners to understand the social issues and structural inequalities facing their patients, support patients with these and have the capacity to refer them to appropriate services. Current evidence shows that the health inequality gap is widening and the current economic downturn is likely to worsen the situation for our most deprived communities and excluded groups; including women, black and minority ethnic people, disabled people, homeless people, refugees and asylum seekers. Financial exclusion is a growing concern in this context and so more needs to be known about the role of financial inclusion interventions in improving health.

About the Review

To date, NHSGGC has piloted a number of financial inclusion initiatives. A Financial Inclusion Group has been established to draw lessons from current practice and mainstream good practice in a sustainable way. It has developed an action plan, which it reviews regularly. To inform the work of the Financial Inclusion Group, the Scottish Poverty Information Unit (Glasgow Caledonian University) was commissioned to conduct a literature review. The broad aim of the review was to summarise the health benefits of financial inclusion identified in existing research and involved:

  •  A review of evidence of the health and quality of life impacts of financial inclusion initiatives, with particular reference to collating evidence of NHS-based interventions & the health benefits of these
  •  Exploring models of practice and learning to improve practice and identify evidence of the tools and barriers that exist
  •  Reviewing research methods used in existing studies
  •  Development of recommendations about future policy, practice and research

The research team undertook a Rapid Evidence Assessment (REA). REAs provide a balanced assessment of what is already known about a policy or practice issue. The method is appropriate for this review because the policy area is relatively new and there are few existing studies. It focused on English language sources and data, and on reports published in the last 10 years, with an emphasis on UK studies.

Key Findings

This review identified 16 key studies or journal articles which have reported health and social outcomes of financial inclusion interventions. It is clear that NHS has long recognised the value of improving access to welfare benefits and income maximisation in tackling health inequalities. Initiatives that tackle the broader issues relating to financial exclusion, such as financial awareness or financial capability are relatively recent. Many of these new initiatives remain at the early stages and few have been evaluated, particularly for their impact on health. This presents opportunities for future evaluation and research to explore the health impacts of these approaches.

All 16 of the studies identified discuss heath impacts of advice provision. Only two evaluated additional approaches including financial exclusion awareness raising sessions, money management guidance, or development activities. The studies generally focused on the provision of welfare benefits advice including income maximisation work. However, Citizens Advice Bureaux (CAB) and many other advice services advise clients on a range of social, legal and welfare rights issues (including, for example, housing, employment, taxation and debt) and several studies highlight the wide range of issues addressed and the fact that individual clients may raise more than one problem.

The main message from across the studies is that both qualitative and quantitative methods identify benefits from advice in terms of improved mental health, reduced stress or anxiety and better quality of life, but there is less evidence of improvements to physical health. Relatively short follow-on study periods and other methodological issues are suggested to have contributed to modest results in some studies.

Targeting services

Where projects have involved targeting vulnerable groups there is limited evidence of analysis of the different situations or the impacts for groups within target populations, for example, on the basis of gender, age, ethnic origin, disability or learning difficulties. Strategies that work for one group or situation can inform work with other groups but may not always be effective. Research and evaluation need to go beyond recording the characteristics of service users and explore different needs, impacts and outcomes of advice. However, this work should also be informed by a growing body of research on effective practice in financial inclusion work.

Benefits for Health and wellbeing

One assessment of work to date is that there is little need to conduct additional work to determine whether welfare rights advice has a financial effect but the potential benefits for health and wellbeing remain largely theoretical. Both qualitative and quantitative research has however identified that financial inclusion interventions can impact positively on people’s mental health and well-being. The importance and value of this has been under-played in the literature. The relationship between debt and mental health and the wider effects of addressing the stress and anxiety of debt and low income is a clear area for future research.

The review has also identified opportunities to further develop existing approaches to tackling financial exclusion. For example, in addition to welfare rights and debt advice, other linked areas of policy and practice have the potential to be considered in integrated approaches to financial inclusion because they are strongly linked to the issues of poverty and ill-health. Addressing fuel poverty is one area that has been highlighted. Prevention of homelessness and eviction and re-housing of homeless individuals is another area in which the right advice and support is essential to addressing the situation of people who are likely to have health and/ or addiction issues.

These wider issues also serve to highlight the need for a broader agenda in research that takes more account of the complexities of people’s lives. The review raised questions about whether enough account has been taken of the effects for different groups of people and different health circumstances (for example acute and chronic health conditions, mental health problems).

Evidence of effective practice exists, but this would benefit from further development. In particular advice needs, like health needs, are often not static and some flexibility in service design may be needed to respond to changing needs. For example, someone diagnosed with a condition involving long-term management or a long period of recovery may have particular and different advice needs at the point of diagnosis, when entering or leaving hospital as an in-patient and during periods of recovery or deteriorating health. Such an approach would be consistent with the aim of holistic provision and the aims of providing seamless services and the use of the pathways approach. Training and information sharing are necessary components for ensuring that health and financial inclusion professionals have the right levels of awareness and expertise for the work they do.

Financial inclusion is an area of mutual concern for local government and health services. It has much potential to contribute to better understanding of how services can help to reduce health inequalities and address any unintended consequences of the way services currently work.

Recommendations for Research

There is considerable potential for financial inclusion initiatives to contribute to an agenda for improving health. To gain a better understanding of the impact on health the following approaches to research are recommended:

  • More research is needed to broaden understanding of the importance of factors such as gender, family circumstances, age, ethnicity or disability for different groups within target populations to improving health, wellbeing and quality of life through financial inclusion work
  • For its contribution to be understood better and the social impacts of financial inclusion taken into account more fully, there is a need for multi-disciplinary research involving people with expertise in both health and financial inclusion
  • More mixed-method and holistic, qualitative approaches should be adopted and more sensitive research tools developed for assessing the impact of financial inclusion and that is relevant for target groups
  • Longitudinal studies are required, lasting beyond the one year duration of most studies in the past, particularly to understand more about the impacts on physical health and the potential for financial inclusion to contribute to reducing the physical health risks associated with poor mental health.

Recommendations for Practice

Recommendations for practical approaches to take forward financial inclusion work within NHSGGS include the following:

  • Project and service monitoring should reflect both project and wider policy priorities, for example, monitoring for family situation / relationships, dependents and caring roles
  • Financial inclusion development and evaluation should take account of the reach to different groups, including within target populations
  • Existing research and practical guidance can inform this area of work, including adaptation of existing effective practice to reach new groups
  • Consistent with holistic service provision and the pathway of care approach, projects and services should be developed in a way that recognises the importance of responding to changing needs over time
  • NHSGGC should consider how addressing fuel poverty can be incorporated within its approach to financial inclusion and the linked issues of housing circumstances, including the risk of or actual homelessness, that are potentially important areas for advice and support
  • There may be a need for wider links, for example with services addressing advice on homelessness and benefits, including CABs and Shelter, in a broad agenda to tackle financial exclusion
  • Partnership working should involve health and financial service providers, but also service users and carers and the services that support them, for example, key workers. Consideration should be given to involving other service providers such as in housing and domestic fuel supply.
  • Training, awareness raising and capacity building are needed for staff, not to become experts in new areas, but to refer effectively, for example: training for staff in financial inclusion work on issues such as health needs, or mental health first aid; for health service staff on the breadth of rights and entitlements, sources of help and when and how to refer; and for all groups, equality and diversity training may be important, particularly in projects involving screening of potential clients for financial inclusion interventions.
  •  

The full report is available to download at the Scottish Poverty Information Unit website:

Health Benefits of Financial Inclusion: A Literature Review (pdf)

Case Studies
Case Study 1- Mum with two children under seven, one with learning difficulties
  • Mum with 2 children under 7. Son suffering from learning difficulties and bowel problems. Mum required replacement bed and bedding, washing machine and clothes. Community Care grant of £373 awarded after initial rejection. Only successful because money advice service persisted given patient under severe emotional and financial pressure.
  • Disability Living Allowance applied for. Son awarded high rate care for 2 years on 5th April but the award was backdated to 11th March. Mum did not wish to appeal the fact that no mobility component was awarded.
  • As there was an award of high rate care this led onto the client being eligible for Carer’s Allowance. Third appointment made to complete forms and benefit awarded. A backdate had been requested and granted to the 11th March when the DLA was awarded.
  • his then led to a review of patient’s Income Support so that all relevant premiums could be added and recalculated.
  • Patient went from receiving £255.00 per week to now receiving £451.71 per week for all benefits.
  • All backdated money received as lump sum was £2,360

Client says: “I have found the service really beneficial and was shocked at how much I was actually entitled to after the Job Centre initially rejected my case. If only there were a million X [Income Maximisers] out there.”

