Health Promotion Service Annual Report 2008

Transcription

1 08 Health Promotion Service Annual Report 2008

2 Forward Foreword - Charles Winstanley This October I had the chance to speak to an unusual audience. Three hundred young people at Howden St. Andrew s Primary School sat politely as I was able to congratulate them on becoming the first school in the Lothians to receive Stage 3 accreditation in the healthyschools+ programme. Teaching young people about healthy diets, oral hygiene and exercise is essential and, while the lessons might not always be reinforced at home, the seed is sown for their future lives as adults. As the Scottish Government s Patients Rights Bill reaches its final draft, it is an interesting time to reflect on our legitimate expectations of patients and the general public. While it is wholly appropriate that our patients in Lothian should expect equity of access to effective NHS treatment, it is perhaps equally reasonable that we in turn expect our patients to take some responsibility for the way they treat themselves. Whether it is their choice of food, decision to stop smoking, or using drugs or alcohol, their attitude towards exercise, or their approach to sexual health, in my view we have an obligation to supply them with the information to help them exercise this responsibility. The NHS Lothian Health Promotion Service has a key role to play in this process. I have seen for myself the excellent work that my colleagues in the Health Promotion Service have been doing in the period covered by this annual report. I welcome the start made on performance management, and discussed this with the service on one visit. The Health Promotion Service has rightly identified the need to measure its contribution to system targets. The capacity building programme has continued to provide training to our staff and partner organisations. I found the example of training for physiotherapists in health behaviour change particularly imaginative - physiotherapists are ideally placed to support clients in dealing with some of the root causes of health problems. The 3,431 members of our excellent NHS Lothian Health Promotion Library and Resource Centre at Deaconess House appreciate the depth and breadth of its services, with a high demand for information and nearly half a million leaflets issued. I fully support the notion of aligning health promotion work with health improvement in Community Health Partnerships and Community Health Care Partnerships (CHP/CHCPs). The report is frank about some of the operational problems encountered in moving towards an effectively functioning relationship. In my view it is essential that we work with locally identified health priorities, and that our own staff work closely with their council and voluntary sector equivalents. I commend this annual report to you, and in doing so thank my colleagues at the Health Promotion Service for their hard work and commitment. Charles Winstanley Chair, NHS Lothian Health Promotion Service Annual Report

3 Introduction Contents Foreword 01 Introduction 02 Background and context 02 Programme development 04 Organisational and partnership development 14 Information and knowledge management 18 Workforce development 21 Looking to the future 25 Staff list 25 Introduction Welcome to the NHS Lothian Health Promotion Service (hereafter HPS; the service) Annual Report, During this year the service has consolidated its structure and focus following a number of developments described in the previous annual report. This report updates on the progress of the Health Promotion Service in carrying out its four main functions: Programme development Organisational and partnership development Information and knowledge management Workforce development This report can only provide a snapshot of what has been achieved and developed. For further information about the HPS please contact us: NHS Lothian Health Promotion Service 3rd Floor Lauriston Building Lauriston Place Edinburgh EH3 9HA Telephone hps.info@nhslothian.scot.nhs.uk Background and context What is health promotion? Health promotion has been defined by the Ottawa Charter 1 as the process of enabling individuals and communities to exert control over the determinants of health and thereby improve their health. It is also a practical approach to tackling health inequalities and so improving health. Health promotion is an internationally recognised specialist discipline. Some of the sub-specialist areas within health promotion overlap with sub-specialisms within public health, and others are unique within the fields of public health and health improvement. As an approach, health promotion strengthens the skills and capabilities of individuals to take action, and develops the capacity of groups, communities, organisations and institutions to act collectively to exert control over the determinants of health. Over the last few years there has been a move, across Scotland, to integrate health promotion into the work of all healthcare providers, albeit with an emphasis on the treatment of illhealth. The Health Promotion Service s prime focus is to drive forward the health inequalities agenda, influence others activities and co-coordinate and evaluate effort. Underpinning the work of the service are the following principles: Guiding principles of health promotion 2 1. Health promotion addresses health issues in context and recognises that many individual, social and environmental factors interact to influence health. 2. It supports a holistic approach that recognises and includes the physical, mental, social, ecological, cultural and spiritual aspects of health. 02 Health Promotion Service Annual Report 2008

