Health Promotion Service

Annual Report

2014-15

Foreword

I am delighted to commend the Health Promotion Service Annual Report to you. Health Promotion is an essential part of public health but it has a distinctive professional and public voice. We know that investment in effective health promotion interventions will engage people and empower communities, and that when we advocate with them to mediate and mitigate the impact of competing interests we can produce measurable improvements in health status and living conditions. By working with respect and compassion for all, health promotion staff and partners build the ability to tackle and bounce back from the everyday experience and consequences of health inequalities. Targeted and tailored interventions increase the likelihood that people will enjoy healthy, fulfilling lives while action with local communities and at national level addresses the wider determinants of health. Health promotion professionals enable people to look at individual and population challenges differently. The staff spread their expertise by training students, volunteers and staff across the NHS and in partner agencies, building skills and putting sound theory and research into practice every day. Essential activities for the people within the service can be summarised as: creating, implementing and communicating the evidence required to undertake interventions with an impact; collaborating with others to support and advocate for action in communities, shining a light on how a change in policy could improve people’s health and making it happen. This report provides ample evidence of all of these activities from helping young people to reach positive destinations to reducing

I am pleased to introduce the Health Promotion Service (HPS) Annual Report for 2014-15. It has been a busy year for the HPS. There have been some changes internally but our work, as shown here, continues. The purpose of the HPS is to lead the implementation of health promotion approaches to address health inequalities and improve health in populations across Lothian. The HPS strategy focuses the implementation of work towards short-term outcomes. The areas of work and figures presented here contribute to these outcomes. Some newer developments are shown, such as those dealing with the impact of welfare reform, the growth of food banks, and in prisons, whereas others are longer term, such as smoke-free homes and promoting mental health in the workplace. Our partnership work with local authorities and the voluntary sector continues and is evident in the report. This report is a snapshot of the work of the Health Promotion Service. If you would like to know more, please visit our website or get in touch using the contact details found at the end of the report. Moyra A Burns Health Promotion Service Manager

Introduction

(i)

hazardous drinking and making workplaces healthier. The ongoing commitment to learning, reflection, evaluation and improvement is clear. That this is achieved with such a small core team is impressive and demonstrates the value and quality of partnerships with professionals, third sector organisations and the public that has been built up over the years. Professor Alison McCallum Director of Public Health and Health Policy

Building capacity to tackle health inequalities

Mitigating the impact of welfare reform and identifying people at risk of poor health outcomes

The HPS was awarded a grant from the Scottish Government Health and Welfare Reform Development Fund to lead, plan, develop, action and evaluate work to mitigate the impact of welfare reform on health inequalities in Midlothian. Working collaboratively with MARCH (Midlothian Area Resource Coordination for Hardship) the project was formed with the objectives of:

• increasing NHS workers’ understanding of the impact of

welfare reform on health and health inequalities and their role in reducing health inequalities

• providing NHS workers with the knowledge, skills and confidence to address hardship issues linked to welfare reform, and to refer service users to advice and hardship support services as part of their routine practice

• patients/service users being actively supported to attend services to address their financial situation and hardship issues

• improving the health and wellbeing of people affected by money, debt and welfare issues.

A ‘Money Matters Health Toolkit’ for financial inclusion and hardship issues was developed in consultation with clients and health staff. The toolkit supports the introduction of routine enquiry about hardship issues by frontline health staff and facilitates better access to welfare and money advice and other specialist support services. All 41 clients who took part in the one year pilot said the toolkit was a helpful resource. Over half were identified as requiring support with at least one money-related issue. 11 said they were

happy to use the information in the booklet to contact an appropriate agency directly but another 11 asked their health worker to help them by making a referral on their behalf. Next steps will see the roll out of the toolkit to all health staff. Quotes from health staff include:

“It has helped to strengthen the partnership between the third sector and other health and social care providers including the council and NHS Lothian.”