Case Study 2- Working mum on maternity leave
  • Working mum on maternity leave, still living with parents, had never accessed the benefits system before. On the 36th week of pregnancy, the patient was referred to the money advice service by her midwife, allowing money advice service to begin a full assessment of her needs.
  • After explaining what statutory pay entitlements the mum would get, a benefit check revealed that she would only be eligible for benefits after the birth of the baby.
  •  Mum agreed to come back for a second appointment to help her to apply for the relevant benefits, including Child Tax Credits, Sure Start Maternity Grant and Child Benefit.
  • The Sure Start Maternity Grant would only be applicable after the qualifying benefit of Child Tax Credits was awarded. At the third appointment, this was applied for after the good news came through about the Child Tax Credits. 
  • All in all, the mum will receive a net gain in benefits awarded of just under £4,890 for the year
Case Study 3 – Young couple with three children, two with disabilities

A young couple with 3 children, the youngest 2 are under 5 and each has a disability. Dad works full time in fairly low paid employment with mum at home full time caring for the children. The couple are owner occupiers. Mum finds it very difficult to go out with the children as she is unable to use public transport and taxis are too expensive. Due to the children’s mobility difficulties, Mum and the children spend most of their time at home which means heating the home for most of the day and night. Due to the children’s disabilities mum has to do lots of laundry. These factors are having a big impact on the family’s energy bills. Debt has been accrued with Brighthouse, a high street weekly payment household goods store, totalling £6000 for a suite and a tv. Weekly payments to Brighthouse are £33 with 2 payments remaining on the suite.  The family Health Visitor suggested a referral to HWC following a diagnosis of significant disability of youngest child. Mum commented she did not think that a child of 2 and half years would be entitled to DLA but was happy for the referrals to be made.

Following referral to HWC the Income Maximiser assisted the family in applying for additional benefits. The family were awarded Middle Rate Disability Living Allowance (DLA) and disabled child element of tax credits. This amounted to an additional £47.80 and £52.21 extra per week respectively. Mum stated that the extra money will help with taxi costs, she can now afford hackney style taxis to get out and about to hospital appointments; this had been a problem in the past with the larger style pram. Mum can also afford taxis to go to clubs and support groups in her area. The extra money will also go towards utilities bills and mum will not have to worry as much about times when she has to heat the house for days at a time, i.e. winter 10/11 was a very worrying time. A benefit check also revealed that the couple were entitled to Council Tax Benefit, they assumed they wouldn’t be as they were owner occupiers, this saved the family £943.44 per year.

The couple were also supported to apply for a mentored loan of £500 from their local credit union and Money Matters, the income maximiser also negotiated the return of the tv to Brighthouse. A tv was purchased from a local supermarket for under £500 with repayments on the mentored loan £12 per week, £2 of which is savings with the credit union.

Engagement with the service has clearly brought about significant improvement for this couple and while this may not be the case for everyone it highlights the potential contribution Health Visitors and other key health staff groups can make to reducing child poverty

Case Study 4 – Client with two children recently separated from partner

Client referred by family support worker. Client recently separated from partner very stressed.

  • Young women with two children one under 5 with long term illness.
  •  Child has had various operations but has not been diagnosed.
  • Income Max got support to complete D.L.A application for child
  • Client has a lot of Debt to Brighthouse to a sum of £6,000 for a suite and television and a small amount to Provident, client paying off debt at £33.00 a week.
  • Client only had 2 payments to go to finish of paying for suite but had just got the television.
  • Outcomes
  • Income Max got client a mentored loan through Credit union and Money Matters for £500.
  • Money Matters negotiated with Brighthouse for client to return television.
  • With the £500 loan the client bought a new television from Tesco.
  • Client now only paying £12 per week back for mentored Loan of which £2.00 is being put into her credit union, by the time client has paid off loan she have savings for the first time.
  • Money Matters got her re-payments to Provident down to a £1 per week and changed clients energy over to the social tariff saving her another £7.00 per week.
  • Client was unsuccessful on the first application for D.L.A – Welfare Rights Officer appealed was given D.L.A and higher rate tax credit and carers allowance which has given the family an additional £130 per week.

Taken nearly 5 months work to get final outcomes

Case Study 5 – Single mum with young baby

Client a young single mum with young baby who is concerned about debt

  • Client has been given a £50 fine for dropping a crisp bag in the street on her estate by community warden. 
  • Client not able to pay fine.
  • Income Max telephoned Community Warden Team to appeal as mother said she didn’t mean to drop it; it fell out of the pram.
  • Community Warden team said “you can appeal for fines for dog pooh or cigarettes but not litter”.
  • Income max explained client’s situation – Community Warden gave client extension of 4 weeks to pay.
  • Client still not able to get the money together in time.
  • Income Max telephoned again to see if she could pay it back so much a week.
  • Case now has been sent to Sheriff court and the fine had gone up to £75.00 for non payment.
  • Income Max eventually managed to get the court to agree that client to pay £5.00 each week which would be taken of her benefits to pay the fine.
  • Court would not waiver the additional £25.00 interest added due to late payment.
  • Have taken this case to Council representative and suggested that maybe instead of a fine that in some cases individuals could be told to attend a two hour awareness session on the environment which might be more appropriate. Instead of increasing peoples debt.
Case Study 6 – Mother not receiving Healthy Start vouchers

Referral from Social work support worker- Mother not receiving Healthy Start vouchers.

  • Client had put in 4 applications for Healthy Start Vouchers never received anything.
  • Income Max contacted Healthy Start Helpline and was told that client must have moved address and not informed Healthy Start therefore 1st application not valid
  • 2nd application midwife wrote the wrong estimated delivery date on the application again void (no letter ever sent to client)
  • 3rd application H/V did not put her postcode of work base therefore application void. (even although H/V tel on the form)
  • Income Max appealed against decision and asked if vouchers payment could be backdated is it was not client’s fault.
  • Healthy Start at first said no and every time Income Max telephoned they would give a different reason why client was not entitled to backdated money. No consistency at all with the helpline staff.
  • When Income Max quoted something from the Healthy Start booklet in defence of client helpline staff stated that the booklet was wrong.
  •  Income Max e-mailed Rights adviser who she had met the week before at a training event and told her the story. The Rights adviser advised Income Max that the booklet was correct.
  •  Income Max eventually got clients claim backdated and client received £269.00 for backdated money alone
Case Study 7- Family with disabled child

Due to the intervention of an Income Maximiser, a family where one of the parents was working, discovered that they were entitled to extra weekly benefits totalling £140.

This was because the youngest of their three children have disabilities and have now been awarded Middle Rate Disability Allowance of £47.80 and the disabled child element of tax credits, equal to £52.21.

The additional cash is easing the financial burden because the mum is unable to work, staying at home to look after the younger children.

Because of the children’s mobility problems they were unable to use public transport and since taxis are expensive, a lot of time was spent at home.

And the children’s disabilities means that mum has a lot of laundry to do, adding to the energy bills.

Now the family can afford taxis to attend hospital appointments, clubs and support groups in their area and have more money to put towards utility bills.

Case Study 8- Family with one parent in full-time low paid employment

A home owning family involved mum working full-time in a low paid job, with dad looking after their three young children.

They spoke to a Health Visitor Support Worker about their financial concerns and stress and anxiety this was causing, but thought that they were receiving all of the benefits they could apply for.

 An appointment with an Income Maximiser led to a benefit check being carried out which revealed that they were entitled to Council Tax Benefit, saving them £943.44 annually.

The parents reported that this extra help is reducing their financial pressures and stress and mum now felt able to look for a better paid job.

Also the family are now in a position to set aside money for any emergencies, such as replacing their washing machine and also buy the children new toys which they hadn’t been able to do for sometime.

Case Study 9 – Single parent with disabled child

A single parent was working part-time (on national minimum wage) and struggling to cope due to the needs of her only child who had been unwell for some time and was exhibiting behaviour and learning difficulties: the child had been undergoing investigation for strange seizures and was not adjusting well at school. When referred, the mother could no longer work due to stress and anxiety and was on sick leave: however, the employer was not paying SSP and the DWP would not award ESA because of the employer’s responsibility.

Fortunately, there occurred at this time a definitive diagnosis of absence epilepsy – a rare condition – which enabled a straight-forward claim for Disability Living Allowance: since the child was awarded high-rate care and low-rate mobility there was also a significant increase in the Child Tax Credits award. It was not really feasible for the parent to return to work due to the time and effort involved in caring for her child hence this meant applying for Income Support and Carer’s Allowance (including the carer’s premium on the I.S.)

In total, including back-dated payments, household income is now £337 per week or £17,524 over the course of the next year. This means that the parent can now focus solely on the support and development of her child and provide properly for additional needs.

Resources for Staff

Healthier Wealthier Children has developed a number of guidance tools for health and money advice services staff. These have been developed, by Healthier Wealthier Children workers, as a result of needs identified by frontline staff.

Guidance – Health staff

Quick Guide to welfare benefits for families with children (pdf) has been used extensively in the project. It fits into staff diaries and is a good reference aid for staff when working with clients.

Quick Guide to benefits for children with additional needs  (pdf) is being piloted with Health Visitors within short awareness sessions about Child Disability Living Allowance . The project found many misperceptions about what children are eligible for DLA and application processes.

Guidance – Money Advice Services Staff

non-engagement protocol (pdf) has been developed with the aim of providing a standard approach for managing Healthier Wealthier Children referrals across NHS Greater Glasgow and Clyde and increasing efficiency of services to respond to referrals. It is considered an example of good practice on managing referralas by NHSGGC’s Strategic Financial Inclusion Group.