4 Introduction 3. It requires a long term perspective as it takes time to create awareness and build understanding of health determinants. 4. It supports a balance between centralised and decentralised decision-making on policies that affect people where they live, work and play. 5. Health promotion is multisectoral. While programme initiatives often originate in the health sector, little can be done to change unhealthy living conditions and improve lifestyles without the support of other people, organisations and policy sectors. 6. It draws on knowledge from a variety of sources, depending on formal knowledge from the social, economic, political, medical and environmental sciences. It also depends on the experiential knowledge of people. 7. Health promotion emphasises public accountability. Those providing health promotion activities need to be accountable and to expect the same commitment from other individuals. NHS Lothian Health Promotion Service NHS Lothian Health Promotion Service works in partnership with various local authority departments, voluntary organisations and communities across Lothian to address the wide range of factors that impact on people s health and quality of life. These factors include income, education, employment, living conditions, other environmental factors, lifestyles and behaviours. Specifically our service tackles health inequalities and improves health by developing knowledge and skills through various approaches including: Empowerment and enablement Raising consciousness Community development Influencing attitudes and behaviours Influencing and informing policy Improving the physical and social environment. The service also provides training, consultancy, resource development and health information material as well as monitoring, evaluation and project management. Policy and strategic context The work of the service is informed by national and local strategies and polices as well as local communities concerns and issues. During 2007/08 the Scottish Government launched Better Health, Better Care - an action plan to improve health and healthcare in Scotland. The action plan recognises that whilst Scotland s health is improving overall in general terms, with increasing life expectancy, inequalities in health are widening and poor mental and physical health is both a cause and consequence of social, economic and environmental inequalities. In response to this, the Scottish Government set up a ministerial task force on health inequalities whose remit was to identify and prioritise practical actions to reduce the most significant and widening health inequalities. This reported in May 2008 and the implications of the report are being addressed in forward plans for the Health Promotion Service. The emphasis on social, economic and environmental factors as determinants of health inequalities has continued across the social and economic policy and strategy framework for Scotland. This cross-governmental, broad policy perspective is reflected in the move towards partnership working with local government on single outcome agreements - a mechanism which has the opportunity to balance national aspirations (outcomes) but recognise the importance of local policy and strategy in the way that these are delivered. Health Promotion Service Annual Report

5 Programme development

6 Programme Development This section of the report describes just four of the programmes out of the 14 that the service is currently delivering; a table at the end of this section illustrates our contribution to achieving the Health Efficiency Access and Treatment (HEAT) targets and Single Outcome Agreement (SOA) indicators. Some of our programmes are well-established whilst others are currently being scoped in order to identify what could be developed in the future. For example, we are currently scoping community violence and examining the potential for leading a community violence demonstration project in Midlothian. Other programmes include sexual health, alcohol, drugs, tobacco and young people, workplace, health promotion and the sex industry, food and health, physical activity, schools, children and young people, older people and capacity building. All health promotion programmes aim to tackle health inequalities, improve health and enhance quality of life. It is necessary that outcomes are seen in a holistic context. Our programmes are designed from a perspective that seeks to reduce inequalities and increase positive good health, rather than an approach that only seeks to reduce ill health, as this can result in a focus on ill-health rather than the broader determinants of health. 1. Workplace programme Introduction The role of the workplace team is to support organisations across Lothian interested in improving staff health either through specific interventions or by registering with the Healthy Working Lives (HWL) award programme. Strategic context The Healthy Working Lives award programme was launched in April 2007 by the Scottish Centre for Healthy Working Lives. The Centre was created following the Scottish Executive "document" Healthy Working Lives: a plan for action" ( 2005 )" which reinforced the importance of supporting people of working age. Other key strategic documents include: Workforce Plus: An employability framework for Scotland (2006) The National Programme for Improving Mental Health and Wellbeing (2001) Let s Make Scotland More Active: a strategy for physical activity (2003) Scottish Action Plan on Health and Safety (2007) Capacity building programme As part of the Health Promotion Service Capacity building programme, the Workplace team delivered four training sessions: Men s health Back care in the workplace Healthy Working Lives award Physical activity/healthy eating Delegates attended from a range of organisations across the Lothians. In addition sessions on alcohol and drugs policies and awareness were delivered within two organisations. Resources The team regularly signposts organisations to the Library and Resource Centre for Health Promotion Service Annual Report

