Funding Opportunity Developing an Effective Response to Health Inequalities in South East Edinburgh Developing a Community Health Response in South East Edinburgh This funding opportunity is for the development of a Community Health Initiative (CHI) in the South East locality area of Edinburgh. The South East locality area is situated on the southern edge of Edinburgh, combining both urban and relatively rural areas. It comprises a number of smaller and quite distinct communities, each with a strong local identity. These include - Liberton, Gilmerton, Inch, Gracemount, Moredun and Southhouse/Burdiehouse. Around 33,000 people live in this area. The area boundary for the South East locality viewed at http://www.edinburghcompact.org.uk/localities/. The South East Edinburgh locality experiences worse health than the average for Scotland that is there is a higher level of risk associated with poor health (i.e. admission rates for alcohol or drug taking or prescriptions for anxiety, depression or psychosis). Just over 20% of people in the Liberton/Gilmerton Ward have a longstanding limiting illness; this is higher than the city-wide level of 16.6% (Census, 2001). Further information about the Liberton and Gilmerton Area Profile can be found at http://www.edinburghnp.org.uk/neighbourhoodpartnerships/liberton-and-gilmerton/downloads/liberton-gilmerton-ward-profile/. Background: Development of Community Health Initiatives in Edinburgh We know that people living in poverty and those who are part of specific social groups experience poorer life chances, reduced health and wellbeing and shorter life expectancy. Tackling the root causes of current levels of inequality as well as reducing the health and social impacts will help us to address the increasing demand for health and social care services. Tackling Health Inequalities in Edinburgh is a key priority for the Edinburgh Health and Social Care Partnership. The H&SC Partnership aims to do this by working with its partners to address the root causes, as well as supporting those groups whose health is at greatest risk from current levels of inequality through supporting individuals to maximise their capabilities and have control over their lives creating healthy and sustainable communities that can resist the effects of inequality on health and wellbeing ensuring that core health and social care services are delivered in such a way as to reduce and not exacerbate health inequality 1
recognising that some sections of the population need targeted support in order to address the cause and effect of inequalities. Within Edinburgh a strategic approach has been developed across the city to ensure that Community Health Initiatives which are based on community development principles and therefore respond to identified local needs are present in a number of areas of need within the city. The aspiration is that each area of deprivation within Edinburgh should have a generic community health initiative based on approaches to support and develop community capacity and social capital which are adapted to the needs identified by local people and organisations. Decisions regarding core funding of these initiatives are channelled through the Health Inequalities Standing Group and jointly agreed between the NHS, EIJB and City of Edinburgh Council. Funding as defined in this brief would aim initially to provide the infrastructure for basic community development work and to achieve Health Improvement outcomes. The performance of a community health Initiative will be assessed against the extent to which it can demonstrate a positive impact on health inequalities in the area and show success in helping people to: gain confidence develop social networks come together to address specific issues met their needs by using services and moving on from and between services as appropriate Core activities may include: Development/outreach work to build links and networks within the community Group work focusing on confidence building, support, developing skills and capacity of individuals who experience health inequalities Effective linking with mainstream services Facilitation of local groups wishing to organise around a particular health issue South Edinburgh Consultation A consultation exercise with local residents and key stakeholders was carried in 2014. The main findings to emerge from the consultation process were: Having the basics (family, home and money) was essential for continued wellbeing Social isolation, mental health and issues associated with living with long term conditions were major concerns in the area There was also concern with alcohol and drug misuse in the area The greatest gaps were around support for those with long term conditions, mental health problems and insufficient access to welfare advice services. 2
The consultant identified that there were no clear spikes in health priorities in the area and no particular patterns emerged across the various neighbourhoods. Consequently, it was recommended that a new project should take a generalist approach and allow community development approaches to determine the focus of the work required in each neighbourhood. The consultation concluded that the new South East project should focus within 7 distinct communities of the South East Locality area: Southhouse/Burdiehouse, Moredun, Ferniehill/Craigour, the Inch, Liberton, Gracemount and Gilmerton. It is recognised that the core budget available ( 60K) would not be sufficient to cover the entire area and that the development across the various neighbourhoods would be dependent on the success of an effective fund raising strategy. You should state clearly in you proposal how you intend to address the geographical issues which present themselves in the SE Locality. The suitability of premises was also addressed in the consultation. It was suggested that a new CHI should attempt to have a geographical presence in a variety of neighbourhoods through the use of existing community focal points such as community centres, libraries or other familiar local bases. It was also suggested that the new CHI should have a separate administrative base within the boundaries of South Edinburgh. How you would adopt a hub and spoke model which would help to maximise the impact of the limited resources should also be addressed in your proposal. Preferred Provision The HISG is looking to provide community health provision in a minimum of 3 areas of the deprived areas of South East Locality area. It is envisage that dedicated staff