Guidance on dealing with sensitive patient issues (pdf). This outlines what is expected and not expected of Money Advice Services staff when dealing with NHS clients, who may disclose complex health issues. 

Good Practice Reports

There have been a number of reports collated on innovative work in Healthier Wealthier Children.

Healthy Start Antenatal Cooking Classes in North West Sector Glasgow City CHP Report (pdf)

In Inverlcyde, Barnardos provide a groupwork programme for pregnant women with complex needs.  Healthier Wealthier Children was integrated into this approach which resulted in increased patient engagement with Money Advice Services. 

Healthier Wealthier Children partnership work with Barnardo’s Inverclyde (pdf) 

In South East Glasgow, engagement and training for nurseries resulted in better partnership working between health visitors, nurseries and Healthier Wealthier Children and improved care pathways for patients.

Healthier Wealthier Children partnership working with nurseries in Soutn East Glasgow (pdf)

An Equality Impact Assessment (EQIA) was carried out for the project overall with some local areas also carrying out EQIAs.

The project has been innovative in providing a service in 48 locations across NHSGGC.  This has been mapped against deprivation levels to inform service planning post project.

Development Workers across NHSGGC collated good practice and challenges with Healthy Start implementation.

Money worries and budgeting were integrated into a pilot project on antenatal cookery classes in North West Glasgow. This pilot was targeted for pregnant women who have complex needs. Budgeting with Healthy Start vouchers and use of Healthy Start vitamins were covered in the pilot.

Healthy Start Antenatal Cookery session Report (pdf) 

HWC Training

Development Workers and, at times, Income Maximisers have carried out a wide range of awareness sessions and training to health and other staff. It has also included innovative work in, for example, nurseries and weaning fairs of referral options for parents and training for Health Visitors on the links between employability and financial inclusion. 

Two standard presentations (shorter and longer versions) were developed on child poverty for frontline staff.

Child Poverty Presentation (short version)

Child Poverty Presentation (long version)

In addition, Development Workers and Income Maximisers themselves have shown a high commitment to learning. HWC provided induction training and an induction pack (pdf)  on welfare reform and welfare benefits for children and families and equalities monitoring. Poverty Alliance Scotland have provided Poverty Awareness Training and Training for Trainers. Child Poverty Action Group provided training on specific issues for children including Child Disability Living Allowance. 

Summary Evaluation report on Poverty Awareness Training delivered to NHS Greater Glasgow and Clyde (pdf)

National Consultations

The good practice within Healthier Children was also recognised in the Equally Well Review  and  in NHSGGC’s response to Scotland’s Child Povery Strategy:

Passported Benifits – Consultation Response (pdf)

Child Poverty Strategy – NHSGGC Final Consultation Response (pdf)

Video Resource for staff

Healthier Wealthier Children, in collaboration with NHS Education for Scotland and IRISS, have produced a video that highlights the challenges and opportunities in raising the issue of money worries with clients. 

Money Worries – A case study of how professionals in health and social care services ask and respond to client’s money worries. Rose Sloan, a special needs in pregnancy service midwife at Inverclyde Royal Hospital, talks about the importance of raising the issue of money worries with clientshttps://player.vimeo.com/video/50375916?color=ffffff&title=0&byline=0&portrait=0

Healthier Wealthier Children: Responding To Money Worries from Mindreel.

Documents and Publications

Articles/Publications/Reports/Documents: 

Media Exposure

Press release in News Medical Online, following this publication entitled “Study evaluates role of midwives, health visitors in tackling child poverty” (2013) Press release by RCN Publishing Company in www.alphagalileo.org entitled “Nurses help fight child poverty in Scotland” (11th June 2013) The Herald 6th March 2011 “Child poverty project which makes a real difference” Evening Times 17th Oct 2013 “£4.5m boost for families in poverty battle” Featured in Evening Times 7th Nov 2014 “Advisors deliver £20 million health boost” and Kirkintilloch Herald 5 Nov “Income advice scheme saves £20 million” Features in Glasgow Advice and Information Network newsletter – Jan 2011; Nov 2011; Aug 2012; NHSGGC Health News – April 2011, Sept/Oct 2011; October 2014; Clydebank Post – June 2011; Herald Features Article (Stephen Naismith) – July 2012; Paisley Daily Express – Jan 2012; Children in Scotland Newsletter – Jan 2012; Herald parenting supplement – Sept 2012

Related Links
Sickle Cell Carrier (HbAS)

What does this mean to the baby and his/her parents?

When a baby is identified as a carrier of sickle cell disease it is important to test the parents, if not done before. This way it can be confirmed from which parent this has been inherited and, at the same time, it ensures there are no risks for future pregnancies.

When either parent has been confirmed as a carrier of sickle cell, information on their implications can be found in the following page:

https://www.gov.uk/government/publications/your-baby-carries-a-gene-for-sickle-cell/sickle-cell-and-thalassaemia-screening-your-baby-carries-a-gene-for-sickle-cell

Actions

Test baby’s parents, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care. 

  • If only one parent is a carrier of sickle cell, the couple has a 1 in 2 chance (or 50%) to have children who are carriers.  
  • If one parent is a carrier of sickle cell and the other is a carrier of any other haemoglobin variant, refer to Clinical Genetics for appropriate counselling on their reproduction options.

If the couple has other children, only test them if the parent is a carrier of any other haemoglobin variant. Otherwise, there is no need to test them unless they are present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.

Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings) They can request a test called “Haemoglobinopathy screen” via their GP

Make sure the patient understands the rare health issues associated with being a carrier. They should therefore be advised to:

  • Avoid situations where there may be a shortage of oxygen (deep-sea diving, unpressurized aircrafts, etc).
  • Inform the anaesthetist if they are going to require an anaesthetic.
  • Keep well hydrated.

Refer children and adults with haematuria.

Refer children and adults urgently if they present symptoms suggestive of renal medullary cancer. Symptoms include: haematuria, weight loss, loin pain, fever and abdominal pain.

Give the appropriate information leaflets (“Information for mums and dads: your baby carries a gene for sickle cell” and “You are a sickle cell disease”).

Make sure the patient has received his/her haemoglobinopathy card.

Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Tel: 0141 354 9201/ 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin C Carrier (HbAC)

What does this mean to the baby and his/her parents?

When a baby is identified as a carrier of haemoglobin C it is important to test the parents, if not done before. This way it can be confirmed from which parent this has been inherited and, at the same time, it ensure there are no risks for future pregnancies.

When either parent has been confirmed as a carrier of haemoglobin C, information on their implications can be found in the following page:

https://www.gov.uk/government/publications/baby-carries-a-gene-for-unusual-haemoglobin-description-in-brief/newborn-screening-your-baby-carries-a-gene-for-haemoglobin-c

Actions

Test baby’s parents, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.

If only one parent is a carrier of haemoglobin C, the couple has a 1 in 2 chance (or 50%) to have children who are healthy carriers.

  • If one parent is a carrier of haemoglobin C and the other is a carrier of Sickle Cell Disease (haemoglobin S), refer to Clinical Genetics for appropriate counselling on their reproduction options.
  • If one parent is a carrier of haemoglobin C and the other is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.

If the couple has other children, only test them if the partner is a carrier of sickle cell disease. Otherwise, there is no need to test them unless they are present with health problems. It is normally recommended to postpone testing until the age of 16, postpone testing until the age of 16, to enable them to make their own informed decision.

Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings) They can request a test called “Haemoglobinopathy screen” via their GP.

Give an appropriate information leaflets. (“Information for mums and dads: your baby carries a gene for unusual haemoglobin” and “You are a carrier of haemoglobin C”).

Make sure the patient has received his/her haemoglobinopathy card.

Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Tele: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin D Carrier (HbAD)

What does this mean to the baby and his/her parents?

When a baby is identified as a carrier of haemoglobin E it is important to test the parents, if not done before. This way it can be confirmed from which parent this has been inherited and, at the same time, it ensures there are no risks for future pregnancies.

When either parent has been confirmed as a carrier of haemoglobin E, information on their implications can be found in the following page:

Newborn screening: Your baby carries a gene for Haemoglobin D – GOV.UK (www.gov.uk)

Actions

There are 7 different types of haemoglobin D. The only clinically relevant variant is haemoglobin DPunjab.

Test partner, if not done previously (that includes haemoglobin screen, full blood count and ferritin levels).

  • If partner is not a carrier of any haemoglobin variant, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
  • If partner is a carrier of Sickle Cell disease (Haemoglobin S), refer to Clinical Genetics for appropriate counselling on their reproduction options.
  • If the partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.

If the couple has children, only test them if the partner is a carrier of a haemoglobin variant. Otherwise, there is no need to test them unless they are present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.

Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings).

Give the appropriate information leaflets.

Make sure the patient has received his/her Haemoglobinopathy card.

Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitat to contact:

Community Genetic Counsellors on Tele: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin E Carrier (HbAE)

What does this mean to the baby and his/her parents?

When a baby is identified as a carrier of haemoglobin E it is important to test the parents, if not done before. This way it can be confirmed from which parent this has been inherited and, at the same time, it ensures there are no risks for future pregnancies.

