Report compiled by NHS Central Lancashire Healthy Communities Team

Transcription

1 Building Capacity for Health and Wellbeing Improvement Knowledge and Skills Audit Central Lancashire Voluntary Community and Faith Sector Report compiled by NHS Central Lancashire Healthy Communities Team Gulab Singh MBE Jenny Ashburner Andrea Smith March 011

2 Contents Page Forward.. 3 Executive Summary 4 Acknowledgements.. 6 Introduction 7 Background to Knowledge and Skills Audit. 8 Capacity Building for Health and Wellbeing 10 Methodology for Implementation 11 Knowledge and Skills Audit Results Chorley and South Ribble... 1 Preston West Lancashire... 5 Conclusions.. 3 Recommendations.. 34 Appendix 1 Preston Health Convention 35

3 Forward The public in central Lancashire attach great importance to their health. They expect to be protected against illness and disease, that people s health will improve and that health will be distributed fairly among our society. The public want its neighbourhoods, schools and workplaces to be both safe and health promoting. The public expectations are that its needs and concerns are dealt with effectively through the development and implementation of public policies. Communities, as part of civic society, wish to play their part in influencing local decisions that impact on their daily lives. Despite the enormous advances made in public health and clinical medicine over the decades in the reduction and treatment of ill health, we still face inequalities in our society with considerable variation in life expectancy, ill health and premature death. These differences are largely between the most advantaged sections of our society compared to those in poorer communities. Fair Society, Healthy Lives (010), Sir Michael Marmot s review on health inequalities, argues that inequalities are a matter of social justice, a key public health principle. As a staring point I have tasked my Healthy Communities Team to lead on undertaking a knowledge and skills audit amongst the voluntary, community and faith sector in collaboration with Preston Community Network and three Councils for Voluntary Service that cover Central Lancashire PCT. The findings of this important survey will support the training and development of this important sector. This report demonstrates the current capabilities amongst the voluntary, community and faith sector in the central Lancashire area in relation to responding to the immerging Public Health agenda; and collective understanding of how to tacking health inequalities across a diverse part of the county both at population and geographical level. The White Paper Equity and Excellence: Liberating the NHS and the public health White Paper Healthy Lives, Healthy People define the organisational and cultural shift in leadership and responsibility for achieving population health outcomes. These reports have kindled awareness among voluntary, community and faith sector members, creating potential to stimulate debate. Above all, we are doing this work as we want to use its findings to mobilise action to achieve a better state of health for our local communities. This is a rapidly evolving agenda and so being confident as we move forward with our understanding of the challenges we face is our priority. There is still considerable work to do to meet the emerging challenges and ensure that we capture Asset Based Community Development and health literacy to systematically achieve health equity throughout all areas of public policy. Maggi Morris Director of Public Health NHS Central Lancashire 3

4 Executive Summary The future presents a changing landscape which will impact significantly on the health improvement of Lancashire s population. Our focus on the development of the knowledge and skills of the voluntary, community and faith sector (VCFS) has identified the underlying needs and challenges of understanding health and wellbeing within the local communities they serve. The Voluntary, Community and Faith Sector reaches out to and engages with the community on a daily basis, particularly to those on the margins of society. It operates across the widest field of social determinates which can impact on the goal of health equality. It has a range of gifts, capacities and skills which when partnered with those of the Community, NHS Central Lancashire and other Public Sector partners can deliver improvements in health. This audit provides a timely and essential starting point to address the changes in the delivery structure of our health system and demonstrates the joint working required to capture the health improvements required. Greg Mitten West Lancashire Council for Voluntary Service The knowledge and skills audit should prove to be an essential starting point for the VCFS working in partnership with local statutory bodies to develop health and wellbeing improvement strategies in the changing economic and social landscape. The audit will help identify areas where capacity building will be most effective in supporting VCFS organisations deliver services to their client groups as part of health improvement programmes. We will be able to build on the already significant knowledge and capabilities of the sector in the delivery of health and wellbeing services in support of the health agenda going forward. Joan Burrows Preston Council for Voluntary Service Improvements in health can only be achieved by the public sector working together with the voluntary and community sector and the people of Preston. Voluntary and community organisations have unique knowledge and insight into the needs of marginalised communities and provide services that are flexible, innovative and responsive to need. We need to be engaged and involved in the rapidly-changing health agenda to create healthier communities for the future. Julie Humphrey, Co-ordinator, Preston Community Network The vision for health and health services has changed to focus on preventing physical and mental health problems, promoting self care and promoting individuals right and responsibility to take control of their health and lifestyle wherever possible. VCFS community based initiatives are able to successfully meet the needs of local communities which are often marginalised by low income, locality in which they live and limited educational opportunities. VCFS are able to initiate innovative and creative ways in which to enhance and support members of the communities they serve behaviour change and improve knowledge, which are not restricted by NHS protocols. By providing knowledge of achieving behaviour change methods people can set personal goals that may lead them to achieve a change in lifestyle that improves their health now, and in the future, for themselves and their children. Cindy Bolton Chorley and South Ribble Council for Voluntary Service I realise that my group s knowledge and practices are very inadequate in this area. Some general information to distribute to our members would be appreciated as so many of the issues mentioned are relevant to our interest of wider social concern. It is sad to reflect that in the current political climate very little is likely to be achieved to improve the situation. VCFS Respondent (Chorley and South Ribble) I am new to the position of Exec Director of Heatbeats but committee to driving the organisation forward over the coming years. Heartbeat has a long and proud history of delivering health improvement services to the people of Lancashire and we are enthusiastic in becoming involved in health and wellbeing initiatives. I will be more than happy to nominate a colleague as a Health Champion. VCFS Respondent (Chorley and South Ribble) 4