in each area would be part-time and would adopt a community development approach to improving health and wellbeing. The programme of activities developed in each area should reflect priorities identified by those communities and may include work on income maximisation, employment, literacy, greening, healthy eating, physical activity and other health-related activities as appropriate. The project would be expected to adopt a broad range of engagement approaches including recruiting volunteers/local activists, networking with key stakeholders and wider geographical communities and offering support to other local organisations to develop additional health promoting activities. The successful provider would need to demonstrate the additionality that will be gained from having a network of community health workers in the area, how it would integrate its service provision with existing provision in the area and how it would use existing community assets to deliver its programme of activities. 3
Submission Requirements Structure for a New South Edinburgh Initiative The aim of this funding is to provide services which aim to reduce health inequalities present in the South East locality. The focus of this provision will be based in Liberton and Gilmerton Ward area. We are looking for an open flexible approach to wellbeing which will address lifestyle factors as well as wider issues around welfare advice, literacy and other issues impacting on the life circumstances of local people. Your proposal will need to: Demonstrate good local knowledge of the area and show a coherent strategic cross sector networking approach which is felt to offer greater impact and a wider geographical spread than a single project approach. Identify how community leadership, which will allow smaller scale but wider spread sustained activity, is to be developed Identify how you intend to provide a geographical presence through the use of existing focal points and achieve best value and a leaner delivery by using existing local assets such as community centres, libraries and local medical facilities. Detail how you intend to further develop community networks and strengthen community wellbeing and resilience by providing support to other local organisations to develop health promoting activities and therefore gain a further reach into the wellbeing of the community Project Action Plan: Development of objectives, targets and outcomes Your proposal should incorporate a Project Action Plan which demonstrates what impact the project will have through appropriate and measureable project objectives, targets and outcomes. When developing measureable project objectives, targets and outcomes a series of issues should be considered: How your proposal will relate to the HISG Funding Criteria as detailed in Appendix 1. How your proposal will incorporate the Standard Impact Assessment Questions (SIAQs) which are part of the Joint Monitoring approach for projects in Edinburgh (See Appendix 2). How your proposal will ensure that the approach used towards achieving the Health Inequality outcomes is based on the expressed health and wellbeing needs of the local community. 4
How local people will be involved in the development of your proposed community health initiative and how it will reflect the diversity of the local population and hard to reach groups. How the project will engage in partnership working with local stakeholders and how this will be measured. Outline estimated budget An indicative budget of 60k is available in 2017/18 to support the development of a new community health initiative in the Liberton and Gilmerton ward area of Edinburgh. This budget will support all the costs associated with the new initiative including staffing costs, running costs, and any other associated expenses. Your proposal should include a detailed breakdown of costs. Future funding would be dependent on a satisfactory performance of your first year of operation and on the successful submission of application to both the NHS Lothian Health Improvement Fund (HIF) and the EIJB s Health Inequalities Grant Programme for 2018 onwards. Submitted proposal To be considered for this funding opportunity you are required to submit the following information: A detailed outline of how the initiative would be implemented, including an outline programme and time plan. An outline of the overall approach and management procedures you would use for this initiative including management arrangements, key issues, identified risks and any additionality your proposal would offer. A project action plan with measurable objectives, targets and outcomes, including the incorporation of SIAQs (See Appendix 3) A detailed financial breakdown for this work Details of the accountable organisation and the qualifications and experience of key team members who will be implementing this initiative, their role and the amount of time each member will contribute. A copy of your most recent audited accounts The proposal should have a clear focus on addressing health inequalities, demonstrate a community development approach and must show an understanding of effective approaches to addressing health inequalities. 5
Timescale The grant is expected to commence in April 2017. Closing date Please return your completed electronic application form to suzanne.lowden@edinburgh.gov.uk, Department of Health and Social Care, Business Centre 1/8, Waverley Court, 4 East Market Street, Edinburgh, EH8 The closing date for all proposals is Noon on Monday 13 March 2017. If you would like to discuss any aspect of this funding brief further, please do not hesitate to contact Suzanne Lowden on 0131 469 3877. 6
