Change Fund LTCs Self Management Programme D&G Building Healthy Communities
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Change Fund LTCs Self Management Programme D&G
Building Healthy Communities
Workstream Supporting People in their Communities
Test duration Mar 2012 – Mar 2015
Author/Lead Thomesena Lochhead
Contact details tlochhead@nhs.net
Contents Comments
tick
1 Test of Change Proposal √
2 PMP
3 Final Report √
4 Appendix √
Test Description
People with long term conditions and their Carers are supported as early as possible to self manage
their conditions and access low level support.
Evaluation to Date
This test demonstrated an increase in access to community development activities, services and
local planning opportunities
Of the 1114 individuals who accessed a range of weekly activities through tasters lasting 4-6 weeks,
573 participants regularly attended longer sessions and completed the ‘before and after
questionnaires’. 473 (83%) had one or more LTC and 75 (13%) were carers.
The following results give an indication on the impact of the interventions delivered:-
• 286 (50%) felt more in control of their health conditions or circumstances
• 395 (69%) reported positive health outcomes and achieved their desired outcomes as a result of
the activities they were involved in.
• 269 (47%) felt better able to manage their symptoms
• 200 (35%) said their increased knowledge had improved their coping strategies.
• 202 (40%) felt less stressed or depressed by their condition/ circumstances.
• 238 (46%) felt more able to socialise
• WEMWBS** mean score has moved from 47.6 to 51.7 indicating a meaningful increase of 4.0 in
the mean wellbeing score to above the Scottish mean (50.7) after intervention.
• 16 respondents with cancer who answered the WEMWBS, mean score moved by 6.6 from 50.7 to
57.3
1Through the PYF funding, 91 volunteers (63 with LTC’s) have had training and are facilitating a range
of health improving activities. These have been a range of physical, social and health activities
which include ‘ self management/ coping techniques’, arts, art therapy, crafts, computing and IT
skills, singing, chair based exercises, Boccia and new age curling, cooking , Tai Chi for health, Reiki,
one to one support and volunteering opportunities
2CHANGE AND INNOVATION FUND PROPOSAL
Title of proposal
Change Fund LTC’s Self Management Programme D&G
Organisation
Building Healthy Communities and partners / LTC programme steering group
Responsible Lead
Thomesena Lochhead, Health and Wellbeing Specialist, JHWU.
Brief description - Outline of purpose, nature of service, delivery model, links to strategic priorities
Purpose
To deliver an LTC programme focusing on local delivery of the health and wellbeing strand of the
PYF strategy to include :-
1) Wellbeing, prevention and early interventions for people approaching the older age group,
older people and those with LTC’s including mental health issues.
2) To nurture positive attitudes to self managing LTC‘s and capacity building.
3) Supporting the development/ training and re-ablement of individuals diagnosed / living with
a LTC and their carers.
4) Reduce financial hardship arising from retirement and diagnosis of LTC.
Underpinned by an assets based and co-production approach, individuals will be supported to
enjoy independence. This will be within the context of the ongoing development of healthy
communities.
Nature and delivery of the service
Building on positive evaluation of the 2 year region wide ‘Holistic LTC Self Management
programme led by BHC, the LTC steering group will work with partners including local health
improvement teams/ PHP’s and front line health professionals to :-
1) Establish co-production between new (and current) partners, strengthen referral pathways,
signposting and outreach to ‘self management opportunities’.
2) Encourage, motivate and co-develop individuals with LTC’s (and carers) to engage in their
communities through activities, volunteering and cascading health improvement opportunities to
hard to reach populations.
3) Demonstrate the benefits of a ‘community development approach’ and its potential to be
incorporated into service design and delivery
4) Evaluate and measure effects of interventions on individuals / communities and ‘test’ new ways
of strengthening community capacity.
Links to strategic priorities
• Change Fund Outcomes : Health, Wellbeing and Reablement/ Reshaping care for older people
• The shared ambitions of the SOA, JHWU and locality health improvement plans, NHS D&G /
D&G Council – to include ‘person centred’, close to home and having a shared approach with
partners and the target group.
Key Features: Aspects that are considered to be particularly significant in the context of Putting You First
The proposed programme will take a ‘community development’ approach, where the linking up of a
range of existing and new partners together so that PYF clients will receive the best possible
service. BHC (a Healthy Living Centre Programme) has an excellent track record in putting local
people at the centre of identifying local problems, formulating solutions, design and delivery of
services and outreach. Consequently BHC has extensive experience of developing community led
activities / projects which have a direct impact on mental health and wellbeing of those taking part.
Within the context of PYF, BHC and partners have taken the opportunity to develop this funding
proposal, by building on the evaluation and evidence from the Self management LTC programme.
1This proposal addresses two of the outcomes of the PYF ‘ framework for service delivery’ :-
Health improvement / Reablement
Prevention and Person centred
Early intervention LTC programme
• Wellbeing and prevention activities • Promote and maintain self management
• Early intervention by accessing :- approaches
o Healthy weight communities • Promote independence/ quality of life
o Living life to the full • Support to re enter or join social networks
o Keep well and / or self help groups
o Heart start • Opportunities to impart new ‘self
o Counterweight management skills’ to others
o Healthy initiatives / opportunities • Training / retraining and support to enable
• Volunteering opportunities volunteering and potential employment
• Involving service users / volunteers in the
development of services to meet local
needs.
Evidence has shown that participation within the
health improvement / prevention programme
frequently leads to re-enablement / volunteering.
Benefits:–
As co- production will strengthen referral pathways and utilise resources that will enable:-
Individuals with Long term conditions and their carers to:
• Have improved access to health improving services/ activities delivered by statutory, private
rd
and 3 sector organisations.
• Experience a ‘holistic’ person centred package of support and opportunities such as self
help support groups, training, volunteering and involvement in community activities,
engagement and decision making.
• Have the opportunity to volunteer, receive coaching and mentoring / one to one support and
training.