5 Have had some good conversations recently with key 'faith' people who are keen to develop initiatives which will have an impact on health. VCFS Respondent (West Lancashire) Overview In order to accomplish our objectives with this audit, members of the VCFS were surveyed on their understanding of terminology and language typically used in public health. Organisations were asked to identify their level of knowledge around the impacts and influences of the determinants of health. To develop future decision making, respondents also rated their understanding of health inequalities and profiles in their area and how they use these to work with influences, barriers and incentives for improving health. A scoring system was used to capture the responses with level one being low and level four being high. Health education, health improvement and wellbeing had the greatest overall level of understanding with districts reporting a high level of understanding (level 3 & 4). Health equity, integrated impact assessment, health impact assessment and social marketing were least understood across all districts mostly scoring a low level of understanding. Knowledge of health inequalities within districts is varied with an even distribution across all levels of understanding Awareness of how health profiles are compiled and used to identify needs and trends are least understood with respondents placing their level of understanding at 1 or. There is a need for further work in raising awareness of the new roles that the NHS Commissioning Board, Local Authorities and GP Consortia will have in promoting health and wellbeing The VCFS cannot work alone to bring about these improvements, so further questions on the knowledge and the skills for engagement with individuals, partners and various other workforce and community sectors were also posed. The findings highlighted that there was a wide variation from the VCFS on understanding the different determinants of health and certain terms/techniques in particular were scored as low. One of the key reasons that may account for this is that the public health jargon utilised is not the core language used within the VCFS on a daily basis. The audit has demonstrated a need to ensure there is a better understanding of public health philosophy, its concepts, terminology, and approaches used in identifying population health outcomes. Finally, members of the VCFS have been invited to be involved in the development of a programme to build capacity within the sector. There was a positive response throughout organisations with over half stating they wish to be involved in the programme (Chorley and South Ribble 66%, Preston 6% and West Lancashire 58%). Objectives: This audit wants to: 1. Identify the knowledge and skills of VCFS members;. Develop a capacity-building programme shaped by and for VCFS members with the direct input of colleagues in public health roles; 3. Prepare VCFS members in their responsibilities to meet the challenges of emerging partnerships. 5

6 Acknowledgements We want to thank the tremendous guidance and support received by Preston Community Network, Chorley and South Ribble, Preston and West Lancashire Council for Voluntary Service who helped to raise the profile and supported the implementation of the Knowledge and Skills Audit amongst the voluntary, community and faith sector within central Lancashire. Without their expertise and experience in working with the voluntary sector, we are sure the response rate would have been much lower than anticipated. In particular, we would like to thank o Julie Humphrey and Steven Dickson, Preston Community Network o Joan Burrows, Preston Council for Voluntary Service o Charlotte Watkinson and Greg Mitten, West Lancashire Council for Voluntary Service o Pauline Lowther and Cindy Bolton, Chorley and South Ribble Council for Voluntary Service And finally we would like to thank the organisations who took the time out of their busy schedules to complete the audit. Preston Council for Voluntary Service 6

7 Introduction NHS Central Lancashire is the local Primary Care Trust which serves a population of 45,000 people living in the area. The catchments include five local authorities: Lancashire County Council, Chorley, Preston, South Ribble and West Lancashire. In 007, the Local Government and Public Involvement in Health Act placed a duty on upper-tier local authorities and Primary Care Trusts to undertake a joint strategic needs assessment (JSNA) and produce district locality health profiles. The JSNA is defined as a process to identify and understand the current and future health and wellbeing needs of the local population leading to improved outcomes and reductions in health inequalities. Firstly, we need to understand the causes of local health inequalities that can influence health improvement. There is clear evidence that shows a number of factors which affect the health of individuals and communities. These include: poor housing, unemployment, social isolation, individual lifestyle factors and the environment in which we live in. This is best illustrated by the Dahlgren and Whitehead diagram shown in Figure 1. Figure 1 (Source: Dahlgren G and Whitehead M, 1991) NHS Central Lancashire has a diverse population profile, in which its geographical catchments have large areas of rural and urban settlements each having different needs for health and wellbeing. There are also considerable variations of demographic profiles across the catchments. Central Lancashire has significant pockets of deprivation in which health inequalities and life expectancy vary. Preston has a considerable amount of health inequalities of which, 9 of the wards are in the top 10% of the multiple index of deprivation. Preston has a younger population structure than the other three districts and has seen a fall in the number of people over 65 years and a 14% rise in 15-4 year olds, much of this linked to the expansion of the University of Central Lancashire. Chorley, South Ribble and West Lancashire have all seen a marked rise (18-4%) in the number of people over 65 years and a fall in the number of 0-14 year olds. At the present time there are more than 11,000 people over 75 living alone in central Lancashire, a figure predicted to rise to more than 15,000 by 00. Black and minority ethnic (BME) communities make up approximately 5.5% of the PCT total population compared to 9% for England and Wales. In central Lancashire individuals of Indian ethnic origin form the largest BME community. The majority of the BME population live in the inner city areas of Preston, where they account for 14.5% of the total population. The voluntary, community and faith sector is a vibrant partner in Central Lancashire that is well placed both strategically and operationally to help tackle health inequalities at grassroots levels. 7

