Health Improvement Annual Report 2017 / 2018
Contents Page 3
Introduction: Elaine Young – Assistant Director of Public Health
Page 4
Our Team
Page 5
Health Improvement at a Glance
Page 6
Capacity Building
Page 9
Strengthening Partnerships
Page 12
Digital Developments
Page 13
Celebrating Success
Page 16
New Developments
Page 20
Next Steps
Introduction As Head of Health Improvement, I am delighted to present our team report to you for the year 17/18. The role of our team is to work at a population level to prevent ill-health, improve health and wellbeing and reduce inequalities. In order to do so, we work alongside many partners, both internal and external to the NHS – working across Acute Services, Health and Social Care Partnerships and community Planning Partnerships. As you may know, at a national level there has been a review of Public Health, which has now progressed into Public Health Reform. I am a firm believer that it is these strong partnerships and close working relationships with colleagues across Ayrshire, which is key to progressing the work contained within this report. As part of this reform process a set of national Public Health Priorities have recently been published which we have outlined in more detail within our Next Steps section. There is great breadth and depth to the work undertaken by the team, which has been demonstrated in a very visual way within this document, I hope you enjoy reading this report, and I am happy to respond to any questions or points you might have. Please contact me at
[email protected]. Elaine Young Assistant Director of Public Health/Head of Health Improvement Team June 2018 DPH Biennial Report 2016
Our Team The Health Improvement Team, as part of the Public Health Department, provide specialist knowledge and expertise to develop projects and programmes which aim to improve the health and wellbeing of the people of Ayrshire and Arran & reduce health inequalities so that individuals, families and communities can experience the healthiest lives possible. Who we are: Assistant Director of Public Health
Our work:
We aim to succeed by: •
Promoting healthy lifestyles and positive behaviours.
•
Taking action to reduce health inequalities and work to address the wider social, environmental and economic determinants of health that serve to create inequalities.
•
Working in partnership with a range of organisations, services and groups and within a variety of settings including schools, communities, workplaces and prison.
Lead for Health Improvement
Teams and Topics East, North and South Locality Teams Mental Health and Wellbeing Practice Development Unit (PDU) Health Information & Resource Service (HIRS) Sexual Health & Blood Borne Viruses (BBV) Workplace Public Health Nutrition
Services Better Health Hub HIRS
Fresh Air-shire (now Quit Your Way) Jumpstart
Administration Staff
This report aims to provide a snapshot of the wide range of work that the Health Improvement Team is involved in by sharing our key highlights for 2017/18.
Health Improvement at a Glance
Capacity Building Building capacity is a core function of the Health Improvement Team. Our vision is that communities, partners and individuals are empowered to make a positive impact on health and wellbeing.
11 companies awarded a workplace achievement
We offer a range of courses, as part of our health improvement training programme, aimed at individuals who work in a range of sectors including health, social care and voluntary organisations. These courses equip participants with the knowledge and skills to reduce inequalities and improve the health of the population.
Capacity Building In addition to our core training programme, we also offer bespoke training and a range of toolkits. We also strive to continually develop new resources based on emerging evidence or demand. The following examples have been developed during the last year to build capacity of the wider health improvement workforce across Ayrshire and Arran. Staying Healthy Whilst Out of Work Pilot
Improve your health and wellbeing: Health Conversations guide
This new train the trainer course was developed to build capacity among the employability workforce to promote health and wellbeing recognising the links between unemployment and poor health as well as unemployment and risk taking health behaviours.
The guide is designed to enhance existing skills and knowledge and provide information on health and wellbeing topics and prompts on key health behaviour change techniques.
The pilot aimed to provide attendees with an increased understanding of actions that can be taken to support the promotion and maintenance of health and wellbeing. As well as, increasing confidence to explain and discuss the links between being in “good work”, having meaningful activity e.g. volunteering, attending training courses and maintaining positive health. Following attendance at this course, employability staff would be able to facilitate and roll out the training to other staff. The feedback was very positive with 93% of staff reporting that they felt they had learned something new. I can now promote what people can do, giving them self worth. I feel I have learned tools to deliver exercises to make clients more aware of their health and progressing into employment.
