SOUTH EAST GLASGOW COMMUNITY HEALTH AND CARE PARTNERSHIP

HEALTH IMPROVEMENT PLAN 2006/07 DRAFT

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FOREWORD

Alan Stewart Chair, South East Community Health & Care Partnership (CHCP)

This Plan sets out a programme for change and action to improve health and reduce the ‘inequalities gap’ of the people of South East Glasgow.

Change in the way health and social care services are delivered and accessed and action that breaks the cycle of deprivation and helps build local communities where no one is held back by disadvantage.

Delivering this agenda will require new ways of thinking to support and encourage people to take greater control for their own health and new ways of working that will win the support and commitment of our staff and the people we serve.

Anticipating need, improving local access and shifting the balance of care from institutions with less reliance on hospital based and accommodated care to care closer to home will require greater collaboration and involvement from all partners.

It is our intention to actively encourage service users, carers and the people of South East Glasgow to participate in local service planning, service modernisation and service delivery. We will also seek to secure involvement from all staff groups and key organisations.

Targeting resources locally on the most vulnerable and those with greatest need to tackle lifestyle issues and those factors that are often considered outside the health domain will also be a key objective for us. These factors or determinants include: housing, education, employment status and living in a community where people feel safe from crime and anti social behaviour.

However, focusing on improving the poor health of those people most disadvantaged will not be sufficient to level up health across South East Glasgow. It is therefore our intention to direct attention to the majority of our population to deliver the systematic change that acknowledges differences in people’s lifestyles and life circumstances.

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Establishing a new organisation, namely the Community Health & Care Partnership for South East Glasgow will create a single system and way of working that will integrate both service planning and service provision within a joint management structure.

I believe such a Partnership will provide clarity, a sense of purpose and ownership to deliver real change. Change and action that can improve health can tackle inequalities and can deliver better, more efficient services.

I hope this our first Health Improvement Plan developed by staff from across both the Council and NHS in South East Glasgow, alongside our partners, is informative and of interest to you. In future years I would be keen to involve you in developing the shape of our next Health Improvement Plan. If you have comments you wish to make on this year’s Plan or get involved in next year’s Plan please contact:

Hamish Battye Head of Planning and Health Improvement City Wall House 32 Eastwood Avenue Shawlands Glasgow G41 3WS

Tel: 0141 287 8831

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1. INTRODUCTION

This Health Improvement Plan has been developed to reflect the health and social care needs of the people of South East Glasgow. It acknowledges the social renewal programmes underway to secure for all Glaswegians the benefits of Glasgow’s thriving economy, its physical and environmental regeneration and its vibrant culture.

The Plan also in identifying a number of key priorities supports the precedence set by Glasgow City Council to improve educational attainment, address worklessness and support community planning priorities and engagement in order to:

ƒ improve the health of the people within South East Glasgow;

ƒ tackle health and social inequalities; and

ƒ develop health and social care services locally.

The Plan will cover a number of key sections, namely:

ƒ Section 2 will provide the policy context that underpins this Plan ƒ Section 3 will highlight the challenges facing South East Glasgow ƒ Section 4 will outline the Plans and Priorities for 2006/07 ƒ Section 5 will describe the resources that underpin the Plan ƒ Section 6 will describe the systems that will monitor performance to demonstrate both change and action

2. BACKGROUND

In March 2003, the Scottish Executive Health Department (SEHD) published Improving Health in Scotland: The Challenge. ‘The Challenge’ identified four key areas or ‘pillars’ where action was required to accelerate the rate of health improvement across Scotland. The health improvement pillars included:

ƒ early years ƒ teenage transition ƒ workplace ƒ communities

Further policy direction for Community Health Partnerships has come from the Scottish Executive’s Advice Note on Health Improvement within Community Health Partnerships, published in March 2005.

It recommends that CHPs contribute to reducing health inequalities by

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ƒ measuring health and health needs and identifying those geographical areas, groups and individuals with the greatest inequalities ƒ working with patients, service users and the wider public to design health and social services which “reach” – addressing unmet need to make a difference ƒ ensuring equity of outcomes, not just equity of access, so working to deliver optimum treatments to the most deprived communities and groups in their area ƒ working with community planning partners to design services and interventions which meet the needs of particular groups (e.g homeless people, minority ethnic groups, people with disabilities, people with severe mental illness)

The Advice Note goes on to suggest a structure for setting priorities for the overall goal of health improvement; again building on the framework suggested in Improving Health in Scotland: The Challenge. This sets out 4 priority themes based on key age groups (early years, teenage transition, and adults of working age) and a key setting (community), together with 7 special topic areas. These themes and topics require a range of actions to be implemented at national and local level covering life circumstances, lifestyles and priority health issues in order to improve health and reduce inequalities. Underpinning all action is the need to narrow the inequality gap.