8 Background to Knowledge and Skills Audit The WHO International Healthy Cities movement exists to promote and improve population health at city and town levels. It requires local government and partnership agencies to work in collaboration to make a commitment to improving health and sustainable development, through political leadership, formal structures and active local communities. Preston obtained WHO Healthy City status in 009 and part of this commitment was to work closely with the VCFS to help build capacity and resilience for improving health in the local communities. This provided the opportunity to develop links with other VCFS organisations across central Lancashire and work collaboratively on health and wellbeing outcomes. FAIR SOCIETY, HEALTHY LIVES : The Marmot Review Following the publication of the report by the WHO Global Commission on Social Determinants of Health entitled Closing the Gap in a Generation (008), the Health Secretary commissioned Sir Michael Marmot to undertake a review on developing the most effective strategies for reducing health inequalities in England from 010. Closing the Gap in a Generation argues that social justice must be at the forefront of tackling health inequalities. The Marmot Review launched its report in February 010 entitled Fair Society, Healthy Lives, which set out the mandate for tackling health inequalities. As a result, Lancashire is committed to ensuring that these principles are at the heart of local action to address health inequalities and these are being formulated within Lancashire s draft strategy Fair & Healthy Lancashire. The key messages from Fair Society, Healthy Lives are: 1. Reducing health inequalities is a matter of fairness and social justice. In England, there are many people who are currently dying prematurely each year as a result of health inequalities.. There is a social gradient in health the lower a persons social position, the worse his/her health status. 3. Health inequalities result from social inequalities. 4. Reducing health inequalities will require action on six policy objectives: Give every child the best start in life Enable all children, young people and adults to maximize their capabilities and have control over their lives Create fair employment and good work for all Ensure healthy standards of living for all Create and develop healthy and sustainable places and communities Strengthen the role and impact of ill-health prevention The NHS White Paper, Equity and Excellence: Liberating the NHS, published on 1 July 010, also picks up on Marmot ideas around fairness in public services. The key changes suggested in the White Paper are listed below: The abolition of Primary Care Trusts, replaced by GP consortia who will undertake commissioning of most services The establishment of HealthWatch as a statutory part of the Care Quality Commission to champion service users and carers across health and social care. Local Involvement Networks (LINks) to become local Health Watch bodies, commissioned by local authorities (LA) 8

9 Big Society The establishment of Public Health England (Public Health White Paper Healthy Lives, Healthy People) which will give local authorities greater responsibility in five areas 1. Leading JSNA to ensure coherent and coordinated commissioning strategies. Supporting local voice and the exercise of patient choice 3. Promoting joined-up commissioning of local NHS services, social care and health improvement 4. Leading on local health improvement and prevention activity 5. Establishment of statutory Health & Wellbeing Boards with the primary aim of promoting integration between a range of partners and improving democratic accountability to agree priorities for the benefit of patients, local people and neighbourhoods. The Big Society is the guiding philosophy for progressing social responsibility (David Cameron, May 010). It is a cross government programme for a stronger society voluntary action in 1 st Century. The key guiding principles of the Big Society are: Localism - returning power to local communities Empowering and encouraging more active engagement from local citizens Devolving power to neighbourhoods and supporting community based solutions Big Society Banks using unclaimed assets to create a community fund 50,000 community organisers for leadership and to support local networks (progressions of the Health Champions role) Increase self reliance amongst individuals and communities and through social networks 9

10 Capacity Building for Health and Wellbeing The VCFS is a crucial partner in supporting, advocating and involving people at local levels to empower and engage them in making decisions that impact on their health and wellbeing. Some agencies in the sector provide direct services whilst others indirectly support people and communities in accessing appropriate services. With the emerging role of the VCFS and in the context of the Big Society for improving health and wellbeing across local populations, NHS Central Lancashire (PCT) acknowledges the rich expertise and skills within the VCFS in helping to shape the emerging health and wellbeing agenda. To build on the current capacity and capabilities of the VCFS and in particular, to fulfil the need for linking health and wellbeing to the social determinants of health, the PCT developed a Knowledge and Skills Audit to identify gaps and knowledge necessary to establish bespoke understanding of community engagement in health and wellbeing. There are three key purposes of the Knowledge and Skills Audit: 1. To Establish a baseline of the collective VCFS understanding of wider determinants of health and the implications for policy and service development;. Explore understanding of key terminology associated with health outcomes to improve VCFS participation in health and well being agendas; 3. To identify skills required to respond effectively to emerging partnership challenges and opportunities for health and wellbeing. By implementing this project as the first step to involve the VCFS into the emerging new public health agenda; we anticipate that the Knowledge and Skills Audit and Capacity Building Programme will support the following outputs and outcomes: Outputs 1. Use the findings to compile a list of skills required to ensure health equity is at the forefront of all policy development in VCFS.. Survey findings to ascertain how the VCFS can effectively incorporate health and wellbeing within business plans. 3. Providing tools to help the VCFS understand health profiles, evidence on tackling health inequalities and challenges within their area. Outcomes 1. Baseline of the knowledge of having health and well being within all policies.. Scope the range of briefing papers and training events required to build knowledge and skills. 3. To enhance the capability to improve the skills of VCFS through a bespoke programme of skill building to lead effectively in emerging partnership structures for health and wellbeing. 4. To enable volunteers within VCFS to champion health issues and be accountable for improved outcomes through co-production. 5. To increase health champion provision within VCFS. 10

