What is the Living Well Wester Hailes Project?
The Boring Answer:
It’s a cross-agency collaboration, based in Wester Hailes, South West Edinburgh.
Our area is known to be an area of multiple-deprivation, presenting a challenge to local public, community and third sector agencies to improve local outcomes.
We work across several themes using a common approach which emphasises early intervention, utilising community assets, aligning services with community need and strengthening relationships with colleagues and our local community.
A steering group comprising health, local authority, education, community and third sector representation co-ordinates the project. We are strongly influenced by a number of previous initiatives including the concept of “Total Place”, the Alaskan ‘NUKA’ healthcare model, and the findings of the 2011 Christie Commission.
The More Interesting Answer:
“People think that stories are shaped by people. In fact, it’s the other way around.”
There are several strands to the story behind the Living Well Wester Hailes Project. As a project we date back to a City of Edinburgh Council initiative – ‘Better Outcomes Leaner Delivery’, which zoned in on some impressive local success stories around youth offending and use of secure accommodation that bucked the trend of similar areas in Lothian.
However our good local relationships pre-date our recently constructed Healthy Living Centre. Indeed it was our determination to share a space with local third sector and council colleagues that had kept us in our old decrepit accommodations for so long – coordinating budgets across three different agencies to construct joint premises is complicated and takes time and patience!
An open minded outlook unites many of the different services in Wester Hailes. We were lucky to get our new building (opened 2013) at the same time as we had very proactive management at our local school, several innovative teams within local Council Services, a progressively minded GP practice (that had radically overhauled its systems to ensure that GP’s actually had time to collaborate with other local services), and supportive and well-run third sector partners keen to co-produce services. Finally we were well supported by key individuals within the Scottish Government, NHS Lothian and City of Edinburgh Council, eager to see new examples of integrated working as outlined in the Christie Commission Report. We kicked off in 2014 as the “BOLD” team, subsequently renamed as “Living Well Wester Hailes” to reflect our focus on healthy aspiration and well-being.
We work across several related themes:
Starting Well directly address the early years agenda focusing on children’s wellness. Living Well focuses on Adult well-being, while Working Well acknowledges explicitly the links between health, education, literacy, and employment. We also work very hard to promote a positive and engaged Staff Culture, and place great store on partnering, and building capacity within our local Community.
We like to use simple interventions which are easy to implement but over time can build to a compelling change story (the “aggregation of minor gains” for any management types reading!). We employ common approaches across the different themes – early intervention, utilising third sector partners where possible, leveraging the correct relationships (e.g. GP for health) across all our themes. We like to try new approaches, but always check for an evidence base before jumping in. We utilise open ended techniques such as “conversation cafés” and “open space” techniques when engaging with our community and partners – to good effect.
The problems that drive poor outcomes in Wester Hailes (and area’s like it) tend to cluster around poor breast feeding rates, smoking, alcohol, lifestyle issues, violence and trauma issues, employment and literacy issues to name but a few. Where possible we try and make the primary outcome we measure as close as possible to the actual desired result – for example if we are trying to improve the breast feeding rate then the key outcome is the breast feeding rate, not the amount of interventions offered, or the empowerment experienced etc. This approach is clearly more applicable in some settings than others.
This focus on the underlying drivers of poor community outcomes helps drive co-operation between services and agencies and allows us to break out of a ‘silo-mentality’. ‘Cancer’ will inevitably be seen as a Health Issue – but the local causes of Cancer – nutrition, lifestyle, smoking, employment engage a much broader base of partners. Child Protection may be perceived to be a social work issue, but the drivers of Child Protection Referrals – deprivation, substance problems, employment issues, late intervention, education etc. involve all the local partners and are clearly a shared problem.
This approach also offers simple opportunities for services to mutually support each other – e.g. a local GP may be well placed to sign some letters that will increase take-up of a Primary School Child Obesity Project; our local Arts Agency provides therapeutic options for our local community, but also produces material for use within the Healthy Living Centre and has access to a secure client referral pathway.
This explicit joint-approach allows access to community and public health intelligence from both City of Edinburgh Council and NHS Lothian. It remains a frustration that our Public Health services are too often asked to focus ‘downstream’ – managing the already ill. It is transformational when they are able to inform local preventative practice ‘upstream’– our local services are currently working to improve uptake of ‘Healthy Start’ and engagement at our 27 month Child Health Check as a direct result of Public Health Early Years Input.
We perceive the poor community outcomes in an area like Wester Hailes to be a entirely predictable phenomenon. Only by intervening against the underlying drivers of these community problems – smoking, lifestyle, employment, domestic violence etc. can the situation improve. Our goal is to have a joint series of simple evidence-based interventions that tackle each of the underlying drivers. This approach should help shrink the size of the problem, especially if we help build community capacity to solve these problems as we along. More resources would speed our project up, but the principle threat we fear is not a lack or resource, but having our capacity to problem-solve undermined by inflexible contracting, weak management, or the imposition of centralised one-size-fits-all approaches that prioritises the needs of a bureaucracy over a local population.