Development School 2019 workshop information

1A – Hidden inequalities in health trends: masking increasing inequalities and how to redress the balance

Aims:   To explore data and concepts in health inequality in a multifaceted way including looking at how inequalities are framed, where interventions are focused and how this can influence how we make decisions in Public Health.

Background:  A principle aim of Public Health is to reduce inequalities in health for the population. However, even in areas such as South Gloucestershire, which have an apparently relatively healthy population (according to sources such as PHE’s local health profiles) a great deal of granularity is lost by looking at the local authority area as a whole.

Whilst health outcomes by deprivation often appear as part of routine local analysis, they have a tendency to centre on a single point in time. And whilst trends by inequality are available for some health outcomes from resources such as PHE fingertips, they tend to only be available at the national level or only for overarching indicators such as life expectancy. Therefore little is known about whether trends in health outcomes differ by area deprivation at the local level.

A recent project in South Gloucestershire has uncovered increasing inequalities gaps in health outcomes over the last 10 years. These appear to be driven by disproportionate improvements in those living in the least deprived areas, and / or disproportionate worsening in the most deprived areas. 

If inequalities appear to be increasing in a number of different apparently unrelated health domains, is the current model of intervening to treat the health outcome the most effective?

Widening the scope and framing of the data to make a bigger picture available and include theoretical concepts of health inequalities causation may reveal there’s more to inequalities and how to address them than we may first think.

This workshop explores what widening the scope of the data does to our perception of the health inequalities, how placing data in a various conceptual frameworks influences how we perceive cause and effect, and how this knowledge and understanding may guide the processes employed in public health decision making. This workshop strives to get us to ask questions of our knowledge and practice and is not designed to deliver solutions to what is a complex and nuanced but critical public health issue.

Learning outcomes:  Demonstrate how informative intelligence can be hidden within restrictively framed data - Explore using wider determinants of health data and associated conceptual frameworks to prioritise Public Health - Describe the place based approach to tackling health inequalities - Demonstrate that this knowledge may influence how we view and attempt to tackle health inequalities.

Format of the workshop

1 hour workshop

10 minutes – introductory presentation and examples of health and health inequalities data

35 minutes – case studies explored in groups, with additional data and conceptual frameworks added to increase the scope of understanding the health inequalities and how this may change recommendation/priorities for interventions, practice and partnership working.

10 minutes – summary and feedback from groups

5 mins – conclusions and take home messages.

Workshop leader:  Sarah Webb Phillips, Senior Public Health Intelligence Analyst: Helen Bradley, Lynn Gibbons, South Gloucestershire Council;

1B – Working better together; improving health outcomes by co-designing Health and Wellbeing programmes with the Voluntary and Community Sector (VCSE)

Aims:   The aim of the workshop will be to explore and share learning about how the statutory sector and Voluntary and Community Sector (VCSE) can work co-operatively to make the most of limited resources and have the greatest impact on health and wellbeing outcomes for local people.

In South Gloucestershire statutory and VCSE partners have been working together closely over a number of years to co-produce services for local people. In the last year this has resulted in two innovative projects delivered in partnership.

Southern Brooks Community Partnerships has been awarded funding as part of Sport England’s £250m strategy to improve people’s health and mental wellbeing through sport and activity. Active in Life is a pioneering project developed through the local Physical Activity Partnership, to help local people who work but are on a low income become more active and healthier. For the first time Southern Brooks are commissioning South Gloucestershire council to deliver a service.

At the same time Southern Brooks has been commissioned by the Council to develop and co-deliver One You South Gloucestershire, a new integrated healthy lifestyles and wellbeing service. One You South Gloucestershire has been developed as a single service with a single point of access, clear brand aligned to PHE national ‘One You’ materials and a shared client referral management system. Public Health Division are delivering lifestyle elements of the service whilst Southern Brooks are delivering the wellbeing component.

The workshop aims to share our learning about developing services in partnership from inception through to delivery including engagement with local people to identify their needs, development of bids for external funding, the tendering process for commissioned services, and the practicalities of working together on a daily basis to provide services and support for local people.

Learning Outcomes:   By the end of the workshop participants will:

- Have some understanding of creative ways of engagement and consultation with residents and stakeholders

- Understand ways to develop a shared value base, which recognises different organisational cultures

- Understand how to bring about effective partnership working.

Format of the workshop:  This will be an interactive workshop with active participant engagement

- Introductions and purpose of the workshop

- Background to our organisations and shared projects

- 2 minute video – Community Heroes

- Put yourself in their shoes – an interactive exercise

- Developing a Theory of Change

- Establishing a good partnership – what works and what to avoid

- Two minutes with the person next to you – what does this mean for the way you work?