11 Methodology for Implementation This project was first piloted in Preston as part of the WHO Healthy City requirement. Based on this process and approach the model was then implemented across the rest of central Lancashire. In collaboration with the three district Council for Voluntary Services and Preston Community Network, a Knowledge and Skills Audit was carried out through a short questionnaire designed online using Survey Monkey. A covering was sent out by the partnership agencies, accompanied by a short briefing paper ( pages) which outlined the emerging policy perspective and rationale for the audit. A three week turn around period was given as a deadline for completing and submitting the questionnaire with the choice of electronic or hardcopy completion. Preston s response was based on electronic returns, whilst West Lancashire had a mixture of electronic and hard copies and finally, Chorley and South Ribble s response was solely hard copy based. The questionnaire was anonymous unless an organisation opted to share their knowledge and skills. A contact name and number was also provided in case further clarification was needed. In addition, participating groups were asked to identify any volunteers within their organisation who wished to be trained up as health champions through the Royal Society for Public Health Level accreditation. A scoring system was used to capture the responses with level one being low and level four being high. The overall response rate is detailed within the table below. Overall response rate: District Total Distribution Responding Organisations Response Rate Chorley and South Ribble % Preston % West Lancashire % Total % 11

12 Knowledge and Skills Audit: Chorley and South Ribble Respondents Total: 9 Date of Survey: December 010 Survey Questions: 1. Terminology and Language: How well do you understand the following health related terms? (1 = low level and 4 = high level) Terminology & Language: How well do you understand the following health related terms? (Low) 3 4 (High) 0 Health Inequalities Health Equity Health Impact Assessment Integrated Impact Assessment Wellbeing Social Determinants Public Health Health Improvement Health Education Social Marketing The most understood health terms were health education (48%) and health improvement (41%). Public health was also well understood with most responses between level 3 (38%) and level 4 (38%). Terms with a good level of understanding at level 3 included health inequalities (41%), health impact assessment (38%), social determinants (38%) and health improvement (38%). Integrated impact assessment (48%), health equity (41%), social marketing (31%) were the least understood, scoring low at level 1.. Determinants of Health: To what extent do you understand the following elements on health? All elements of health were well understood with the social (45%) and environmental (41%) scored at level 4 and emotional (45%), cultural (45%) and psychological (41%) scored at level 3. Level 1 scores for the social, environmental, emotional and psychological elements of health equated to 14% of responses with cultural at 17%. 1

13 To what extent do you understand the following elements of health? Responses (Low) 3 4 (High) 0 Social Environmental Cultural Emotional Psychological 3. Determinants of Health: To what extent do you understand the following factors which influence wellbeing? There was a high understanding of the factors influencing wellbeing with the highest responses at level 4. Social (45%), environmental (45%), cultural (38%), emotional (38%) and psychological (34%). The percentages for each factor scored at level 1 was 17%. To what extent do you understand the following factors which influence wellbeing? Responses Social Environmental Cultural Emotional Psychological 1 (Low) 3 4 (High) 13

14 4. Data and Evidence to inform decision making: Please rate your understanding / skill in relation to the following: Questions asked: How basic health related data is used in commissioning services How local health profiles are compiled How local health profiles are used to identify needs and trends Knowledge of health inequalities within your area of work Awareness of Joint Strategic Needs Assessment (JSNA) and its purpose Data and evidence to inform decision making and commissioning Responses (Low) 3 4 (High) 4 0 Health data & commissioning Local health profiles Local health profiles & needs/trends Knowledge of health inequalities within your work JSNA & its purpose Awareness of JSNA and its purpose (48%) was least understood at level 1. There is also low knowledge of how basic health related data is used in commissioning services at level 1 (38%) and level (38%). Furthermore, it is evident that further work is needed on health profiling with the way in which they are compiled scored at level 1 (41%) and level (45%) and how health profiles are used to identify needs and trends scored at 34% at level 1 and 45% at level. There was an overall even distribution of knowledge of health inequalities within areas of work. 14

15 5. Developing health and wellbeing in communities: Please rate your understanding / skill in relation to the following: The lowest scores at level 1 were the value of asset mapping (6%), 5 steps to wellbeing (5%) and the role of industry in promoting health and wellbeing (45%). The responses in relation to the role of NHS Commissioning Board (41%), local authority (38%) and GP consortia (38%) were also scored low at level 1. The majority of respondents scored their understanding and skill in the importance of community assets in tackling health and wellbeing at level 1 (38%) and level (38%). Just under half the respondents ranked level 3 for awareness of ways of communicating with different groups of people about their wellbeing needs (41%) and the impact of the media on public perceptions (also 41%). 34% of respondents also scored level 3 for ways of engaging effectively with service users on health and wellbeing. There was a wide distribution with regards to ways of engaging effectively with communities on health and wellbeing at level 1 (31%), level (8%), level 3 (4%) and level 4 (1%). Questions asked: Ways of engaging effectively with service users on health & wellbeing Ways of engaging effectively with communities on health & wellbeing Awareness of ways of communicating with different groups of people about their wellbeing needs What are community assets? Value of asset mapping for VCFS Importance of community assets in tackling health and wellbeing Role of local authority in promoting health & wellbeing Role of NHS Commissioning Board in promoting health & wellbeing Role of GP Consortia in promoting health & wellbeing Role of Industry in promoting health & wellbeing Role of Media in promoting health & wellbeing Role of Health Trainers in promoting health & wellbeing Role of Health Champions within community in promoting and supporting health & wellbeing How major government policies impact on health and wellbeing within communities The impact of the media on public perceptions Are you aware of the 5 steps to wellbeing 15