Themes Topics

Smoking

Early Years Physical Activity Teenage Transitions Adults of Working Age Healthy Eating

Mental Health & Wellbeing

Alcohol Community Sexual Health

Health & Homelessness

Homelessness

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In Glasgow with 80% of our population living in deprivation categories 6 and 7 the test will be to translate national policy and strategy into local health improvement plans that focus on delivery whilst taking account of the wider determinants of health, such as income, housing, education, employment status and the environment. Our approach to translating national policy and strategy will focus on: ƒ health but will include more emphasis on well-being, and on mental and social aspects as well as the physical ƒ factors that affect health but will include more emphasis on people's life circumstances as well as their lifestyles, with increased attention to tackling inequalities ƒ action to improve health but will include more emphasis on incorporating the promotion of social inclusion and social justice

ƒ communities and building capacity and capability that delivers action to support sustainable change.

Community Health & Care Partnerships Equally important in terms of policy direction is the creation of Community Health & Care Partnerships with new and enhanced roles at the heart of a decentralised but integrated health and social care system. Community Health & Care Partnerships will be responsible for:

ƒ improving population health and well being ƒ securing service user, carer, staff, partner and public involvement ƒ shaping service to anticipate future demand and meet local need ƒ integrating and delivering better health and social care services closer to home ƒ being the main agent through which Joint Future is delivered ƒ progressing children’s services ƒ establishing robust Partnerships and promoting collaborative working

Much of this agenda is shared and reinforced by the vision for Community Planning, which is developing in parallel with Community Health and Care Partnerships.

Community Planning The NHS is a key partner within Community Planning, which has formally developed through the Local Government in Scotland Act of 2003. Within the city of Glasgow, the commitment to partnership working is evidenced by the combination of Community Planning developments along with a fully integrated model for Community Health and Care Partnerships.

The Glasgow Community Planning Partnership will work to realise community planning within the city, adhering to the definition of:

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“ (Community Planning) is about the structure, processed and behaviours necessary to ensure that organisations work together and with communities to improve the quality of peoples’ lives, through more effective, joined up and appropriate delivery of services.” (Communities Scotland Guidance, 2003)

The shared agenda between Community Planning and Community Health and Care Partnerships in the city reflects not only a commitment to improving services, but also in involving our communities in articulating their needs to enable the development of services.

Locally, the establishment of 5 Community Health & Care Partnerships within Glasgow and the proposed changes in the support structures for community planning which will come into effect formally in April 2006 will complement the inclusive approach we have adopted to produce this Plan.

3. RISING TO THE CHALLENGE The South East Area – Characteristics of Our Communities

The South East area is a diverse part of the city, with areas of significant deprivation and other more affluent communities. It is also an area where there is a high minority ethnic population, concentrated in particular postcodes within the CHCP boundary. There are 5 hostels in the area, with an estimated 22% of Glasgow’s homeless population in the area. (Glasgow Homelessness Partnership)

Despite a range of health challenges this Plan will go on to describe, there are many positive aspects to the area. This includes considerable improvements in the physical environment in some parts of the south east, in housing and facilities such as the Gorbals Library and Cybercafe.

Another key strength is a history of partnership working for the CHCP to build upon. Multi agency structures, principally but not exclusively in the Social Inclusion Partnership areas, have provided a platform for driving forward joint work including Gorbals Healthy Living Network, community based Well Man Clinics and local strategies for key priorities such as addictions, spanning the statutory and voluntary sectors.

The community and voluntary sector within the SE CHCP can be a major partner in the delivery of the health improvement agenda as identified through this Plan. Through their closeness to communities and their understand of the needs and priorities of these communities, this allows them to act as conduits for information on services and support provided by the CHCP.

Within the new partnership boundaries there have been identified 86* community and voluntary organisations that have a focus on providing service to ‘hard to reach’ groups. It is important that the Partnership works with this sector to develop and implement its plans.

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Our future Health Improvement plans will explain in detail the mechanisms to engage with this sector and ensure their contribution through participation in appropriate forums within the CHCP or as a partner or service provider.

*Source: GCVS Infobase 2005

Locally, the Partnership has a population of approximately 120,198. Appendix 1 shows a map of the South East CHCP boundary. However, with recent boundary changes to align NHS and Social services to the ten Local Community Planning Partnerships it is estimated that the population will decrease to approximately 112,975. Of this

ƒ 76% of the population lives within Gorbals, Toryglen, Kingspark, Croftfoot, Govanhill, Crosshill and Castlemilk area with Toryglen, Gorbals and Castlemilk all having social inclusion partnership status ƒ there are diverse community with a mix of relative affluence and high deprivation. Some of the most marked features of that diversity include 32.7% of the population living in deprivation category 7 ƒ there is a high black and ethnic minority (BME) population concentrated in particular parts of the area: 22.25% of Crosshill residents are from minority ethnic groups, with similarly high figures for Strathbungo (37.6% of the population), Dumbreck (28%) and Govanhill North (13.2%) ƒ 75% of homeless people in the area are under forty, and 138 of the homeless presentations were from pregnant women which makes up approximately 15% of the total live births (figures based on South East LHCC profile only) ƒ in some areas, the figures are as high as 66% of the population who are permanently sick/disabled, have a limiting long term illness or are unemployed or low paid workers

The sections that follow will focus on health improvement performance locally and in line with the ‘Challenge’ set nationally. The national ‘Challenge’ identified 2 key objectives, namely:

ƒ improving the health of all of the people of Scotland ƒ to narrow the opportunity gap and improve the health of our most disadvantaged communities at a faster rate, thereby narrowing the health gap

The following sections setting out our plans and priorities for the next year are structured around the four priority themes of the Scottish Executive Advice Note; namely early years, teenage transitions, adults of working age and the community.