7 Programme Development leaflets, posters, videos and books to support their health campaigns. The team participates in the annual review to ensure that the resources available are up to date and relevant. A leaflet "Lifestyle tips for shift workers" was developed and designed by the team with support from NHS Lothian s Communication Team. Publication and distribution will occur later this year. The Workplace team s newsletter, Workplace, is designed in house and distributed to 190 organisations in Lothian. Publicity/communications coverage In January 2008, the Scottish Centre for Healthy Working Lives hosted an awards ceremony for organisations that had received a HWL award since the launch. Four organisations from Lothian received awards and one also received a Mental health and wellbeing commendation award. Following on from the ceremony a number of the Lothian-based organisations were featured in articles in local and national newspapers. These include East Lothian Council, St. John s Hospital and Lothian and Borders Fire and Rescue Service. Community Health Partnerships The Workplace team contributed to the away day for Midlothian CHP. The Workplace team is represented on the Healthy Working Lives groups established within East Lothian and Midlothian CHPs and West Lothian CHCP. Performance outcomes There are 90 organisations registered with HWL covering employees from across public, private, NHS and voluntary organisations. Since the launch of the award programme, there have been six gold awards, three silver and three bronze achieved within Lothian, in addition to the Mental health and wellbeing commendation award. Summary of future action The Workplace team will continue to support organisations across Lothian interested in promoting staff health and wellbeing. 2. Physical activity and health programme Strategic context Physical inactivity is a major public health issue and therefore high on the agenda at national and local levels. Let's Make Scotland More Active (Scottish Executive 2003) is the national physical activity strategy for Scotland, which sets the target to increase and maintain the proportion of physically active people in Scotland. Service level agreements/funding The Health Promotion Service has service level agreements and partnership agreements with a range of partners to help the delivery of the physical activity programme: Midlothian Community Health and Fitness Officer post Tackling health - rugby pilot project and evaluation. The Health Improvement Fund supports the following programmes of work: On the move (West Lothian) Move-it (Pilton) Healthy moves (Wester Hailes). 06 Health Promotion Service Annual Report 2008

8 Programme Development Capacity building programme Research has shown that knowledge of the key physical activity and health message is not widely known, and many people still think you have to be vigorously active to protect your health. This is not the case, and the Health Promotion Service run a full day training course A little physical activity means a lot twice yearly as part of the service s capacity building programme to raise awareness of the key messages. The service has also developed a new training programme called Feel fit, feel good which is about physical activity and mental health. This programme will run every six months starting in Resources In partnership with Edinburgh Leisure and City of Edinburgh Council, the Health Promotion Service has contributed to the production of a DVD for year olds in Edinburgh. This DVD promotes physical activity in its broadest sense, and provides a base of information to signpost children onto local services and projects where they can take part in physical activity. A Health Promotion Service pull-up banner has been developed with correct physical activity and health messages. Community Health Partnerships The CHPs/CHCPs are each involved in their local Physical Activity & Health Alliance groups. Work is currently underway in Edinburgh and Midlothian to develop an exercise referral scheme which takes into account social inclusion and sustainability. The Health Promotion Service is a key part of this process to ensure the approach adopted is consistent with the evidence base. The service is also working with West Lothian s On the move - the West Lothian exercise referral scheme. Summary of future action Further work is required to increase awareness of physical activity with policy makers and the general public. Midlothian and the City of Edinburgh currently have draft action plans; these need to be finalised and implemented. 3. Schools programme Introduction During the year work has been developed by a number of senior health promotion specialists throughout the Lothians focusing on the schools setting. This includes: The continual development and implementation of the Health Promoting School (Edinburgh and the Lothians healthyschools+ scheme) Mainstreaming and continuation of Sexual health and relationships education (SHARE) training from Healthy Respect to the Health Promotion Service Strategic development and support for education services (or equivalent) and partners in relation to food and nutrition, including breakfast club provision and guidance for nutritional standards Strategic support for the City of Edinburgh in relation to a review of drug education provision and the delivery of a training course entitled Cocaine in my brain Strategic development and implementation of the Tackling health project which focuses on physical activity and health improvement. Health Promotion Service Annual Report

9 Programme Development Strategic context Traditionally schools have been institutions that focus on education and attainment. Within the past five years however, this has changed and various targets, policy documents and education frameworks have set the direction for more work with regards to improving the health and wellbeing of our children and young people. The following strategy/policy documents are examples of the many which contribute to health improvement work for schools: Improving health in Scotland - the challenge (March 2003) identified the target that...all schools...become Health Promoting Schools by 2007 The Scotland (Health Promotion and Nutrition) Schools Act (2007) places a duty on schools to be health promoting and adhere to guidance in relation to food and nutrition Edinburgh and the Lothians healthyschools+ framework and scheme identifies a process for schools developing health promotion activity. Local authorities identified that all schools were to achieve stage one accreditation to meet the national target for health promoting schools. The national strategy for improving sexual health, Respect and Responsibility, identifies school aged children as a focus for work regarding sexual health and relationships. The revised HEAT targets no longer include a specific target around reducing teenage pregnancy but it still remains high on the agenda when the Health Promotion Service is developing sexual health improvement work. SLAs/Funding The Health Promotion Service has service level agreements and partnership agreements with a range of partners to help the delivery of health promotion work with schools, including with Roots and fruits, a project which supports the delivery of fruit to Nursery Schools in East Lothian. The service also has partnership agreements with the City of Edinburgh for its breakfast club programme and the Scottish Rugby Association (SRA) for its Tackling health project. Capacity building programme Health Promoting Schools Health Coordinator training has taken place with the majority of schools throughout Lothian having attended (324 schools) The service facilitates the Health Promoting School networks which provide opportunities for health coordinators to come together, to plan work, discuss health promotion issues and access training/updates SHARE training course was delivered three times with 45 participants from all sectors attending this three day course Young people, sexual health & risk training course was delivered as part of the capacity building programme for professionals working with young people, looking at practical ways of addressing risk behaviours Healthy Tuck shop/packed lunch training course for schools took place in West Lothian Training course entitled Cocaine in my brain co-facilitated with Crew 2000, with 48 participants. 08 Health Promotion Service Annual Report 2008