• Have health benefits from supported volunteering to deliver activities and engage in the
community
rd
LTC programme, 3 and independent sector to:
• Have increased referrals, increased numbers of volunteers and more interagency working.
• Close working links/ outputs with Pathfinder projects and other relevant PYF programmes
Communities to:-
• Be enabled /empowered to develop, deliver and sustain initiatives/activities and services
relevant and needed for their communities
2The key features of this proposal:-
For more than 10 years BHC’s approach has been focused on those who find themselves either
disadvantaged or experiencing challenging circumstances and help them turn their lives around,
address their issues and start to experience a better quality of life. Incorporating BHC’s model of 1)
Partnership working (with 3rd sector, public sector and local individuals), 2) Outreach (through
health improving activities, volunteering and engagement) and 3)‘One to one’ tailored support and
mentoring (to motivate, empower and enable individuals who would not other wise get involved),
this proposal is to :-
Deliver preventive, early intervention and reablement activities:-
1. To establish a more streamlined ‘person centred’ approach in‘ strengthening referral pathways
for older people that will :-
a) Promote health and wellbeing
b) Establish strong links with front line health professional staff such as cardiac rehabilitation
unit, falls clinic, diabetic clinics, primary care staff etc. This would be an evolving process
with increased referrals, consequently reducing the need for time and resources required to
raise awareness of opportunities available.
c) Establish similar links with other agencies e.g. WRVS, Stars, Job Centre Plus, Social work
and the Personalisation team.
2. To promote the ethos of self management so ‘to promote independence for as long as possible’
a) Make early interventions for and with vulnerable people, families and communities
b) Identify barriers and enable participants to adopt potential solutions.
c) Support systems that enable participation and development of skills for self management
d) Access to relevant advice, information and support. This will include access to benefits
advice, social issues and utilisation of technical support (e.g. Telehealth).
3. To build community assets and resilience by supporting, developing, training and mentoring
individuals who will champion / volunteer to deliver more health improving interventions and
opportunities :-
a) Enable individuals to learn new skills and encourage community participation
b) Opportunities for retraining and refocus on improving employability if desired.
c) Offer opportunities for volunteering, peer support and befriending; skills and knowledge
acquired can then be used within the communities.
d) Integrate a focus on tracking of volunteers/ service users’ progress in relation to ‘health and
wellbeing’.
e) Evaluate the impact of volunteer work on the community (social capital).
4. To establish and demonstrate a region wide model of joint working with partners :-
a) The target group will be involved in identifying, designing, implementing and evaluating
health improvement activities through a range of engaging methods (e.g. participatory
appraisals, consultations, partnership working etc.) They will also be involved in testing
new ways of engagement.
b) Individuals and communities will be enabled to inform/ influence community planning
partners.
c) The already established links with partners of the LTC steering group will be strengthened
by additional new public and 3rd sector partners who have similar interests in :-
i. prevention of ill health
ii. promoting health and wellbeing of older people
iii. reablement of those diagnosed with a LTC
d) Link with tele-health team and facilities
e) Link with other ‘change fund projects’ e.g. ‘Whole Systems Response Programme’
5. Test ‘transformational change’ on using ‘community development’ approaches in relation to:-
a) Co-production and referral processes
3b) Community engagement
c) Effect on individual’s health and wellbeing.
Evaluation will be a cornerstone of the LTC program. Advice and support will be sought from the
evaluation sub group and for consistency it is intended that similar tools are used throughout the
program.
Proposed delivery model
It is proposed to deliver this programme throughout D&G with the help of the PHP / LHP teams,
front line health and social care professionals based in hospitals and communities.
The ‘Test of change’ will be determined at Area and Steering group level in consultation with the
PYF team and be linked with other ‘Change fund programmes’
In the light of equality is suggested that a total of 3 WTE Band 4 posts be employed to work in each
of the 4 BHC areas (West Wigtownshire, Machars, Upper Nithsdale and Lower Nithsdale),
Stewartry and Annandale . Please see appendix.1
Proposed delivery model-
‘Test change Building ‘Test change
‘on outcomes Healthy ‘on outcomes
for partnership Communities for individuals
working
3rd and Public Long Term Front line Health
and social care staff
sector agencies Conditions / / other relevant PYF
including other older people programmes e.g.
‘Change fund Service User promoting
programmes’ independence & WB
Nithsdale
PHP’s / LHP teams /
A&E SHAPS/ Health
Several tests of and Wellbeing
change determined Strategic
by PYF team and Partnerships/
steering group JHWU
Innovation – focusing on older people and those with Long Term Conditions
Additionality – formal partnership arrangement that will establish a more streamlined
referral route to community development / health improvement activities.
4Supporting policies to utilising ‘Community Development’ approaches
The World Health Organisation’s (2002) definition of ‘active aging’ as the ‘process of optimising
opportunities for health, participation and security in order to enhance the quality of life as people
age‘ sums up the ethos of policies advocating support for older people and those with Long term
conditions :-
Adding life to years (2002)
‘Older people should be encouraged to be physically and mentally active‘,
‘Older people should have access to information about healthy lifestyles and health promotion
campaigns should actively involve them’,
All our futures (2007) ‘All the years of life are fulfilling and the contribution of older people is
valued , appreciated and where necessary supported’, Older people should be able to ‘access
information’, ‘participate in learning activities’, ‘volunteer for as long as they want’, and ‘enjoy more
years of healthy life’
The Whit fettle (Dumfries and Galloway Lifestyle survey (2007) indicate a strong relationship
between optimism / pessimism and high / low wellbeing. In other words, pessimism is associated
with poorer levels of physical health in comparison to those who are optimistic about the future.
Building on this theory and evidence that if one belongs to a group their life mortality rate
decreases and demonstrates a need to support older people and people with LTC more. A
national study of the positive impacts of self care interventions and group belonging for people with
LTC is reported in the Gaun Yersel (LTC strategy 2008) as demonstrating the effects of increased
levels of peer support and education between individuals as improving optimism and ultimately
health and wellbeing.
