TEST SITES - A MOVEMENT FOR CHANGE
"If you do what you've always done, you'll get what you've always got." - Dr Harry Burns, Chief Medical Officer for Scotland
"Commitment to doing things better means agreeing that we don't yet know how best to do things better." - Elspeth Murray
Health inequalities in Scotland are complex issues that cannot be solved overnight. The test sites are a means of putting the Equally Well recommendations into practice. Community planning partners will transform and redesign their public services to improve client pathways into, through, between, and out of a range of local services, with the long-term intention of improving health and wellbeing outcomes.
Tackling complex problems
The Equally Well test sites are neither short-term projects nor pilot studies. They are areas where local authorities and their partners improve on both the reach and impact of mainstream local services, within existing resources, drawing on the knowledge and opinions of frontline staff who deliver services, and the people who use them. Third Sector organisations may be involved where they are providing key local services.
Scottish Government and COSLA put out a joint call for test site proposals in June 2008, asking public sector applicants to select their own focus from the Task Force's priorities. The call for applications resulted in significant enthusiasm and high-level interest across local authorities and community planning partners during the summer, as ideas were developed. High-level
buy-in from those who direct the use of resources will be crucial in transforming service delivery at a local level.
We received nearly 30 applications for test sites, which covered a range of priorities. The most popular focus for the test sites was on children's very early years, a key priority from Equally Well, with 13 proposals. Other applications focused on mental health and wellbeing; increasing employability; learning disabilities; planning and health; violence and alcohol misuse; healthy weight; tackling poverty; and smoking.
The Government and COSLA jointly chose to take forward eight of the proposals as core test sites. Between them, the eight sites cover the Equally Well priority areas of children's early years; the harm caused by drugs, alcohol and violence; mental health; and risk factors for the big killer diseases of cardiovascular disease and cancer. The core test sites cover a wide geographical spread and include urban and rural areas. Brief descriptions of the test sites have been included with the relevant clusters of recommendations and elsewhere in this implementation plan.
The eight test sites are in:
- Whitecrook, West Dunbartonshire - targeting the high prevalence of smoking in the area.
- East Lothian - looking at health inequalities in early years in Prestonpans, Musselburgh East and Tranent.
- Govanhill, Glasgow - looking at community regeneration and development through the adoption of a neighbourhood management approach involving all key community planning partners.
- Blairgowrie - looking at delivering health inequality sensitive services in a rural setting for people with multiple and complex needs.
- Lanarkshire - focusing on sustained employment and supporting people to find decent work.
- Fife - focusing on anti-social behaviour in relation to alcohol and under-age drinking.
- Dundee - focusing on methods of improving wellbeing.
- Glasgow City - looking at integrating health into current and future city planning.
Learning and knowledge exchange are vital for the test sites. The Government will establish and support Equally Well learning networks for the test sites. The networks will build on experience from past or current similar networks, to ensure that lessons already learned are taken on board. The networks will include all the partners highlighted in Equally Well, because all are interactive parts of a complex, but adaptive system.
The eight core test sites are being supported in their development and delivery by a National Programme Manager, and will have at their disposal techniques and expertise from a wide range of people, teams and organisations. This includes using improvement methods that encourage local flexibility and creativity to test out and explore service change. Test sites will be able to draw on evidence of what works and on other relevant policy and practice developments.
All the proposed test sites will be encouraged to take forward their ideas locally and will be included in the shared learning networks. The sites focusing on children's early years have been invited to work together with key teams within Scottish Government to identify learning from their local experience.
Unmet needs projects, providing principles for planning local services
Unmet needs pilot projects between 2004 and 2008 in NHS Tayside, former NHS Greater Glasgow and former NHS Argyll & Clyde aimed to provide evidence on whether increased resources would lead to an improvement in access to health services.
The pilots covered unmet health needs from mental health and stress, to treating causes of ill health (smoking, addiction), and services aimed at specific hard to reach or equality groups (eg homeless people, ethnic minority communities).
The pilots found that targeting health resources can indeed help address unmet needs, if health services:
1. Shape and adapt services to fit users - the services provided should be shaped by the communities and populations that are to receive them.
2. Deliver services at appropriate times - issues of childcare, finances and often chaotic lifestyles mean that the timing of service delivery needs to be flexible.
3. Deliver services in the community - this may mean moving out of the buildings and places where they are traditionally delivered.
4. Integrate with other services.
5. Provide patient pathway support - services should provide consistent support along the whole patient pathway.
6. Use a personal approach - services should support and facilitate links and relationships between specific workers and specific service users so that their needs are met in a way that is personal, respectful and non-judgemental.
7. Are persistent - in order to overcome the significant barriers to engagement with services, services should work to overcome barriers for users such as low literacy and poor organisational skills.
8. Provide services that users value - working with service recipients to identify goals.
Unmet Needs - Recommendations for future service design (Nov 2008)
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