The Public Health Directorate provides Clinical and Public Health input into maintaining, protecting and improving population health and relevant acute health services. This includes clinical and professional leadership of Acute Out of Area Activity and cross boundary flow. 

For information on 'Overseas Visitors' and 'Preventing Illegal Working' please view the following page:

• Acute Health Services - Overseas Visitors + Preventing Illegal Working

Acute Unplanned Activity

Acute Unplanned Activity (UNPAC), is NHS work which needs to take place but which is either unusual or highly specialised to the extent that there is not an existing service covered by a service level agreement. Some highly specialised services are provided by National Services Scotland under national agreements but where no agreements exist it is necessary to arrange treatment on a case by case basis.

The CPHM Acute Services provides clinical leadership and professional advice on requests for Acute Unplanned Activity (UNPACS) which refers to all Acute NHS Activity which takes place outside the pre-existing Service Level Agreements.

Referrals for NHS care for local residents should wherever possible be made to the appropriate local NHS services unless there is a pressing clinical reason to refer elsewhere. Primary Care referrals outside NHS Scotland require prior funding approval from the CHP. The NHS Board and Public Health Directorate cannot approve out of area referrals by Primary Care, which must be made through the primary care UNPACS process led by Sue Dow, General Manager, Falkirk CHP. Where a patient requests referral for a highly specialised procedure then the opinion of a local consultant should be sought. The consultant can then make the appropriate acute referral as set out in the following guidance.

• NHS Scotland: Guidance on Establishing the Responsible Commissioner (PDF 155 kb - 32 pages)
• Who Pays? Establishing the Responsible Commissioner (Department of Health) (PDF 160 kb - 39 pages)
• Overseas Visitors’ Eligibility to Receive NHS Care and Services - A Guide for NHS Professionals in Scotland - August 2009 (PDF 93 kb - 17 pages)
• Healthcare Improvement Scotland - evidence based reviews and guidance on health technologies and novel treatments
• National Institute of Clinical Exellence (NICE)

• National Services Division

Primary care referrals outside NHS Scotland need prior funding approval from the appropriate Community Health Partnership (CHP). Secondary Care referrals are managed through the UNPACS process led by the CPHM (Acute Services).

• Acute Unplanned Activity Funding Requests from Primary Care - Letter (PDF 506 kb - 1 page)

Obesity

Obesity presents a huge public health challenge in the developed world. Scotland has some of the highest levels of adult obesity in the world. Over 6,000 adults in Forth Valley are morbidly obese. In partnership with other west of Scotland NHS Boards Forth Valley NHS Board is endeavouring to tackle obesity in a wide range of ways. This includes making available bariatric surgery for some of the most morbidly obese. Currently Bariatric surgery in the West of Scotland is limited to the treatment of type 2 diabetes in patients with a BMI over 40.

There is good evidence to suggest that a moderate weight loss of 5-10% of body weight will have major impact on the physical and metabolic complications of obesity. The evidence is summarised well by the National Obesity Forum. The Forum also provide a range of useful resources to support professionals and their patients.

Most patients should be able to achieve 5-10% weight loss with simple support from a concerned professional or by joining a local group such as Slimming World or Weight Watchers. In Forth Valley we are also actively rolling out the Counterweight programme to willing general practice settings.

• Bariatric Surgery Policy 2011 (PDF 49 kb - 3 pages)
• Counterweight
• National Obesity Forum
• Slimming World
• Weight Watchers

Infertility

The prevalence of couples presenting with infertility problems is increasing in Forth Valley as is the case throughout the UK. This is thought largely to reflect the increasing age at which many couples are first trying for a pregnancy and also the delayed impact of earlier sexual activity with increased risk of infections such as Chlamydia.

NHS Forth Valley does not have a local tertiary infertility centre but we purchase cycles of IVF and ICSI for couples diagnosed with infertility by our local consultant with an interest in infertility. The local process is set out in the NHSFV Infertility Policy.

• InfertilityPolicy (PDF 127 kb - 8 pages)

Winter Pressures

The Acute Services Consultant supports NHS planning for Winter Pressures through a variety of inputs. One key issue for winter planning is preparation for winter outbreaks. The CPHM (Acute Services) works with the Infection Control Team to prepare plans and strategies for key outbreaks and hospital infections.

• Health Protection (NHS Forth Valley - Public Health Directorate)
• Health Protection Scotland - Influenza
• Health Protection Scotland - Norovirus
• Health Tips Benefits for Scotland (HTBS)
• Information Services Division (ISD)
• National Institute of Clinical Exellence (NICE) 
• Scottish Intercollegiate Guidelines Network (SIGN)

* Please note that NHS Forth Valley Directorate of Public Health takes no responsibility for the accuracy or quality of external websites linked to from this page. If you have a query, please contact the Acute Health Services Team.

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