Locally, we have involved key staff and partners in identifying key priorities for South East Glasgow. This Plan is the result of an intensive organisational development process with contributions from a wide range of stakeholders. Appendix 2 lists the contributors to the Plan. DRAFT 8

The priorities for action record our plans, along with examples of current activity is already established to address the priority.

In drawing up this Plan, it was recognised that data collection and the sharing of information would need to be improved and simplified to inform future decision making. This will be a key objective for the Partnership.

The data sources for the indicators listed in the following sections are provided. Much of the data is drawn from the Health Scotland Community Health and Well Being Profiles for the South East LHCC and the Greater Shawlands LHCC ( relevant postcode sectors). This has limitations, as do some of the other sources: the recent realignment of boundaries has meant that thus far, obtaining data on a CHCP boundary presents some challenges. This we would wish to address for future plans.

The sections that follow will detail performance for each of the specific areas, and will take account of the risk factors highlighted.

ƒ Early years – Children under 5 and their families

Performance South East Glasgow Glasgow Scotland Time Data Indicators Number Measure Period Source Smoking during 241 18.2% 27.3% 23.8% 2004 ISD Pregnancy 9.2% 14.8% Scotland Breastfeeding at 6-8 310 36% + 5% 2000 - Health weeks 58.9% +27.9% 2002 Scotland

Immunisation uptake 93% - 4% 2000- Health (excluding MMR) 95.6% -2.6% 2002 Scotland

MMR Immunisation 87.6% - 3% 2000- Health uptake 87.1% -3.5% 2002 Scotland

Low birthweight 183 6.7% + 16% 2000- Health babies 4.25% +13.5% 2002 Scotland

Figures in red show the average for the relevant Greater Shawlands postcode sectors

Whilst the South East average rate for smoking during pregnancy falls well below the Glasgow figure and the national average for 2004, there is substantial variation in smoking rates across the CHCP boundary. The Health Scotland Profile provides figures for smoking in pregnancy over 3 years from 2000-02, showing that whilst the rate is particularly low in postcode sectors such as Cathcart (G44 3) at 10.5%, this contrasts with Castlemilk East DRAFT 9

(G45 0) at 47.9% and Castlemilk West (G45 9) at 50.6%; the south east average figure over the same period being 29.2%.

Similarly breastfeeding rates across parts of the South East vary tremendously with areas such as Battlefield (G42 9) rates as high as 57.9%, contrasting with some of the lowest rates in Glasgow city such as Castlemilk West (G45 9) at 10.1% and Toryglen (G42 0) at 19.1%.

ƒ Teenage Transition

Performance South East Glasgow Glasgow Scotland Time Data Indicators Number Measure Period Source Teenage Pregnancies 14 8.2* 9.0 7.5 2004 SMR01/SM (13 – 15 years at 9.7 R02 conception) Proportion of 15 year 70.2% - 11% 1998 - Health old boys surviving to 78.6% -19.4% 2002 Scotland 65

Proportion of 15 year 84% - 4% 1998 - Health old girls surviving to 86.2% -6.2% 2002 Scotland 65 Higher grade passes 22% 20% 29% 2003 Glasgow (3 or more passes) Community Langside and Linn Planning Local Community Partnership Planning Partnership ** Higher grade passes 19% 20% 29% 2003 Glasgow (3 or more passes) Community Pollokshields East Planning and Partnership Southside Central**

Figures in red show the average for the relevant Greater Shawlands Postcode sectors * Rates per 1000 women aged 13- 15 years

** community planning partnership areas; together these 2 areas largely fit the boundary of the south east CHP. Langside and Linn local CPP comprises Castlemilk, Carmunnock, Kings Park, Mount Florida and environs whilst Pollokshields East and Southside Central contains Gorbals (Hutchesontown, Oatlands and Laurieston), Pollokshields East, Govanhill, Strathbungo, Queens Park, Dumbreck, Polmadie, Crossmyloof, Toryglen and part of Shawlands.

Again it is worth highlighting the variation in the figures across the south east, and the implications of this in terms of concentration of effort. Teenage pregnancy figures overall in the south east fare better than elsewhere in the city, however areas such as Castlemilk East (G45 0) and Kingston (G5 8,9) were shown in the Health Scotland profile which measured the rates over three years, to be 131% and 171% above the Scottish average. DRAFT 10

In terms of mortality, we have significant variation in the number of 15 year old boys surviving to 65 across the area, dependent on postcode. Whilst 70.2% of the male population overall in the south east survive to 65, the figure for Kingston (G5 8,9) is 49.9%. By contrast, in Croftfoot (G44 5), 76.8% of 15 year old boys survive to 65.