In addition, Labonte’s (1998) theory of health as among other things ‘experiencing a
connectedness to community’, ‘having good social relationships’ and ‘experiencing a sense of
control over one’s life and living conditions’, then initiatives / interventions that help to address
these will only improve health and wellbeing.
Gaun Yersel – The Self Management Strategy for Long Term Conditions in Scotland 2008
Although this strategy addresses the issues and needs for people with LTC’s it is universally
recognised that a large percentage of this population are older people. The strategy emphasised
that people do not have the information or skills to make good responses to their conditions and
good decisions about their life and points out that if the appropriate timely support was offered such
as ‘one to one’ support, structured education, self management courses, self help groups etc then
‘people will feel empowered to learn about their condition, make changes accordingly and identify
areas they need more support’. Although the total cost of LTC’s in Scotland is not known, it is
evidenced that self management can reduce the impact of LTC on the NHS services.
‘Self management’ is not a single intervention, action, treatment or service and cannot be delivered
by one organisation. Instead it should be tailored to suit each individual and therefore be sensitive
to their needs. While some individuals will need individual support to help them cope with health
issues others will benefit from a wide range of group activities / interventions that address their
issues. These could range from volunteering, being involved in community issues / decision making
or perhaps learning / retraining for something new. The evaluation of D&G’s Holistic Self Help LTC
programme (lead by BHC) demonstrated challenges in attracting specific people with LTC’s (many
individuals do not wish to be labelled). The Change fund proposal should address this by stronger
referral routes for older people to health promotion/prevention activities from front line health, social
care and 3rd sector care providers which will include those with LTC’s
Holistic Self help LTC programme evaluation
This D&G wide programme funded by Fairer Scotland Fund for 2 years, (October 2009- September
2011) has just completed a full scale evaluation of the service users who attended activities. By
the end of September 2011 the programme has had direct contact with approximately 723
participants across D&G who have a LTC. While most were reached though signposting/ referring
from other agencies (particularly 3rd sector) the majority were self referrals as a result of local
publicity. Working in partnership with agencies such as DG arts, Arthritis care, Community learning
5and Development, Home Scotland, Supported Employability Services, Benefits Maximisation team
and Job Centre Plus etc, individuals received a wide range of opportunities. These ranged from
citizen’s advice, benefits advice, social networking, health improvement activities and creative
workshops, all of which were evaluated at different levels to determine their effectiveness.
Although many of the participants were just offered taster sessions of activities (approx 3-4 weeks),
the evaluation demonstrated some improvement. Of 299 service users who ‘correctly’ completed a
‘before and after interventions WEMWBS questionnaire’, 62% reported a positive shift in how they
were feeling and of 59 participants 43% indicated feeling more ‘in control of their conditions’ after
intervention.
Comments include ‘Got me out of the house’, ‘enabled me to be more active and I have a better
understanding of my condition’. Specific activities such as the Tai Chi for health, The Drop in’s, Arts
and crafts have demonstrated positive effects: ‘Tai chi has made a great difference in my life – it
helps me breath properly and relieves my anxiety’, ‘Blood pressure has come down and less visits
to the GP’, ‘Hopefully I can join something else now as I feel more confident – feel useful and
happier’.( LTC PA carried out September 2011)
Consultation: Please indicate individuals, groups or professional bodies involved with or consulted on the
development of this proposal
BHC Regional partners/ Area partnerships to include 3rd sector partners :-
Partners spoken to re new funding proposal
Director of Public health
Public Health Consultant
Cromarty (Mental Health Team, Stranraer,
D&G Community Learning and Development (CLD)
D&G Leisure and Sport
Geoff Mark, Joint planning and commissioning Manager, Older adults ( West) and Physical
Disability
Rehabilitation unit (Chris Wallace and team)
Arthritis Care
Joint Health and Wellbeing unit, NHS D&G
Locality Health Improvement Teams (PHP’s) Stewartry, A&E, Nithsdale and Wigtownshire
Capability Scotland
Community members and service users in all 4 BHC partnerships (West Wigtownshire, Machars,
Lower Nithsdale and Upper Nithsdale)
Chest, Heart and Stroke Groups, Stranraer
NSF/ Kaleidoscope
Home Scotland.
Tai chi Community for Health and Wellbeing- Dumfries
Benefits Maximisation Team,
Phoenix club
Port William Fibromyalgia Group
Supported Employability Services
SHAWL ( Supporting Holistic Arts and wellbeing ) Stranraer
PYF team
Wigtown Partnership for Health
Other partners to approach as part of the proposal
Accessible transport
Adult Literacy and Numeracy
Benefits Advice Project
D&G Citizen’s Advice Bureau ( DAGCAS)
Connect Group, BreathEasy Support group.
D&G Council for Voluntary Service ( Nithsdale- the Hub) ( Wigtownshire – The Bridge)
D&G Volunteer Action
6D&G Women’s Aid, Kirk care,
Loreburn housing, Job Centre Plus
Service users with LTC, Stranraer Cancer Support Group, Stranraer Writing Support Group
Newton Stewart Day Centre, Newton Stewart Arthritis Group
Turning Point Scotland, APEX, AD action
Keep Well Team
Scottish Healthy Living Centre Alliance (SHLCA)
Wigtown Cancer Group, Wigtown Breathing Group, Wigtown Diabetes Group.
Machars Coronary Club
New potential partners to approach
Food train, Social Services, Key Housing, Personalisation Team, STARS, Telehealth team.
Age Scotland, Age Concern, Senior Forum, Carers Princes Trust, Wellbeing Rhins
Health Professionals; to start with Cardiac Rehab Unit, Falls clinic, Diabetic clinic, Rehab clinic,
Primary Care Staff – GP practices, Health Visitors/ District Nurses
WRVS , NHS Health Scotland
Other partners as advised
Benefits: please list including
- benefits for service users
- realisation of efficiencies
Service users will benefit from :-
• Joined up (co-production) of health improving activities and eliminate duplication
• Improved referral / signposting processes and the ‘test of change’ on how it strengthens patient/
client pathways.
