EXERCISE 2

THE NATIONAL STANDARDS FOR COMMUNITY ENGAGEMENT

(Communities Scotland – 2005)

The National Standards for Community Engagement were developed with the involvement of over 500 people from communities and agencies throughout Scotland. They are a practical tool to help improve the experience of all participants involved in community engagement to achieve the highest quality of process and results and can be used in both formal and informal community engagement. During the development of the Standards, community engagement was defined as:

“Developing and sustaining a working relationship between one or more public bodies and one or more community groups, to help them both to understand and act on the needs or issues that the community experiences”

The 7 Standards are:

• Inclusion - We will identify and involve the people and organisations that are affected by the focus of the engagement.

• Support - We will identify and overcome any barriers to participation.

• Planning - There is a clear purpose for the engagement, which is based on a shared understanding of community needs and ambitions.

• Working Together - We will work effectively together to achieve the aims of the engagement.

• Methods - We will use methods of engagement that are fit for purpose.

• Communication - We will communicate clearly and regularly with the people, organisations and communities affected by the engagement.

• Impact - We will assess the impact of the engagement and use what we have learned to improve our future community engagement.

There's more on the National Standards for Community Engagement here.

EXERCISE 2

A Fairer Healthier Scotland Our Strategy 2012 – 2017 (extract): NHS Health Scotland

The policy framework

This strategy is entirely consistent with the main tenets of World Health Organization (WHO) strategies (Action plan for implementation of the European Strategy for the Prevention and Control of Non communicable Diseases (2011–2016). Copenhagen: WHO Regional Office for Europe; 2010), including WHO Euro Health 2020, which seek to:

• improve daily living conditions, especially for the worst off
• tackle inequitable distribution of power, money and resources
• measure and understand the problem and assess the impact of action.

The Scottish Government’s National Performance Framework (Edinburgh: Scottish Government; 2007) sets priorities in order to achieve a common public service focus on building Scotland’s economic prosperity. Below this primary goal there are five strategic objectives: healthier; wealthier and fairer; smarter; greener; and safer Scotland. While effectively reducing Scotland’s health inequalities will mean action in all these areas, fairer and healthier is the particular focus of our strategy for the five years to 2017, so that our work is designed to contribute significantly to the following national outcomes:

• We have tackled the significant inequalities in Scottish society.
• Our children have the best start in life and are ready to succeed.
• Our people are able to maintain their independence as they get older and are able to access appropriate support when they need to.
• We live longer, healthier lives.

Health inequalities do not exist in isolation. The broader pattern of income inequality, the state of the economy, welfare reform and the impact of recession on poverty and health provide an important context for our work over the next five years. The values of the NHS are at the heart of this strategy. NHS Health Scotland is part of the ‘mutual’ NHS. The NHS Scotland Quality Strategy (Edinburgh: Scottish Government; 2010) puts. It sets out three Quality Ambitions, which provide a focus for all NHS Scotland, including ourselves. Our work will be:

• Person-centred – understanding and working with Scotland’s diverse population through research and direct engagement, and seeking to maximise mutual respect and fairness and to eliminate discrimination in all we do.
• Safe – providing accurate information that is accessible and understandable to all it might benefit, and minimising unintended negative consequences for people or the environment.
• Effective – advocating and contributing to policies and actions for improving health and reducing health inequalities that are evidence-informed, carefully designed and evaluated, and sustainable in use of resources and impact on the environment.

As outlined in the report of the Commission on the Future Delivery of Public Services (Christie C. Edinburgh: Scottish Government; 2011), radical changes are needed in the way public services are delivered so that they place strong communities at the centre of achieving better outcomes, drawing on their assets. We welcome and will support this change, as well as ensuring that the wider themes of public service reform also provide a focus for our contribution, including:

• the shift towards prevention
• better integration of public services locally
• investment in people who deliver services
• improved performance, through innovation and the use of technology

Learn more here.

EXERCISE 3

SCENARIO 1

You have 2 children under the age of 5 and you live in an area where there is a lack of good quality, well-maintained outdoor play areas. There are a large number of families with young children in the area.

1. There are a range of people/organizations that have an impact on the provision of local play areas. List as many of these as you can.

2. Pick 2 or 3 of these and discuss how you as citizens could influence them in order to gain better play facilities for your children.

3. What barriers might exist to you influencing the decision-making and/or the service provision?

4. What means could you employ to overcome these barriers?

5. What other influences might there be on the decision-making and the delivery of service? (Look Upstream)

EXERCISE 3

SCENARIO 2

You have a problem getting assistance for your elderly mother who lives alone. She is becoming less mobile and needs assistance on a daily basis. You are working so you cannot provide this and there is no-one else in your family able to help out.

1. There are a range of people/organisations that have an impact on the care of older people? List as many of these as you can.

2. Pick 2 or 3 of these and discuss how you as citizens could influence them to get assistance for your mother.

3. What barriers might exist to you influencing the decision making and/or the service provision?

4. What means could you employ to overcome these barriers?

5. What other influences might there be on the decision making and the delivery of service? (Look Upstream)

THE CHIROPODY CAMPAIGN ‘FEET FIRST’

(Taken from ‘Private Troubles & Public Issues’, (1999) Jones, J.)

