Visit by new Permanent Secretary and Chief Medical Officer

 

On the 19th July Scotland’s new permanent secretary Sir Peter Housden, accompanied by Dr Harry Burns, visited First Step in Musselburgh to speak to a range of people involved in using or providing early years services. 

After a tour of  First Steps facilities staff, volunteers and services users took part in a discussion facilitated by Susan Deacon about some of the challenges to, as well as the supports for, early years in East and Midlothian.

Many issues were brought up in the short period that was available for discussion – but what heartened me was the tremendous positive energy there was in the room ( no doubt contributed to by the wonderful home baking provided by First Step) This energy and enthusiasm for what a difference early intervention can make was there despite the awareness of the challenges faced by parents and children in some of our communities,  and of the funding issues faced by statutory and voluntary services. 

The other issue that chimed for me was the importance of services not stigmatising their users and the importance of the community seeing a service that is something anyone can access when the need is there. I was reminded of a  rather ugly phrase use by Sir Micheal Marmott – ‘proportionate universalism’ – services that are universal but provided in proportion to the need. The universalism of a service prevents it from being stigmatised, but it makes no sense to provide universal services equally, because need is not distributed equally. First Step is respected within its community because of the hard work and dedication of its staff – but also, I think, because it has that element of a universal service with additional support built in to address more complex or enhanced need.

Mapping support and interventions for attachment

 

Service mapping has been one of the goals of the test site in East and Midlothian – this has been focused on the ten medium term outcomes for the test site. These outcomes draw on existing service planning for health and social care services and were agreed as part of the  logic model for the test site by the planning board for Support from the Start. The objective of  the maps is to represent the path to achieving the agreed outcomes – what is that we are already doing that helps us achieve the outcome we are aiming for and what are the gaps.

Improve emotional well being  (draft)

Support from the Start Breastfeeding pathway summary (2)

Increase proportion of newborn children breastfed at 6-8 weeks (final)

Reduce Obesity Levels in p1 (draft)

Reduce pregnancies in under 16 year olds (draft)

Oral health draft)

Reduce Smoking Rates in Pregnancy (draft)

Increase opportunity for involving parents and children in services (draft)

Increase number of Health Impact Assessments on new developments (no pathwayidentified as yet)

Improved outcomes for looked after children (no pathwayidentified as yet)

Improve Readiness for learning (Draft)

Janice Macleod (School nurse manager and Leisa Randall (educational psychologist are now leading on the mapping of an attachment pathway for East Lothian. This work has been generated by discussions in the service champions action learning sets and Janice’s indefatigable enthusiasm for early intervention and the role of attachement 

A session has been organised to bring ‘stakeholders’ together to map out what is already happening to support the identification of attachment issues and how children and parents who are having difficulties with attachment are supported and access services. The output from this session will help to inform what interventions need and can be developed to shape this area of work in the future.

Mapping an attachment pathway V3

The outcome for pathway mapping session will be posted here

Whitecraig – making a difference

 This is my first attempt at posting an interview from the  ‘voxur’ unit which has been used to get views of comunity members and professionals about early years issues.

This is Tracey from Whitecraig talking about the impact Support from the Start has had on early years in that community.

tracey doran

Service Development Fund

The service and community champions that are key to the Support from the Start test site process have access to a development fund to support and take forward learning around tackling inequality and supporting parents in the early years.

The fund is accessible to the champions only and they are responsible to each other and the steering group for the test site as to how it is spent.  The fund has simple criteria – in addition to the criteria below champions have been asked to demonstrate the sustainability of any proposed projects

  • It contributes to one of the four learning outcome areas of Support from the Start
  • It demonstrates a potential for learning in one or more service area
  • Is explicit about how the lessons from the supported work will be communicated

A great deal of discussion and debate has been generated between the champions on many of the proposals and ideas. It has been my impression that  even when a proposal hasn’t been taken forward there is often learning and connections that come from the discussion around the proposal. A number of very exciting projects have been developed over the last year and you can read about them in the summary at the bottom of this page. 

development fund summary1

Wallyford Support from the Start

 

Wallyford consultation took place on the 18th May 9am-11.30am at Wallyford Community Centre.  The invitation to participate in the consultation was extended to members of the wider community.  The consultation aimed to engage members of the local community in identifying health inequalities within their area and to get them to identify key health improvements. 

 

An assortment of health information and information on Support from the Start was also available through information stands and leaflets which participants took the time to read and many took information away.   As an incentive to take part, money off vouchers, for East Lothian Roots and Fruits was given out.

