CHEX National Conference November 2017: Community–led health – people, policy, and practice

On 21st November Community Health Exchange (CHEX) welcomed 76 representatives from the community-led health sector and colleagues from across Scotland for our National Conference.

The conference was held in St Paul’s and St George’s Church Edinburgh, which provided a spacious and comfortable setting to explore the themes set for the day.

Evaluation feedback showed that while people really enjoyed the venue and food they were particularly enthusiastic about the contributions made on the day and the content of the workshops.

“All of the conference input was useful in a variety of ways – networking, sharing and learning”

“The presentations and discussions were interesting, informative and challenging.”

Welcome and Introduction

Helen Scammell, Pilton Community Health Project, was our Chair for the day and described her career as running full circle, back to where she began in community-led health. She used her experience to explore the challenges of holding true to a commitment to community development approaches to tackling health inequalities. In particular, she noted the continued funding pressures faced by the sector as being a major obstacle to securing long-term services and support to those facing most need.

Helen remains positive and excited about the opportunities for the community-led health sector and the real need to promote a roots-up approach to tackling the issues faced by people living in areas of multiple deprivation.

Linda Arthur from the Health Agency then reflected on the journey made by the agency in the Wester Hailes area of Edinburgh. Beginning in a temporary, rat infested hut 15 years ago, the Health Agency has transformed itself and is now delivering services from a modern multi-agency hub, increasing its staffing levels from 4 to over 18 during that time. This has allowed the agency to work more widely with the residents of the area, which ranks within the 10% most deprived areas in Scotland. Last year the agency worked with over 1,000 people from Wester Hailes and beyond.

As the agency has expanded so has the complexity of its operations and Linda gave a brief run through of the wide range of funders and partners the agency has been involved with. This has allowed them to take a multi-faceted approach to tackling local health and wellbeing issues.

 

See Me Community Champions

Callum Irving gave an exposition of how See Me had started as a national awareness raising campaign on the issues faced by those experiencing mental illness but now wanted to expand and deepen its roots in communities through community champions and working with other community organisations to raise awareness and remove stigma.

Following Callum, Gemma MacMillan spoke from personal experience of her of mental ill-health. She noted the crucial need for early intervention and for the need of medical professionals to take the issues presented seriously and act. She reinforced Callum’s message of the need for communities to play a supporting role: to fill a gap helping people with an illness – seeing beyond the stigma.

Following a coffee break conference broke up into four workshops

Workshops

Workshop 1: Workshop: Fife Woman’s Aid – sharing lessons …

In this workshop, Heather Ratcliff and Kirsty McMahon from Fife Women’s Aid kindly agreed to share their approach, experience and learning in responding to domestic violence. A person with lived experience of domestic abuse was able to share her powerful story, describing the impact abuse has had on her, including a lack of community awareness and support during and after her experiences. 

Participants in the workshop discussed the need to recognise domestic abuse as an issue of gender inequality and power within communities as well as its impact at a personal level. It was agreed that, in terms of our practices, we should constantly seek to shift the focus onto the perpetrator of abuse and the power structures of gender inequality within communities.

In practical terms, participants underlined the importance of single gender community spaces and activities i.e. groups of mums supporting mums, with support available for instances where issues of domestic violence may surface. The White Ribbon Campaign was highlighted as a good example of a campaign against domestic violence at a community level.

Workshop 2: Workshop: See Me workshop: Community Champions Challenging Stigma

Toni Groundwater from See Me introduced this workshop, which focused on how to strengthen the voice of those with lived experience of mental ill health and on how to build a stronger social movement around mental health.  

‘Community champion’, Suzanne spoke of the discrimination and harassment she has faced in employment and other areas of life. She described how, with advocacy support, she has been able to channel her experience into supporting others in similar circumstances, and also into tackling power imbalances around mental health.

Having heard Suzanne’s story, the workshop participants broke into small groups, relating what they had heard to the themes of people, policy and practice. 