Workshop leaders:  Sarah Weld, Public Health Consultant; Julie Close, Chief Executive, South Gloucestershire Council; Rob Stirzaker, Healthy Lifestyles & Wellbeing Manager, South Gloucestershire Council

1C – Developing and evaluating interventions that promote health: Reflections on proposed revisions to the Medical Research Council ((MRC) guidance from a ‘real world’ perspective

Aims:  This workshop aims to provide an introduction to proposed revisions to MRC guidance on developing and evaluating complex interventions in the context of ‘real world’ public health. Specific attention will be given to the RE-AIM framework, which seeks to move beyond the identification of ‘what works’ and focuses instead on the robustness, translatability and public health impact of a given intervention/programme.

Learning Outcomes:  By the end of this workshop, delegates will be able to: · Identify and compare MRC guidance on developing and evaluating complex interventions. · Describe the RE-AIM framework and differentiate between framework domains. · Give examples of how the RE-AIM framework can be applied to the planning, delivery, and evaluation of ‘real world’ interventions that aim to promote health, and identify how it could be used in their current role. · Describe strategies for enhancing intervention/programme reach, effectiveness, adoption, implementation, and maintenance.

Format of Workshop:

A range of teaching and learning approaches will be utilised: didactic information provision; small group activities; and, wider group discussion. ‘Kahoot’ will be used to assess learning. 

Workshop leader:  Emma Bird, Senior Lecturer in Public Health, University of West of England

1D  – Reshaping services with SHAPE

Aims:  SHAPE is PHE’s free interactive mapping tool that informs and supports strategic planning of services and assets across a whole health economy.

By linking national datasets for clinical analysis, public health, primary care and demographic data with GP & hospital sites and pharmacies, SHAPE can help decision makers and commissioners to map and assess if they have the right services in the right location. A new addition is also the CVD SHAPE, designed to support the ABC of CVD prevention.

This workshop aims to support public health colleagues to use the tool and interpret the data and maps in aid of evidence based decision making and service planning

Learning Outcomes: 

· Learn the basics of SHAPE

· Better understanding of how to interpret the outputs

· Better understanding how to use SHAPE in your service planning and commissioning to help meet the population health needs

Format of the workshop:

· Short introduction to SHAPE

· In groups work through a scenario of using the data from SHAPE to inform service planning

· Discussion around challenges and opportunities for evidence based decision making with SHAPE.

Workshop leaders:  Mia Moilanen, Principal Knowledge Transfer Facilitator; Filiz Altinoluk-Davis – Health and Wellbeing Programme Manager, Public Health England

1E  – Peer on peer support to improve offender health outcomes – a settings approach

Background:  Offenders suffer some of the poorest health outcomes worldwide today, with cardiovascular disease being the most prevalent physical health condition for the prison population.

Healthy rehabilitation through education and 1:1 interventions can support the health outcomes and rehabilitation of offenders.

HMP Erlestoke in Wiltshire is a Category C establishment holding adult male sentenced offenders with an operational capacity of 500 men. Since July 2018, the prison has been dual registered and can now accept up to thirty young adults. The prison is built on the former grounds of Erlestoke Manor House and has over the past few years expanded in both offender numbers and intervention programmes.

Since 2009 Wiltshire’s Public Health team have implemented a 1:1 Health Trainer service model within HMP Erlestoke prison. During this time Health Trainers have supported over 500 offenders to make lifestyle changes. In 2018 over 60 offenders were supported and 86% of these either achieved or part-achieved their main goal.

The programme trains offenders to become Health Trainers to provide peer on peer support to those wishing to improve their health. Offender Health Trainers will support their peers with healthy eating, increasing physical activity, remaining smoke-free and emotional wellbeing.

Aims:   To provide guidance of how to establish and deliver a Health Improvement programme in a prison setting, whilst highlighting the importance of improving the health of the prison population.

Learning outcomes:  Explore how to establish and deliver a health improvement programme in a prison setting · Discuss the challenges of delivering public health related projects in a prison environment and with offender groups · Understand how to work in partnership with key prison professionals to support service delivery and sustainability of the programme.

Format of the workshop

Video - Challenging perceptions: The journey from prison to rehabilitation

Presentation – Establishing and delivering a health improvement programme in a prison setting (prison health outcome statistics, introduction to the Prison Health Trainer programme model, the process of establishing and delivering the peer-led programme in a prison setting.

Activity – Delegates will be given picture cards that highlight a challenge of delivering in a prison setting and will discuss and explore these in groups.

Presentation – Overview of additional work undertaken in Wiltshire to improve the health outcomes of people in prison.

Activity – Using a map of the south west region, in groups delegates will view the prison setting in their area. Delegates will discuss what is already happening to support the prison population and explore potential opportunities. Using sticky notes, delegates will add these to the maps and feedback.

Questions – There will be an opportunity for questions at the end.

Workshop leaders:  Kate Mountain, Public Health Specialist – Obesity; Rachel Kent, Public Health Consultant, Wiltshire County Council

2A – A framework for developing systems leadership in Public Health

Aims:   To enable participants to explore the application of systems leadership thinking to their own public health practice.

Learning Outcomes:  Deeper understanding of systems leadership theory and application to public health practice.