Tracy McLeod

“Internally it has given staff a language to talk about health inequalities’… and…‘we can talk sensitively with service users about how their living circumstances might be affecting their health.”

1

14 new information resources produced to support evidence-based practice

Building capacity to tackle health inequalities

Community health projects

The HPS supports 28 projects across Lothian that work to address health inequalities. These are funded through a mix of HPS funding, Health Improvement Funding and other external sources. The work of the projects contribute to multi-agency strategic outcomes. They cover a breadth of activities, including welfare reform, early years, food and health, physical activity, tobacco, lesbian, gay, bisexual and transgender (LGBT) health and wellbeing and older people. The projects are supported by Link Officers from the HPS. This role is varied and requires knowledge and skills around partnership working and co-production to build close working relationships with individual projects. Part of the role involves ensuring Service Level Agreements and annual action plans are agreed and that budgets are managed appropriately. Link Officers also have a role in facilitating equalities monitoring. An impact assessment is conducted every three years, or if there is a change in funding, to ensure that action plans are targeted at harder to reach populations and have inequalities-focused outcomes. Projects report six-monthly on progress and the Link Officers work with staff to support robust monitoring and evaluation methodology with a view to ensuring the sustainability of the project.

Over the past two years the HPS had led the co-production of a streamlined monitoring and reporting framework to produce an agreed joint annual report for the varied funding streams. This has been piloted with several of the projects.

Sue Muir & Helen Smart

Picture produced with permission from Broomhouse Community Health Project

85% of

community health projects can evidence equalities monitoring

2

64% of projects have a community

engagement component

100% of projects supported by HPS staff

work with people in the 20% most deprived

areas

Reducing barriers to healthy living

Food banks and food poverty Across Edinburgh, there has been increasing concern about the number of people accessing food banks. A food bank is a not for profit distributor of publicly donated food. Throughout Edinburgh there are approximately five organisations that provide the majority of the food bank service. The HPS led work to ensure that food bank provision was linking in to existing services to provide an opportunity for users of food banks to access other support services. The Edinburgh Food and Health Task group, which comprises NHS Lothian, City of Edinburgh Council and voluntary sector staff members, was tasked with engaging and working with food bank providers to aid links with support services. A half day network event was facilitated for frontline staff and volunteers. Two further sessions for the organisations involved provided an opportunity to link food banks with welfare advice services and promote good practice within this field. Following up on links made at the initial networking day, the group were successful in securing funds from the Scottish Government Emergency Food fund which enables the provision of a Citizens Advice Bureau worker based within one food bank network. This work was presented at the 2014 Annual Scottish Faculty of Public Health Conference.

Tracy McGillivray

Picture by NHS Lothian

3

Tackling the causes of health inequalities at strategic level

Improving positive destinations in East Lothian Approximately 10% of young people across Lothian currently experience difficulty in accessing employment, education or training on leaving school. Improving positive destinations for children and young people is a key priority for the Scottish Government

and a number of policies have been developed

aimed at improving post-secondary opportunities for this population.

1, 2 A Scottish Government commission set up in 2013

also produced a number of recommendations aimed at delivering high quality vocational and training provision in order to develop and maintain a skilled workforce.

3

Local authorities and the NHS have a key role in the implementation and delivery of strategies and interventions to increase the numbers of young people achieving positive destinations on leaving school, as do a range of third sector organisations. Over the last few months, the HPS has been working with partners from East Lothian Council, NHS Lothian, Edinburgh College and the third sector on a short life planning and delivery group. The Positive Destinations group is one of six children’s strategic partnership groups whose purpose is to inform East Lothian Council’s Children’s Strategic Partnership Planning Group (CSPPG) in its role in Integrated Children’s Services Planning. The group is responsible for advising the CSPPG on the delivery of integrated services and for improvement planning, self-evaluation and performance reporting within the area of positive destinations.