This new resource was developed as a result of discussions at a local multi-disciplinary Health Promoting Health Service meeting, It was thought developing a resource that would provide staff with tools to enable them to have healthy conversations with anyone they come into contact with, to encourage positive lifestyle changes would be beneficial. Health Improvement, working closely with our Allied Health Professional (AHP) colleagues, had a lead role in the development of this resource. The guide will be distributed to AHP staff and participants attending our Health Behaviour Change training.
Capacity Building Health Inequalities Self Assessment (HISA) Health Improvement staff together with other Public Health staff have developed a Health Inequalities Self Assessment (HISA) which is designed to help Health and Social Care services and wider teams, services and partnerships to address health inequalities by challenging them to identify where action is needed and possible in frontline practice; within service planning and strategic practices; and in partnership. The HISA resource supports teams to ask themselves sometimes challenging questions and helps to facilitate change, where required, and develop plans for action by considering the following areas:
Health inequalities can be described as unfair differences in health within the population across social classes and between different population groups. These differences are not random but largely socially determined and can result in inequalities in wellbeing, healthy life expectancy and morbidity. Good health is a resource which allows individuals, families and communities to engage in learning, leisure, employment and community life. However, unequal distribution of income, wealth and power in society and stark differences in life circumstances can have a negative impact on experiences and ultimately health outcomes across all our lives. Reducing Health Inequalities is a key priority for the Health Improvement team. However, health inequalities require to be addressed at a number of levels and across a range of organisations, agendas and partnerships.
• • • • • •
Working with individuals; Workforce learning and development; Quality of services; Working in partnership; Employing staff and procuring goods and services; Advocating for individuals, communities and lobbying for change.
To find out more and use the resource, please visit www.nhshisa.net.
Next steps: We will continue to raise awareness of HISA through information sessions and facilitated workshops, locally and nationally. We will also develop key inequalities information and an inequalities checklist.
Strengthening Partnerships Gender Based Violence During 2017, we worked collaboratively with the Violence Against Women Partnerships (VAWP) across Ayrshire to plan and host sessions on routine enquiry to empower and encourage partners to recognise and respond effectively to victims of abuse. It is widely recognised that there are strong links between health and wellbeing and learning. In partnership with North Ayrshire Council Education and Youth Employment Department we developed a Health and Wellbeing Strategy which shares a vision for the future of learning in health and wellbeing across the authority. Six framework documents were also developed by a multi agency group, in consultation with pupils and schools, to support delivery. The frameworks were developed to be used as a planning tool to generate ideas and activities to meet the requirements of the Health and Wellbeing Experiences and Outcomes within the Curriculum for Excellence.
Good levels of health and wellbeing supports effective learning
16 Days of Action is an annual international campaign which aims to raise awareness of violence against women, calling for changes at an international, national and local level to make women and children safe from abuse.
Effective learning supports postive health and wellbeing Staff presenting on Routine Enquiry
Strengthening Partnerships Our Natural Health Service (ONHS) is a national initiative supported by both the health and environment portfolios in Scottish Government to instigate a step change in how the natural environment can be used to improve people’s health. Public Health staff have been leading the implementation of this programme locally for the past 5 years which began with the NHS Greenspace demonstration site at University Hospital Ayr/Ailsa. In the past year we have rolled out the learning from this project to the Ayrshire Central site in North Ayrshire and are now leading the local implementation of another of the ONHS strategic interventions through the creation of a Green Health Partnership (GHP) in North Ayrshire. Through this work with partners key achievements have included the following: Greening the NHS- Ayrshire Central Woodland Walk has been created. This was previously an inaccessible area of woodland on the edge of the site, now open for everyone to benefit. This work was funded via Woods In And Around Town Funding from the Forestry Commission and NHS Endowments.
Next steps: Work with partners to develop and evaluate the GHP by increasing engagement with the environment, participation in activity and integration within referral pathways and developing networks/community greenspace for health projects.
Strengthening Partnerships To support NHS Ayrshire & Arran’s smoke free grounds policy, a partnership was developed between NHS Ayrshire & Arran and East Ayrshire Health & Social Care Partnership’s Criminal Justice Social Work Department.
The Winter Wonderland was officially opened by East Ayrshire’s Depute Provost, Claire Leitch in December 2017
Next steps: Additional activities will to be explored in order to continue and expand this successful partnership due to the potential impact on participants’ health such as, improving mental health, social connectedness, physical activity levels and self-esteem.
