Taking a joined-up approach to improving health and wellbeing
‘Integration’ is the word currently on everyone’s lips. Intense pressure on budgets coupled with an increasing demand for services means that joining up health and social care is no longer simply desirable, but is now seen as essential to ensuring the quality and sustainability of services in the long term.
“Unless Scotland embraces a radical, new, collaborative culture throughout our public services both budgets and provision will buckle under the strain,” the recent report of the Christie Commission on the future delivery of public services warned.
The Scottish Government concurs and has repeatedly stated its commitment to integrating health and social care. Health Secretary Nicola Sturgeon has said the time to remove the divide between health services and local authorities in their roles as providers of social care is “long overdue”, and she has pledged to reveal the Government’s eagerly anticipated proposals for bringing them closer together in a statement to the Scottish Parliament later this year.
However, more informal considerations of how to translate this ambition are already well under way across the country and practical examples are beginning to emerge. In Dumfries and Galloway a joint Health and Wellbeing Unit was launched earlier this year, bringing the council and health board together to work in partnership to improve health and advance wellbeing in the population.
“This unit will be the first of its kind in Scotland,” Derek Cox, Director of Public Health, NHS Dumfries and Galloway proudly boasted when the unit was announced. “In this respect we are leading the way and I am certain that others will follow in the future. It has been far-sighted of our council to pursue this actively and this reinforces the fact that health is everybody’s business.”
The council shared his enthusiasm for the joint venture, with Richard Grieveson, Head of Resource Planning and Community Services at the council, describing the unit as “a model of good practice.” “I hope we can continue to work in partnership so successfully. The unit will support our council’s priorities and bring expertise in our two organisations together, avoiding duplication and making us more efficient and effective.”
Avoiding duplication so as to maximise current resources in these straitened times was a key factor in the decision to set up the joint health and wellbeing unit, explains Elisabeth Smart, a consultant in public health with the unit, as was a keen desire to foster closer working relationships with council colleagues.
The unit has been put forward as an example of best practice by Scotland’s Chief Medical Officer. So with other areas considering their own approaches to integration, what advice can Smart offer for smoothing the transition?
“In Dumfries and Galloway we have the advantage that the NHS health board and the council boundaries are coterminous. This is a big advantage for us because it makes joint working much easier,” she says. “We have a history of good partnership working in Dumfries and Galloway anyway. Other areas have a number of CHPs. So a health board would have to work with, it can be six or seven different CHPs, which does make it very challenging. Whereas in Dumfries and Galloway we just have the one CHP, which is the same boundary as the local authority and it does make it easier for us.”
The joint unit reinforces the message that health is everybody’s business. But how have staff reacted to the changes? “If you think about our job, which is about health improvement and tackling health inequalities, we’ve always worked with the underpinning principles of partnership working, so in that sense, the staff had no problems with moving into a joint health and wellbeing unit because it helps meet our overall goals and aims,” Smart says.
While the unit is still in its infancy Smart hopes that as time goes on it will be able to demonstrate its value by working more closely with its council and thirdsector colleagues. In addition to providing strategic expertise, the unit will also fulfil a commissioning role by providing financial support for councils, the NHS and thirdsector organisations to deliver projects and initiatives on a number of key policy themes.
Smart explains: “We are going to be commissioning services and I know that this happens elsewhere in Scotland to a lesser or greater degree, but we are going to try and use this as an approach under the auspices of the joint health and wellbeing unit. So again, that is something a bit different.”
The unit will seek to improve health through a whole systems approach, she says. “Rather than just looking at elements of improving health, we are looking at how we can improve health from an individual perspective through to a community perspective and a settings perspective, as well as what we can do around policy and strategy locally.”
The public sector is itself a large employer, she points out, and so through a workplace setting has an opportunity to tackle a range of health issues, backed by a number of workplace-based national policies. “One of Scotland’s biggest successes has been in introducing the smoking ban in the workplace,” she says. “We followed that through here, we offered additional support and now we have smokefree environments within the workplace. So we have a role in implementing some of those national policies.”
Policy documents such as the NHS Quality Strategy and the Equally Well implementation plan are also key drivers for the unit, and inform its longer-term ambitions, she says. “The long-term ambitions would be around tackling the health inequalities agenda so that there are no existing inequalities.”
This, she recognises, is a “very tough” ambition that will require both local and national action. She continues: “For example, if you take the problems that we have with obesity and lots of people now have a weight problem. We can’t do this on our own. We have to do this backed up by policy. For example, supporting policy that would enable people to travel to work in an active way rather than just sitting in a car which is particularly challenging in Dumfries and Galloway because we are a large rural area. But our overall ambition in the future would be that we have tackled health inequalities.”
The unit aims to address both council and NHS priorities for Dumfries and Galloway, especially those that have already been agreed jointly in the Strategic Partnership, such as: parenting in early years; childhood obesity; mental health and wellbeing; and improving the health and wellbeing of people involved with the criminal justice system.
Everybody can achieve a sense of wellbeing, explains Smart. “It is about feeling that you are able to reach your full potential, that you are getting the best out of life, just being happy.” As part of achieving this, wellbeing tools are used to measure people before and after interventions, she explains.
“This links into, particularly, our Keep Well and Live Life to the Full programmes. As well as getting a health check, which is the usual stuff of getting your blood pressure and cholesterol taken, it also incorporates the wellbeing scale. People with low wellbeing are then offered coaching. If people are found to have mental health problems, or any severe health problems they would be asked to go to their GP. But we do use these tools to try and pick up people with low wellbeing and then after a bit of coaching and support, which links into cognitive behaviour therapy techniques, people can actually help themselves to improve their wellbeing. So you can see quite a difference.”
Cox and Grieveson will speak about the new unit and how it is also seeking to improve mental health and wellbeing through a population-based approach when they address Holyrood magazine’s ‘Scotland’s Mental Health: A new strategy, a new approach,’ conference in Edinburgh this week. Happiness and wellbeing are powerful predictors of health and Cox has previously spoken of his ambition to make the people of Dumfries and Galloway, “the happiest and healthiest people in Scotland.” And Smart insists that they are off to a good start.
“In terms of some of the statistics, we do have a low crime area, for example, and we do have a longer life expectancy here than in Glasgow,” she says. “So we are on the right path. And that is a good aspiration to have.”