The local chiropody services came up as one of the major issues (for the Pilton Elderly) Forum. A chiropody clinic was provided in the local community centre, but only for one session a month – on the second Tuesday of the month.

Appointments had to be made by phoning on this particular day and the chiropodist who was there treating feet had to answer the phone to deal with the appointments as well. People had difficulty remembering which Tuesday it was and even the day was sometimes changed. There was a long waiting time for appointments and even longer for home visits. This poor service had a direct impact on elderly people who not only had to suffer pain and discomfort for long periods, but it reduced their mobility which in turn affected their social contacts and independence.

There was support for the campaign from local health professionals, the community health services manager who wished to improve the service, voluntary organisations, from local people, the local press who were sympathetic to the issue and liked seeing elderly people in action and of course the wide membership of the Pilton Elderly Forum (P.E.F.). At that time the Forum was serviced by the Health Project, which took minutes or had them typed and circulated and paid for the mailing.  Forum business could be done on our phone and we supported various tasks identified by Forum members.

The obstacles to change at that time seemed to be a lack of concern by the Health Board and a chiropody service which did not seem to see any need to improve the service.

There was also media and public support for an issue which clearly affected elderly people. The initial strategy in the campaign concentrated on persuasion by writing letters and holding public meetings. These bore no results, but the resistance seemed to be from the area chiropodist and bureaucratic inertia rather than powerfully held opinions or widespread professional attitudes.

Although the local health council had made various representations to the Health Board, the effects of this poorly run service on the elderly had not been forcibly drawn to their attention in a more concerted way and the Board had not bothered to investigate this issue.

The next tactic was therefore, to exert some mild pressure and some education. The health project suggested a survey of local health professionals’ views, particularly those who dealt with the elderly such as district nurses, GPs, health visitors and occupational therapists. Through the Forum, many of them had already individually expressed their dissatisfaction with the service and the strategy was to weld this support together into a more powerful collective stance.  The Forum also decided to organise a petition from the local area, coupled with publicity. The health project also linked with the local arts worker who then worked with a group of pensioners to construct a large six feet high foot which was displayed in the local shopping centre, sporting the slogan – ‘Cut our Nails not our Services!’ Lastly the campaign was widened in collaboration with the Edinburgh Health Council, to include other areas in Lothian.

Elderly people in the area took to the campaign with relish! The chiropody clinic was eventually provided on a weekly basis and management changes within the chiropody service enabled them to attend more home visits and the waiting list dropped. This example shows that community action can be very effective, even if there is issue difference between those who use the service and those who provide it, if the local organisation is well grounded and supported and alliances can be forged with some professional groups and agencies in order to exert mild pressure on the service providers.

Alternatively

A slightly different approach, to the same issue, using a co-production approach, in North Ayrshire can be seen on video by clicking here and scrolling down to it.

There is also a text explanation:

North Ayrshire Foot Care Project – TSI North Ayrshire

What was the issue you were addressing or working on?

Due to the increasing demands on the Podiatry service within NHS Ayrshire & Arran, the Podiatry service required to re-shape their service delivery to ensure that those with the greatest need get access to adequate resource and evidence based podiatry care.

What you did?

At present 6% of resource is allocated to those with the highest need and this requires to increase to 30%. The NHS Scotland National Personal Foot Care Guidelines (draft – due for completion in Dec 2012), confirms that ‘Personal Foot care’ should not be considered a core component of Podiatry Services and suggests self-care and asset approaches to be adopted to deliver services such as low risk foot care to older people.

A model was identified where a volunteer (or social enterprise employed) workforce could undertake personal foot care for older people. Regular basic foot and nail care will be provided safely by trained volunteers / employees and more frequent care from the service will significantly reduce the risk of possible injury through trips and falls. The model encompasses rural and town based communities, and is based upon a partnership and pathway approach with demonstrable mutual benefit.

Money was allocated to the Third Sector from the RCOP budget to enable this service to be established. In North Ayrshire service provision has been subject to a tender process conducted by the TSI North Ayrshire.

A steering group comprising of third sector organisations with experience in this type of service delivery, podiatry service management and Development workers from the TSI was established to set out clear criteria and guidelines for the provision of this service. From these meetings a tender document was put together with advice provided by a member of the NHS A&A contracting team, This was advertised to 3rd Sector organisations through Ayrshire utilising partner TSIs in East and South Ayrshire and through Press advertisements.

What were the outcomes - benefits or otherwise?

Older People will be able to access an affordable foot care service that will be working closely alongside NHS services to ensure that their feet remain healthy which will promote mobility and falls prevention

You can read more here.

UNIT 12: LEARNING LOG

MAKING DEMOCRACY WORK

1. What are the key things about participation and citizenship that you have learned today?

2. Describe 3 of the National Standards for Community Engagement that are particularly important to you and say why this is the case.

3. Describe some of the key features of the case study which you feel reflect a community development approach in health.

4. How did you find the session today?

5. How did you feel you contributed to today’s session?

6. Do you feel you have any particular strengths or areas for improvement?