When either parent has been confirmed as a carrier of haemoglobin E, information on their implications can be found in the following page:

https://www.gov.uk/government/publications/baby-carries-a-gene-for-unusual-haemoglobin-description-in-brief/newborn-screening-your-baby-carries-a-gene-for-haemoglobin-e

Actions

If a carrier is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.

Test baby’s parents, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels) This can be done in primary care.

  • If only one parent is a carrier of haemoglobin E, the couple have a 1 in chance (or 50%) to have children who are healthy carriers.
  • If one parent is a carrier of haemoglobin E and the other is a carrier of Sickle Cell Disease (Haemoglobin S) or Beta Thalassaemia, refer to Clinical Genetics for appropriate counselling on their reproduction options.
  • If one parent is a carrier of haemoglobin E and the other is a carrier of any other haemoglobin variant, reassure the couple as there is no other significant interaction with any other haemoglobin variant.

If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease. Otherwise, there is no need to test them unless they are present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision

Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.

Give the appropriate information leaflets (“Information for mums and dads: your baby carries a gene for unusual haemoglobin” and “You are a carrier of haemoglobin E”).

Make sure the patient has received his/her haemoglobinopathy card.

Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin Lepore Carrier

What does this mean to the baby and his/her parents?

When a baby is identified as a carrier of haemoglobin Lepore it is important to test the parents, if not done before. This way it can be confirmed from which parent this has been inherited and, at the same time, it ensures there are no risks for future pregnancies.

When either parent has been confirmed as a carrier of haemoglobin Lepore, information on their implications can be found in the following page:

https://www.gov.uk/government/publications/haemoglobin-lepore-carrier-description-in-brief

Actions

If a carrier is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.

Test the baby’s parents, if not done previously (that includes haemoglobinopathy screen, full blood count and ferritin levels). This can be done in primary care.

  • If only one parent is a carrier of haemoglobin Lepore, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
  • If one parent is a carrier of haemoglobin Lepore and the other is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer to Clinical Genetics for appropriate counselling on their reproduction options.
  • If one parent is a carrier of haemoglobin Lepore and the other is a carrier of any other haemoglobin variant, reassure the couple as there is no significant interaction with any other haemoglobin variant.

If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease (haemoglobin S). Otherwise, there is no need to test them unless they are present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.

Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “Haemoglobinopathy screen” via their GP.

Give the appropriate information leaflets (“Information for mums and dads: your baby carried a gene of unusual haemoglobin” and “You are a carrier of haemoglobin Lepore”).

Make sure the patient has receive his/her haemoglobinopathy card.

Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin OArab Carrier

What does this mean to the baby and his/her parents?

When a baby is identified as a carrier of haemoglobin OArab  it is important to test the parents, if not done before. This way it can be confirmed from which parent this has been inherited and, at the same time, it ensures there are no risks for future pregnancies.

When either parent has been confirmed as a carrier of haemoglobin OArab, information on their implications can be found in the following page:

https://www.gov.uk/government/publications/baby-carries-a-gene-for-unusual-haemoglobin-description-in-brief/newborn-screening-your-baby-carries-a-gene-for-haemoglobin-o-arab

Actions

If a carrier is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.

Test the baby’s parents, if not done previously (that includes: haemoglovinopathy screen, full blood count and ferritin levels). This can be done in primary care.

  • If only one parent is a carrier of OArab, the couple have a 1 in 2 chance (or 50%) to have children who are healthy cariers.
  • If one parent is a carrier of OArab  and the other is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer to Clinical Genetics for appropriate counselling on their reproduction options.
  • If one parent is a carrier of OArab and the other is a carrier of any other haemoglobin variant, reassure the couple as there is no other significant interaction with any other haemoglobin variant. 

If the couple has other children, only test them if one parent is a carrier of OArab and the other is a carrier of beta thalassaemia or sickle cell disease (haemoglobin S). Otherwise, there is no need to test them unless they are present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.

Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “Haemoglobinopathy screen” via their GP.

Give the appropriate information leaflets (“Information for mums and dads: your baby carries a gene for unusual haemoglobin” and “You are a carrier of haemoglobin OArab).

Make sure the patient has received his/her haemoglobinopathy card.

Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Newborn Screening Results – Further Information and Resources
Haemoglobin C carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin C, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis.   Information for fathers on haemologlobin C carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Sickle Cell Disease (haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin C”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin D carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin D, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on haemoglobin D carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • There are 7 different types of haemoglobin D. The only clinically relevant variant is haemoglobin DPunjab.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Sickle Cell Disease (haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin C”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin E carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin E, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on haemologlobin E carrier screening, can be downloaded or ordered via PHRD. 

Actions

If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.

  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Sickle Cell Disease (haemoglobin S) or Beta Thalassaemia, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin E”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin Lepore carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin Lepore, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on haemologlobin Lepore carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing,
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin E”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Haemoglobin OArab carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin OArab, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on haemologlobin OArab carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin OArab ”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Beta Thalassaemia carrier

What does this mean to the patient?

When a patient is identified as a carrier of beta thalassaemia, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on Beta Thalassaemia carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If the partner is a carrier of Beta Thalassaemia, Sickle Cell Disease (Haemoglobin S), Haemoglobin E, Haemoglobin Lepore, Haemoglobin OArab or Delta-Beta Thalassaemia, refer urgently to Clinical Genetics for appropriate counselling on their reproduction options.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of a haemoglobin variant. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of beta thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Alpha Plus Thalassaemia carrier

A haemoglobinopathy screen cannot differentiate between alpha thalassaemia carriers and iron deficiency. For this reason, it is important to interpret the patient’s results in combination with ferritin levels.

What does this mean to the patient?

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis.

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of alpha plus or alpha zerothalassaemia, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of alpha zero thalassaemia. Children diagnosed with Haemoglobin H disease should be referred to Haematology. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of Alpha zero Thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Alpha Zero Thalassaemia carrier

A haemoglobinopathy screen cannot differentiate between alpha thalassaemia carriers and iron deficiency. For this reason, it is important to interpret the patient’s results in combination with ferritin levels.

What does this mean to the patient?

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis.

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of alpha plus or alpha zerothalassaemia, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple.
  • If the couple has other children, only test them if the partner is a carrier of alpha zero thalassaemia. Children diagnosed with Haemoglobin H disease should be referred to Haematology. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of Alpha zero Thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Delta Beta Thalassaemia carrier

What does this mean to the patient?

When a patient is identified as a carrier of delta beta thalassaemia, information can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on delta beta thalassaemia carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of a haemoglobin variant. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of delta beta thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Sickle Cell Carrier

What does this mean to the patient?

When a patient is identified as a carrier of sickle cell, information on their implications can be found in the following leaflet:

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. 

Actions

  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variant, the couple has a 1 in 2 chance (or 50%) to have children who are carriers.
    • If partner is a carrier of any haemoglobin variant, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
  • If the couple has other children, only test them if the partner is a carrier of a haemoglobin variant. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Make sure the patient understands the rare health issues associated with being a carrier. They should therefore be advised to:
  • Avoid situations where there may be a shortage of oxygen (deep-sea diving, unpressurized aircrafts, etc).
  • Inform the anaesthetist if they are going to require an anaesthetic.
  • Keep well hydrated.
  • Refer children and adults with haematuria.
  • Refer children and adults urgently if they present with symptoms suggestive of renal medullary cancer. Symptoms include: haematuria, weight loss, loin pain, fever and abdominal pain.
  • Give the appropriate information leaflets. (“You are a carrier of sickle cell.”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Community Genetic Counsellors on Telephone: 0141 354 9201 / 0141 354 9229 (secretary)

Email: Community.Genetics@ggc.scot.nhs.uk

Pregnancy Screening Results – Further Information and Resources
More information on haemoglobin and disease

Haemoglobin is a protein that is carried by red blood cells. Its main function is to pick up oxygen in the lungs and deliver it to the peripheral tissues to maintain the viability of cells. Haemoglobin is made from two similar proteins, usually referred to as subunits, which “stick together”. Both subunits must be present for the haemoglobin to function normally. One of the subunits is called alpha, and the other is beta. Inside each subunit, there is a small iron-containing molecule called heme, to which oxygen is bound. Before birth, the beta protein is not expressed. Instead, a chain called gamma is produced.

Like all proteins, the “instructions” to synthesise haemoglobin are found in DNA (the material that makes up genes). Normally, an individual has four genes that code for the alpha protein, or alpha chain. Two other genes code for the beta chain. The alpha chain and the beta chain are made in precisely equal amounts, despite the differing number of genes. The protein chains join in developing red blood cells, and remain together for the life of the red cell.

The composition of haemoglobin is the same in all people. The genes that code for haemoglobin are identical throughout the world. Occasionally, however, one of the genes has a change or variant. Although the changes that produce abnormal haemoglobins are rare, several hundred haemoglobins variants exist. Most variant haemoglobins function normally, and are only found through specialized research techniques. Some haemoglobin variants, however, do not function normally and can produce clinical disorders, such as sickle cell disease.

Usual types of haemoglobin

Haemoglobin A: This is the designation for the most common haemoglobin variant that exists after birth. Haemoglobin A is a tetramer with two alpha chains and two beta chains (a2b2).