10 Programme Development Publicity/communications coverage The launch of the Tackling health rugby project, a partnership between the SPA and NHS Lothian, was promoted through a press release issued by NHS Lothian s Communications department. Community Health Partnerships Whilst work in schools has an impact in CHP areas, most work undertaken is through each local authority education department (or equivalent e.g. children and families departments or local neighbourhood partnership areas). Summary of future action Due to current re-direction from various national bodies including the Scottish Government and Learning Teaching Scotland, we are currently looking within Edinburgh and the Lothians at a mainstreamed approach to health promoting schools. This will consist of the current accreditation scheme from the healthyschools+ framework being incorporated into the quality improvement processes that education departments already implement. Two senior health promotion specialists will attend Respect training for trainers which is being delivered in partnership by Zero Tolerance and Healthy Respect. This will enable the service to work in partnership with Healthy Respect to develop capacity for primary teachers across Lothian to use the Respect pack in schools. Drugs education evaluation - we are currently awaiting the evaluation of substance use education findings before developing future action. The Cocaine in my brain course is currently being adapted before further courses run. Tackling health - evaluation to be completed by Glasgow University before any further activity is planned. Performance outcomes The number of schools which have achieved accreditation: City of Edinburgh East Lothian Midlothian West Lothian Total number of schools in local authority area Stage One Stage Two Stage Three Health Promotion Service Annual Report

11 Programme Development 4. Food and health programme Strategic context. Food and health is high on the agenda at both a local and national level. The main policy driver for improvements in diet and nutrition in Scotland is the Scottish Diet Action Plan (Eating for Health). More broadly, improvements in diet are supported by the key themes and priorities of the national regeneration policy, Closing the Opportunity Gap, and the Scottish Government s recent Better Health, Better Care: Action Plan. SLAs/Funding To support the delivery of the Food and health programme the Health Promotion Service provides funding for a range of activities across Lothian, supported by SLAs. These include: City of Edinburgh breakfast club programme Edinburgh Community Food Initiative East Lothian Roots and fruits Similarly, a range of activities are supported by funding from the Health Improvement Fund. These include: Children and young people food group in East Lothian Eatright in West Lothian. Health through diet for children and young people in Midlothian. Capacity building programme One of the key priorities of the food and health programme is to build capacity within the workforce to deliver effective food and health initiatives and messages as part of the Health Promotion Service capacity building programme, delivered twice yearly. Resource development A number of resources have been developed this year as part of the food and health programme. These include: Breastfeeding materials, including a breastfeeding calendar for 2008; diary covers for staff and a parents guide to NHS Lothian breastfeeding policy. These resources received positive publicity in the local press and internal NHS Lothian publications Health Promotion Service banner depicting healthy eating messages (one of a series of Health Promotion banners) The development of nutritional guidance for breakfast clubs to be included in a Breakfast in a box resource for schools. Community Health Partnerships The food and health programme works with a number of partners and organisations, including CHPs. These working links are made through local food and health strategy groups as part of local planning processes. The food and health programme leads on the development of a strategic approach to food and health in the City of Edinburgh. This work is driven forward by the Edinburgh food and health task group, directly linked to the Edinburgh CHP. Performance outcomes Action plans with overall aim of improving access and uptake of healthy food items are developed at a local level across Lothian Increased knowledge of food and health and increased confidence in delivering food and health activities and messages is achieved through training and networking opportunities Increased local knowledge of food and health initiatives is achieved through opportunities for sharing good practice and partnership working. 10 Health Promotion Service Annual Report 2008