• Access to experienced team of BHC staff, volunteers, service users and partners in relation to
developing self management techniques. A working group for LTC programme is already
established with at least 8 service users as members and if continued is ready to develop this
programme.
• Progress of the LTC work as new partners come on board thus increasing referrals and
opportunities in line with the PYF agenda.
• Access to health improving activities and interventions that will offer support on issues such as
benefits advice, health improvement, coping strategies and self management techniques.
• One to one support, coaching and mentoring, training and new experiences including
volunteering
• Being involved in community led activities i.e. identifying, designing and implementing local
health improvement activities.
• Contributing to the ‘test of change’ and the potential opportunity for ‘transformational change’ in
service delivery for the target group as a whole
Realisation of efficiencies
BHC is able to build on the experience of previous work and evaluations to shape the direction of
this proposal and the opportunity to influence transformational change of service delivery.
There is strong potential to inherit a small number of volunteers (with LTC’s) who have been trained
in activities such as reiki, Tai Chi and ‘mindfulness’ and are ready to lead programmes to the wider
community.
As the current LTC programme has had a number of referral routes to the programme, this funding
proposal aims to develop a stronger focus on older people / LTC referral pathways to and from
Social work, Primary care, Front line health professionals, WRVS D&G Good Neighbours scheme,
Stars etc.
BHC and LTC programme partners will also be able to utilise a range of measures to indicate
efficiencies and good use of resources that show :
• Improvement of accessibility to local health improving initiatives and opportunities.
7• Numbers of individuals referred to the programme.
• Impact individual volunteers have on the community they serve.
• Service user’s progress and the effect interventions have on their health and wellbeing
(before and after interventions)
• Community based groups/ developments established can now be evaluated against their
overall impact on the community (community resilience) and should help determine future
planning of resources.
Advice will be sought from the evaluation sub group regarding use of measurement tools. It is
anticipated that these will relate to mental health and wellbeing, satisfaction scales, group and self
assessment tools (Rickter scales).
The final evaluation of the current LTC programme has already demonstrated a reduction in clinical
dependency and increased health and wellbeing. This proposal which takes on new innovations
and test change will improve overall health and wellbeing of the target group and thus take
pressure of clinical and social services.
Has service redesign been considered as a possible alternative means of achieving the
same benefits? If so please explain why this has been rejected.
The current LTC steering group carried out a SWOT analysis that showed further gains could be
achieved by introducing a more substantial referral system and co production, underpinned by
community development approaches through the PYF agenda. There are opportunities now to
establish and strengthen pathways, increase the breadth of responses by linking into other projects
/ programmes e.g. ‘whole system responses in lower Nithsdale’
BHC plan to approach new partners such as :-
Stars, Telehealth assessors, Social Services, Personalisation team, WRVS (good neighbours
scheme) and other potential partners who have been involved in the current LTC programme on an
ad hoc basis e.g. cardiac rehab team, Falls clinic, diabetic clinic etc.
Costs: Please indicate
- the minimum required to deliver useful change and improved outcomes
- the optimum to maximise the pace and delivered benefits of the proposal
- whether costs are recurring or non-recurring
Minimum Amount -- £150,000
Optimum Amount --- £165,000
Recurring/Non-recurring - Recurring
How will any funding be used?
Identify what the money would be spent on, including any related capacity building
In the process of developing this proposal more formal arrangements will be made to promote
referring/ signposting from 3rd and public sector clients / patients to community development /
health improvement activities. There needs to be focused resources identified to ensure BHC /
LHP will be able to establish with service users new relevant activities / interventions, volunteering,
one to one support and community engagement.
It is proposed to employ 2 x 37 hrs and 2 X 18.5 hrs Band 4 Change Fund Workers supported by
BHC and PHP’s and will :-
• Work with Older people and those with LTC’s
• Work closely with partner agencies and front line workers and ensure good working
relationships are forged and referral systems are in place
• Be involved in the identifying and setting up of activities and interventions.
• Support individuals and relevant community groups
8• Offer advice, information and contribute to effective working systems
• Play a large part of the development and running of the evaluation processes.
And 1 x 20 hours Band 2 Administrator who will support all 6 areas to ensure Dumfries and
Galloway wide cover of evaluation material. This will ensure the evaluation material is carried out
across the region in similar manner using the same materials and collection times etc. In
preparation for the reports to PYF team, BHC regional partnership and the projects steering group.
This post managed by the BHC lead should support the CHDW’s and PHP in their responsibility to
ensure the Change Fund work is being monitored.
BHC and partners have looked at several options of how this programme could be delivered within
the funding available, capacity of existing structures, staffing and resources. The option below was
the preferred option :-
Staffing costs Salary/ banding Min to Include Optimum Totals
on costs Min / Optimum
3 x WTE Band 4 £21,798 pro rata £78,000 £78,000 £78,000 / £78,000
Change Fund Workers (18.5. hrs – £10,899)
(cover 6 areas) (£13,000inc on costs)
2 full time split between 4 BHC teams (1 East and 1 West) and 2 x 18.5
hour posts for Stewartry and Annandale and Eskdale
1 x 20 hour Band 2 (£17,003) pro rata £10,800 £10,800 £10,800 / £10,800
Administrator
Mileage costs £ 4,000 £ 6,000 £ 4,000 / £ 6,000
Recruitment costs £1,200 £ 1,200 £1,200 / £1,200
Initiatives and training of £56,000 £69,000 £ 56,000 / £ 69,000
volunteers
Breakdown D’fries and Lower £10,000 £14,000 £10,000 / £14,000
Nithsdale
1)Stewartry, £46,000 (5 areas £55,000(5 areas £46,000 / £55,000
2) Machars @ £9200 each) @ £11,000 each)
3) Annandale and
Eskdale,
4) West
Wigtownshire,
5) Upper Nithsdale
£150,00 / £165,000
Risk: please outline any actual or potential identified risks
• Recruitment of posts across D&G. – previous experience shows that it can be difficult to
recruit outwith the major urban areas.