Haemoglobin A2: This is a minor component of haemoglobin found in red cells and consists of two alpha chains and two delta chains (a2d2). Haemoglobin A2 generally comprises less that 3% of the total red cell haemoglobin.

Haemoglobin F: Haemoglobin F is the predominant haemoglobin during foetal development. The molecule is a tetramer of two alpha chains and two gamma chains (a2g2).

Clinically significant haemoglobin variants

Haemoglobin S: This is the predominant variant in people with sickle cell disease. The disease-causing gene change is found in the beta chain. The highest frequency of sickle cell disease is found in tropical regions, particularly sub-Saharan Africa, tribal regions of India and the Middle-East. The carrier frequency ranges between 10% and 25% across equatorial Africa.

Haemoglobin C: Haemoglobin C results from a gene change in beta globin. It can cause sickle cell disease when it is inherited with haemoglobin S. It can also cause haemoglobin C disease when two haemoglobin C variants are inherited. Haemoglobin C is most prevalent in Western Africa, especially in Nigeria and Benin.

Haemoglobin E: This variant results from a gene change in the haemoglobin beta chain. It can cause thalassaemia major or intermedia hen coinherited with beta thalassaemia. Haemoglobin E is extremely common in Southeastern Asia (Thailand, Myanmar, Cambodia, Laos, Vietnam, and India) where its prevalence can reach 30-40%.

Haemoglobin D: There are different types of haemoglobin D variants, but the most vlinically significant is haemoglobin DPunjab (also called DLos Angeles). It results from a gene change in the beta globin chain. It can cause sickle cell disease if coinherited with haemoglobin S. As the name indicated, it is most frequent in the Punjab Area (Northwestern India), where the carrier frequency can be around 2%.

Haemoglobin OArab: This variant results from a gene change in the beta globin chain. It can cause sickle cell disease when it is inherited with haemoglobin S. It is more frequent in North Africa, Middle East and Eastern Europe.

Haemoglobin Lepore: Haemoglobin Lepore is an unusual variant that is th product of the fusion of the beta and delta globin genes. It can cause thalassaemia major/intermedia when a person inherits two copies of haemoglobin Lepore, or when it is inherited with beta thalassaemia. It can also cause sickle cell disease when inherited with haemoglobin S. It occurs most frequently in patients originating from the Mediterranean region.

More information on sickle cell

Sickle cell disease is the name for a group of inherited conditions that affect the red blood cells. The most serious type is called sickle cell anaemia. Sickle cell disease mainly affects people of African, Caribbean, Middle Eastern, Eastern Mediterranean and Asian origin. In the UK, it’s particularly common in people with an African or Caribbean family background. People with sickle cell disease produce unusually shaped red blood cells that can cause problem because they don’t live as long as healthy blood cells and they can become stuck in blood vessels. Sickle cell disease is a serious and lifelong condition, although long-term treatment can help manage many of the problems associated with it.

Sickle Cell Anaemia (HbSS)

Sickle cell disease is an inherited blood condition. Babies with sickle cell disease are usually well at birth but may start to develop symptoms from around 4 months of age. The symptoms of SCD are:

  • Chronic anaemia: long term decreased number of red blood cells and/or the amount of haemoglobin they carry.
  • Infections: people with SCD, especially infants and children, are more likely to experience infections such a flu, meningitis, and hepatitis.
  • Sudden pain crisis: this happens when the sickle blood cells obstruct a blood vessel. This can be triggered by different situations, such as intense exercise, stress, infections, sudden temperature changes and not drinking enough water.
  • Hand-Foot Syndrome: swelling in the hands and feet, often along with a fever, is caused by the sickle cells getting stuck in the blood vessels and blocking the blood from flowing freely through the hands and feet.
  • Acute Chest Syndrome (ACS): blockage of the flow of blood to the lungs can cause acute chest syndrome. ACS is similar to pneumonia; symptoms include chest pain, coughing, difficult breathing, and fever.

Because of the sickling, the patients suffer a chronic haemolytic anaemia and the usual 120 half life of erythrocytes falls to 20 days for patients with sickle disease. The chronic haemolysis results in a rapid production of erythrocytes and a FBC that contains reticulocytes, occasional nucleated erythrocytes, target cells and sickle cells. As the spleen becomes compromised with repeated infarctions, Howell-Jolly bodies are also seen.

Several factors can lead to crises in sickle cell disease: hypoxia, dehydration, vascular stasis, fever, cold and acidosis. Anything that leads to hypoxia will promote sickling. Therefore, patients with respiratory compromise due to infection or chronic respiratory diseases are prone to develop sickle crisis.

There is no single best treatment for all people with SCD. Treatment options are different for each person depending on the symptoms. Treatments can include receiving blood transfusions, maintaining a high fluid intake (drinking 8 to 10 glasses of water each day), receiving intravenous therapy (fluids given into a vein) and medications to help with pain. Nowadays, with the proper treatment, most people affected with SCD live normal long lives.

Other types of sickle cell disease

The different forms of sickle cell disease are:

Severe sickle cell disease: symptoms and management similar to that in sickle cell anaemia.

  • HbS/ß thalassaemia
  • HbS/OArabModerate sickle cell disease:
  • HbS/C
  • HbS/DPunjab
  • HbS/LeporeMild sickle cell disease: clinically non relevant
  • HbS/E
  • Hbs/HPFH
More information on beta thalassaemia

Beta Thalassaemia is generally caused by point mutations or chromosome 11, following a recessive inheritance pattern (meaning that a mutation in each allele is needed to develop the disease). The symptoms of beta thalassaemia differ greatly from one patient to another, depending mostly on the severity of the mutation. Beta thalassaemia includes:

  • Thalassaemia minor: this usually occurs in patients who are heterozygous for one beta thalassaemia mutation (beta thalassamia carriers or bête thalassaemia trait). Individuals will suffer from mild microcytic hypochromic anaemia, whih is usually asymptomatic and it is not expected to cause any health issue.
  • Thalassaemia intermedia: Patients with symptoms that range from those observed in thalassaemia minor and those in thalassaemia major. Patient’s require frequent medical check ups and usually require sporadic blood transfusions.
  • Thalassaemia major: also called Mediterranean anemia or Cooley anemia. It is caused by severe mutations in both alleles. No functional ß chains are produced, and thus no haemoglobin A can be assembled. This is he most severe form of ß-thalassemia: those with thalassaemia major need to have regular blood transfusions from infancy onwards in order to survive. Long term transfusions can lead to iron overload, so this patients also need iron chelating therapy.
More information on alpha thalassaemia

Alpha globin is made by four genes, two on each strand of chromosome 16. Alpha thalassaemia usually occurs by deletion of some of these four genes. Depending on the total number of alpha genes that a patient has, there are different outcomes:

Alpha globin genes:

4 alpha globin genes: most common scenario, person is not a carrier.

3 alpha globin genes: silent alpha thalassaemia carrier. There is overlap between the red blood cell indices of these individuals and those with 4 gene copies, although the MCV may be slightly lower.

2 alpha globin genes: alpha thalassaemia carrier (also called alpha thalassaemia trait). Individuals who have alpha thalassaemia trait are identified by microcytosis, erythrocytosis, hypochromia and mild anaemia. Individuals with a thalassaemia trait will experience no significant health problems except a possible slight anaemia which cannot be treated with iron, with consequent mild fatigue symptoms.

  • When the two copies are in different alleles (also called in trans), the person is an alpha + carrier. It is most commonly detected in people with African ancestry.
  • When the two copies are in the same allele (also called in cis), the person is alpha 0 carrier. It is most commonly detected in people with Southeast Asian ancestry.

1 alpha globin gene: the person will be affected with haemoglobin H disease. Haemoglobin H disease is characterized by mild to moderate anaemia, hypochromia and microcytosis. Individuals who have haemoglobin H disease generally have a persistent stable state of anemia, which may be accentuated by increased haemolysis during viral infections and by exposure to oxidant medications, chemicals and foods such as sulfa drugs, benzene, and fava beans (similar to individuals who have G6PD deficiency).

As the red cells mature they lose their ability to withstand oxidant stress and haemoglobin H precipitates, leading to haemolysis. Therapy for individuals who have haemoglobin H disease includes folate, avoidance of oxidant drugs and foods and frequent medical check ups.

No alpha globin genes: the absence of alfa chains causes severe anaemia and leads to hydrops foetalis. This diagnosis is frequently made in the last months of pregnancy when fetal ultrasound indicates a hydropic fetus. The mother frequently exhibits toxemia and can develop severe postpartum hemorrhage. These infants are usually stillborn. There can be other congenital anomalies, though none are pathognomonic for alpha thalassaemia major. If the diagnosis is made early, intrauterine transfusions can be performed.

More uncommonly, alpha thalassaemia can also be caused by point mutations in any of the four alfa globin genes. Some examples of these haemoglobin variants are: Constant-Spring, Icaria, Seal Rock, Pakse, Quong Sze, Sun-Praire and Adana.

