1. The East Lothian Experience Support from the Start

2. Ministerial Taskforce Report – June 2008 Scotlands health is improving rapidly but it is not improving fast enough for the poorest sections of our society. Health inequalities remain our major challenge Scotlands health is improving rapidly but it is not improving fast enough for the poorest sections of our society. Health inequalities remain our major challenge

3. 20 th century trends in life expectancy in Scotland and 16 other Western European countries Life expectancy in years 30 40 50 60 70 80 19001910192019301940195019601970198019902000 Scotland

4. The National Programme Health inequalities are Health Ministers top priority Health inequalities are Health Ministers top priority Key priority areas of childrens very early years; the big killer diseases of cardiovascular disease and cancer; drugs and alcohol problems and links to violence; mental health and wellbeing Key priority areas of childrens very early years; the big killer diseases of cardiovascular disease and cancer; drugs and alcohol problems and links to violence; mental health and wellbeing Eight test sites established to find new ways of working at a community partnership level Eight test sites established to find new ways of working at a community partnership level

5. East Lothian Test Site

6. East Lothian One of 32 Scottish Unitary Councils One of 32 Scottish Unitary Councils Known as Edinburghs garden Known as Edinburghs garden Fastest growing population in Scotland (90,155) Fastest growing population in Scotland (90,155) A good place to live, bring up families & retire to. A good place to live, bring up families & retire to. Lot of service pressures esp. housing, and care services for older people Lot of service pressures esp. housing, and care services for older people Health is slightly above Scots average Health is slightly above Scots average Inequality is the issue Inequality is the issue

7. Health Inequality in East Lothian Percentages – source Community Health Profile 2004

8. Health Inequality in East Lothian Percentages – source Community Health Profile 2004

9. Health Inequality in East Lothian Percentages – source Community Health Profile 2004

10. Community Planning Partners can make a difference by focusing services on pathways that can reduce health inequality in the early years of life.

11. Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it. And then he thinks that perhaps there isnt.

12. The Test Site approach Consistent parenting, safe, nurturing early years, supportive education Health behaviours Opportunity to escape poverty. To have decent housing, social networks, self esteem, control

13. Key Elements of Approach Leadership – strategic, service & community champions Leadership – strategic, service & community champions Learning – what works Learning – what works Engage with Communities Engage with Communities Mainstream services Mainstream services Innovation Innovation

14. Activities Action learning sets Action learning sets Civic Conversations – short term learning outcomes Civic Conversations – short term learning outcomes Development fund Development fund Service mapping & redesign – medium term outcomes Service mapping & redesign – medium term outcomes Measuring and evaluating change Measuring and evaluating change

15. Action Learning Sets Action Learning Sets are a small group of individuals who support each other in learning and development in an area where they have an interest and want to expand their expertise. They consist of 5- 8 people with a facilitator. Each set reflects a range of services but does not mix managers and practitioners. Service Champions participate. Action Learning Sets are a small group of individuals who support each other in learning and development in an area where they have an interest and want to expand their expertise. They consist of 5- 8 people with a facilitator. Each set reflects a range of services but does not mix managers and practitioners. Service Champions participate.

16. Service Champions An Equally Well Service Champion is an individual, identified by senior managers who is able and willing to foster a learning environment within their areas in relation to promoting Health Equality. An Equally Well Service Champion is an individual, identified by senior managers who is able and willing to foster a learning environment within their areas in relation to promoting Health Equality.

17. Service Champions Communicating the vision and values of Support from the Start within their area Communicating the vision and values of Support from the Start within their area Bringing the experience and knowledge of their service area to an Action Learning Set Bringing the experience and knowledge of their service area to an Action Learning Set Supporting services to identify training and information needs related to Support from the Start and communicating these to the Project Manager Supporting services to identify training and information needs related to Support from the Start and communicating these to the Project Manager

18. Service Champions Contributing as appropriate to a Support from the Start online learning log Contributing as appropriate to a Support from the Start online learning log Be willing to participate, as appropriate, in the dissemination of the East Lothian Test Site experience to other authorities and agencies within Scotland Be willing to participate, as appropriate, in the dissemination of the East Lothian Test Site experience to other authorities and agencies within Scotland

19. Civic Conversations How do we get communities, parents and children involved in key health improvement challenges for the early years of life? How do we get communities, parents and children involved in key health improvement challenges for the early years of life? Do East Lothian services make it easy for parents to be good enough and can parents access the right support early enough when they are finding it hard to cope? Do East Lothian services make it easy for parents to be good enough and can parents access the right support early enough when they are finding it hard to cope?