• Vulnerability of 3rd Sector partners who depend on external funding groups
• Challenges between ‘professional cultures and community development approaches ‘
• Failure to engage all stakeholders
Project Timescales: On the basis of work to date or knowledge of relevant local systems, indicate
when it is envisaged that the proposal will :-
Commence: - November 2011 (as soon as proposal is approved) This proposal could start
instantly building on the work already carried out. The Steering group can establish an action plan
(with service users involved) to determine various stages and milestones.
Be Evaluated :- Ongoing 6 monthly until end of programme ( report to LTC steering group on
monthly/ 6 weekly basis) It is anticipated that each outcome will require different evaluation
9methodologies and therefore select the relevant validated tools negotiated with the PYF team /
Public Health.
End :- Duration of the Change fund
(Please provide dates)
Anticipated Outcomes including how these will be measured
Anticipated outcomes will underpin Priority 3 of the SOA (2011-2014) (particularly3.2 and 3.7) and
the Change fund outcomes listed page 7 ( PYF Framework for delivery)
Objectives :-
• To deliver a ‘Person centred solution focused’ service that will support older people including
people with LTC at key stages in their lives
• Promote the ethos of self management of own health and social benefits
• Local communities will be stimulated into developing locally identified needs with older people
and those with LTC’s
• Tackle health inequalities and social exclusion
Change fund Keep people as Place the person Maximise Promotes a
outcomes : healthy as possible firmly at the potential to proactive
• Person for as long as centre of their regain health as approach to care
centred possible own care quickly as provision
• Safe possible
• Delivered in Improves overall Builds
partnership, quality of life Reduces community
• Close to dependence and resilience
home as promotes
possible independence
Change fund Co –production Referrals Impact individual Community
LTC’s self volunteer has on based groups/
management the community developments
programme they serve established
anticipated
outcomes
Co –production:-
1. There will be an effective working partnership established to co-ordinate and support the
change fund objectives though the LTC programme.
2. People with LTC’s are able to organise for themselves with the support of the programme some
health improvement activities, initiatives and programmes
KPI’s
• Increase in partnership working (measure co-production) by number of active partners
• Number of new partners engaging with the LTC programme
• Number of referrals made by partners / who referring
Referrals (Accessibility to services / initiatives and opportunities)
1) Older people, people with LTC’s and carers will access health improvement support thus
reducing social isolation, increase independence and promote coping strategies.
2) Individuals with LTC will be encouraged and supported to develop ‘Self help techniques’.
KPI’s
• % people (older people, people with LTC or carers ) will access activities in the
community through referral process
• % of service users will report health interventions having a positive effect on their health
10and wellbeing (measure before and after interventions)
• Number of individuals referred to programme and have increased their activities
• % will take up opportunities such as self help techniques, LLTF, Steps.
Impact individual volunteer has on the community they serve
1) Increase in older people, people with LTC’s and carers taking up new experiences such as
volunteering, training and being part of community engagement processes.
2) Individuals will have peer support from joining groups which address social exclusion issues
KPI’s
• % will take up opportunities such as training, engaging with the community and/ or
Volunteering
• % people who report improved quality of life
• % take up volunteering /facilitating activities / groups
• Qualitative report from groups on impact of volunteers facilitate
.
Community based groups/ developments established / evaluated against their overall impact on the
community (community resilience) and help to determine future planning of resources.
1. Local communities are more understanding on the needs of older people / those with LTC’s
and are galvanised into developing services / interventions that will include people with LTC’s
2. Communities will identify barriers to self management and solutions to these thus supporting
systems that enable participation and development of skills for self management
KPI’s
• Number of new groups established
• Number of participants attending and evaluated (Group rickter)
• Number of groups sustaining independently
• Number of needs assessments and action planning involving target group
Reporting: Please indicate
Frequency of reporting; - As required to PYF team. 3 monthly to the LTC working group, Joint
Health and Wellbeing Team and BHC regional partnership. There will be additional requirements
depending on the ‘tests of change’ being measured
How :- BHC has embedded various methods of evaluation that :-
1) Identify target groups
2) Measure improvements in wellbeing (before and after interventions)
3) Monitor progress towards self identified goals ( PDP’s)
4) Measure effectiveness of activities
Build on current reporting systems / regular evaluation and monitoring including the use of
feedback forms that collect information on regular BHC work :- referrals / service users attending
activities, number of groups and their evaluations / volunteers and what they are actively doing etc.
In addition can utilise relevant validated evaluation tools (provided by Change Fund) where
appropriate and as advised by PYF team and the range of quantitative and qualitative evaluation
tools BHC and partners are experienced in using, of which can be introduced where appropriate
e.g. Individuals’ Rickter score using the life board , Health & Wellbeing tools ( Before and after
interventions) evaluations, Group rickter, case studies etc BHC has also
For this programme there continues to be a need to have a uniform system of evaluation between
areas and partners.
To whom- Regional lead / Long term Conditions working group / Regional partnership/ Locality
health improvement partnerships/ community planning / PYF team
By Whom/Where – BHC/ LHP / new proposed staff
11Exit Strategy: Please provide details of what is intended at the end of the agreed period of funding
In developing and working through ‘tests of change’ it is anticipated that community development
work will be adapted into service redesign and adopted into the community pathways.
Any other points about the proposal?
This proposal supports Annandale and Eskdale in their proposal for a similar post. Their work could
be evaluated using the same tools throughout and gathered by the proposed administrator. As
Annandale and Eskdale has identified areas for the ‘Pathfinder sites’ it is recognised that their
proposal may evolve differently.