Information to give to patients and relatives

Information Leaflets

Patient associations and information sources

Resources for healthcare professionals

A detailed list of Screening Programme resources available to patients and Health Professionals is available via the following link: 2019-april-screening-information-resources.xlsx 

Screening information for the transgender community is available via the NHS inform website

How to order: Public Health Resources Directory is an easy to use online ordering facility for a range of public health and health improvement resources, available free of charge to clients across Greater Glasgow and Clyde. www.phrd.scot.nhs.uk

Acute Hospitals and Community Health Care

The key aims of this strand of work are to modernise services and improve health through innovative and cost-effective approaches to person-centred care and by providing leadership to enable delivery of art and therapeutic design strategies into new capital builds, green spaces and refurbishments and a programme of year-round exhibitions and performing arts.

Hospitals

Therapeutic Design and Art Strategies have been successfully delivered in new Acute Hospitals developments at:

New Stobhill Hospital

New Stobhill Ward Block including waiting room in the park, the New Neo Natal and Maternity Extension)

GROVE

The New Stobhill Hospital provides an attractive and welcoming environment for patients and visitors with light, airy public spaces, comfortable waiting areas and fresh, modern consulting rooms. It is located on the north side of the city, adjacent to Springburn Park.

Patients will not only benefit from modern new facilities. The way care is provided from the hospital has also changed for the better. Services have been redesigned around the needs of the patient to enhance the quality of care and speed up diagnosis and treatment.

The hospital will treat about 400,000 patients every year.

In addition to outpatient clinics, day surgery and diagnostic services, the hospital provides a number of specialist services such as cardiology, renal dialysis and gynaecology.

Concept

It is our understanding that art in a hospital should contribute to a healing environment.

The new hospital is set within an apparently random planting of silver birch trees. Open courtyards are planted with larch trees and surfaced with natural larch boarding. The theme of woodland light and shade is continued within the building by means of installed painting, video and poetic texts.

It is a grove of larch in a forest of birch.

The New Stobhill Hospital GROVE project has resulted in the installation of groups of works by five artists across the Hospital.
 
Thomas A Clark, poet and artist, working closely with Reiach & Hall Architects, wrote a number of short poems which have been installed throughout the Hospital.  In response to these poems four visual artists have created artworks. 

Kenneth Dingwall painted a series of abstract designs in the corners in surgical and endoscopy waiting areas, and placed a sequence of shapes above eye level in the Imaging Waiting Area. 

Olwen Shone, Andreas Karl Schulze and Thomas A Clark created a series of works within the main clinic waiting areas comprising 14 films of natural scenes installed on monitors and projectors and 130 small abstract compositions, juxtaposed with Clark’s poems. 

Donald Urquhart and Clark created a series of works entitled Six Landscapes in specialist clinic waiting areas.  Urquhart also created Alphabet, a series of drawings of indigenous trees which are also keys to the ancient Gaelic alphabet.  Urquhart worked with Reiach and Hall, Clark and Schulze to create the Sanctuary.  Urquhart had previously developed the award winning Sanctuary at Edinburgh Royal Infirmary

In parallel, and as a direct result of the work in the New Stobhill Hospital, a public art scheme has been developed for the adjacent entrance to Springburn Park.  Developed by Alec Finlay from work with staff and patients in the Hospital as well as with users of the Park, this extends the ideas embedded in the Hospital.

The aim has been to create another Waiting Area in the Park, encouraging walking (even short distances) as well as connecting the natural themes of the artworks in the hospital to the natural environment of the Park.

It has been implemented through a partnership between Glasgow City Council Land Services, Culture & Sport Glasgow and NHSGGC Endowments.

Team

Architects: Reiach & Hall Architects
Curator and Lead Artist: Thomas A Clark

Artists (some web sites are indicative rather than personal sites):
Kenneth Dingwall
Andreas Karl Schulze
Olwen Shone
Donald Urquhart

Project Manager: Chris Fremantle

Funders

Scottish Arts Council, NHSGGC Staff Lottery, NHSGGC Endowments, many Glasgow Faith Groups.

Key Dates

Project Completed Spring 2009

Awards

Prime Minister’s Better Public Building Award 2010
RIBA Stirling Prize 2010 Midlisted
Design & Health International Academy Awards Best International Project under 40,000 sqm 2010
RIBA Award 2010
Scottish Design Awards Best Public Building 2010 Commendation
Public Private Finance Awards Best Designed Project 2010
Civic Trust Awards 2010 Commendation
Glasgow Institute of Architects Awards Best Healthcare Building 2009
Building Better Healthcare Awards Best Designed Hospital 2009
Roses Design Awards Best of the Best 2009
Grand Prix Roses Design Awards Best Public Building 2009 Gold
RIAS Andrew Doolan Best Building in Scotland 2009 Finalist
Building Design Healthcare Architect of the Year 2009 Finalist

Links

Architecture & Design Scotland – Case Study 

New Victoria Hospital

The Hospital and the Park

The New Victoria Hospital is located on the Southside of Glasgow, near Queens Park.  It provides an attractive and welcoming environment for patients and visitors with light, airy public spaces, comfortable waiting areas and modern consulting rooms.

Patients will not only benefit from modern new facilities. The way care is provided from the hospital has also changed for the better.  Services have been redesigned around the needs of the patient to enhance the quality of care and speed up diagnosis and treatment. About 400,000 patients attend the hospital every year.

In addition to outpatient clinics, day surgery and diagnostic services, the hospital provides a number of specialist services such as cardiology and gynaecology.  There is also a new Minor Injuries Unit with its own dedicated entrance for rapid access to a highly skilled clinical team.

And for the first time, patients from south-east Glasgow, Rutherglen and Cambuslang requiring an MRI scan, renal dialysis or chemotherapy are able to get this locally at the New Victoria Hospital.

Concept

The New Victoria Art & Environment project has delivered permanently installed artworks by five artists, and an initial programme of residencies and projects within the Hospital.  The curatorial concept for the project focused on The Hospital and the Park, linking the new hospital with Queens Park.

Ally Wallace was appointed as Lead Artist.  He developed an integrated coloured glazing scheme working closely with HLM Architects, and also developed a number of wall paintings for the basement car parking area.

Ronnie Heeps worked closely with the Spiritual Care Committee to develop the Sanctuary in the New Victoria Hospital, drawing on the concept of ‘Squaring the Circle’.  The Friends of the Victoria worked with Glasgow Metropolitan College to commission furniture for the space.

A key part of the New Victoria Art & Environment project focused on Waiting Areas where Jacki Parry and Hanneline Visnes created works permanently installed in five locations.  Calum Stirling was commissioned to create the work, Sculpture Park, adjacent to the Hospital.

In addition HLM Architects developed the concept of a multimedia projector in the Atrium showing a range of artists’ film and video.  An initial work drawing on the New Victoria, the Victoria Infirmary, Queens Park and the local area has been created by Ronnie Heeps.

Team

Architects: HLM Architects
Curator: PACE
Lead Artist: Ally Wallace

Artists

Ronnie Heeps
Jacki Parry 
Calum Stirling
Hanneline Visnes

Project Manager: Chris Fremantle

Funders

Scottish Arts Council, NHSGGC Staff Lottery, NHSGGC Endowments, many Glasgow Faith Groups.

Key Dates

Completed: Spring 2009

Queen Elizabeth University Hospital Campus
Community Health Centres

Therapeutic Design and Art Strategies have been successfully delivered within new Community Health and Social Care Centres at:

Barrhead Health and Care Centre

The overarching vision demonstrated in the Barrhead Health and Care Centre Art Strategy recognises the benefits of art and creativity in the healthcare environment. As a result, the strategy delivers high quality artwork in parallel with a positive model of participation, creating opportunities for the local community to engage with the artists, impacting on the artist’s research and the final artwork for the centre.

Barrhead Health and Care Centre

Patricia Fleming Projects are delighted to announce: Barrhead Health and Care Centre wins Public Building of the Year 2012 at the Scottish Design Awards.

We would like to take this opportunity to congratulate Avanti Architects, Artists Iain Kettles, Susie Hunter, David Zérah, our clients NHS Greater Glasgow and Clyde, and East Renfrewshire Community Health and Care Partnership (CHCP).

We are very proud of the thought-provoking, sensitive and beautifully executed artwork created specifically for the Barrhead Health and Care Centre. The art in the centre acts as a conduit between people and ideas. It raises questions about the importance of wellbeing, design and location. External (above) and internal permanent sculpture by Iain Kettles and Susie Hunter create not only a marker for new public space in a busy main street, but also begins a dialogue about art and health out into the wider community. The photography of French artist David Zérah can be seen throughout the building. Thirty works were selected from thousands taken during a residency in the area. Based in Barrhead the series instigates an on-going conversation with the community, patients and staff about the space we share. As part of the art strategy a new collection of artworks was started which we hope will continue to grow. Works by leading Scottish contemporary artists Jacqueline Donachie, Katy Dove and new talents Mary Wintour and Lisa Ure.  Residents from across Barrhead and Neilston took part in a series of workshops exploring the project themes with Glasgow-based designer Anna Sheard.