12 Programme Development Summary of future action Further action is required to ensure consistency across Lothian. This will include building the structures and developing action plans to focus food and health activity in Midlothian and the City of Edinburgh. 5. Health Promotion Service, HEAT and SOAs A number of the HPS's programmes contribute to the Scottish Government's HEAT targets and Single Outcome Agreements. The table below illustrates the service's contribution to date. Health Improvement HEAT Targets Reduce mortality from Coronary Disease among the under 75 s in deprived areas. Physical activity, Food and health 80% of all three to five year old children to be registered with an NHS dentist by 2010/11 Child health Achieve agreed completion rates for child healthy weight intervention programme by 2010/11. Physical activity, Food and health, Child health and Schools Through smoking cessation services, support 8% of each NHS board s smoking population in successfully quitting (at one month post quit) over the period 2008/ /11 Tobacco and young people Single Outcome Agreement Indicator 21 Reduce mortality from Coronary Heart Disease among the under 75s in deprived areas Physical activity, Food and health Indicator 11 60% of school children in Primary 1 will have no signs of dental decay by 2010 Child health, Food and health, Schools Indicator 14 Reduce the rate of increase in the proportion of children with their Body Mass Index outwith a health range by 2018 Physical activity, Food and health, Child health and Schools Indicator 17 Reduce the percentage of the adult population who smoke to 22% by 2010 Workplace and Schools Health Promotion Service Annual Report

13 Programme Development Health Improvement HEAT Targets Reduce suicide rate between 2002 and 2013 by 20% supported by 50% of key frontline staff in mental health and substance misuse services, primary care, and accident and emergency being educated and trained in using suicide Capacity building Increase the proportion of newborn children exclusively breastfed at 6-8 weeks from 26.6% in 2006/7 to 33.3% In 2010/11 Food and health Achieve agreed number of screenings using the setting - appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11. Alcohol Single Outcome Agreement Indicator 15 Increase the average score of adults on the Warwick Edinburgh Mental Well - being Scale by Physical activity Indicator 16 Increase healthy life expectancy at birth in the most deprived areas. All Health Promotion Service activity Indicator 18 Reduce alcohol related hospital admissions by 2011 Alcohol and Schools Indicator 29 Decrease the estimated number of problem drug users in Scotland by 2011 Drug use and Schools Indicator 36 Increase the proportion of journeys to work made by public or active transport. Physical activity, Workplace Indicator 37 Increase the proportion of adults making one or more visits to the outdoors per week Physical activity, Workplace 12 Health Promotion Service Annual Report 2008

14 Programme Development Health Improvement HEAT Targets Single Outcome Agreement Indicator 7 Increase the proportion of school leavers in positive and sustained destinations Schools and Workplace Indicators 30 reduce the number of working age people with severe literacy and numeracy problems. Workplace Indicators 39 reduce to 1.32 million tonnes waste sent to landfill by Workplace Indicator 10 Decrease the proportion of individuals living in poverty. All topics and settings Indicator 28 Increase the percentage of adults who rate their neighbourhood as a good place to live Violence Indicator 31 Increase the positive public perception of the general crime rate in local areas. Violence Health Promotion Service Annual Report

15 Organisational and partnership development

16 Organisational and Partnership Development Intersectoral and partnership working is fundamental to health promotion. An effective health promotion service is one which promotes and develops partnership working. Organisational development and partnership development are inseparable core functions for an effective and evolving service. NHS Lothian Health Promotion Service is hosted by East Lothian CHP. Having a central, hosted service has been essential for developing the specialism of health promotion as well as retaining and strengthening Lothian-wide topic and setting specialist programmes and expertise to benefit all CHPs and to support the wider organisations and functions within NHS Lothian. Service integration with CHPs/CHCPs During the year work has progressed on developing service integration with CHPs/CHCPs with mixed success. The service has sought to align itself more closely with CHPs by forming four teams - comprising Lothian-wide setting and topic specialists with some existing geographicbased posts. Only the East Lothian Health Promotion team has successfully relocated to Edenhall. A lack of suitable accommodation has made this difficult for the Health Promotion Service and CHPs/CHCPs to implement in other areas. The role of geographic health promotion specialists, established to be based in CHPs, remains under review. This role could be seen as being setting- based, but as the arrangements and responsibilities within CHPs have evolved, the effectiveness of the posts has varied. Where there has been stability of a geographic health promotion specialist (e.g. in East Lothian) this has greatly assisted the integration of the Health Promotion Service within the Health Improvement team and planning arrangements. Geographic health promotion specialists in Midlothian are also consolidating their work within the Health Improvement team. Arrangements for West Lothian have been less consistent and within the Health Improvement Team in Edinburgh there has been a move to develop city-wide remits. Co-located with East Lothian CHP at Edenhall Hospital are the Workplace Team, Food & Health and Physical Activity Senior Health Promotion Specialists, a Team Leader and two administrative workers. Staff moved to Edenhall during October 2007 and the team is now well settled in its new home. Besides strengthening the links with East Lothian, the team continues to provide leadership and support for its health promotion programmes across Lothian. The co-location has enhanced opportunities for building relationships with other staff on site and this has lead to informal joint working. More specifically the team is working in conjunction with the East Lothian Public Health team and has run a half day event to develop the contribution the CHP can make to implementing East Lothian Joint Health Improvement Plan. A key element of the programme will consider how the Health Promotion Service can and does support health improvement work. As always, balancing the different elements of our diverse and developmental remit is a challenge. A briefing system for CHP/CHCP management teams has been piloted in order to improve information sharing and increase visibility of the Health Promotion Service s Health Promotion Service Annual Report