 

The consultation was very informal being based on discussion and participatory appraisal methods.  This seemed to work really well generating in-depth discussion whilst highlighting community issues and concerns.

 

Wallyford Support from the Start

Whitecraig Support from the Start and play

Dear All

As you are aware Whitecraig is one of the communities that is part of the Support from the Start process in East Lothian, which aims to improve health outcomes by focusing on intervention in the early years and support for parents.

 

As part of this process we have begun a ‘civic conversation’ on health and well being in Whitecraig with an event that looked at the health needs of early years families from a parents perspective (see enclosed report). The output of this event was the identification of two themes by the parents that were present – play, and access to services.

 

I would like to invite you to attend a short meeting to discuss how we can take the ‘civic conversation’  to the next level in Whitecraig  by focusing on the play issue in particular. This meeting would be to look at how parents in Whitecraig can be engaged in play as a health issue.

 

If you are happy to participate in this I would be grateful if you could indicate which of the following dates you could make.

 

Friday 12th June am

Monday 22nd June pm

Tuesday July 7th

 

Many thanks

Lena Hutton

 

abc-launch-and-support-from-the-start-consultation-at-whitecraig-community-centre

 

Conference feedback

Almost 180 people attended a one day conference which launched East Lothian’s Equally Well test site – Support from the Start.

The day was started off with Dr Sue Ross Executive Director of Community Services for East Lothian Council welcoming participants and setting the scene for the day with a description what the test site hopes to achieve. 

The keynote speaker for the morning was Dr Harry Burns – Chief Medical Officer for Scotland – who spoke about the ‘Need for action’ to tackle inequality in health. He explained the latest research on the causes of health inequality and emphasised the importance of intervention in the early years of life if Scotland is to redress inequality in health outcomes. Dr Burns presentation made it very clear that the environment that children are brought up in has a clear and direct influence on physical and mental development in a way that can continue to influence responses to social and environmental stimuli in later life. His central thesis, from a variety of research sources, was that environmental, social and psychological influences that produce an inconsistent parenting environment creates a physically evident stress response in children. In turn this stress response prompts maladaptive responses in the way that children respond to the physical, social and psychological environment they inhabit and this produces health and social problems both in childhood and later life. 

Participants in the conference were invited to discuss what they had heard from Dr Ross & Dr Burns in the light of their own concerns for health and well being in their service areas. Having identified their concerns for trends in health they looked at the consequences of these concerns / trends if nothing was done to address them. Finally they were asked to think what could be done to address the consequences they had identified and in particular to complete the statement  – We will tackle inequality in health by……  A summary of the output from the discussion can be found here. These statements will contribute towards an action plan for Support from the Start

The morning session was closed by Don Ledingham Acting Executive Director for Education and Children’s Services for East Lothian Council with a presentation on the theme of – ‘A call to Action’. Don Ledingham’s presentation focused on the need for a sense of ‘belonging’ in children and communities as an essential part of what is required to create the circumstances for god health. He emphasised that services had a responsibility to generate that sense of belonging in all children, and that unconditional positive regard (or in old money – love)  was essential to achieve this. He also pointed to free school entitlement as a marker for many of poor social, educational and health outcomes that Support from the Start seeks to address and suggested that this would be one way of making sure that the right suppport is reaching the right people.

The them of the afternoon session was creating a ‘conversation’ about health and inequality that actively engages communities and families. The session was opended by East Lothian’s Depute Provost, Councillor Roger Knox who spoke about the importance of making connections, and reaching different parts of the community with support and information.

The keynote speaker for the afternoon session was Andrew Lyon of the Intrnational Futures Forum. Andrew’s presentation focused on how we think about the future, and critically that our individual and collective futures are created by what we do in the present. He talked about the role a ‘civic conversation’ can have in shaping our understanding of the present and future, by bringing together the many different perspectives that exist about the same issues to create a shared understanding of what is needed and what is possible.

Th table discsussions in the aftenoon focused on what communities could do to create a conversation about health and inequality. Folowing the same process as the morning the participants genrated – We will ….. ‘ statements and these will aslo be usedto form the action plan for Support from the Start.

The conference was closed by Alan Blackie, Chief Executive of East Lothian Council. His presentation was on the theme of ‘Keeping the conversaton going’. he emphasised that Support from the Start was not a short life project but a focus within mainstream services on tackling the kind of inequality in health that can be passed from generaton to generation if action wasnt taken to break the cycle. He made it clear that this could not be achieved without the active engageent of families and communites and that a consistent and creative dialogue had to be  developed with communities on this issue. This dialogue or conversation was not the purpose but a means to ensuring that services were doing all that could be done to redress inequality in health and improve life chances for children in East Lothian.