Workshop 3: Integration of Health and Social Care – opportunities and challenges for community led health

Susan Paxton from CHEX opened the workshop by providing a short summary of what health and social care integration is – that its purpose derives from the need to deliver health and social care services differently in response to changing demographics and an aging population, and described the main structures that have been established since 2015 – Integrated Joint Boards and Strategic Planning Groups at strategic levels, and Locality Planning as the most local tier of the integration process. Stephanie-Anne Harris, Strategic Development Manager at Lothian Community Health Initiatives Forum then told the story of the Forum’s involvement in Edinburgh’s integration structures and processes to date, and some of the opportunities and challenges involved. Delegates were then invited to discuss what integration meant to them and for the people they work with, which they discussed in small groups.

Some of the key issues raised were the tensions between having enough capacity as 3rd sector organisations to participate at all levels, whilst also recognising a ‘seat at the table’ is important to exert influence and maximise opportunities.  There was also recognition that the integration ‘landscape’ is quite complex and confusing, as is some of the language and volume of information being used. Ultimately delegates commonly found the pace of progress slow, and this combined with the lack of public debate about the why and how of integration means further work is necessary to move things forward in a meaningful way.

Workshop 4: Workshop: Community Empowerment Act

This workshop began with a presentation by Rebecca Smith from the University of Highlands and Islands who outlined some of the key parts of the Act focusing on asset transfer and participation requests. Using examples from the Highlands and Islands, Rebecca noted some of the potential problems where public service authorities may not comply with the spirit of the act in the face of a potential backlash from key vested interests. She also highlighted the need for clear unbiased evaluation to ensure that the spirit of the Act as well as the detail was being applied fairly and properly.

The workshop then broke into smaller discussion groups to reflect on Rebecca’s contribution. This stimulated a lively debate, with participants emphasising the need for oversight and support to ensure that power really shifts towards communities, particularly those who currently struggle to have their voice heard.

Afternoon discussion

Fife Woman’s Aid

Following lunch Helen introduced a short presentation form Kirsty McMahon of Fife Woman’s Aid who outlined the range of support Woman’s Aid can provide to victims of domestic violence. She emphasised that domestic violence is not a domestic issue but one where the whole community need to understand and support victims in order that they can rebuild their lives and regain their confidence to play an active role in society again. She added that everyone has a role in challenging sexism, in order that we “don’t treat women as second-class citizens.”

Dr Margaret Hannah: Participatory Discussion

Margaret led us through a participatory discussion examining and illuminating the new approach to health being implemented in Fife. Using the analogy of a glass half-full rather than half-empty Margaret asked a series of questions for conference participants to consider as she explained NHS Fife’s approach to tackling health issues in the community.

Normally we see the glass as half empty and therefore look at our health in a negative way. In that sense, we look to treat illness rather than promote health. Margaret focused on applying this approach in a health-care setting with individual patients, and asked conference participants to relate the themes to their own work. In their table discussions, participants highlighted the value of thinking holistically about health and wellbeing, emphasising the health benefits of community activity, peer support and social contact. 

Health Issues in the Community (HIIC)

This Q and A session was introduced by Fran Loots a HIIC Tutor from West Lothian Health Improvement Team, who was joined by HIIC participants Ash, Dawn, and Janet. The course participants reflected on taking the course and what difference it had made to them. All contributed to explaining how the course had made them feel more in touch with their community and more empowered to take action over issues that affected them. They had, as part of their course, undertaken research into services around mental health in the West Lothian and had found that provision was insufficient to meet demand. As a result they now wish to take forward a community development approach to providing support for people with mental health issues and are actively looking at what measures can be put in place within their community to bridge the gap in service provision.

Susan Paxton (CHEX) closing remarks

Susan stated that CHEX would continue its work of promoting conversations around the benefits of community-led health both locally and nationally. She spoke of the vital role played by community led approaches to health and that that this role needs, not just to be acknowledged but accepted as an integral part of the processes adopted by all statutory service providers.

Susan outlined a range of pieces of work CHEX will be undertaking in the coming months. This will include, providing awareness raising sessions on the Community Empowerment Act, tracking how the opportunities provided in the Act are being used, training for community champions, and a range of stakeholder events.

 

Susan finished by thanking everyone for coming to the conference and making it such a successful day.

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