17 Organisational and Partnership Development contribution to tackling health inequalities in each CHP/CHCP. These briefings summarise work being undertaken and plans for the future. Following a review of this pilot, the briefings have proved most useful as sixmonthly CHP/CHCP Sub-Committee reports which can be presented to each committee by the Health Promotion managers. Business management and development The development of business management functions within the service has made major progress. Later sections of this report show the importance of sound and progressive business management, including finance and information and knowledge management. people in Lothian develop the knowledge and skills required to improve their health. In recognising that marketing and communication is a fundamental function of health promotion, during this year, the service has focused on developing a marketing and communication strategy. As part of this strategy we have monitored our press coverage. Examples include: Toni O Toole, Senior health promotion specialist (Alcohol) and her involvement with Edinburgh Drug and alcohol team and black and ethnic minorities, featured in Outlook summer edition and Connections Kerry Kempston, Health promotion vocational trainee and her involvement in Business Management and Development Information & Knowledge Management Databases Business Compliance Library & Resource Centre Effective Evaluated Contemporary Safe Progressive Pam Nicholson June 2008 Organisational & Partnership Development Performance Management Capacity Building Programme Marketing & Communication Strategy Health promotion and the prevention of ill health require an emphasis on providing individuals, communities, organisations and institutions with the skills, knowledge and motivation to make positive choices for health. The Health Promotion Service supports this by working with partners to reinforce these messages, through communication, marketing and clear signposting to services which can help helping to design a Polish migrant worker pack for West Lothian featured in Connections Kathryn Sinclair, Senior health promotion specialist (Workplace team) and her involvement with St John s Hospital and their water collection process developed as part of the Healthy Working Lives award, featured in Connections and The Guardian newspaper. 16 Health Promotion Service Annual Report 2008

18 Organisational and Partnership Development The strategy also ensures that contact details for our partners and partner networks remain appropriate and up-todate. IT management systems have been implemented to allow this to happen efficiently using existing NHS Lothian software packages with minimum modification. The system enabled our Capacity building programme brochure to be sent directly to 3,000 contacts in hard copy, and electronically through more specific individual networks. Individual information on events was ed directly to targeted individuals (recognised as the most appropriate to circulate the information throughout their organisations) so our reach was further expanded. Intranet The Health Promotion Service unfortunately experienced some delays in setting up an Intranet site last year due to IT issues. However, an IT Editorial group was initiated and a web tree for the service was designed with navigational templates for programme and setting section plans also drawn up. Look for us under Corporate - Health Promotion Service or - hps.info@nhslothian.scot.nhs.uk. for further information. Health Promotion Service Annual Report

19 Information and knowledge management

20 Information and knowledge management To ensure that the Health Promotion Service makes the right decisions in assignment of programme resources and investment, it is vital that good quality data is available and that staff work closely with colleagues to improve the quality and usability of available data. This means that the effectiveness of current service resources can be benchmarked, the impact of service changes can be more accurately monitored and more meaningful dialogue can take place with partners. The focus for developing the service during this year was firmly on ensuring that the workforce, the decision-making processes and the business management of the organisation were united to deliver the priorities set out for the year. Financial governance The introduction of the NHS Lothian Efinancial system enabled the Health Promotion Service to improve control and governance of its financial processes. The system allows access to the service s accounts for information and interrogation purposes, feeding in to the financial governance group. This group s management ensures that the Health Promotion Service acts in a manner which promotes safety and quality and provides a clear framework of accountability for the department. The Health Promotion Service internal control framework is underpinned by NHS Lothian s standing financial instructions. A need was identified to ensure that the community-based services we fund could demonstrate effectiveness and viability. The service developed an evidence based approach to commissioning services and supported them to become more efficient with service planning and processes. Community health development grants The service has a small grant scheme to promote and support community development approaches to reducing health inequalities. During this year this scheme used 50,000 to fund various projects across Lothian. Multi-agency steering groups led by the Health Promotion Service oversee a bidding process to allocate the grant funds within each local authority area. In some areas match funding is available from local authority partners. Case study: Physical activity opportunities for people with a disability in East Lothian Two projects funded during this year have increased access to physical activities for people with a disability and helped to challenge stereotypes of wheelchair users. The first project successfully set up a sports club for disabled young people. The second helped to expand wheelchair basketball. East Lothian Junior Wheelchair Basketball Club offers sessions in schools where able bodied and disabled young people can experience the sport together while Lothian Phoenix Basketball Team provides training sessions and opportunities to take part in league competitions, also for a mixture of able bodied and disabled athletes. The team coach summed up how this challenges stereotypes of disability as part of his evaluation report: I m not sure how many people are used to seeing a group of wheelchair basketball players walk and wheel into their local fast food restaurant. What they see is a typical sports team on a trip, with the usual group Health Promotion Service Annual Report