This proposal also supports the ‘promoting independence and wellbeing – towards a whole
systems approach in part of Lower Nithsdale. ( GP practice cluster : Greyfriars, St Michaels,
Lochthorn)
Once completed, this form should be returned to:
Judith Proctor
NHS Director of Planning & Head of SPC&P
Lochar South, Crichton Hall
Tele: 01387 272709/32709
Email: judith.proctor@nhs.net
Included – Appendices
a) Structure – workforce plan
b) Excel sheet : Breakdown of funding request
12V1d8 This is 1 of 2 reports:-
1) Building Healthy Communities LTC/
Self Management Programme –
January 2013 – March 2015
2) Social Prescribing being submitted by
Claire Thirlwall and Sharon Walker
End of Test Report until March 2015
Workstream Supporting people in their communities
Test of Change 1. Test the impact of ‘Community Development
approaches’ on health and wellbeing
2. Test the added value of partnership working
Test duration January 2013 – March 2015
Author T Lochhead - Health and Wellbeing Specialist/ Building
Healthy Communities Programme Lead
Test of Change Description (Max 100 words) This should match section 1.1.2 of your PMP
The region wide Building Healthy Communities’ Self-Management Programme has been testing
Community development approaches: -
Test of change- To ascertain if community development approaches to self-management support
and learning are effective in improving the ‘health and wellbeing’ of older people, individuals with
‘long term conditions’ and carers.
Test of change - Benefits /added value of partnership working. Test for better understanding, co-
working, signposting, referring and pooling of resources so to reach more people. To measure using
the ‘Community Engagement Standards’
Test of change: - Social Prescribing in Stewartry is reported on a separate PYF report by Sharon
Walker PHP and Claire Thirlwall
Did the test of change achieve any of these outcomes:
Delivering a service as close to home as possible? √
Supporting people to retain or regain their maximum level of independence? √
Reducing avoidable emergency admissions to acute care or reducing delayed discharges?
Creating proactive approaches to reducing the need to 'react to crisis'?
Removing barriers for people accessing care and support? √
Providing a service which is more responsive to the changing needs of the individual? √
Providing of facilitating a seamless service between partner organisations?
People in control to ‘self-manage’ and supported to make decisions about their own care? √
More options for living at home?
1V1d8
Highlights
Highlights from the Test (Max 300 words)
Covering all localities across D&G, BHC’s Self-Management Programme (SMP) enabled individuals
and agencies to work together in supporting and facilitating, older people, carers and people with
LTC’s to develop independence and improve their health and quality of life.
Through this project there is now a genuine willingness amongst participants to overcome barriers to
health and wellbeing, be involved in creating sustainable community networks and activities. People
have and continue to form new relationships, building on their assets are up skilling through training
and volunteering, particularly people aged between 50 and 78 years of age.
The main highlights included:-
o Enhanced opportunities for learning between partners and participants across all sectors
o A D&G wide awareness on the benefits of ‘self-management’, now evidenced though the
PYF/ BHC evaluation systems and a slow increase in the number of agency referrals.
o New links with key stakeholders continue to be made e.g. Recovery College, Cancer Support
Services and Social Services.
o Working with partners such as:-
Access Arts, Turning Point Scotland, in generating enthusiasm for creativity and
resulting health benefits
Arthritis Care in delivering self-management and coping techniques and
Leisure and Sport in delivering physical activities such as ‘chair based’ exercises.
o Over 64 initiatives and self-management support groups have been delivered of which
approx. 30 were/are in rural areas where transport is a barrier to engagement.
o Provision of ‘STEPS’ (Steps to excellence for personal success) courses with positive
individual outcomes.
o Across the region Tai Chi for Health Programmes (approx. 11-12 sessions weekly) are being
facilitated by a team of volunteers who have LTC’s themselves and have good understanding
from personal experiences. Individuals have reflected improved balance, stamina and
wellbeing since attending the groups.
o Recruitment, training and support of 91 volunteers to lead their own groups, thus cascading
more opportunities to a wider population.
o Engagement skills (Participatory Appraisal (PA) training for 43 local people and agencies and
9 Trainers). A recent PA was carried out to determine views on ‘mental health and wellbeing’
with 443 individuals of which 52% (231) were SMP participants. A regional PA network was
launched in February 2015 and is available to support agencies and/ or communities to
engage with individuals / groups locally.
o Contributed towards 2 HIME inspections with Community Learning and Development (D&G
Council) in both Dumfries/ Lower Nithsdale (October 2013) and West Wigtownshire (March
2014). BHC, including the SMP was commended for good partnership working on both
occasions.
o A range of SMP activities / initiatives are now able to self-sustain within their own locality
Evaluation/Analysis
Outcomes as defined in the original proposal (bullet points)This should also match section 1.1.1 of your PMP
Older people and individuals with LTC’s and carers will:
o Access community development activities, services and local planning opportunities-= 980
o Experience an improved quality of life and wellbeing
o Reduce dependence and maximise the potential for older people, carers and individuals with
LTC’s to maintain / regain health as quickly as possible
2V1d8
o Be motivated to learn new skills and adopt self-help techniques
o Take up new experiences such as volunteering, training and being part of community
engagement processes
Partners and service users :
o Will work together to promote a proactive approach to service planning and provision
o Will have increased understanding on the needs of older people, those with LTC’s and carers and
are motivated to develop in partnership interventions that will be inclusive, reduce dependency
on health and social services and create independence
Did the test of meet all of the anticipated outcomes? Yes met most of the outcomes but
Detail in Appendix 1 challenge in the number of referrals.
Case studies in Appendix 2 These are slowly increasing as the
benefits are being realised.
If not, please provide details
• Considering the amount of ‘1 to 1 support work’ required, some of the targets were set too high.