Digital Developments The NHS Ayrshire and Arran public facing website has been redesigned and was re-launched during 2017. http://www.nhsaaa.net
Health Improvement has led the department’s Social Media group. 2017 saw the launch of the department’s own Twitter account @PublicHealthAAA
Health Improvement has been leading on the development of the Public Health section of the new and improved website. We saw this as an opportunity to change our approach to providing information to the general public as well as partners. The new approach sees the move away from Public Health pages to a “Healthy Living” section within the site.
NHS Inform National Service Directory (NSD) In response to the national developments, a local partnership group has been established to support the development of this work across North, South and East Ayrshire. Given the directory relates to the inclusion of services to support health and wellbeing, Health Improvement has been leading the work to date.
We have been working collaboratively with other departments and partners to create a single point of reference for healthy living advice and guidance.
The NSD will bring together information about local health and wellbeing services thus contributing to efforts to improve health and wellbeing, enable selfmanagement and support people in their health and social care needs.
Next steps: 60 local services have been identified and have gone live on the NHS Inform NSD covering a wide range of health topics. Engagement has also begun with the public to look at the user experience and to identify any gaps in the information being provided.
Complete and launch our pages which will include information such as:
NHS Inform National Services Directory Meeting held at NHS 24.
• • • • •
Alcohol Mental Health Children and Young People Income and Fuel Poverty Health Inequalities.
Celebrating Success The Hepatitis See Campaign led by Hepatitis Scotland for World Hepatitis Day aimed to raise awareness of and challenge stigma associated with the disease through art workshops. Our Sexual Health and BBV team were key contributors to the campaign in Ayrshire and Arran. We worked with a group of individuals who are / who have been affected by Hepatitis C by providing support and encouragement to become involved in this art project and competition. The group attended a free workshop led by an experienced artist that enabled participants to express their emotions and experiences of life before and after hepatitis C treatment, in a visual form. Exhibitions and prize giving took place locally and nationally. Local artwork was exhibited in Ayr, Kilmarnock and Irvine during the month of July culminating in a final exhibition for all artwork produced at the Gallery for Modern Art (GoMA) in Glasgow on World Hepatitis Day. These exhibitions provided a valuable opportunity to, not only raise awareness of hepatitis C and generate discussion in relation to stigma, but also the positive impact that new treatments have, with fewer side effects and ability to cure up to 90% of people treated. The Hepatitis See project received a high level of engagement with the public. Locally, the artists were very positive about the experience with some reporting that it helped boost their self-esteem and mental wellbeing. In addition the North Ayrshire Peer Support workers who attended the local exhibitions were able to engage in discussion with the public resulting in two people being tested for hepatitis C.
All three of NHS Ayrshire & Arran’s main hospitals have been awarded ‘Cycle Friendly Employer’ status from Cycling Scotland. The Health Improvement Team, working in partnership with Ayr and Kilmarnock Active Travel Hubs and North Ayrshire Councils Sustrans Employer Engagement Officer were able to offer a number of opportunities to staff at each site e.g. staff engagement, Dr Bike checks and active travel breakfasts.
Celebrating Success Ahead We have been working closely with a range of partners including our Local Authority colleagues and Aspire to Access to deliver the Ahead programme. This programme, targeting seven communities in Ayrshire, was set up in 2014. Through a team of Community Builders, asset based community development has been taken forward. The Community Builders connected with local people to support them to share their skills and talents and take forward local initiatives based on the things that matter to people. From the beginning, external evaluators from the Social Marketing Gateway have followed the programme. The final report is now complete and the Health Improvement Team and key partners have developed a plan to share the learning from the programme, and to influence discussions about asset based community development being continued. The evaluation report highlights the programme has had a positive impact, which includes people reporting greater levels of social connectedness.
Improving the mental health and wellbeing for the whole population is one of our key priorities. NHS Ayrshire and Arran’s Mental Health Action Plan 3 year action plan, which involved a range of work being implemented, came to a conclusion. The main areas of work included: •
AHEAD Project
•
CYP Seminars
•
Cool Heads
•
Ahead for Health - toolbox talk
•
Wellness Recovery Action Plan® (WRAP®)
•
Identify what schools are doing to take forward MHW component of Curriculum for Excellence
•
Social Media & Digital Technologies
•
Mental health improvement training brochure
Next steps: We will be sharing the learning from the programme over the coming months – so please keep an eye out for this or alternatively get in touch with us!