16 Developing health and wellbeing in communities Service users on health & wellbeing Communities on health needs Communicating with different groups about wellbeing Community assets Asset mapping for VCFS Community assets in tackling health and wellbeing Government policies impact on health & wellbeing within communities Impact of the Media Awareness of 5 Steps to Wellbeing Local Authority NHS Commissioning Board GP Consortia Industry M edia Health Trainers Health Champions within community

17 6. Are you willing to get involved in a capacity building programme to increase your knowledge and skills? A total of 66% of respondents were willing to get involved in a programme for capacity building. 7. Are you happy to share any knowledge / skills you have in relation to this area? More than half (76%) of respondents were willing to share their knowledge and skills. 8. What format would best suit you in developing your knowledge and skills for health and wellbeing? There was an even distribution in the preference for different formats as listed below with training / workshops, web based resource and fact sheets scoring marginally higher at 16%. What format would best suit you in developing your knowledge and skills in health and wellbeing? 14% 11% 13% Briefing/Awareness Session (1-1.5 hours) 16% Training/Workshops ( hours) Briefing Paper (no more than 4 sides of A4) Fact Sheet (1 side of A4) 16% 14% Web based resource Health & Wellbeing Guide Book 16% Debate/Discussion Group 9. If you have any further general comments to make, please take the opportunity to do so below (please also indicate below if you wish to nominate someone in your organisation to train as a 'Health Champion'. A total of 7 responses were received which included 4 volunteers signed up for Health Champion training and people from Chorley and South Ribble Disability Forum having recently attended Health Champion training in Preston. 1. I realise that my group s knowledge and practices are very inadequate in this area. Some general information to distribute to our members would be appreciated as so many of the issues mentioned are relevant to our interest of wider social concern. It is sad to reflect that in the current political climate very little is likely to be achieved to improve the situation.

18 . I am sorry that I feel unable to complete this questionnaire. I have shown it to another member of my committee and she agrees with me that there is too much jargon. We cannot see the point of it and find the whole thing incomprehensible. Sorry. 3. I wonder how this questionnaire will inform you whether respondents have a clear knowledge of the areas you are addressing. Their understanding and the questioner s may be very different eg the term health improvement may have several different meanings. A more rigorous and productive assessment could be made by asking what is your understanding of the term.? leading to a more accurate outcome of the audit. I have lay-man s understanding of all these terms. Whether this equated with the meaning health care professionals afford to each of these terms is a different matter. How can you evaluate anything other than subjective understanding from this questionnaire? 4. Too many jargon words are creeping in, proportionate universalism, are we seriously talking just about Britain s health appropriate action would be better understood! 5. I don t know how much education in schools focuses on knowledge of one s own body, how it works, and generally good health, but biology, and perhaps social biology should be a mandatory subject. I bet they teach this in independent schools! The Plain English Society may be able to help you!! 6. I am new to the position of Exec Director of Heatbeats but committed to driving the organisation forward over the coming years. Heartbeat has a long and proud history of delivering health improvement services to the people of Lancashire and we are enthusiastic in becoming involved in health and wellbeing initiatives. I will be more than happy to nominate a colleague as a Health Champion. 7. Our CAB ability Project funded by the PCT evidences how interventions can promote health and wellbeing. An extensive report was compiled by the lead person on this project, which clearly endorsed the role of CAB within this agenda. It focused clearly on the Marmot Review and in particular the recommendations by Marmot to engage CAB to deliver healthy outcomes. We would be happy to share this report. 18

19 Knowledge and Skills Audit: Preston Respondents Total: 36 Date of Survey: October 010 Preston Council for Voluntary Service Survey Questions: 1. Terminology and Language: How well do you understand the following health related terms? (1 = low level and 4 = high level) Terminology & Language: How well do you understand the following health related terms? (Low ) 3 4 (High) 5 0 Health Inequalities Health Equity Health Impact Assessment Integrated Impact Assessment Wellbeing Social Determinants Public Health Health Improvement Health Education Social Marketing The most understood health term were health education (67%), health improvement (3%) and wellbeing (3%) at level 4. The term health inequalities is well understood with most responses between level 3 (4%) and level 4 (44%). The terms with the lowest level of understanding were integrated impact assessment (8% scoring level 1 and 39% level ) and social marketing (5% scoring level 1 and 5% level ).. Determinants of Health: To what extent do you understand the following elements on health? With over 40% of respondents scoring at level 4, the social (44%), environmental (47%), emotional (4%) and psychological (4%) impacts on health were well understood. Understanding of the cultural impact scored 33% at level 3, 17% at level and 11% at level 1. 19

20 Preston Council for Voluntary Service To what extent do you understand the following elements of health? Responses Social Environmental Cultural Emotional Psychological 1 (Low) 3 4 (High) 3. Determinants of Health: To what extent do you understand the following factors which influence wellbeing? Overall, there was a high understanding of the factors influencing wellbeing with between 44% and 56% of respondents answering at level 4 (high). To what extent do you understand the following factors which influence wellbeing? 5 0 Responses (Low) 3 4 (High) 5 0 Social Environmental Cultural Emotional Psychological 0