140 people accessed ‘1 to 1 support work’ most of which were 2 or more sessions. This proved
more than what was expected particularly in Stewartry covered by 1 x Self-Management
Programme Worker (18.5 hours a week)
• Partnership working – Although a good number of partners have linked in with the programme
most have been in the extended network or at area level. The actual steering group, which is
composed of 12 service users were finding it challenging to attend each time thus affecting
consistency from meeting to meeting.
• The uncertainties created by the forthcoming ‘Health and Social care integration’ has had an
impact on agencies ability to commit to partnership meetings though much front line work is
being carried out where possible.
Impact
What difference has been made for the Individual?
(Please attached your case studies / stories as appendices)
The programme has reached and benefited approx. 4,337 service users, families and partner
agencies across D&G. For many service users it has been a journey which has enabled them to
explore, discover and try new activities and skills such as : -
A range of physical, social and health activities which include ‘self-management /coping
techniques, arts , crafts, computing and IT skills, singing, chair based exercises, Boccia & new
age curling, cooking, healthy eating and some alternate therapies such as Tai Chi and reiki.
91 individuals (with Long term conditions) through training have taken up volunteering and are
delivering activities and /or involved in local planning and community engagement activities.
In addition service users (at least 135) have been enabled to access other services where appropriate
e.g. Support in mind, social work, housing, psychology services or for support in relation to welfare
reforms.
1,114 individuals’ accessed a range of activities via tasters, short to medium length programmes. 932
people completed the evaluation forms. The remainder (182) either did not want to complete the
forms or were missed. The chart below shows the breakdown of the 932 :--
Referral source Number % of
3V1d8
total
GP / Nurse 125 (11%) Social prescribing (57 which 31 disengaged)
Increase from 7 % last report
Agencies / 3rd sector 146 (13%)
Self / other 843 (75%)
Totals 1114 573 regularly attended activities and completed
st nd
both the 1 and 2 part of the (before and after)
evaluation questionnaires.
Long term conditions 891 80%
Carer 233 20%
Carer with LTC 122 12%
Over 55 780 70%
Of the 573 participants who regularly attended sessions and completed the ‘before and after
questionnaires’ (part 1 and 2 respectively) 473 (83%) had one or more LTC and 75 (13%) were
carers.
The following results give an indication on the impact of the interventions delivered:-
• 286 (50%) felt more in control of their health conditions or circumstances
• 395 (69%) reported positive health outcomes and achieved their desired outcomes as a
result of the activities they were involved in.
• 269 (47%) felt better able to manage their symptoms
• 200 (35%) said their increased knowledge had improved their coping strategies.
• 202 (40%) felt less stressed or depressed by their condition/ circumstances.
• 238 (46%) felt more able to socialise
• WEMWBS** mean score has moved from 47.6 to 51.7 indicating a meaningful increase of
4.0 in the mean wellbeing score to above the Scottish mean (50.7) after intervention.
• 16 respondents with cancer who answered the WEMWBS, mean score moved by 6.6 from
50.7 to 57.3
WEMWBS ***(If a participant’s score increased by three to eight WEMWBS points during the project, WEMWBS would be
2
demonstrating that mental wellbeing meaningfully improved over the course of the project “ (Putz et al, 2012)
There were opportunities for volunteering and :-
• 91 participants have had training to be volunteers or facilitators
• 63 with one or more long term conditions are now volunteers and actively delivering
activities.
• 20 volunteers who completed their accredited training to deliver Tai Chi are now delivering
to approx. 12 groups across Dumfries and Galloway reaching more individuals across the
region.
• 5 people completed their reiki training and will be delivering to groups
Of 368 respondents (368 answered these questions):-
• 67% wished for a ‘better/ healthier lifestyle’ and 64% of these achieved this outcome
• 63% wanted to ‘make new friends’ and 86% achieved this.
• 60% desired to learn new things and 72% achieved this
• 53% wanted improved wellbeing and 59% felt they had achieved this.
In relation to the social prescribing project in Stewartry :-
Out of the total referred via social prescribing - 57 people were referred to BHC/ SMP and 11
completed both parts of the OMR forms. Only 6 participants completed the WEMWBS score with
an average mean before BHC/ SMP activities at 38 and 45.5 after - a positive increase of 7.5.
4V1d8
Of the 57 people referred - 31 disengaged. Some did not wish to engage /not interested in
activities. They did not attend several appointments offered.
Please see case studies attached as appendix 2
Quotes from participants
Glen Luce Chair Based Exercises group participant:-
“We meet with a common aim – to get and keep as fit and active as we possibly can.
We have all derived a great deal of benefit from these weekly sessions, not just from an
improvement in strength and fitness, but also from a social aspect. We all encourage each other,
which is most important and as everyone knows, laughter is a potent medicine”.
Machars participants (Isle of Whithorn- Access Art)
“I myself can honestly say that I have never enjoyed two hours as much as I do. It surpasses
everything else. The teacher encourages us, praises and has brought out talents we didn’t know we
had. It is inspirational, for two hours we are transported away from bills, housework and the
hundreds of other mundane things in our lives”.
Dumfries craft participant
“Learning new skills has lifted my spirit and taken my mind off the pain my arthritis demands of me
at times”
Tai Chi participant (Dumfries)
“I was suffering from high blood pressure and bit of stress due to issues in my life – My doctor
suggested yoga which I tried and hated. At the diabetic clinic I picked up a leaflet about the Tai Chi at
BHC and went along. I have made new friends, felt much better in health and more relaxed. Having
discovered BHC, I have done computer training, art classes and some weight management. I now run
my own Tai Chi classes for BHC. I see this as pay back and I love doing it because it has increased my
confidence”
“I have been going to Tai Chi for a while now and find it very beneficial with having had two hip
replacements (left and right). I find I have more balance and coordination as I do my exercises my
feet get warm with the blood circulation going around”.
What difference has been made for Carers?
(Please attached your case studies / stories as appendices)
233 carers, (122 had long term conditions themselves) accessed a range of taster sessions of
activities mostly through being asked by a friend or by bringing their dependant to activities.
