South Wales Health Improvement Review External Stakeholder Engagement Events – Summary of Feedback
Working Age Adults
Needs & Issues
Access – Need to increase access to healthy eating and physical activity opportunities; access to services generally needs to be improved;Lack of support – community based free – not commercial e.g. healthy weight; Affordability; Need to continue + /or access meaningful work; Accessing appropriate services inc/ knowing what’s available; Specific target groups – engaging in services;
Social Inclusion & Inequities –There is a general need for services to support weight management/ stopping smoking/ reducing alcohol/increasing healthy eating and reducing accidents and injuries at work; Increasing unemployment is a key social determinant; Increasing gap in inequalities – richest taking message on board / poorest static or going backwards; Impact of adult behaviour on younger people?; Ageing workforce; Conway = Bournemouth of Wales; Older drinkers/ drug users; Sexual health needs – new relationships –drop in centres ok for younger people but not to for older people; Work/life balance; Rural/urban community differences inc. Transport/cost/isolation; Vulnerable groups inc disabled/ single mothers etc. – NEETS; Need to tackle stigma; Overcoming barriers; Need for non-working adults to have their aspirations & confidence harnessed;
Service Delivery –Need to encourage planners to develop more supportive built environments; Need to change perceptions & attitudes; Co-ordinated approach between public & private sectors; Influencing institutions to move towards healthier choice e.g. Discouraging university pub crawls & unhealthy meals in hospital canteens; Cultural barriers /resistance – moderate front line staff behaviour/engagement processes; Ensure quality of life; Planning for older age; Consider mental health as well as physical health needs; Acknowledgeever earlier onset of chronic conditions; Need for Integrated and consistent services; Using respected community organisations to drive/facilitate Health Improvement; Lifestyle – targeting pre-pregnancy (women’s health); Need to consider Infrastructure + environment; Values – identifying needs/ priorities; Peer champions within communities; Political issues; Need to be able to evidence /measure change;
Communication – NHS Health ambassadors needed; Improved awareness/simple health messages; People’s choice rather than imposed values; Conflict between financial drivers e.g. leisure centres using weight watchers; Smarter use of technology; Making initiatives better known; Improve health literacy; Ask people what they need/ how they need the message to be relayed; Media impact – learning from commercial marketing skills; Re-normalising what is ‘normal’ – values; Reinforcement of positive health information; Goal – employment – build aspirations; Need to understand quality of life; Need to ensure good access to information – external factors sometimes giving conflicting messages; Need to understand what information people want and where they want to get it from;
Resources –Need to make healthy options more attractive; Focusing on micro-communities; Need to be aware of key life transitions Work/Marriage/ Childbirth/ Illness/ Retirement etc. with services developed accordingly;Balance between benefits / work and survival (financially driven); Community assets – now more than ever; Need to develop an information hub; Resources/skills – to encourage engagement;
Training & Education –Education – behaviour change;
Existing Services
Lacking – Marketing the services; Contacting people at an early intervention stage; Accessibility; GP awareness; Barriers to work – “can’t afford to take a job”; Barriers to improving health e.g. people not detoxing if their benefits will be cut; Initiatives to reduce teenage pregnancy; Community first –reduction in access points; Integration – some good examples e.g. NERS (Health and Leisure (LA) – but not strategic level!?; Problem of uncertainty regarding LA boundary changes; Clarity of messages/ product info; Short term funding limitations – undermines existing work – impacts on capacity/ turnover of staff etc.; Services
need to be available when needed not when convenient;Do we cover ‘transitions’; Need to take broader approaches to physical activity e.g. not just gym based;Current existing service provision needs to be crossing all sorts of sectors and the need for integration (too much silo working);More brief interventions; Current services often being disengaged with by individuals because of the financial impact this may have re: benefit changes; Existing services traditionally not good at promoting themselves – Private sector much slicker; Consumer confusion – often multiple logo’s on leaflets etc who is actually running the service?;
Available – NERS; NHS Direct; NHS Services; Job centre/ Career Advice/ Employment services; React & Proact; Stop Smoking Wales; Healthy Working Wales – CHSA, WBW; British Heart Foundation; ASH; Homeless Help; Alcohol Concern; FRANK; A.A.; Weight Watchers; Change for Life; Slimming World; Health Challenge Wales; GAVO, Voluntary Services; Local Authority Services; Benefit System Health Support; Primary Care – GPs, Opthalmic