The starkness of these figures require further exploration; part of the picture concerning Kingston (more commonly known as Laurieston) could relate to the presence of a number of hostels in the area, along with proximity to the city centre and high drug and alcohol problems. Further analysis of what is behind the statistics presented must be an ongoing task for the CHCP.

ƒ Adults of Working Age

Performance South East Glasgow Glasgow Scotland Time Data Indicators Number Measure (% above or Period Source below nat. average) Adults with no 22, 335 37.2% + 12% 2001 Health qualifications 24.8% +0.4% Scotland Lone Parent 3, 716 27.3% + 52% 2001 Health Households 14.7% +39.4% Scotland Children in 5, 507 32.8% + 79% 2001 Health Workless 19.7% +65.9% Scotland Households Adults unable to 8,905 17.2% + 63% 2000 Health work through 9.1% +54.9% Scotland illness/disability Income Support 11, 190 21.7% + 71% 2000 Health Claimants 12.3% +61.6% Scotland

Figures in red show the average for the relevant Greater Shawlands postcode sectors

The above indicators, highlighting poverty in the area as a whole, can be interrogated further to differentiate between the postcode sectors in the south east. For example, whilst 19.2% of the adult population in Cathcart ( G44 3) have no qualifications, this compares to 57.1% of residents in Toryglen/Polmadie ( G42 0).

Similarly, the indicator around Income Support, often used as a baseline measure of poverty, shows that whilst the south east average is 21.7%, this varies from 5.1% of the population in Cathcart (G44 3) to 38.9% of the Castlemilk East population (G45 0).

Lone parent households range from 6.4% in Cathcart, to 15.2% in Croftfoot, to as high as 37% in Toryglen and 48.3% in Castlemilk East.

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Worklessness There are significant sectors of the south east where high proportions of adults of working age are on Incapacity Benefit, particularly Hutchesontown and parts of Castlemilk. Glasgow wide research carried out in 2004 (Equal Access Mapping Study, Glasgow University) found that of the 110, 000 workless residents in the city of Glasgow, about a third would like to work if they received the right support.

Often multiple barriers to employment exist for those out of work, with some of the most commonly reported barriers being:

ƒ low self esteem and confidence ƒ lack of job related skills ƒ low motivation ƒ poor communication skills ƒ lack of qualifications ƒ literacy and numeracy problems ƒ money and debt ƒ difficulties with childcare

Part of the challenge for the CHCP will be working in partnership to overcome these barriers for its communities, as evidence shows the health benefits of being in employment. Indeed, work in the Pollok area via the Compass Project has shown that for the clients it supported into training or employment:

ƒ there was a 23% reduction in the number of people attending their GP on a regular basis ƒ 23% reduced their medication (such as anti – depressants and methadone) ƒ 17% reduced their alcohol consumption and 29% reduced unhealthy snacking ƒ 17% increased their consumption of fruit and vegetables ƒ 43% said their health was “good” compared to 28% at the start of their contract with the project

Mental Health and Well Being The links between worklessness and poor well being are clear. In fact, mental health and well being with its many connections to other key issues such as alcohol and drug use, is a key challenge for the CHCP.

The total number of referrals to adult mental health resource centres in the south east during 2004/5 was 1595. In addition, the relatively new STEPS Team (primary care mental health service) in the south east reported that in November 2005, 230 people accessed the service.

Improving well being across our population, but particularly in those areas where health is worse, will be an ongoing focus for the CHCP. DRAFT 12

ƒ Communities

“A community is a group of individuals with a common interest and an identity of themselves as a group. We all belong to multiple communities at any given time…. We cannot really say that a community exists until a group with a shared identity exists” (Toronto Dept. of Public Health. 1994)

The term community is used in a variety of settings and situation, for example community schools, community police and community care. Within the context of this plan it is important that we clarify what we mean by the term community. Communities are often viewed as the physical or geographical areas where people live. Castlemilk and Pollokshields are two examples of relatively large geographical communities. The Circus in Toryglen or Laurieston in the Gorbals are smaller geographical communities.

Increasingly it is recognised that a geographical or physical definition of community, while important, is limiting. People can and do belong to more than one community based on a variety of factors such as race, religion, age, class, gender or sexual orientation. Communities of interest where people come together because of issues affecting their lives are particularly important within the context of the this plan. Carers, people with disabilities or hospital patients are examples of possible communities of interest. Members having a sense of belonging, a shared interest or a common purpose, define a community.

The CHCP proposes to work with different types of communities and recognises that people may belong to a variety of communities.

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Performance South East Glasgow Glasgow Scotland Time Data Indicators Number Measure Period Source Long term limiting 19, 296 23.9% +18% 2001 Health illness 18.7% +12.8% Scotland

Self assessed 11, 530 14.3% + 41% 2001 Health health “not good” 10.2% +36.9% Scotland

Minority Ethnic 5, 385 6.7% + 232% 2001 Health groups 24.9% +256.9% Scotland

Alcohol 1, 484 1530.3sr + 46 1999- Health related/attributable * 2001 Scotland hospital 859.7 admissions Drug related 44 54.5cr2** +99 1997 - Health deaths 44.4 +88.9 2001 Scotland

Hospital 278 335.1sr + 7 2000- Health admissions – 288 -40 2002 Scotland suicide/deliberate self harm First hospital 229 235.4sr + 22 1999- Health admissions – 147.05 -66.3 2001 Scotland psychiatric

*standardised rates per 100, 000 population **Crude rates per 100, 000 population – data presented at community level Figures in red denote the average for the relevant postcode sectors of the Greater Shawlands profile

In terms of the communities the CHCP will serve, there is the need to consider not just the clear variation in social and economic circumstances across the patch, but additional significant issues.

