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Developing a Strategic Direction for Community Development in Public Health

On 21 March 2019 NHS Health Scotland held the above event, which brought together approximately 30 participants from different sectors to highlight the opportunities, challenges and shared vision of community development in public health in Scotland. We asked the participants to identify what is currently working well and what we need to do differently to move forward together.

On the day Eibhlin McHugh, Co-director of the Public Health Reform Team and Alasdair MacKinlay, Policy Manager in Scottish Government, presented a brief overview of the public health and community empowerment contexts. Short presentations were then delivered by those working with communities on the challenges and strengths of community development in public health these included Iain Stewart (Edinburgh Community Food), Anna Baxendale (on behalf of the NHS Health Promotion Managers) and Susan Paxton (SCDC). These presentations highlighted the current situation, challenges and opportunities that could be utilised.

The participants then worked in groups to develop a shared future vision and after lunch an idea of how to get there and the first steps that need to be taken on this route.

The 5 year vision consisted of the following:

• Rebalance the system to focus more on impact, lived experience and mainstreaming participatory budgeting
• Greater understanding of Community Development and Community Empowerment by workforce and investment in it to improve local delivery (including commissioning of services)
• Shift from reactive to preventative
• Public Health Scotland has a defined role in terms of leadership
• A minimum infrastructure for each anchor organisation
• Community leadership will shape Public Health
• Dispersed leadership throughout the system and Community Development skills essential for all leadership roles.

On the day there were key themes highlighted, which are noted below:

  • The place of evidence and data and the importance of lived experience and the understanding of front line practitioners within what is considered acceptable evidence. There was discussion to build on analysis of themes and trends in community learning development plans 2018-21 that are currently being carried out by Education Scotland, Scottish Government and partners. The discussion highlighted the need for a cultural shift for all staff to understand and value lived experience and other evaluation/different models of hearing evidence from community groups. It was agreed that there was an opportunity to join up more around community-led research to ensure the best use of resources.
  • The existence of good practice along with the challenge of how to effectively identify, share and sustain effective practice was highlighted. Good practice examples included social prescribing, participatory budgeting and specific examples that Edinburgh and NHS Fife colleagues mentioned but participants felt that whilst it was a good start it needed more support/resource and further links to ensure successful implementation. Another discussion highlighted that annual funding and constant need for innovation limited opportunities for building and sharing good practice. The Scottish Communities for Health and Wellbeing is a joint platform for recommendations and delivery and was recognised as a positive in terms of not adding a new layer of infrastructure. It was felt that it would be important to ask why a good idea hasn’t spread already and to think carefully about the factors that are critical to its success.
  • Workforce development was another key area that was discussed. It was felt that the participants wanted a workforce that truly understands community development/community empowerment approaches and this requires further support and should be needs led. Some leaders display good community development understanding and skills but this could be built on as well as opportunities for mentoring roles. There was a need to increase awareness of the workforce in general (the key players, system needs and tools available). It was felt that it would be important to learn from the national study of the Community Learning Development workforce (Working with Scotland’s Communities Study). An opportunity would be to enable people to undertake community roles as part of their paid role. One discussion was on distributed leadership and the role that Public Health Scotland could play in order to provide more power to neighbourhoods but distributing skills, power and leadership to communities.
  • The importance of generating genuine and effective collaboration. Communities need supported to engage and make sure that they can actively be involved through commissioning approaches and shaping public services. In some areas the local planning partnership works well however this is not universal and requires further support. An opportunity that was highlighted was that Public Health Scotland could have a role to support co-designing and delivering action learning sets on how inequalities are being tackled as well as having a community/voluntary sector representative on the board and facilitate collaborative working.

Participants fully engaged in a useful discussion and highlighted community development’s potential contribution to taking a whole system approach. The participants seemed positive and optimistic about the future opportunities.

Next steps
The event was a great opportunity to build understanding and awareness of the direction of travel. Work will be continuing as we move from NHS Health Scotland to Public Health Scotland and we are committed to working with partners to continue to establish a strategic direction to community development in public health and for the national body to be empowering and helping to support local work. We hope to hold an event early next year to showcase the progress made.

Thanks to everyone who helped make the day a successful event.

Frances Birch

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