Community based care; Public Health programmes; Occupational Therapy; Community Dietician;LA services – exercise referral – concessionary rates/ corporate rates; Secondary Care – addictions – mental health services; Tertiary care –inpatient detox ward – surgical interventions – weight management; Third sector – many and varied; Occupational health; Dental services; Social enterprises; Private business; Community nutrition and education; Brief interventions – alcohol; Workplace health – corporate health improvement standard; Community groups;Communities first; Sport Wales; Pharmacies; MEND; Mental Health Services; Substance misuse services;
Potential - Out of hours Services (e.g. access out of hours for information);
Front line staff knowledge of services; Flu Vac/ inoculation (access point); Non- Health issues impact on health – housing – transport – services in area e.g. vegetable shop in area – benefits; Linking into communications and voluntary sector;
Opportunities
Partnership –Utilising “windows of opportunity” take services to the users e.g. men and football/rugby clubs; Bring certain infrastructures together – brands, websites for example; Better engagement with the voluntary sector; More community based services; Better integration & grouping of services; Need to widen capacity; Empower communities – building in community assets; Job centres – point of contact for health messages – financial incentives to engage – benefits etc; Hold weight management interviews outside of a clinical setting (or any other health issues); Everything is in Silos, we need teamwork;
Good Practice –Simple and easy to use information;Peer community champions; Sharing best/good practice; Fit services to people’s needs rather than expecting them to fit in; Centralised service – directory of “endorsed” services;Managers need to support their employees health - Managerial support for a lunchtime walk;
Potential development –Communication and mapping of service – understanding what is out there; Effective branding – when pending changes names sometimes change which is confusing for the user; Opportunity to begin thinking about planning cycles; If/when LA reorganisation happens this must be grasped to maximise benefit; Social media – promote services – branding;Central hub for information with consistent messages/ branding; Development of local community ‘hubs’; Need to improve transport and reduce isolation; Local planning app’s signposting health initiatives; Present economic climate will force integration/ shared services etc.; Smarter recruitment; Explore alternative access points to provide health information to men such as ‘Out of Hours’ services/ workplaces/ the Driving Test (discuss substance use etc.)/ Inoculations/ Supermarkets/ Societies/ Football clubs etc; Reframing occupational health; Calorie count @ tills in supermarkets on receipts; Portion control – people will eat what’s on their plate – drinking alcohol/fizzy drinks in smaller glasses; Need to advertise and promote ourselves (Public Health) better in a similar way to commercial organisations;National brand – and keep it the same e.g. HCW & Health Professional need to refer /signpost to it; Legislation or guidance to offer healthy options in hospitals, schools & public sector buildings;
Conditions & Provisos - Short term funding arrangements are damaging; Improved infrastructure; ‘Stuff’ needs to be easier; High level policy changes – should include health input; Withdraw from services that aren’t performing – advertising services that do well;Build in evaluation from start; Streamline service e.g. stop reinventing the wheel e.g. communities first wanting to reproduce health literature; PHW need to clearly state who they are going to support e.g. Do we link with Weight Watchers?; National focus with local implementation; Stop diversifying the brand – e.g. stop smoking Wales is a single health service; Think about the bigger picture – planning, infrastructure e.g. less fast food chains, cycle paths, stop selling playing fields etc; Stop investing in “one off events” & start supporting long term campaigns e.g. Day events;
Summary
Much of the debate and discussion during this event focused on the need for greater clarity and attention to lifestyles and health related behaviours with a general consensus that there was a need for closer collaboration on the development of clear, concise, consistent and unified messages.
There are a wide range of services and interventions available, although there was also a feeling that these tend to be fragmented. The idea of community-based ‘hubs’ where a range of services could be accessed was proposed, which would in turn help to generate more collaborative working and enhance consistency of services and messages. There was also the recognition of the great potential to build on community assets whether sports clubs, workplaces, ‘out of hours’ services etc. and including those in the private sector such as retailers.
One strong message from participants was the need to get away from short-term funding arrangement and move towards more sustainable longer term planning and resourcing.