For example, we have a high number of minority ethnic residents concentrated in particular parts of the area (eg 22.2% of Crosshill, 37.6%of Strathbungo) bringing specific challenges for the CHCP in providing appropriate, accessible services as well as more disease related considerations such as diabetes rates. There is also a significant Asylum seeker and Refugee population.

NHS Greater Glasgow and Glasgow City Council have committed themselves to the Commission For Race Equality Scotland’s Race Equality Scheme. The South East CHCP will continue to recognise this commitment to provide fair and equitable services and guarantee equal opportunities in employment.

The South East CHCP has the highest concentration of Black and Ethnic Minority communities in Glasgow. For example, East Pollokshields has 46% of its residents recorded as being from a black and ethnic minority DRAFT 14

background, with 48% of its population recorded as from a non white background (Census, 2001); these are communities that services continue to fail to reach.

Throughout the area there is also a significant Asylum Seeker and Refugee population. Working with their partners, the new CHP will seek to improve the health status of its diverse communities by providing culturally sensitive services which it is hoped will improve health awareness and access to health and social care.

This commitment to an integrated equality and diversity approach, it is hoped, will extend and be responsive to the individual circumstances of all persons. In addition to race and ethnicity, other characteristics such as age, disability, gender, religion or belief and sexual orientation will also receive consideration from the CHCP.

Also relating to access, there is particularly low car ownership in parts of the patch such as Castlemilk East And West, and Toryglen (71.5% of households in all three postcode sectors with no car).

There is also a concentration of homeless units and hostels in the south east CHCP area, with again particular challenges about how we engage with and cater for this population with our partners.

4. PRIORITIES & PLANS

In delivering the priorities outlined within this section a key requirement for all of us is our ability to mainstream work on health improvement and inequalities, so that it becomes the day job and not something we add on. Collaborative working with other partners will be crucial to the delivery of tangible improvement whether that is educational attainment, getting people back into work or improvements in lifestyles.

However, to achieve that ‘real’ improvement will require greater collaboration and integration. For example, educational attainment, worklessness and access to adequate housing are very much part of the health improvement agenda and the sustainable step change that we are required to deliver.

Early years

Priority Objectives:

1. Bring services to hard to reach families 2. Improve assessment and care planning for vulnerable young children 3. Join up early years strategies, partnerships and fora to rationalise and maximise effective delivery

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Proposed Activities: Look at the way services are provided and how we can adapt them to meet the needs of hard to reach families, considering programmes such as :

ƒ immunisation in the home ƒ intensive support for vulnerable young families ƒ access to cheaper fruit and vegetables ƒ home based small groupwork on healthy eating and cooking ƒ providing parents with training in healthy eating to cascade to other families ƒ training for staff and parents to deliver key oral health messages ƒ carry out a literature review on the barriers for hard to reach families using services ƒ use this evidence base to inform and make changes to the way services are delivered

Existing Activity: (selected highlights) ~ PACT team – Starting Well Phase 2, providing intensive support to vulnerable families ~ Parenting support provision and co-ordination across the south east CHCP ~ Work of the Oral Health Action Team, particularly focussing on pre-fives ~ Toryglen Children and Families Group – a multi agency group providing support to community groups, a local arts programme and links with the community garden and play area development

Teenage Transition

Priority Objective: Support young people to improve their health

Proposed Activities: ƒ Seek better co-ordination of youth health activities across the whole of the area ƒ Develop a core multi agency group to achieve the above, with representatives covering Cultural and Leisure services, the voluntary sector, New Learning Communities, mental health staff, addictions, and health improvement team ƒ Implement programmes to address addiction among young people, including smoking, alcohol and illicit drugs ƒ Explore with young people what barriers exist to their participation in physical activity and how these could be overcome in order to develop appropriate opportunities for young people to become more active

Existing Activity: (selected highlights) ƒ Extensive consultation with young people into their levels of physical activity, barriers and what would be attractive has recently been carried out in secondary schools, the content of which has influenced a new

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initiative planned for April to run a healthier breakfast menu in schools with physical activity component based on requested options ƒ Following local research in Castlemilk in 2005, an outreach addictions worker for young people has been funded through Lloyds TSB for 3 years, to carry out groupwork and awareness raising, along with signposting those with an identified addiction issue appropriately to the Community Addiction Team – this model may provide learning for the whole of the CHCP area ƒ Emotional Literacy training and Baby Think it Over programmes being run by the Youth Health Service in schools and in the community setting

Adults of Working Age

Priority Objective: Examine the profile of usage of CHCP services in the worst 15%* of the south east, with a focus on those out of work/on benefits.