21 Information and knowledge management cohesiveness and team banter that you would expect to see...what will probably challenge the public s existing attitudes to disability is that this typical sports team includes wheelchair users that are clearly having a great time. The community health development grant scheme is valuable as it helps existing community development and health projects to develop new work. These pieces of work provide excellent value for money as they are supported by the infrastructure of the parent project. The scheme also increases the reach of the Health Promotion Service since it taps into the flexibility and creativity of the voluntary sector in making contact with and working with vulnerable groups to address their health needs. Small local organisations such as after school clubs and local women s groups are encouraged to take up health issues and provide health promoting activities as part of their programme. Relatively small amounts of money, in individual grants, can help to make innovative work a reality. Performance management The performance management framework is designed to assess the operational service as a whole and the indicators within in it seek to reflect the core functions of the service using available (or realistically obtainable) quantitative data on activity. The process of development and implementation has produced some predictable challenges and prompted some developments, including the need to develop further understanding of performance management across the service. designed to reflect the functions of the operational service as a whole - not the desired health promotion outcomes or performance indicators for NHS Lothian or partner organisations or performance management for specific programmes - has been and remains a challenge. For example, the framework was designed to assess performance on programme delivery across the service by choosing indicators from a sample of programmes which were initially chosen due to the quantitative performance indicators available for use. The service s performance management group has continued to work through these challenges, in particular to seek to develop programme performance management frameworks. A peer support/review process has been initiated to allow pairs of health promotion specialists working on different programmes to share knowledge and skills, and to work towards all programmes having a performance management framework. This will provide quantitative indicators of activity and, based on theories of change, a link to wider performance outcomes (HEAT; SOA targets) or strategy specific targets or objectives. The concept that the framework has been 20 Health Promotion Service Annual Report 2008

22 Workforce development

23 Workforce Development Developing the capacity of the health improvement workforce across Lothian to tackle health inequalities and improve health has been a key focus for the Health Promotion Service for a number of years. The service also strives to ensure that those without health improvement in their job title understand the critical role they can play in promoting health and tackling health inequalities with their patients, clients and colleagues. Capacity building programme The Capacity building programme continued to be a crucial part of the service as an effective, efficient and flexible way of fulfilling our responsibility in developing the knowledge and skills of the wider health improvement workforce. A hard copy of the training programme is produced every six months and 3,000 copies are distributed each time. This year the uptake of courses showed an increase of 10% over the previous year. The emphasis has been on increasing the range of courses in a way that is sustainable and meets an identified need. The courses offered are in line with current national and local strategies, policies and targets and are intended to increase the skills and knowledge of people working in the wider field of health improvement. Course content focuses on building confidence, influencing attitudes and reinforcing sound health promotion methodology in the health improvement workforce. The new courses, which include Cocaine in my brain and Alcohol awareness for black and minority ethnic group workers have also been fully subscribed. The training programme provides a group work skills course on a regular basis on the premise that basic group work skills are a key principle of a health promoting approach. The course is always popular and there is usually a waiting list. Of the total of 375 people who successfully completed courses during the year it was found that 81% of attendees were based in Edinburgh CHP, 12% from Midlothian, 6% from West Lothian and 2% from East Lothian. The majority (54%) of participants were from the voluntary sector, 20% were from a local authority or NHS background, whilst a small number (6%) of delegates were from private/commercial and other organisations. The capacity building programme also responds to requests for training from other agencies or parts of the NHS. For example, health promotion specialists provided input to continuing professional development for the NHS Lothian Public Health department on current health promotion approaches. Training sessions were also delivered to physiotherapists from Midlothian and East Lothian CHPs on an Introduction to motivational interviewing in health behaviour change. Motivational interviewing (MI) is a method that can support individuals with health behaviour change (HBC). However this work with individuals is set within the wider context of health promotion activity at multiple levels: political, economic, social and environmental, national and local (Health Scotland 2005). In February 2008, 19 physiotherapists from East and Midlothian attended Health Promotion Service training which was delivered using a motivational style by 22 Health Promotion Service Annual Report 2008