21 Preston Council for Voluntary Service 4. Data and Evidence to inform decision making: Please rate your understanding / skill in relation to the following: Questions asked: How basic health related data is used in commissioning services How local health profiles are compiled How local health profiles are used to identify needs and trends Knowledge of health inequalities within your area of work Awareness of Joint Strategic Needs Assessment (JSNA) and its purpose Data and evidence to inform decision making and commissioning Responses (Low) 3 4 (High) 4 0 Health data & commissioning Local health profiles Local health profiles & needs/trends Knowledge of health inequalities within your work JSNA & its purpose Awareness of JSNA and its purpose was least understood with 7% scoring at level 1 and. It is also evident that there is a low understanding of health profiles. Over 70% of respondents scored their understanding and skills of how local health profiles are compiled at either level 1 or and 31% scoring level on their use in identifying needs and trends. There was a good distribution of knowledge of health inequalities and the use of basic health related data in commissioning services. 5. Developing health and wellbeing in communities: Please rate your understanding / skill in relation to the following: There was mostly a high understanding of developing health and wellbeing in communities. The 5 steps to wellbeing (43% at level 1) and the role of health champions 31% at level 1) were the least understood terms. The role of industry and media in promoting health and wellbeing scored 36% and 33% at level. 1

22 Preston Council for Voluntary Service Questions asked: Ways of engaging effectively with service users on health & wellbeing Ways of engaging effectively with communities on health & wellbeing Awareness of ways of communicating with different groups of people about their wellbeing needs What are community assets? Value of asset mapping for VCFS Importance of community assets in tackling health and wellbeing Role of local authority in promoting health & wellbeing Role of NHS Commissioning Board in promoting health & wellbeing Role of GP Consortia in promoting health & wellbeing Role of Industry in promoting health & wellbeing Role of Media in promoting health & wellbeing Role of Health Trainers in promoting health & wellbeing Role of Health Champions within community in promoting and supporting health & wellbeing How major government policies impact on health and wellbeing within communities The impact of the media on public perceptions Are you aware of the 5 steps to wellbeing

23 Preston Council for Voluntary Service Developing health and wellbeing in communities Service users on health & wellbeing Communities on health needs Communicating with different groups about wellbeing Community assets Asset mapping for VCFS Community assets in tackling health and wellbeing Government policies impact on health & wellbeing within communities Impact of the Media Awareness of 5 Steps to Wellbeing Local Authority NHS Commissioning Board GP Consortia Industry Media Health Trainers Health Champions within community

24 Preston Council for Voluntary Service 6. Are you willing to get involved in a capacity building programme to increase your knowledge and skills? A total of 6% of respondents were willing to get involved in a programme for capacity building. 7. Are you happy to share any knowledge / skills you have in relation to this area? Over half (53%) of respondents were willing to share their knowledge and skills. 8. What format would best suit you in developing your knowledge and skills for health and wellbeing? At 5% and 1%, training / workshops ( hours) and briefing / awareness sessions (1-1.5 hours) were the most popular formats of knowledge and skill development for health and wellbeing. The least preferred option was the development of a health and wellbeing guide book. What format would best suit you in developing your knowledge and skills in health and wellbeing? 1% 6% 1% Briefing/Awareness Session (1-1% 1.5 hours) Training/Workshops ( hours) Briefing Paper (no more than 4 sides of A4) Fact Sheet (1 side of A4) 15% 9% 5% Web based resource Health & Wellbeing Guide Book Debate/Discussion Group 9. If you have any further general comments to make, please take the opportunity to do so below (please also indicate below if you wish to nominate someone in your organisation to train as a 'Health Champion' and whether you will be attending the Convention on November 010) A total of 14 responses were received which included 6 volunteers signed up for Health Champion training.

25 Knowledge and Skills Audit: West Lancashire Respondents Total: 59 Date of Survey: December 010 Survey Questions: 1. Terminology and Language: How well do you understand the following health related terms? (1 = low level and 4 = high level) Terminology and Language: How well do you understand the folllowing health related terms? (High) 3 1 (Low) 5 0 Health inequalities Health Equity Health Impact Assessment Wellbeing Social Determinants Public Health Health Improvement Health Education Social Marketing In the above chart a larger representation indicated greater levels of perceived understanding. The most understood health terms were health inequalities, wellbeing, public health, health improvement and health education with 80-95% of all respondents scoring these terms either a 3 or 4. The terms with the lowest level of understanding were health equity, health impact assessment, social determinants and social marketing with 41-58% of all respondents scoring these terms either a 1 or.. Determinants of Health: To what extent do you understand the following elements on health? Responses indicated that elements of health, except cultural, are relatively well understood with 85-90% scoring a 3 or 4. However it should also be noted that for each element, the most common score was a 3 not a 4 as can be seen in the chart below. The cultural element of health is less well understood compared to the other named elements, with a comparatively lower 73% scoring their understanding as a 3 or 4. This element also had the highest number of people (19%) scoring their level of understanding as a and was the only element to have any people (9%) score their understanding as a 1. 5

26 Determinants of Health: To what extent do you understand the following elements of health? (Low) 3 4 (High) 0 Social Environmental Cultural Emotional Psychological 3. Determinants of Health: To what extent do you understand the following factors which influence wellbeing? Determinants of Health: To what extent do you understand the following factors which influence wellbeing? (Low) 3 4 (High) 5 0 Social Environmental Cultural Emotional Psychological Again, responses indicated that except for cultural the impact of all the above factors on wellbeing is relatively well understood with 86-9% scoring their understanding as a 3 or 4. 6