Click here for the full poster
Celebrating Success We were successful in showcasing a selection of our work at the 2017 Faculty of Public Health Conference in Aviemore, with both poster and oral presentations Poster Presentations
Working In partnership to create a whole school approach to promoting mental wellbeing in Largs Academy using
Prevalence of vitamin D deficiency in pregnant women in Ayrshire:
Wellness Recovery Action Plan® (WRAP®)
An exploratory study
This presentation outlined how Health Improvement, CAMHS, North Ayrshire Education and Largs Academy worked in partnership to improve mental health and build resilience within the school community. The project created opportunities for pupils and staff to take part in WRAP® workshops in order to improve individual wellbeing, identify wellbeing ambassadors and initiate a whole school approach to
This poster provided an overview of a study that we carried out with other NHS Ayrshire and Arran staff and Glasgow Caledonian University. The study suggested that universal provision of vitamin supplements is effective in improving women’s vitamin D status. However, it also identified that further studies are required to establish the optimal amount and timing of supplementation to maintain adequate vitamin D levels throughout pregnancy and the benefits on clinical outcomes.
wellness. Feedback from both groups attending WRAP® was very positive. Pupils were able to identify ways in which this
Click here to see full poster
had developed their own thinking about what keeps them well,
Sexual Health Guideline for Mental Health In-Patients
and what stresses them, as well as reinforcing the fact that others experienced the same issues as them. Teaching staff
This poster highlighted work that was undertaken in partnership with
also felt that attending the WRAP® workshop had had a
Mental Health Services to ensure their staff have the knowledge and
positive impact on their own lives, and
confidence to contribute effectively to the sexual health, relationship
their ability to deal with the pressures
development and wellbeing of patients experiencing mental ill-health.
of work.
The guideline produced supports best practice and a holistic approach to care provision.
Click here to see full project report
Click here to see full poster
New Developments Healthy Start Scheme The Healthy Start Scheme supports eligible families to access healthy food and vitamins. However, it has been identified that some families in South Ayrshire may be missing out on the opportunity to access Healthy Start vitamins. Using improvement methodology health improvement staff carried out a test of change in Girvan. A questionnaire was developed to establish eligibility and identify potential issues in receiving the Healthy Start entitlement and carried out with families attending Girvan Early Years Centre (EYC). Recommendations were made and activity agreed with our Early Years and Health Visitor colleagues based on the collated and interpreted data.
Activity included: • Girvan EYC serving as a distribution point for Healthy Start vitamins • Sustained input from Assistant Nurse Practitioner who advised on the importance of vitamin supplements for children under 5, pregnant and breastfeeding mums • Enhanced promotion of the Healthy Start scheme in the centre and local area • Support for eligible families to complete application forms The combined activity, which forms part of the local Healthy Weight Strategy, has led to a significant increase in the number of vitamins being collected by families. Prior to the initiative, six bottles of Healthy Start vitamins were distributed from Girvan Community Hospital between January and June 2017. Since targeted work started in August 2017 there have been a total of Next steps: 128 bottles issued from Girvan EYC up until February 2018. We will continue to monitor and evaluate the Healthy Start scheme in Girvan and support similar activity in identified areas in South Ayrshire
New Developments
Ayrshire
Dalmellington Young Person’s Sexual Health Outreach Service This year we supported the establishment of a Young Person’s Sexual Health Outreach Service in Dalmellington to improve access to education, contraceptive advice, pregnancy testing and STI screening. The service was developed in order to support the five high level outcomes of the Sexual Health and Blood Borne Virus Framework. The purpose of the pilot programme is to provide a sexual health service that includes information/discussion around general health and wellbeing, mental health issues, lifestyle factors including diet, exercise, alcohol, smoking and drugs. The outreach service utilises a multi-agency approach linking with Doon Academy and a local youth service as well as supporting a local LGBT group hosted by Vibrant Communities. It is hoped that the drop-in sessions delivered by the GP Practice Nurse in the school setting and at Dalmellington Health Centre will support a downward trend in teenage pregnancy rates. Signposting and referral to appropriate services is also offered.
This service development aim to support the outcomes of the national Sexual Health and Blood Borne Virus Framework, namely: Next steps: • • •
a reduction in BBV, STI and unintended pregnancy a reduction in health inequalities an opportunity to discuss sexuality, raising awareness of abuse, coercion and harm while promoting healthy relationships
Continue to contribute to the development of the service including providing resources, advice and support to facilitate awareness sessions for young people.