24 Workforce Development experienced, enthusiastic trainers. This course was innovative in terms of its creative, imaginative teaching style and the telephone follow up of participants once they were back in the work place. The process encouraged them to practise their skills and reflect on what they had learned. Follow up also provided information on the extent to which training had had an impact on HBC skills within the work environment. The participants reported that they had been able to motivate more than one client to make health behaviour change by using MI skills, often with challenging clients. Their confidence had increased and they were positive about continuing to practise in this way. In future years it is hoped that the training brochure will be available online, on both the intra- and internet to increase access to the information. Thought is being given to linking the learning outcomes and content of the courses to the Public Health Skills and Career Framework and attention will be paid to providing courses which are directly relevant to addressing health inequalities. In order to further our work in developing the knowledge and skills of the wider health improvement workforce, we need improved IT systems to facilitate the administration process. In relation to NHS staff, the NHS Lothian Empower core programme allowed us to capture applicant and course information whilst enabling the data held to be easily disseminated for quality control purposes. A process for the administration of individual courses was developed to include objective timelines for each with milestones clearly marked. This method of service development significantly increased our standards in time management for programme delivery. Vocational trainee programme The vocational trainee programme has developed over its second year. The two post holders continue to be supported by a multi-agency steering group with representatives from the University of Edinburgh, learning and development representatives from NHS local and national agencies, Scottish Government, Public Health and the voluntary sector. Placements have included: West Lothian - CHCP is auditing a primary school food and health teaching resource, and completing a scoping exercise on the health needs of the local ethnic minority community Health Promotion Service Children and Young People's team evaluating a Lothian-wide health promoting schools resource and providing recommendations which contributed to the improvement and mainstreaming of this resource. The Scottish Development Centre for Mental Health taking work forward in gender and health. This was achieved by setting up focus groups and workshops across Scotland. Subsequently the workshop developed on Mental health, empowerment, social networks and gender was selected to be presented at the Mental Health Europe Conference 2008 in Denmark. Future placements include climate change and health with the Scottish Government, a review of NHS Lothian smoking cessation services and work with Health Scotland around folic acid supplementation. NHS Lothian Health Promotion Library and Resource Centre The Library and Resource Centre is based Health Promotion Service Annual Report

25 Workforce Development at Deaconess House. It holds a wide range of books, teaching kits, DVDs and videos relating to tackling health inequalities and health improvement. The Library has 3,431 members. Membership is open to anyone living or working in Lothian. 3,000 people visited the library over the year and nearly 2,000 requests for information were received. There continues to be a very high demand for health information and 4,800 orders were fulfilled. In total 480,000 leaflets were issued. Information about the Library and Resource Centre, including a regularly updated bulletin of new resources and a leaflet and poster catalogue, is available on NHS Lothian intranet in the Training and development section. Health campaigns which were supported in this year include Sun Safety; National Smile Month; Child Safety Week; World Aids Day and National No Smoking Day. Materials for these were distributed throughout Lothian. A library review group has met regularly to consider developments over the past year. Actions include rationalising stock and storage systems, developing IT systems and e-lib, monitoring campaign and health promotion materials and usage. As more journals became available online through e- lib, the number and type of journals held was reviewed in consultation with NHS colleagues. A comprehensive review of all library stock, including books, teaching kits, videos and DVDs was carried out with the assistance of the health promotion specialists. This helped to ensure that resources held were up-todate and appropriate for use. The Library and Resource Centre staff are working with other NHS Lothian libraries on developing the Quality Assurance Framework for Knowledge Services Supporting NHS Scotland (NHS Education for Scotland and NHS Quality Improvement Scotland). Continuing professional development (CPD) CPD is an important component of quality assurance for the Health Promotion Service as it enables further development and updating of professional knowledge and skills. The service aims to offer 40 hours of CPD each year. In the past year five CPD sessions were provided on: Mental health Children and young people (two sessions) Creative imaginative learning (see below) Networking. Creative imaginative learning (CIL) training course This year one of our vocational trainees and a senior health promotion specialist facilitated an invigorating CPD day that involved our staff in active learning on the techniques, principles and theories of CIL, which are core methods in the delivery of Kaizen training/ Lean in Lothian. CIL is promoted by NHS Health Scotland as a key methodology enabling effective delivery of training to the health improvement workforce. Staff had an opportunity to explore and experience the five key concepts of CIL - rich and multi-sensory, honour uniqueness, state is everything, keep it real, and creation not consumption. The aim of the CPD was to encourage the staff team to revisit past skills and learn new ways of delivering training, making their teaching methods more stimulating and engaging to the health improvement workforce. Subsequently the facilitators have delivered CIL training to the West Lothian CHCP health improvement team and the course is now offered as part of our capacity building programme. 24 Health Promotion Service Annual Report 2008