The tasks included: overseeing the review, update, implementation and delivery of current work plans within the Services for Children Improvement Plan, developing outcome indicators and measures of success, engaging the multi-agency workforce in planning and evaluating service delivery, developing, monitoring and ‘joint’ self-evaluating the theme area, producing/updating annual work plans, and identifying service gaps. The HPS also provided input to the Mental Health and Wellbeing work stream.

Helen Smart

1 The Scottish Government (2012) Opportunities for All: supporting young people to participate in post-16 learning, training or work.. Edinburgh: the Scottish Government

2 The Scottish Government (2012 a) Action for Jobs – Supporting Young Scots into work; Scotland’s Youth Employment Strategy. Edinburgh: the Scottish Government. 3 The Scottish Government (2014) Education working for All: commission for Developing Scotland’s Young Workforce: Final Report. Edinburgh: The Scottish Government

4

35 national, Lothian or local policies and

strategies, and 25 Lothian or local action

plans influenced by HPS

Picture produced with permission from Broomhouse Community Health Project

Health promoting environments

Mentally healthy workplaces The Workplace Team provides a range of advice and resources to organisations to support them to address mental health issues in the workplace. Many employers underestimate the prevalence of mental health problems at work. The Scottish Association for Mental Health’s report, “What’s it worth now?”

1 estimated that

mental health problems at work cost Scottish employers £2 billion per year. Support is provided to organisations to conduct wellbeing surveys and/or stress audits to identify key areas for action.

The Team delivers the nationally recognised Mentally Healthy Workplace training for managers. Six courses are held per year, attended by managers from a range of organisations. Managers are provided with information on managing mental health in the workplace and are given an opportunity to share experiences with counterparts from other organisations. The feedback received indicates that this is a key benefit of the course. In response to a number of requests, the Team has developed and delivered training to complement existing wellbeing programmes in different organisations. For example, delivering training and awareness sessions to over 200 managers within one organisation led to a reported increase in knowledge and confidence among the management in relation to mental health in the workplace. In addition, there was significantly increased level of staff engagement in their developing mental health and wellbeing strategic programme.

The Team also continues to promote the NHS Lothian “Stress Control” courses held across Edinburgh and the Lothians. The aim of the course is to help participants to understand the psychological aspects of stress and to learn how to cope better with stress in their lives. The number of attendees from workplaces has increased this year.

Kathryn Sinclair, John Brennan, Danny Burns, Maria Campbell, Clare Casciani & Julie Hunter 1 http://www.centreformentalhealth.org.uk/pdfs/what's_it_worth_now_report.pdf

“Informative and help-

ful. Useful to hear

about other people’s

experiences.”

208 employers

engaged with Healthy Working Lives services

148 employers supported in the development

of health, safety and wellbeing action plans

174 different employees attended training

and awareness raising sessions

37 training and awareness sessions

organised

5

Increasing confidence, knowledge and skills in target populations

HMP Addiewell ‘World Hepatitis Day’ 2014

World Hepatitis Day takes place annually on 28 July to increase awareness and understanding of viral hepatitis, and to call for access to treatment, better prevention programmes and government action.

1

It is estimated that approximately 39,000 people in Scotland are living with Hepatitis C, and approximately 50% of those infected with the virus are unaware that they are.

2 Research conducted in

2011 found that Hepatitis C antibody positive prevalence at HMP Addiewell was 16%, and that 41% of these were unaware of their status.

3

Given the high prevalence of Hepatitis C within prison populations, NHS Lothian, in partnership with Sodexo Justice Services and external agencies who work with HMP Addiewell, organised a Hepatitis C awareness-raising information campaign, and a number of awareness-raising interactive educational sessions in the prison to coincide with World Hepatitis Day.

Delivery of such activities is in line with strategic frameworks,

4 5 the

vision of a health promoting prison and the taking forward of health promotion in a comprehensive and integrated approach.

The awareness-raising campaign included information on the Hepatitis C virus and its transmission, how it affects people, information on why and how to get tested, as well as where people can access further support, both within the prison and also in the community.