New Developments Better Health Hub, Crosshouse Hospital As part of our actions to support the Health Promoting Health Service agenda, which is about the health service supporting and promoting better health, we have been continuing to implement the ‘Better Health Hub’ (formerly called the Health Information and Support Centre) at University Hospital Crosshouse. The service was set up to provide patients, carers, visitors and staff the opportunity to have a: • • •
holistic, person centred discussion about health and wellbeing, support to identify with them what may help improve this, and, link them into services and supports.
The focus of the service is on the provision of quality conversations about health and wellbeing. Over the course of the year, the team have been working closely with staff within the acute hospital setting to develop a programme of training that will enable them to facilitate initial discussions about referral to the Hub. This has included developing a training needs assessment to be carried out with hospital staff. A marketing plan is being implemented which has seen the team engage numerous professionals and partners in discussions to promote the service. This includes medical and nursing staff, Allied Health Professionals, Patient Transport and Pharmacy. We have also made connections with key partners working within our Health and Social Care Partnerships and Local Authority areas to ensure people are linked into supports at a local level. This includes money advice services and housing.
Next steps: Consider findings from the evaluation and use this to inform future developments including, supporting other identified hospital sites to develop Better Health Hubs.
New Developments Social Isolation and Loneliness Social isolation and loneliness can affect anyone. Research over the last two decades has highlighted the growing ‘epidemic’ of social isolation and loneliness as well as the significant impact it can have on a person’s physical and mental health.
•Increases risk of high blood pressure •Higher risk of the onset of disability
•Greater risk of cognitive decline •64% chance of developing clinical dementia •More prone to depression •Predictor of suicide in older age
Independence
•As harmful as smoking 15 cigarettes per day
Mental health
We have focused our initial work on a preventative framework that considers differing individual circumstances.
Health impacts of social isolation and loneliness
Physical health
NHS Ayrshire and Arran’s Health Improvement team have been taking steps to raise awareness of this emerging “public health issue” affecting individuals across the life course and identifying ways to work in partnership to tackle this issue across the three Ayrshire localities. It is recognised that there is a wide range of work currently taking place contributing to tackling social isolation and loneliness, either directly or indirectly. We have been taking steps to work with health and social care and community planning partnerships to support this agenda and recommend these partnerships consider a strategic direction to tackle this priority area.
•More likely to visit GP and higher use of medication •Early entry into residential nursing care •Higher use of accident and emergency services
Next steps: Develop and start to implement a 3 year action plan for the Public Health department and continue to support local health and social care and community planning partners to tackle social isolation and loneliness.
Next Steps Public Health Priorities The 2016 Health and Social Care Delivery Plan highlighted the Scottish Government and COSLA’s commitments to develop a set of public health priorities for Scotland by Spring 2018. During 2017/18, as part of the Public Health Reform, work took place across Scotland to engage with a wide range of partners and stakeholders from the public and third sectors. Additionally, public health experts undertook a review process in order to develop a set of national Public Health Priorities that reflect the issues where we can make the greatest difference to health. In June 2018 the Public Health Priorities for Scotland were officially published. As part of the Public Health Department, these priorities will be used as a basis for forward planning and future reporting of our health improvement work. Therefore, we wanted to use this report as an opportunity to highlight the areas that will form the focus of public health work over the next decade. These are as follows:
Priority 1 A Scotland where we live in vibrant, healthy and safe places and communities
Priority 2 A Scotland where we flourish in our early years
Priority 3 A Scotland where we have good mental wellbeing
Priority 4 A Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs
Priority 5 A Scotland where we have a sustainable, inclusive economy with equality of outcomes for all
Priority 6 A Scotland where we eat well, have a healthy weight and are physically active
It is recognised that these priorities do not reflect everything that contributes to population health in Scotland. However, the hope is that these priorities can provide a foundation for systematic change. We look forward to continuing to strengthen our partnership work in the hope that focusing our collective efforts in these areas can achieve substantial improvements in health and lead to the greatest reduction in health inequalities in Ayrshire and Arran and across Scotland.
Thank you for reading.
Follow us on Twitter: @PublicHealthAAA
https://en.wikipedia.org/wiki/Goal