The overarching vision demonstrated in the Barrhead Health and Care Centre Art Strategy recognises the benefits of art and creativity in the healthcare environment. As a result, the strategy delivers high quality artwork in parallel with a positive model of participation, creating opportunities for the local community to engage with the artists, impacting on the artist’s research and the final artwork for the centre.

The arts strategy was created with support from the Barrhead Arts Team. The aim is to put the new centre, health and wellbeing at the heart of the community and promote the imaginative role that artists can play in the creation of inspiring places.

http://www.scottishdesignawards.com/

Credits:

Barrhead Health and Care Centre Project Manager: NHS Greater Glasgow & Clyde
Architect: Avanti Architects Ltd
Main Contractor: Graham Construction
Civil & Structural and Mechanical & Electrical Engineer: Cundall
CDM Coordinator: Turner & Townsend
Quantity Surveyor: Cyril Sweett
Curator: Patricia Fleming Projects
Artists: Iain Kettles, Susie Hunter, David Zerah
Artwork Fabricator: Scott Associates
Landscape Consultant: Fiona Robertson

For images of the artworks, artists cv’s or further info contact

ruth@patriciaflemingprojects.co.uk

The West Centre

The West Centre is a new purpose built Centre for Children’s Community Health and Care.

The Centre offers a ‘one stop shop’ combination of services for children, young people and their families who are affected by a wide range of difficulties such as developmental, emotional, behavioural and mental health problems, communication difficulties, Autistic Spectrum Disorders, Physical Disabilities and Neurological Disabilities.

The Centre supports a whole new way of integrated working for those providing services with social workers, community child health staff, educational psychologists, mental health professionals and more, all having bases within the building and working together.

The Centre also provides services to patients and clients not only from West Glasgow but also East Dunbartonshire and West Dunbartonshire. The Centre also features integrated art and design features throughout the building, both inside and out.

The West Centre by Anderson Bell Christie

Concept

The integral art and architecture programme was introduced into the final design process, and developed in collaboration between a Lead Artist, Architect and an arts support team drawn from Centre staff.

The final programme was designed to offer an aesthetic logic running throughout the building, respecting and engaging its users. The aim was for a definite sense of uniqueness and place, with a light touch, but rewarding repeated visits with layered meanings and discoveries: more elements to search out and find familiar details to return to.

The artworks tread a delicate path with care and respect, aiming to reconcile a high standard of professionalism with the often conflicting demands of different ages and abilities of children and adults. The outcomes offer a sense of childlike wonder and engagement without ever being patronising or childish.

Funders

The artworks programme was made possible with a grant of £250,000 from the Yorkhill Children’s Foundation

Awards

The West Centre has picked up the Glasgow Institute of Architects Design Award (Healthcare), and was also short listed for the highly prestigious Royal Incorporation of Architects in Scotland – Doolan Award.

Key Dates

July 2008 – appointment of Lead Artist
November 2008 – start of building work on site
June 2010 – completion of building and artworks programme

Team

Linda Mallett, lead artist and curator
Tassy Thompson, external artworks
Tim Taylor, internal niche artworks
Graven Images, design and graphics
Anderson Bell Christie, architects

Links

Architecture & Design Scotland – Case Study
Atrium Screen by Graven Images
Cloud by Tim Taylor
Fence by Tassy Thompson
Floor niche by Tim Taylor
Flying Saucers by Tim Taylor
Harp by Tim Taylor
Interactive Ship niche by Tim Taylor
Peephole view by Tim Taylor
Reception desk by Tim Taylor
Totem by Tim Taylor

The Vale Centre for Health and Care

Location

The site is located on the A82, the main road from Glasgow to Loch Lomond and is adjacent to the Vale of Leven Hospital.

The VHCC, currently under construction is designed to be a state-of-the-art community health and care facility within which will be based a variety of key services including General Practices; General Dental Practice; Dietetics; Podiatry; Speech and Language Therapy; Primary Care Mental Health; Physiotherapy and Community Dental Services. It will also provide a local base for district nursing, health visiting, prescribing support as well as teaching and studying facilities.

VHCC users will be from a wide catchment area, encompassing both urban and rural communities.

Framework

Two workshops were held, bringing together four creative thinkers with members of the VHCC Art and Design Strategy Group, as part of the initial research. The following concepts were investigated and will inform each of the therapeutic art and design commissions:

The journey;

Thresholds, welcome and departure;
Interaction in public spaces;
Relationships between the built environment and the rural environment.
The aim for each commission is to deliver specified projects to support the patient experience and the working day for staff through reference to the local natural environment by bringing the outside into the Centre and by leading the gaze beyond the walls of the building into the wider landscape.

Therapeutic Art and Design at the Vale of Leven Centre for Health and Care

Unique artworks made by four of Scotland’s leading artists commissioned to reflect the local natural environment are permanently installed in the building and grounds of an inspirational new health and care centre for the Vale of Leven West Dunbartonshire

By focusing on the surrounding locality each artist tells a different story about people and place through a range of media including textiles, painting, photography and wood.

Working with staff and the community, each artist has produced integrated artworks designed to support orientation, to bring the outside into the building and to promote a sense of wellbeing for patients, visitors and staff.

Artist Jephson Robb was tasked to create seating from the trees felled on site during the building process, to be situated in the atrium and at the two approaches to the building. Five sculptural benches are now permanently in place offering both resting points and beautiful objects to enjoy which work in harmony with the design of the new building itself.

Scotland’s foremost environmental artists Dalziel and Scullion have made four beautiful light emitting artworks which explore the wild and cultivated plants growing on allotments in the patient catchment area, bringing a sense of the domestic into the healthcare environment.

Donald Urquhart developed two works which focused on the near and far. The first piece was influenced by the pot shards found on the site during the excavation process for the new building. Dating back to the Bronze Age their beautiful geometric markings informed the design for the manifestation for the gym window, offering privacy for staff and patients in the gym yet allowing views out whilst letting plenty of light in.
The second work was inspired by the stunning mountain scenery so close to the Vale of Leven and designed to integrate seamlessly into the new building. Painted as a modernist pixilated frieze around the first floor of the atrium are colours capturing the soft autumn and winter beauty of the Loch Lomond and the Trossacks, offering a contrast to the close up detail of the allotment images by Dalziel and Scullion.

Textile artist Deirdre Nelson worked with pupils at the Vale of Leven academy to research the history of the area within living memory and create artworks from the gathered stories which were incorporated into a design printed onto healthcare curtains for the couches in the GP consulting rooms.

The design and build of the Centre was commissioned by West Dumbartonshire Community Health and Care Partnership and managed by NHS Greater Clyde and Glasgow. The Therapeutic Art and Design strategy was managed and delivered by Wide Open.

West Dumbartonshire Community Health and Care Partnership would like to thank the dedicated involvement of the staff and pupils at the Vale of Leven Academy, the patient focus groups and NHS staff, without whom his project would not have been possible.

Planning treatment in a European Country   

If you are thinking about any sort of planned medical or dental treatment outside the UK, please discuss this fully with your GP, hospital consultant or dentist. Make sure you are fully informed as it is important to have the information you need to make the right choices. You will need to be fully informed about your European healthcare provider and the details of the treatment you are planning to have. You may also need to consider:

  • when you will be able to travel
  • how your medical notes will be exchanged between teams
  • arrangements for after-care or follow-up treatment either abroad or at home
  • how you would deal with any complaint or problem should something go wrong following your treatment abroad

All treatment under the S2 scheme requires Health Board approval before treatment can commence. Please click on the linked heading above for more information. 

The arrangements for reimbursing health care costs to people who live in Scotland and receive treatment in EEA states stopped on 31 December 2020 (EU Exit Implementation Period completion day). Click on link above for more information

Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients and about 90% of the adult population visit a community pharmacy at least once a year. This presents an important opportunity for pharmacists and their staff to motivate and empower their customers to improve their health.

Health Improvement covers a wide range of topics some examples are discussed below and the topics boxes give a little more detail.

Health Improvement targets for Scotland can be found by linking into the Scottish Executive’s website

For further information for pharmacy staff in NHS GGC click here

Stopping smoking

Stopping smoking is one of the most important health improvement interventions. Community pharmacy can supply nicotine replacement therapy or varenicline with behavioural support to help patients stop smoking.

Advice on healthy living

Pharmacists can provide the right advice on healthy living and signpost patients to the best resources to achieve their health improvement goals.

Reduce health inequalities

Community pharmacy offers the Pharmacy First Service (PFS) which encourages people to go to their local pharmacy for support with minor and acute health conditions. Pharmacies undertake a NHS PFS consultation and provide advice, treatment or referral to another healthcare professional if appropriate. 

Managing long term conditions
Many long term conditions require health improvement interventions in addition to medicines which might be prescribed.

Mental health

Good mental health is of key importance to maintaining good general health. Pharmacists should know where to signpost patients for appropriate support as they may need more assistance in managing their daily living requirements. Also patients suffering from poor mental health may need more support to make important lifestyle changes.