Key messages were highlighted via poster and leaflet displays and distribution across the prison, including in the prison wings, the Health Centre and the main staff areas. Information and leaflets were also available for visitors in the visitors centre. Six 30-minute awareness-raising interactive educational sessions were scheduled to allow more in-depth discussions on Hepatitis C and included information on Hepatitis C prevention, testing, treatment and support. Engagement and feedback from offenders and staff, although predominantly informal, was positive.

Sabina McDonald 1.http://worldhepatitisday.org/en 2. http://www.hepcscot.org/ 3. Taylor, A., Munro, A., Allen, E., Dunleavy, K., Hickman, M., Cameron, S. and Miller, L. (2012) Hepati-tis C Prevalence and Incidence among Scottish Prisoners and Staff Views of its Management. 4. http://www.hepatitisscotland.org.uk/files/1913/9662/6738/World_Hepatitis_Day_Campaign_Pack_2014.pdf 5. 'Better health, better lives for prisoners: A framework for improving the health of Scotland's prison-ers' (ScotPHN, SHPMG and SPS 2011). Web reference: http://www.scotphn.net/projects/previous_projects/health_improvement_in_prisons

6

85% of HIF, Ageing Well and third party grant

projects contain actions to increase confidence, knowledge and skills amongst their target population

Furthering knowledge and use of evidence-based practice

Research study: protecting children from second-hand smoke

Developments around legislation and shifts in attitudes have reduced levels of exposure to second-hand smoke. However many children, particularly those from more deprived socio-economic backgrounds, have higher levels of exposure in homes and cars.

The HPS has collaborated with the University of Edinburgh to explore the particular challenges mothers living in difficult circumstances face when attempting to protect their children from second-hand smoke exposure.

1

Funded by a grant from the Edinburgh and Lothians Health Foundation (ELHF), the study found that mothers are motivated to protect their children but efforts to do so are constrained by factors including people’s places of residence changing, single parenthood, children becoming more active so needing close supervision and parental smoking.

503 homes signed up to the smokefree home

pledge 133 primary schools engaged in smokefree

homes across Lothian

12 contributions to research

41 contributions to conferences,

seminars, workshops and consultation events

29 contributions to Lothian-wide or

national professional networks

7

A further grant has been awarded by the ELHF in order to allow the research team to work with a group of parents and practitioners using a co-production approach, to turn the results from the original study into practical ways to reduce harm to children whose parents experience barriers to smoking outside.

Colin Lumsdaine 1 Rowa-Dewar, N, Lumsdaine, C, Amos, A. Protecting Children From Smoke Exposure in Disadvantaged Homes. Nicotine & Tobacco Research (Oxford), 2015, 496-501

Furthering knowledge and use of evidence-based practice

Resource Centre

The Resource Centre provides a range of information services for anyone living, working or studying in the Lothians. This includes the dissemination of national campaign materials, leaflets, posters, teaching and training packs. The Resource Centre also has responsibility for dealing with all enquiries within NHS Lothian relating to the NHS Education for Scotland (NES) Knowledge Network and the administration of related Athens accounts.

8

2,874 visitors to the Resource Centre

367,986 leaflets provided to support

professionals in their roles

2,005 training or educational resources

loaned

2,072 requests for support responded to for

the NES Knowledge Network

Promoting opportunities for volunteering, engagement and life-long learning

Ageing Well in West Lothian, East Lothian, Midlothian and the City of Edinburgh The HPS funds Ageing Well projects across Lothian. The aim is to improve, maintain and promote the physical and mental health and wellbeing of older people (50 years+) and improve their quality of life. The focus of the HPS funding is on those who are more likely to experience health inequalities. Ageing Well West Lothian is delivered by West Lothian Leisure, who employ the project coordinator. Whilst people benefit physically by taking part in the range of physical activity opportunities offered, such as walking, line dancing, yoga, tea dances, Tai Chi and New Age Curling, the biggest benefits reported have been to mental health. By being more active, people learn new skills, meet people and become involved in volunteering. Lifelong learning and volunteering is hugely beneficial for mental health and wellbeing.