Appendix 1 HISG FUNIDING CRITERIA HEALTH INEQUALITY PROGRAMME 2017-18 Your Output and Impact Targets for 2017/18 Please provide a brief description of your proposed activities your organisation wishes to undertake in 2017/18, with measurable outputs and impacts in the table provided. You will need to identify which Strategic Objectives and which Health Inequalities Priority Outcomes your proposed service provision relates in your proposed action plan: Strategic Objectives Health Inequalities Priority Outcomes 2017/18 HI 1: Enable all adults to maximise their capabilities and have control over their lives (PO1) Increased social capital: reduced social isolation; increased community participation and volunteering (PO2) Increased community capacity: communities of place and interest and cultural bridging (PO3) Reduce the stigma surrounding poverty and health inequality and tackle discrimination HI 2: Create and develop healthy and sustainable places and communities HI 3: Strengthen the role and impact of ill-health prevention by increasing preventative Interventions and improving take-up of treatment services (PO4) More people live in healthy environments and use greenspace (PO5) Increased participation in physical activity: including walking, cycling, dance, active travel, gardening (PO6) Increased number of people eat healthily; increased number of people know how to cook healthy food and how to eat healthily on a budget (PO7) Reduced damage to physical and mental health from misuse of alcohol and drugs (PO8) Reduced levels of anxiety and depression HI 4: Ensure a healthy standard of living for all (PO9) Reduced damage to physical and mental health from all forms of abuse and violence (PO10) Increased income due to improved access to income maximisation services and advice on problem debt levels 7
Appendix 2 Standard Impact Assessment Questions (SIAQs) In addition to providing measurable outputs for your proposed service, you are also required to indicate what realistic impacts you hope your service will on service users. It is recommended that you select a range of measureable impacts from the Standard Impact Assessment Questions (SIAQs) which have been co-produce by the Council, NHS Lothian and the third sector in Edinburgh. The SIAQs are listed below for information. 1. PO1 Increased Social Capital a) I feel less isolated since using the project. b) I feel more connected to my community (seeing more people, getting out and about more). c) I am more able to participate in community activities (eg. social activities, community events, groups, school life, adult learning, etc). P01 Impact of volunteering (new questions) d) I feel I have gained new friendships/contacts I can call on e) I have gained new skills f) I have gained in confidence/self esteem g) I feel of value and /or am valued 2. PO2 Increased Community Capacity 8
a) I feel more involved in my community since using the project. b) I feel that my opinion matters. c) I feel more positive about my local community. d) I have a better understanding of the people and groups within my community (e.g. black and minority ethnic, lesbian, gay, bisexual and transgender, disabled, older, younger, carers, etc.). 3. PO3 Reduce the stigma surrounding poverty and health NO questions developed 4. PO4 More people live in healthy environments and use greenspace a) I am more aware of greenspace (e.g. gardens, allotments, local walks, etc.) and local parks since using the project. b) I feel more comfortable using greenspace and local parks. c) I am using greenspace and local parks more often. 5. PO5 Increased participation in physical activity a) I am more aware of the importance of physical activity since using the project. 9
b) I am more physically active than I used to be (e.g. gardening, walking, housework, exercising, dancing etc). c) I have changed my travel habits e.g. using the car or bus less often and getting about by walking or cycling d) In the past week, on how many days have you done a total of 30 min or more of physical activity which was enough to raise your breathing rate? This may include sport, exercise & brisk walking or cycling for recreation or to get to and from places. 1 2 3 4 5 6 7 None 6. PO6 Increased numbers of people eat healthily/ know how to cook healthy food and how to eat healthily on a budget. a) I am more aware of the importance of eating healthily since using the project. b) I feel more able to cook healthy meals. c) I am eating more healthily (including 5 daily portions of fruit & vegetables). d) I feel more able to plan my meals/food shopping since using the project. 7. PO7 Reduced damage /harm to physical and mental health from misuse of alcohol and drugs a) I have a better awareness of the risks & harm that alcohol and or drugs can cause to my health and wellbeing since using the project. b) My involvement with the project has encouraged me to reduce my alcohol consumption c) My involvement with the project has encouraged me to take fewer drugs. 10
d) I have more awareness of how to access help and support to reduce my drug or alcohol use. 8. PO8 Reduced levels of anxiety/ depression a) I am more aware of things that affect my mental/emotional health and wellbeing since using the project. b) I feel more able to cope with the ups and downs of everyday life. c) My mental/emotional health is better. 9. PO9 Reduced damage to physical and mental health from all forms of abuse and violence a) I am more aware of different forms of hate crime, emotional abuse and physical violence since using the project. b) I feel more confident that I will be able to seek support and help when I need it. c) I feel more in control of my life and able to sustain healthy relationships. 10. PO10 Increased income due to improved access to income maximisation services and advice on problem debt levels. a) I have more awareness of how to access help with welfare benefits and debt issues since using the project. 11
b) I feel more confident that I will seek help with welfare benefits when I need it. c) I feel more confident to seek help with debt issues before a crisis is reached Don t Know/Unsure d) I am more able to manage my finances. Don t Know/Unsure e) I feel less anxious about my financial situation. Don t Know/Unsure 12
Appendix 3 Action Plan Format HISG Priority Outcome/ Impact E.g. PO8 Reduced levels of anxiety and depression Activity Deliver Confidence Building courses for people who are feeling anxious or depressed Output Targets Activities, volumes and outputs 3 x 6 weekly Confidence Building group sessions each with 10 participants per session 30 Individuals per year Intended Outcome or Impact of Proposed Service on the Health and Wellbeing of Clients (using appropriate SIAQ measures) 60% (18 individuals) report they feel more able to cope with the ups and downs of everyday life (SIAQ 8b) 50% (15 individuals) report feeling their mental/emotional health is better (SIAQ 8c) 50% (15 individuals) report they feel more less isolated (SIAQ 1a) 40% (12 individuals) report they feel more connected to their community (SIAQ1b ) Finally, we are interested in the number of individuals who will be benefitting from your proposed service. In addition to providing the number of sessions and participants for each activity, could you also indicate how individuals you will aim to have direct contact with through each activity. 13