27 The impact of culture on wellbeing is less well understood then the other named factors with 75% of respondents scoring this a 3 or 4. With this being the case culture again had the most number of people scoring their understanding as a 1 or. 4. Data and Evidence to inform decision making: Please rate your understanding / skill in relation to the following: Questions asked: How basic health related data is used How local health profiles are compiled The limitation of local health profiles in describing district and ward data How local health profiles are used Knowledge of health inequalities within your district Different types of evidence used to influence and evaluate policies Incentives and barriers to using scientific evidence in decision making Data and Evidence to inform decision making: Please rate your understanding / skill in relation to the following: (Low) 3 4 (High) 5 0 How data is used How health profiles are compiled Limitations of health profiles How health profiles are used Knowledge of health inequalities Types of evidence used Incentives and barriers to using scientific evidence Overall responses indicate that understanding of the above topics is quite low with 53-73% of people scoring 1 or across all questions. Responses indicate that in particular people felt they had low understanding about the limitation of local health profiles in describing district and ward data with 51% scoring this with 1. Although understanding was low across the board there was an indication of stronger understanding about: how basic health related data is used; how local health profiles are compiled; and knowledge of health inequalities within their district with 3-39% scoring these areas as a 3. 7

28 5. Developing health and wellbeing in communities: Please rate your understanding / skill in relation to the following Questions asked: Questions Asked: Ways of engaging effectively with individuals Ways of engaging effectively with communities on health Awareness of ways of communicating with different groups of people about their wellbeing Role of local authority in promoting health & wellbeing Role of NHS Commissioning Board in promoting health & wellbeing Role of GP Consortia in promoting health & wellbeing Role of Industry in promoting health & wellbeing Role of Media in promoting health & wellbeing Other people and agencies you need to influence and collaborate with to improve communities' wellbeing Other people and agencies you need to influence to protect communities' wellbeing How major government policies impact on health and wellbeing within communities The impact of the media on public perceptions Overall there were rather mixed responses to the above questions with varying levels of understanding. Topics people have relatively high understanding of (scoring these with a 3 or 4) were: ways of engaging effectively with individuals (76%); and the impact of the media on public perceptions (69%). Topics people had a low understanding of (scoring these with a 1 or ) were: the role of GP Consortia in promoting health & wellbeing (69%); and the role of Industry in promoting health & wellbeing (75%). 8

29 Developing health and wellbeing in communities: Please rate your understanding / skill in relation to the following: Ways of engaging effectively with individuals Communities on health needs Communicating with different groups about wellbeing Local Authority NHS Commissioning Board GP Consortia Industry Role of Media Other people and agencies you need to influence and collaborate with to improve communities' wellbeing Other people and agencies you need to influence to protect communities' wellbeing How major goverment policies impact on health and wellbeing within communities Impact of the media

30 6. Are you willing to get involved in a capacity building programme to increase your knowledge and skills? A total of 58% of respondents were willing to get involved in a programme for capacity building. 7. Are you happy to share any knowledge / skills you have in relation to this area? 37% of respondents were willing to share their knowledge and skills. 8. What format would best suit you in developing your knowledge and skills for health and wellbeing? The most preferred format to help people develop their skills and knowledge was a fact sheet (3%), and/or a web based resource (0%). The least preferred options were briefing/awareness sessions (11%) or a briefing paper (1%). It was commented that time/resource restraints have a huge impact on VCFS organisations, especially in the current economic climate this would impact upon their preferred format. 9. If you have any further general comments you wish to make, please take the opportunity to do so here: A total of 7 written comments were submitted as follows and 5 volunteers signed up for Health Champion training. 1. Funding is a major issue for us. Although I am a qualified Health Trainer I am unable to offer this service due to lack of funds.. Volunteer's time is precious.

31 3. Have had some good conversations recently with key 'faith' people who are keen to develop initiatives which will have an impact on health. 4. My experience is mainly with elderly people. They would benefit greatly if the GP consortia arranged regular health checks for such people. 5. Ability to get involved in a capacity building programme would be time dependent. 6. Dr Alex McMinn- We run (with expert volunteers) programmes on mental and physical wellbeing, social connectivity, diet etc for over 000 older people. 7. Re question 5: 'understanding of' and 'skill in' may be very different. 31

32 Conclusions The knowledge and skills audit has been a very useful exercise in a number of ways. Firstly it provided an opportunity to brief the VCFS on the emerging policies and themes associated with health and wellbeing, even to those groups who chose not to complete the audit. Secondly it provided a tool facilitated by the lead umbrella VCFS organisations to work with their membership to place health and wellbeing on their agenda; and thirdly provided the PCT with useful insight on the knowledge and skills base held by the sector on health and wellbeing. Due to the current economic climate, changes within public sector structure and funding patterns, the variation in responses to completion of the audit questionnaire from across the locality is not surprising. It is also important to note that the timescales in implementing the audit may have affected the response rate due to the some organisations, requiring committee approval to participate. Based on the analysis of the audit it is evident that whilst VCFS members feel they have a sound understanding in some areas of health and wellbeing, there are areas where they feel their understanding could be strengthened, such as understanding health profiles. It is of interest to note that the better understanding seem to relate to more front-line, service delivery focused concepts whilst lower levels of understanding seem to relate to more sociological, and wider executive themes. Many of the comments raised concern over the level of jargon used throughout the survey. These terms are regularly used in the health sector and within partnership structures. This further reinforces the need to establish a baseline of the knowledge held around terminology widely utilised throughout the public sector and key government policies. It is imperative that a level of understanding and knowledge is reached on such jargon in order for VCFS and other organisations to be able to adequately respond to and be involved in future shaping, decision making around health and wellbeing and delivery of services. The results around the cultural, social determinants and social marketing really back the joint work currently being undertaken on asset based community development (ABCD) in Lancashire. Ensuring that health is fully embedded into this ABCD work is an approach which will further enable us to move towards adopting and embracing the Big Society philosophy. A significant finding was the low level of understanding of the use of data and evidence such as Joint Strategy Needs Assessment [JSNA] and health profiles as a tool to informing decision making and commissioning. These findings enforce our approach to raising awareness of tools such as JSNA to become more widely known and used throughout the VCFS and the need for health impact assessment. It was encouraging to note the enthusiasm projected by the sector in sharing expertise, knowledge and skills with others on health and wellbeing. Furthermore, the willingness to take up the potential offer of Royal Society for Public Health Level Health Champion training. In many cases it is believed that in order to improve understanding of health related terminology or jargon typically used in the public sector, a simple glossary of terms, fact sheets or web based resources would be beneficial. Often it seems VCFS organisations understand a principle or concept being discussed but lack knowledge of its label. These results give us a useful steer, to producing resources which are adequate to the organisations we work with. 3