1 Recent

developments include the ‘Knit and Knatter’ group, where people socialise whilst learning and developing their knitting skills. Blankets, hats, booties and jumpers have been knitted for premature babies at St John’s Hospital and various charities. Knitted breasts have been provided to support the NHS breastfeeding education programme and penguin jumpers for the penguin sanctuary near Oban. There is a ‘Singing for Health’ group and a ‘Silver Sunday’ event where people are encouraged to bring someone who is at risk of isolation.

The volunteer programme ensures a sustainable approach to the delivery of activities as do the other Ageing Well projects in East Lothian, Midlothian and the City of Edinburgh. Often, people who take part in activities go on to become volunteers and all receive appropriate training and support. This ensures the programmes are not dependent on expensive tutors and encourages a peer-led, community approach which also benefits the health and wellbeing of the volunteers. There is the same focus on participation, lifelong learning and volunteering in each project.

In East Lothian volunteers are recruited to help run monthly tea dances in North Berwick, which are open to residents from the local nursing homes and service users from the day centre. Walking football for older men has been re-launched in Musselburgh and a team will be competing at the Walking Football Festival in June. 1 New Economic Foundation (NEF) 2011, Five Ways to Wellbeing; New Application, New Ways of think-

ing, NEF

64% of HIF*,

Ageing Well and third party grant projects have a core volunteer component * Health Improvement Fund

75 different

settings in which Ageing Well activities take place

9

Pictures produced with permission from West Lothian Ageing Well

Promoting opportunities for volunteering (continued)

In Midlothian there were 38 active volunteers with the project last year. Volunteers led walks, singing, dancing, curling, table tennis, walking football and functional fitness testing. The volunteers contribute to shaping the Midlothian Ageing Well Action Plan to ensure activity is in line with identified needs. There is an annual award ceremony highlighting their contributions. Ageing Well Edinburgh currently has 51 active volunteers who contribute 100 volunteer hours a week. At the Celebrating Older Adults day in October 2014 (to mark International Day for Older People) Bette Bell (age 83) won an “Outstanding Contribution” award. The judges said of her 13 years of volunteering: “Bette has helped literally hundreds of older people throughout Edinburgh become and stay active through her dedicated and caring leadership of Ageing Well activities and exercise classes.”

Gill Amos, Liz Simpson, Tracy McLeod & Emma Dempsey

“I feel volunteering keeps me

going. I like the idea that I

have to get up and go

somewhere in the morning.”

Bette

10

4 student placements

2 work placements supported by HPS

“The chance to participate

in the Queens Baton Relay

was one of my proudest

moments as a volunteer.”

Midlothian Volunteer

Contact us

Address: Health Promotion Service Health Promotion Resource Centre Canaan Park Blackford Pavilion Astley Ainslie Hospital Astley Ainslie Hospital 143 Grange Loan 143 Grange Loan Edinburgh Edinburgh EH9 2HL EH9 2HL

Tel: 0131 537 9399

E-Mail: HPInformation@nhslothian.scot.nhs.uk

Webpages:

Health Promotion Service http://www.nhslothian.scot.nhs.uk/Services/A-Z/HealthPromotionService/Pages/default.aspx

Resource Centre http://www.nhslothian.scot.nhs.uk/services/a-z/healthpromotionresourcecentre/Pages/default.aspx

Training Programme www.nhslothianhpstraining.com

Annual Report Editorial Group Elizabeth Oldcorn, Sue Muir, Helen Smart, Phil Horne, Alison Allison

Front cover picture credits: 1st picture: © Copyright M J Richardson and licensed for reuse under this Creative Commons Licence 2nd & 3rd pictures: www.freedigitalphotos.net