* as defined by the Scottish Index of Multiple Deprivation (SIMD)

Proposed Activities: ƒ Profile the usage communities make of the CHCP services in 2 pilot areas of the south east, concentrating on those out of work/on benefits ƒ Identify current working links and practice between CHCP staff and employment/training agencies in the south east. ƒ From activity 2 above, focus on one particular care group (suggestion of addictions) and map where the support and links are into employment

Existing Activity: (selected highlights) ~ Community addiction team work across Toryglen and the Gorbals to train stable methadone clients in community development, with a volunteer placement to offer opportunities for skills development ( in partnership with the voluntary sector) ~ Welfare rights in primary care service across the south east CHCP, for all practice patients to access money advice, debt consolidation and benefits checks – this has resulted in £2.556M client gain over the past two years ~ Participatory Appraisal Training for local residents – this course, provided through the Gorbals Healthy Living Network, enabled 16 local residents to become skilled in the use of P.A research techniques creating a bank of sessional workers who were later used by the Gorbals Health Forum to consult with local parents on their support needs

Communities

Priority Objectives:

1. To work with communities to develop the health improvement plan for year 2007 DRAFT 17

2. To develop community engagement based on the ‘standards of community engagement’ (see Appendix 3) 3. To audit ethnic monitoring throughout CHCP area with service providers

Proposed Activities:

ƒ To identify key personnel networks (e.g. service users/carer) to engage with communities and community group ƒ To develop methods of engagement within communities ƒ To identify and secure resources to enable participation. ƒ To identify training needs of personnel/service users involved with developing the plan ƒ To explore support from the Scottish Centre for Community Development ƒ To identify key players to contribute to the development of the role e.g. community planning partners ƒ To prioritise the standards to be piloted in year 1 ƒ To develop the tool ƒ To identify training needs ƒ To roll the tool out across CHCP area ƒ To identify key personnel to develop audit tool ƒ To work in partnership with service providers ƒ To create baseline to inform future health improvement planning

Existing Activity: (selected highlights) ~ Chronic disease self management programme – where local people with a range of chronic conditions participate in short courses to enable them to manage their conditions ~ Research into needs of older people; Gorbals area, exploring the social, economic and health needs of people aged 50 plus with a view to shaping and informing services (due for completion March 2006) ~ Access to information and services group, Castlemilk; brings together agencies and local people to raise and seek to address issues regarding access to health services ~ Work with black and minority ethnic women in Pollokshields, supporting women to address issues of importance to them through drama and increasing self esteem, reducing isolation ~ Support to asylum seekers and refugees through established networks in parts of the south east, multi agency working with significant input from local volunteers provides: English as a Second Language classes, Drop ins and Distribution centres, advice clinics, multi cultural festivals and information leaflets

5. INVESTMENT

This Health Improvement Plan has set objectives, and proposed a range of corresponding activities to be progressed in 2006/7.

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These areas of work are reflective of the integrated partnership, focussed organisation the South East CHCP will become. This Plan will require commitment and resources from across the organisation, and from its partners, many of whom have contributed to the content of this Plan (see Appendix 2).

The activities proposed will inform the workplan of the Health Improvement Team, a dedicated resource of 15 individuals within the organisation. Whilst this team will co-ordinate the work described in this plan, and in some instances lead on key areas of work, success will be dependent on the input and expertise of the appropriate mix of CHCP staff across partner organisations. These include statutory and voluntary sector. This is outlined in Section 6.

It should also be highlighted that the Health Improvement Team will continue to carry out the necessary core work on national programmes, addressing the needs highlighted in Section 3 of this Plan. Programmes such as smoking cessation, Oral Health and youth health will continue to be a feature of the team’s work.

Joint investment is already a significant feature of partnership working in the South East; the examples of existing work contained 4 are largely multi agency in nature. Work is underway to align budgets to key areas of work. However, there are significant resources being made available from across the partnership to improve health and tackle inequalities.

A key feature for future planning will be to demonstrate real improvement and where this is not evident, a review and realignment of funds will be targeted to areas where narrowing of the health gap can be realised.

6. MEASURING PERFORMANCE

This section details the proposed ways in which progress on the Plan will be measured. The tables reflect the work produced by groups of relevant experts at a planning session attended in January 2006.

Early Years

ACTIVITY – what is to be RESPONSIBILITY MEASUREMENT – how will done? who will deliver on we know it has been done? this? Objective 1 Children & Families Bring services to hard to in conjunction with reach families (especially local multi-agency at this time of change) planning group and Look at the way services are relevant experts provided and how we can adapt them to meet the needs of hard to reach families DRAFT 19

• Provide an Increase in number of babies Immunisation service being immunised in people’s own homes

• Provide intensive Evidence in number of young support for vulnerable families being supported young families

• Provide access to Increased access to cheaper cheaper fruit and fruit and vegetables. vegetables Measure number of people buying and consuming fruit and vegetables

• Provide learning Increased numbers of people opportunities to taking part in learning events promote healthy for healthy eating and eating and cooking cooking (in the home – bring small groups together)

• Provide carers with Monitor number of carers training in healthy participating in training and eating and to give awareness raising amongst support/advice to other community groups others