20. Civic Conversations How should we target support for children and families that are at risk of poor health so that those who need the most support get it when they need it? How should we target support for children and families that are at risk of poor health so that those who need the most support get it when they need it? Does the physical space of our communities contribute to creating good health in the early years and support parents in raising healthy children safely? Does the physical space of our communities contribute to creating good health in the early years and support parents in raising healthy children safely?

21. Development Fund Initial Fund of £49000:- Initial Fund of £49000:- Applications for small development grants can be made by the Service Champions. Applications for small development grants can be made by the Service Champions. Projects must Projects must contribute to at least one target area contribute to at least one target area demonstrate potential for learning demonstrate potential for learning lessons from the work must be communicated. lessons from the work must be communicated.

22. Community engagement Open ended dialogue with communities about health in early years Open ended dialogue with communities about health in early years Civic conversations for short term outcomes Civic conversations for short term outcomes How does it work – How does it work – Different in each community Different in each community The Tranent experience The Tranent experience

23. Outputs A healthier start to life for children in Prestonpans, Wallyford, Whitecraig, Tranent & Musselburgh East. We haves explored a diverse range of ways to involve communities, parents & children in key health improvement challenges All relevant services have reviewed how they can make it easy for parents to be 'good enough', and how they help parents to access the right support, early enough when they are finding it hard to cope? All services have reviewed how we target support for children and families that are at risk of poor health, and ask is it effective? We have assessed the physical space of our communities and its contribution to creating good health in the early years and support for parents in raising healthy children safely Reduce obesity levels among children in P1 Reduce pregnancies in under 16 years Increase no. of children with no obvious caries experience in P1 Reduce smoking rates in pregnancy Increase opportunity for involving parents and children Increase number of HIAs on new developments Improved outcomes for looked after children Increase proportion of newborn children breastfed at 6 -8 weeks Improved educational attainment Improve emotional well being in early years Review of Service pathways to identify - what works? what needs improved? what are the gaps? NHS Services - Health Visitors - Midwifery Services - General practise - Health Promotion & public health services - CAMHS ELC Services - Early Year services - Primary school P1–P3 - Childrens social work - Community Services - Environment Services Voluntary sector Children 1 st First Step Care Free Kids Barnardos Others Private Sector - Nurseries - Childminders Integrated Childrens services Plan Joint Health Improvement Plan Equally Well Implementation Plan Early Years framework Getting it Right for every Child Curriculum For excellence Single Outcome Agreement Lothian Health Plan Support From the Start service development Fund Developing Service pathways -Identifying interventions - Agreeing intervention - Implementing - Evaluating Identify Service Champions to lead on learning process Supporting learning Establish a local research & evaluation network Establish a local learning network Establish action learning sets for champions Establish a web log Assumptions & Risks This model assumes that health inequality is best addressed by mainstream services combined with a vigorous community engagement strategy. It also assumes that service providers and the target communities have a shared interest in improving health and addressing inequality and are willing to prioritise this Logic Model For Support from the Start Risk are: Recession. Time pressures on services limiting capacity for change. Prioritisation of health and social justice issues change before objectives can be realised. Barriers to working across agencies reduce capacity for change and shared learning. InputsActivitiesParticipationShort-term outcomes (learning)Medium Term Outcome (Action) Long-term outcomes

25. Finally…………….

27. …………..but this is to facilitate change

28. If we keep on doing what we have always done then we will not address the equity issues in our community

29. We will know we have succeeded when:- Children and families are engaged with the key health improvement challenges Children and families are engaged with the key health improvement challenges Parents can access support for healthy living when they need it Parents can access support for healthy living when they need it Parents and children have good quality child friendly environments Parents and children have good quality child friendly environments Those at most risk of poor health receive most support Those at most risk of poor health receive most support

30. More information Web log http://edubuzz.org/blogs/equallywell/ http://equallywell.ning.com/