For any enquiries regarding Pharmacy Public Health Improvement please contact pharmacyhit@ggc.scot.nhs.uk

Alcohol Awareness

Approximately 1 in 8 men and 1 in 24 women have some degree of alcohol dependence. Excess drinking puts long term health at significant risk. Excessive alcohol consumption is associated with an increased risk of a range of illnesses that collectively contribute to a massive impact on morbidity and mortality.  Please see Alcohol Consumption Questions and the Fast Alcohol Screening Test (FAST

For more information visit

  • Drinkaware A Charity promoting responsible drinking.
  • Alcohol Focus Scotland – is the national charity working to reduce alcohol harm.
  • DrinkSmarter  A Scottish Government practical website with many handy tools, supporting healthier drinking habits. 
  • Glasgow Council on Alcohol (GCA) Providing support, counselling, advice, information, group work and training for those affected by alcohol misuse. 
  • Alcohol Concern   A charity campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems. 
  • Al-Anon Family Groups provide support to anyone whose life is, or has been, affected by someone else’s drinking, regardless of whether that person is still drinking or not.

 Key points for community pharmacy

  • Offer advice on sensible drinking
  • Give advice on prescription and Over the Counter (OTC) medicines about interactions with alcohol.
  • Signpost patients to local services offering support
  • Further Information, Resources and Support (including “Alcohol Before, During and After Leaflet) Alcohol and Pregnancy Leaflet 

Some pharmacies may

  • Offer alcohol brief interventions using a FAST tool
Cancer

It is estimated that 1 in 3 people in Scotland will develop some form of cancer during their lifetime.

This is a wide ranging topic and there are many different types of cancer. Some are more likely to occur in females e.g. cervical and breast cancer while others in men e.g. prostate cancer.

Many forms of cancer can now be successfully treated if they are identified in their early stages and we now have screening for the commonly occurring breast, bowel and cervical cancers.

Some cancers such as melanoma (skin cancer) may be prevented by health protection measures such as avoiding the sun and using sunscreens. Smoking cessation remains one of the most important health improvement measures to avoid developing cancer.

For more information visit

  •  Scottish Cancer Index provides links to cancer related websites specific to Scotland.  
  • Cancer Research UK  Helpline 0808 800 4040  Mon – Fri 9-5pm
  • Bowel cancer UK providing support and advice. Telephone: 020 7940 1760
  •  Encourage completion and return of Bowel Screening Kits information at this website
  • Breast Cancer Care providing information and assistance for those affected by breast cancer. Freephone Helpline 0808 800 6000 Textphone 0808 800 6001  
  • Cancer Support Scotland  Cancer Support Scotland offers counselling, support groups and complementary therapies to anyone affected by cancer, including family members and carers: before, during and after treatment.
  • Sun Smart   This Cancer Research UK website provides a wealth of information including, information on skin cancer, sunburn and how it damages your skin, advice on protective measures to take – applying sunscreen, staying in the shade, wearing protective clothing and sunglasses, and advice on protecting children from the sun.    
  • British Lung Foundation provides advice on all diseases affecting the lungs including lung cancer. Helpline: 03000 030 555
  • Leukaemia Care provides support for people with leukaemia, lymphomas and related disorders. Tel: Helpline: 08088 010 444 or chat via WhatsApp on 07500068065
  • Lymphoma Action provides support for those affected by Hodgkin’s disease and non-Hodgkin’s lymphoma. Tel. Helpline no: 0808 808 5555
  • Macmillan Cancer Support is a national charity providing expert care and support for people living with cancer. Tel. Helpline: 0808 808 0000
  • Maggies Centre provides support organisation for those affected by cancer. One of the centres is in Glasgow.   
  • Marie Curie Cancer Care. Dedicated to the cure of people affected by cancer and the enhancement of their quality of life through its caring services, research and education.  Telephone Support Line: 0800 090 2309
  • Oesophageal Patients Association Telephone: 0121 704 9860 (Mon – Fri 9am – 5pm)
  • Orchid: Fighting Male Cancer  Good range of leaflets on testicular and prostate cancer.  National male cancer helpline: 0808 802 0010
  • Prostate Cancer UK Telephone:  Helpline: 0800 0748383 

 Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Many quality, free resources can be ordered to support from Quick Guide for Community Pharmacies on where to access Patient Resources 
  • Be alert to red flag symptoms such as a persistent cough which might suggest a patient should be referred to their GP for investigation.
  • Encourage patient’s participation in national screening programmes e.g. cervical screening whenever possible.
  • Only sell a minimum of SPF 15 sun protection products. 
Healthy Lifestyle… at any age

Many factors go together to improve an individual’s health. Their health needs change through life as they get older and different issues might impact on men’s and women’s health. However, a healthy lifestyle is important at any stage of an individual’s life.

Diet and nutrition, exercise, smoking cessation and managing alcohol intake are modifiable lifestyle factors that can be addressed to improve health.

Other factors may not be readily addressed by individuals but rely upon society working together to promote healthy living and working environments.

Health inequalities arise when individuals or communities are not empowered to make healthy lifestyle choices.

For more information visit

 Child Health

 Health in older age

 Healthy Living 

Community Pharmacy – Signpost patients to appropriate support organisations.

Beware of your patients particular needs. Check out your locality’s health profile.

Long Term Health Conditions

The effective management of long term health conditions (LTHC) can greatly improve a patient’s health and wellbeing. Examples of these conditions include epilepsy, cardiovascular disease, diabetes asthma and chronic obstructive pulmonary disease (COPD).

In addition to taking appropriate medication LTHC patients are often asked to make lifestyle changes such as smoking cessation or alcohol reduction. But at the same time they may be struggling with psychological issues caused by the impact of their diagnosis.

So in addition to understanding the clinical management of patients and the guidelines that are in place for these it is important to consider the patient as a whole and understand their attitudes to their condition and its management.  

For more information visit

Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Know when to call for medical assistance in the event of a heart attack and how to deliver basic resuscitation (CPR) for patients who have collapsed. Details of suitable courses may be found at St Andrews Ambulance Brigade
  • Advise on use of inhaler devices for asthma and COPD patients

 Some pharmacies may

  • Offer health screening such as blood pressure or glucose monitoring
Mental Health

Mental health is a complex topic affecting a significant percentage of people in the UK at any one time. Issues might include depression (including postnatal depression) bipolar affective disorders, stress, anxiety disorders, phobias, eating disorders, schizophrenia and others. Some individuals may suffer from a combination of symptoms.

The management of patients suffering mental health problems may range from self help approaches to in patient care at a psychiatric specialist hospital or facility.

Regardless of how patients are managed, good mental health is underpinned by a healthy lifestyle. Good diet, smoking cessation, exercise, sleep hygeine and alcohol management will not necessarily cure a patient but they will significantly contribute to their recovery.

For more information visit

  • General Local  Mental Health Care For extensive information on mental health care available in Greater Glasgow and Clyde.   
  • NHS24 Tel 111. Can provide or source help for a patient in crisis when their GP is not available
  • Breathing Space Scotland Tel: 0800 83 85 87. Free, confidential phone and web based service for people in Scotland experiencing low mood, depression or anxiety.
  • Mind Tel 0300 123 3393. Mental Health Charity aimed to ensure anyone with a mental health problem has somewhere to turn to for advice and support, and offer useful leaflets and publications.
  • Samaritans Provide confidential emotional support 24/7 to those experiencing despair, distress or suicidal feelings.


Key points for community pharmacy

Palliative Care Services

This service is provided by a network of 70 pharmacies across the NHS Greater Glasgow & Clyde area. These pharmacies maintain

  • a stock of specific core medicines
  • provision of advice and useful contact numbers for specialist palliative care advice
  • a support network to other pharmacies within their localities. 

Some participating pharmacies are available to dispense out-of-hours urgent prescriptions. This can be arranged through NHS 24. A courier service protocol is available to ensure timely supplies of medicines to palliative care patients in emergencies. The aim is for the first pharmacy contacted (regardless of being a part of the Palliative Care network or not) to ascertain the urgency of the prescription and resolve any supply issues, in order to avoid patients, carers, or nurses needing to phone or visit multiple pharmacies. All community pharmacies are provided with a list of the network pharmacies for this purpose and the specific core medicines list. For more details on the Palliative Care Service, click here  or contact: Palliative Care Specialist Pharmacists on the below telephone numbers: 07876 478140 or 07880 786659 or 07775 012560

Quit Your Way

NHS GGC are responsible for a wide range of tobacco projects including the “Quit Your Way” Pharmacy Service.

Suitable pharmacotherapy (Nicotine Replacement Therapy [NRT] or varenicline) together with personalised advice and support is provided from the community pharmacy for usually up to 12 weeks.

For further details, please contact any participating pharmacy or the Quit Your Way Pharmacy Team (T:0141 201 4945 or e: pharmacyhit@ggc.scot.nhs.uk)

To access the list of Pharmacies involved in Quit Your Way please click here

Click here to access the Guidance Notes for Service Delivery.

Click here to access Quit Your Way Questions & Answers (for Community Pharmacy)

Resources

View and order resources

This aspect of Pharmacy Public Health deals with the planning for, and managed introduction of new medicines. The Scottish Medicines Consortium  is responsible for providing advice on the clinical and cost-effectiveness of all new medicines and important new indications for existing medicines.

The NHS GGC prescribing website provides useful links to the local Medicines Formulary, medicines policies and associated resources.