• Carry out a literature Review completed review on the barriers Demonstrate usage of for hard to reach equality impact tool on new families accessing service or delivery services mechanism created

• Use this evidence Record and demonstrate and base to inform and increase in families are using make changes and services (especially in improvement to the relation to BME families) way services are Use satisfaction surveys to delivered inform service modernisation

Actively support the • Develop opportunities establishment of service for specific groups of user/care involvement groups parents of young to inform/influence priority children to be able to setting influence this priority Demonstrate increase in the

number of Babies with

development concerns

presenting earlier

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Group discussed: Where young children or babies are involved the adult services should focus on the baby or young children – question should be asked if the referral and assessment process include information about the children involved (especially in relation to Addictions), if not why not – ensure this is incorporated

Pay particular attention to links with maternity – develop new protocol for transferring information especially before the baby is discharged

DRAFT 21

ACTIVITY – what is to RESPONSIBILITY MEASUREMENT – how will we be done? who will deliver on know it has been done? this? Objective 2 Children & Families Evaluate the impact of new Improving assessment in conjunction with forms/tools currently in use and care planning for the local multi- vulnerable young agency planning Staff training in place children groups and relevant experts Management/monitoring processes in place

Audit child health record and integrated assessment methodology to ensure standardisation of systems

Implementation of Hall 4 using agreed national evaluation mechanisms

ACTIVITY – what is to be RESPONSIBILITY MEASUREMENT – how will we done? who will deliver on know it has been done? this? Objective 3 Children & Families Clear understanding among staff Join up Early Years in conjunction with of the linkages between strategies/ the local multi- strategies Partnerships/Fora to agency planning rationalise and groups and relevant Produce diagram showing the maximise effective experts various early years structures delivery and avoid and inter–relationships duplication Locally, where appropriate amalgamate structures to reduce duplication

Teenage Transitions

ACTIVITY – what is to be RESPONSIBILITY MEASUREMENT – how will done? who will deliver on we know it has been done? this? Priority Objective: Support young people to improve their health

Seek better co-ordination of Health improvement Clarity of workplans and youth health activities across team to co-ordinate structures within the south the area appropriate group of east people to progress this DRAFT 22

Develop a core multi agency Health improvement Map produced of existing group to achieve the above, team with relevant youth health with representatives experts as listed groups/structures to covering the voluntary determine need for a core sector, cultural and leisure multi agency group services, mental health staff, addictions, new learning New group established if communities and health required improvement team

Implement programmes to Health improvement Targeted programmes address addiction among team, Community established and evaluated young people, including addiction team, New smoking, alcohol and illicit Learning drugs Communities Explore with young people Health improvement Work on barriers completed – barriers to physical activity team with appropriate production of report. and how these can be partners such as overcome, develop Cultural and Leisure Programmes implemented appropriate opportunities services, voluntary and progress documented – sector, New Learning Breakfast bistro, community Communities clubs etc

Adults of Working Age

ACTIVITY – what is to be RESPONSIBILITY MEASUREMENT – how done? who will deliver on will we know it has been this? done? Priority Objective Health improvement Production of report with Examine the profile of team leading, along the profile and usage of CHCP services with: recommendations by March in the worst 15%* of the CHCP staff 2007. south east, with a focus Local partners such on those out of work/on as EQUAL Access benefits. Manager Profile the usage LEDCs communities make of the CHCP services in 2 pilot areas of the south east, concentrating on those out of work/on benefits

Suggested pilots are 1 former SIP and one newly identified priority area – Castlemilk/Govanhill

DRAFT 23

Identify current working links Health improvement Production of report and and practice between CHCP team with CHCP staff recommendations by March staff and employment/training – steering group to be 2007. agencies in the south east. established to (this will build a local progress. Linking to dimension to a city wide partner agencies. review being carried out in a similar vein) From activity 2 above, focus Community Addiction Specific report produced in on one particular care group Teams and Health relation to employment and for example, addictions and improvement team training links for addictions undertake a mapping exercise clients - by December 06. to identify current support and links to employment.

The Community

ACTIVITY – what is to RESPONSIBILITY MEASUREMENT – how be done? who will deliver on will we know it has been this? done? Priority Objective:To work CHCP staff, health Use LEAP evaluation tool to: with communities to improvement team Demonstrate ways of develop the health and community having engaged with improvement plan for year engagement team community and 2007/8. addressing the needs To identify key personnel they have identified. networks (e.g. service Plan will look different in users/carer) to engage with Year 2. communities and community A service has been group. developed/modified as a To develop methods of result of community engagement within involvement. communities. Evidence the process of To identify and secure engagement. resources to enable Plan signed off by the participation. community To identify training needs of Demonstrate personnel/service users commitment to involved with developing the community e.g. training plan. resources.

DRAFT 24

Priority Objective: Community Use performance indicators To develop community engagement team and for community engagement engagement based on the Public Involvement standards. ‘standards of community worker with identified engagement’ partners Measure engagement through LEAP process. To explore support from SCDC To identify key players to contribute to the development of the role e.g. community planning partners. To prioritise the standards to be piloted in year 1. To develop the tool. To identify training needs. To roll the tool out across CHCP area.