33 Any training and development resources that are produced as a result of this survey to ease understanding of commonly used terminology should be developed in collaboration with the VCFS and in plain English, and to be as concise as possible (i.e. as quick and easy to read as possible). Any materials should also be convenient and easily accessible both physically and electronically and distributed using the existing strategic connectivity of networks across central Lancashire. As part of the pilot work of the WHO Healthy City carried out in Preston, a convention was held in order to disseminate the findings of the audit to members of the VCFS. Further details on this convention can be found in Appendix A. A similar commitment has been made with Chorley, South Ribble and West Lancashire CVS and this will take place in early

34 Recommendations The eight recommendations listed below are set out into two sections. The first six recommendations are for the Healthy Communities Team of NHS Central Lancashire to lead on and the remaining two are for the VCFS umbrella organisations within each catchment of central Lancashire to lead on. The Healthy Communities Team of NHS Central Lancashire to: 1. Work with the lead umbrella VCFS organisations through its established networks to produce a series of short briefings on health and well being, to be used within their local newsletter and web sites.. Explore with the Joint Health Unit a specific briefing/training programme on Health Impact Assessments and their purpose for the VCSF similar to the programme for professional in other sectors. 3. Strengthen its commissioning and contracting arrangements with CVS s to embed the use of the ABCD model to raise awareness of the wider determinants of health, and in particular social inclusion and social networks through the promotion of the 5 Steps to Wellbeing as part of the Northwest Decade of Wellbeing. 4. Work with the Joint Health Unit to create a user friendly format of JSNA for community groups. 5. As part of the launch of the North West Decade of Wellbeing [011] promote the Five steps to wellbeing and its benefits to individual / communities. 6. Promote the Role of Health Champions in different settings and provide level RSPH training. VCFS umbrella organisations for each catchment to: 7. West Lancashire CVS to utilise the Community Newspaper as a means of raising the awareness of the ABCD model within the locality. 8. The CVS in each catchment work with the emerging new structures such as GP Commissioning Consortia and Health & Wellbeing Boards to show case what the VCFS can offer to service provision. 34

35 Appendix A Preston Convention 36 VCFS organisations completed and submitted the questionnaire sent out to VCFS organisations in Preston. Following the completion of the Knowledge and Skills Audit, a Health Convention was held on nd November 010 at which people attended. The programme and attendance list for the convention are detailed herewith. The event was a platform for sharing with the VCFS, the findings of the Knowledge and Skills Audit, promotion of the next cohort Health Champion training and outlining the next steps for capacity building linking to the health literacy programme. The event was organised by both Preston Community Network and Preston CVS. The Convention was opened by Joan Burrows who welcomed those present and outlined the programme. The PCT was represented by the Assistant Director Healthy Communities & Preston Healthy City Co-ordinator, and Public Health Associate Healthy Communities, who presented on: o the Healthy Inequalities in Preston o Preston WHO Healthy Cities programme, o Big Society o Health Champion Training provision and o The emerging programme for Health Literacy. This was then followed by Julie Humphrey, Co-ordinator, Preston Community Network, who set the scene on why the VCFS are a key element in the delivery of the emerging health agenda in Preston. Steven Dickson, Project Worker at Preston Community Network delivered a power point presentation, detailing the findings of the audit. 35

36 Health & Wellbeing VCFS Convention November 010 (14:30 18:00) at Celebrity Lounge, Preston Guildhall AGENDA Part I Part II 1. Welcome/Event Outline Joan Burrows, Chief Executive, Preston Council for Voluntary Services. Setting the Scene for Health & Wellbeing Gulab Singh MBE, Assistant Director Healthy Communities & Preston Healthy City Co-ordinator, NHS Central Lancashire DVD Health Inequalities in Preston Healthy Cities update (to include changes in upcoming White Paper & Big Society ) 3. Health Literacy & Links to Health & Wellbeing Audit Jenny Ashburner, Public Health Associate NHS Central Lancashire 4. Questions and Answers Chaired by Joan Burrows Refreshment Break (15 minutes) 5. The importance of building up Health & Wellbeing Knowledge and Skills in the Voluntary, Community & Faith Sectors Julie Humphrey, Co-ordinator, Preston Community Network 6. Health & Wellbeing Audit Methodology and Findings Steven Dickson, Preston Community Network 7. Questions & Answers Chaired by Julie Humphrey 8. Health Champions and Next Steps Gulab Singh MBE 9. Closing Remarks Julie Humphrey, Co-ordinator, Preston Community Network 10. Networking & Refreshments 36