Copies of the presentation and a summary of the ‘We will statement will be posted here shortly.

Dr Harry Burns presentation slides dr-harry-burns-part-1 dr-harry-burns-part-2 

 Andrew Lyons International futures forum Andrew Lyons presntation equally-well-east-lothian-march-09

Regards

Steven Wray

Service Champions

A key feature of ‘Support from the Start’ – East Lothian’s Equally Well test site are Service Champions.

A service champion is an individual who has been identified as someone who can lead on the learning needed to address health inequalities within their service area.  This doesn’t mean that they are the only person within that service who carries the responsibility for health inequality – tackling health inequality is all of our responsibility. The role of the service champion is to bring the experience and knowledge of their service area to the work of Support from the Start, and to bring what they learn from Support from the Start to their service areas.

Service Champions will have a key role in linking across service boundaries and in making sure that health inequality is high on the agenda for services within East Lothian.

The expectations of a Service champion are :-

  • Communicating the vision and values of ‘Support from the Start’ within their service area
  • Bringing the experience and knowledge of their service area to a multi agency ‘action learning set’. 
  • Supporting services to identify training & information needs related to ‘Support from the Start’
  • Contributing as appropriate to this online learning log.
  • Be willing to participate, as appropriate, in the dissemination of the East Lothian Test Site experience to other authorities and agencies within Scotland.

Service Champions will be drawn from a range of services from both the statutory and voluntary sector. Senior managers have been asked to identify the right people for this role, and this process is currently underway . The names and contact details of Service Champions will be posted shortly.

Support from the Start

Scotland’s public health minister Shona Robinson chaired a ministerial taskforce to look at how Scotland can challenge the kind of inequality that leads to significantly different health outcomes for different parts of our community. The taskforce published a report called ‘Equally Well’ which amongst a number of recommendations called for the setting up of ‘test sites’ to lead on the learning that is needed to address the issue of health inequality. East Lothian has been selected as one of eight test sites in Scotland with a focus on early years and parenting. We have called the test site in East Lothian ‘Support from the Start’ to reflect the aim of ensuring that communities and services are doing all that is possible to address the health needs of the youngest members of our community in the areas where we know that health outcomes are poorest.

Support from the Start is not a short term project but rather a focus within all mainstream services on health inequality in the early years of life. Governance for the programme will be provided by a steering Board consisting of Councillor Roger Knox (Depute Provost & Health Spokesman); Councillor Ruth Currie (Cabinet Member for Joint Future & Community Care & Youth Champion); Sue Ross (Director of Community Services & Chair of Joint Health Improvement Project Board); Don Ledingham (Acting Director of Education & Children’s Services & Chair of Children’s Services Chief Officers Group); Gerry Power (General Manager East Lothian Community Health Partnership)  This group will provide strategic leadership and ensure that all relevant planning groups are involved in developing Support from the Start.

Four broad outcome areas for mainstream services in relation to health inequality have been identified:-

  • Community Engagement with key health issues in the early years,
  • Improving Support for Parents & Carers,
  • Improving Support for Families,
  • Creating Child Friendly Environments

We know that there is already lots of good practise in these areas but ‘Support from the Start’ will be asking service providers to review what they are are already doing with the following questions in mind : –

  • How do we get our communities, parents and children involved in key health improvement challenges for the early years of life? e.g. increasing the number of breastfeeding mothers, reducing passive smoking in the home environment, increasing physical activity levels of children in the early years, improving diet and dental hygiene
  • Do East Lothian services make it easy for parents to be ‘good enough’, and can parents access the right support, early enough when they are finding it hard to cope?
  • How do we target support for children and families that are at risk of poor health, and is it effective?
  • Does the physical space of our communities contribute to creating good health in the early years and support parents in raising healthy children safely

 Key to ensuring success in this endeavour will be engagement, leadership and learning. A process has started to identify individuals from across a range of services who can act as ‘champions’ for ‘Support from the Start’. These champions will be tasked with creating a learning environment in their service areas on the issues of health and social justice related to tackling health inequality in the early years. The champions will be contributors to this blog.

My hope for this web log is that it will be a space in which discussion and reflection on the complex task of reducing health inequalities in East Lothian can be supported and encouraged.

All views and opinions welcome.

Steven Wray

Health Improvement Development Officer