Priority Objective:To audit Multi disciplinary Use of audit cycle to ethnic monitoring group to be demonstrate outcome. throughout CHCP area established, featuring with service providers. multi cultural health To identify key personnel to officer and others as develop audit tool. appropriate To work in partnership with service providers. To create baseline to inform health improvement plan.

7. Conclusion

This plan has been developed during a period of significant transition and change. Staff have acknowledged that timescales have now allowed for service users and carers to participate fully. However, it is the intention of the CHCP team from 1 April 2006 to establish mechanisms that both inform and involve key stakeholders in service planning, service modernisation and projects that address health improvement whilst tackling inequalities.

This plan is currently in draft and people now have the opportunity to comment on its content. If you wish additional copies or access to a different format please contact:

Hamish Battye, Head of Planning and Health Improvement on 0141 287 8831.

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APPENDIX 1

South East CHSCP

The River Clyde would continue to form the northern boundary for the CHSCP with the city council boundary forming the Eastern and Southern boundary. The Western boundary of the CHSCP would become

• Heading south on Bridge Street from the River Clyde • Following the A77 southward till it intersects Cumberland Street and follow the railway line at this point south west to Dumbreck Station • Follow past Dumbreck Station till the railway intersects Dumbreck Road • Follow Dumbreck Road south into Haggs Road and Haggs Road southward to Pollokshaws Road • Follow Pollokshaws Road east till it intersects the railway line. • Follow the Newton railway line east till it intersects with the Neilston railway line • Then following the Neilston line south west to the city boundary. DRAFT 26

This paper has been prepared on behalf of Glasgow City CHSCP Executive Group, following their boundary decision of 8th September, 2005

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APPENDIX 2

Contributors to Plan Health Improvement Event

Cathie Cowan Director South East CHCP

Hamish Battye Head of Health Improvement and Planning South East CHCP

Sheena Morrison Head of Children’s Services South East CHCP

Fiona McNeill Head of Mental Health South East CHCP

Sheena Wright Head of Health and Community Care South East CHCP

Liz Blyth RES Manager Community Centre for H

Marjory Smith Principal Officer Development and Rege

Jo Harrison Planning Manager Changing Children’s Se

Julie McCarthy Community Planning Representative Gorbals SIP

Janet Hayes Community Planning Representative Castlemilk Partnership

Kevin Fellows Clinical Director South East CHCP

Anne Marie Carr Nurse Manager (Children) South East CHCP

Margaret Brown Nurse Manager (Health & Community Care) South East CHCP

Janice Greig Homelessness Representative Simon Community

Lorraine Cribbin Community Addiction Manager Social Work Services

Christine Laverty Community Addiction Manager Social Work Services

Marion Russell Children and Families Operations Manager Social Work Services

Kevin Glennie Practice Team Leader Social Work Services

Aileen Shaw Children and Families Operations Manager Social Work Services

Liam Purdie Children and Families Operations Manager Social Work Services

Bill Stewart Older People & Physical Disability Operations Social Work Services Manager Maggie Quinn Older People & Physical Disability Operations Social Work Services DRAFT 28

Manager Jeannie Gillen Operations Manager, Mental Health Social Work Services

Janice Prentice Operations Manager, Mental Health Gartnavel Royal Hospit

Isla McGlade Community Nurse Carlton Day Centre

Anne Fitzsimmons Learning Disability Operations Manager South East CHCP

Eileen Carroll Senior Manager, Mental Health Florence Street Resour

Alison Davidson Pharmacy Representative

Marie Farrell LHCC General Manager, South East Govanhill Health Centre

Margaret Lamont Podiatry Team Leader Govanhill Health Centre

Nichola Brown Health Improvement Manager South East CHCP

Monica Lynch Public Health Practitioner Govanhill Workspace

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APPENDIX 3

Commitment to Community Engagement

National Standards have been developed for Community Engagement. These standards aim to transform the quality of community engagement by providing measurable performance statements that can be used by everyone involved to achieve highest quality process and results. There are ten standards by which community engagement can be measured and which can be used to develop and support better working relationships between communities and agencies delivering public services. The standards covered are:

• involvement, i.e identifying and involving people who have an interest: • support, i.e overcoming barriers to involvment; • planning, i.e gathering needs and resources information and using this to agree the purpose, scope and timescale of engagement; • methods, i.e use of methods of engagement that are fit for purpose; • working together, i.e use of clear greed procedures that enable participants to work with one another effectively and efficiently; • sharing information, i.e ensuring necessary communication of information between participants; • working with others, i.e effective work with others who have an interest; • improvement, i.e active development of skills/knowledge/confidence of participants; • feedback, i.e feedback of results to wider communities/agencies affected; • monitoring and evaluation, i.e performance monitoring of engagement against standards.

The engagement process within the CHCP will be measured using these standards and work done to develop a number of key indicators and outcomes for the process. The standards will be useful for increasing participation in the planning and delivery of services and provide a mechanism where all groups are enabled and empowered to have a voice equally.

DRAFT 30