They chose from a range of SMP activities or attended specific ‘Carers groups (e.g. Cherish group).
Self-management support offered included social support, social inclusion, buddying and access to
advice on issues such as welfare reform. A few Carers took up the offer of ‘Keep Well’ clinical checks,
‘Living Life the Full’ and STEPS (Steps to excellence for personal success) sessions.
72 carers went on to attend regular sessions and completed the ‘before and after questionnaires’.
Of the 72 who completed the ‘before and after’ questionnaires:-
61 felt more in control of their circumstances, leading a healthier lifestyle and overall
improvement in quality of life
58 felt more able to manage,
62 felt less stressed,
64 more able to socialise and
62 have more knowledge.
5V1d8
On answering the WEMWBS question, the carers mean score at the beginning of the programme
was 48.7 and the mean score at review was 51.2, an increase of 3.0, indicating a meaningful increase
in carers mean wellbeing to above the Scottish mean (50.7) after the programme
Quotes from several carers
“I get lots from doing Art and Craft ... it is the only ‘me time’ I get. It has been improving my health
and wellbeing greatly, I am less stressed and more tolerable. It reminds me that I am a person with
a life and not just a ‘carer”
“Through registering with the SMP, it made me realise I don’t need to rely on others for help. I was
becoming more timid and frightened – talking things through and then thinking about them on my
own helped me find myself again. I am much happier now and feeling more positive”.
“I attend the craft group run by BHC (SMP/PYF) on a Thursday morning. I find it very beneficial as I’m
the main carer for 4 family members. It’s the only thing I attend due to “commitments”. I rely on
the friendship and company and “me time”.
A case studies in Appendix 2
How has the test of change made best use of technology?
(Please attached your case studies / stories as appendices)
The use of the Optical Map Reader (to track progress)
The use of ‘Remark systems’ and with the Health Intelligence department we were able to analyse
large numbers of ‘Referral forms, Taster forms and Registration forms’. The latter are
questionnaires used for tracking progress of service users and are completed at the beginning and
end of an intervention usually between 6 weeks to 6 months after (Registration form -appendix 3).
The system allows for easier analysis of data for evaluation purposes. As a result of the PYF
programme BHC is now using these forms with all BHC participants to measure impact, not just
people 50+
Blogs and Face book
The SMP is promoted in all 4 Area blogs, established by a volunteer and SMP participant who is now
establishing a small business using his computer skills.
BHC volunteers, PYF initiatives/ activities and news are submitted frequently and in some areas by
service users themselves as part of their group work. The blogs also support partners, promoting
their work and events e.g. Arthritis Care, Visibility Scotland, Training For Carers, D & G Wellness &
Recovery College etc.
The blogs combined have had over 13,293 hits
www.bhcmachars.blogspot.co.uk number of hits 8500
http://bhcdumfriesandlowernithsdale.blogspot.co.uk number of hits 3258
http://bhcwestwigtownshier1.blogspot.co.uk number of hits 1193
www.smpbhcstewartry.blogspot.co.uk number of hits 342
In addition a Stranraer initiative ‘Stranraer Holistic Arts Wellbeing Lifestyles’ promote awareness of
their services through social websites such as Face book
Electronic LEAP: - all areas are reporting using an electronic evaluation system which enables
planning, developing and sharing of information with partners, service users and work colleagues.
Other programmes out with D&G can access information too. It aims at encouraging better
understanding, joint working and sharing of good practice.
See Hear programme: - visited the SMP steering group to highlight services they offer, some of
which includes technology to support those with hearing or sight difficulties. This service is now
6V1d8
utilised and accessed by all 6 areas of the SMP
Computer support
Participants who attend a weekly IT group (Riverside Centre, Newton Stewart) has been enabled to
keep in touch with relatives, learn how to shop safely on the Internet, set their security on their
laptop or computer, etc. In some cases assistance has been given to help with Internet issues and
general set up at home.
Quotes from participants:
“D… has helped me enormously with things (IT tasks) that I have tried to do myself and not quite
get there. We can bring ANYTHING to the table and we will all get the help and assistance that
we require. This is a great club.”
“I’ve been coming (Laptop Heaven) for 3 months now and I have learned enough to want to buy
my own laptop.”
“We wouldn’t get anywhere without the input of BHC. Both J… and I are greatly appreciative of
the time given and the patience shown. My memory is not what it was! We have even
given up other activities to attend the classes.” ( IT Classes)
What difference has this test made for staff?
(Please attached your case studies / stories as appendices)
The programme has seen a few challenges in ensuring all areas work in a consistent manner across
D&G, while still taking into account the differences in each locality. In addition the SMP team which
was originally 6 part time workers and over time evolved to 3 almost full time workers (due to part
time contracts)had a lot of catching up to meet targets with less staff. However the BHC core staff
have worked hard alongside offering huge amount of support and considerable time to ensure that
the programme is supported and running as planned.
Each of the BHC / SMP staff teams have indicated :-
• An appreciation on receiving the resources that has enabled staff and partners to help
community members and groups build on their assets, try new things, take part in training and
observe their development and empowerment.
• The monitoring and evaluation tools which capture better the impact of the work has improved
staff confidence in progressing towards achieving agreed outcomes. It has set precedence for
expanding the evaluation systems to other non SMP BHC activity.
• Building new relationships with service users and agencies have enabled further signposting to
other opportunities and services. There has been considerable learning between new agency/
partnership links, which in turn enabled more positive partnership working and created positive
connections with other organisations
• Staff training has not only enhanced the SMP work, but contributed towards staff personal
development.
• Increased awareness of the whole BHC programme and the benefits of community development
approaches. It has provided the opportunity to roll out programmes and activities across the
region to ensure equity and continuity for all participants regardless of where they live
• The Participatory Appraisal training which included older people, carers, people with Long term
conditions and staff will leave a legacy for Dumfries and Galloway in the shape of a PA Network
7You can also read