Format of workshop

This participatory workshop will build on the preceding plenary presentation by Richard Bolden on developing systems leadership in public health. Working in small groups participants will share their prior experiences of systems leadership and explore the framework presented for making sense of, and further developing, their own role in systems leadership.

Workshop leaders:  Professor David Evans, Professor in Health Services Research, University of West of England; Charlotte Bigland, Specialty Registrar in Public Health, Gloucestershire County Council

2B – Planning and Health – We have enough evidence, do we have enough leadership?

Aims:  The aim of the workshop is to introduce planning and health with specific focus on new resources available to help local areas and on the need for public health leadership. The emphasis for the workshop is on getting evidence into practice.

The workshop will provide delegates with:-

An overview of planning and health Facilitated discussion on Public Health leadership in place based public health and the opportunities through PCNs and ICS. Signposting to key PHE resources.

Learning Outcomes:  By the end of the workshop delegates will

•  Identify the role of the built and natural environment in place based public health
• Identify the role of ICS and PCNs in place based public health
• Describe the opportunities and barriers to place based public health for ICS and PCNs
• Identify sources and support and information getting into practice.
•  

Format of workshop

Short presentations, group work, facilitated discussion, Q&A , use of social media and voting.

Workshop leaders:  Aimee Stimpson, National Lead, Healthy Places, Priorities and Programmes Division; Michael Chang, Programme Manager Planning and Health, Public Health England

2C - Practical ways to increase immunisation uptake in target groups and address in equalities in a local authority area – experience from the Twerton/Gypsy, Roma and Traveller (GRT) projects in Bath and North East Somerset (BANES)

Aims:  To explore how to work with groups that experience health inequalities, working in

innovative ways to improve access to childhood immunisations and increase uptake.

Learning outcomes:  By the end of the session, participants will have:

 - An overview of childhood immunisation uptake in the South West

- Knowledge of the NICE guidance and best practice for improving immunisation uptake

- An understanding of groups that have lower uptake for childhood immunisations

- An understanding of some of the barriers these groups experience

- Learnt about practical ways to address these barriers

- An understanding in their own roles how they can influence immunisation uptake

- Knowledge of what resources are available to help increase uptake

Format of Workshop: This interactive workshop will give an overview of the relationship between inequalities and immunisation uptake, how data can be used to identify target groups and an overview of two projects. Delegates will be able to identify how in their own roles they can improve access to immunisations following the workshop.  NHS England and NHS Improvement - South West commissioned a 12 month pilot for a Screening and Immunisation Health Inequalities Service. As part of this work a multidisciplinary pilot was set up in Twerton, Bath to explore innovative ways of improving childhood immunisations and a new pathway was implemented in B&NES to support access to immunisations for Gypsy, Roma, Traveller (GRT) families temporarily residing in ‘unauthorised encampments’.

Workshop leaders:   Lizzie Henden, Senior Public Health Specialist, Bristol City Council (Previously Virgin Care BANES); Anna Brett, Health Protection Manager, Becky Reynolds, Consultant in Public Health, Public Health Team, BANES Council.

2D – Turning data sharing on its head: the risk of NOT sharing

Aims:   To describe :

· how information is shared, or not shared, between agencies in Somerset, and the associated risks.

· the legal and governance aspects of data sharing

· how local governance can try to balance risk and overcome the difficulties.

Learning Outcomes:  Understanding :

· the context of information sharing and data integration

· the relationship between data integration and the development of integrated care systems

· the role that Health and Wellbeing Boards and Sustainability and Transformation Partnerships can play in integration.

Format of workshop: Presentation (about 20 minutes) based on the 2019 Somerset JSNA, followed by questions and discussion (30 minutes)

Workshop leaders:  Pip Tucker, Public Health Specialist, Somerset County Council

2E – Using population health management at all levels in a system

Aims:   -Improve understanding of Population Health Management (PHM).

-Understand how to use PHM at system, place and neighbourhood level.

-Use group work to share examples of PHM from across the South West to share learning and ideas to develop local capabilities.

-Understand the link between PHM/population health intelligence and the Local Health Care Record (LHCR).

Learning Outcomes:  -Be able to describe PHM, and the potential uses at different levels of the system.

- Understand LHCR and the link to PHM.

–Understand real uses in the South West alongside being able to use learning from these locally.

-Develop relationships and contacts for further PHM discussion and learning.

Format of workshop: -Presentation describing Population Health Management and different levels of the system, including LHCRE. (15 minutes)

-Break into three groups to work through the following:

       - what has already been done,

       - solutions to overcome challenges,

       - what could be done or what else would you like to do,

       -remaining challenges.

 (30 minutes)

-Feedback from groups about useful learning, solutions and actions needed to develop local capabilities. (15 minutes)

Workshop leaders:  Becky MacLean, Consultant in Public Health, Katie Hopgood, Consultant in Public Health, Gloucestershire County Council;Simon Chant, Public Health Consultant, Devon County Council;  Malcolm Senior, SW LHCR Programme Director.