Health Inequalities Collaborative Learning. Plan

Transcription

1 Health Inequalities Collaborative Learning Plan NHS Health Scotland and the Scottish Council for Voluntary Organisations (SCVO), alongside third sector partners, have worked to develop a learning programme with specific focus on health inequalities. The learning programme aims to address a specific set of learning needs. This in turn will promote and facilitate collaborative, cross sectoral working towards the reduction of health inequalities in Scotland. September

2 1. Introduction NHS Health Scotland s vision, shared by the third sector, is a Scotland in which all of our people and communities have a fairer share of the opportunities, resources and confidence to live longer, healthier lives. One of the enablers towards achieving this vision is the development of capacity and capability of the workforce to take action that will reduce health inequalities and promote health equity. This plan was developed following a health inequalities learning needs assessment of the third sector, undertaken by NHS Health Scotland. The needs assessment was carried out through an online survey backed by feedback from extensive discussions with a number of third sector partners. It was clear from the findings that the learning needs identified were not specific to the third sector but more widely applicable to all organisations that deliver public services regardless of sector. NHS Health Scotland (HS) and the Scottish Council for Voluntary Organisations (SCVO) teamed up and developed a six month joint project to design a collaborative learning programme in response to the findings and recommendations from the needs assessment. This partnership is guided by the following underlying principles: Genuine commitment to co-design and co-production of the plan and proposed activities Third sector organisations are users and deliverers of the learning programme Development of a plan that is flexible, cost effective and builds on and strengthens existing assets/learning initiatives Knowledge sharing, collaborative learning and continuous improvement at the heart of delivery A steering group comprising of a range of third sector organisations has been formed and provides direction and governance for the delivery of the project. 2

3 Key points to note The term public services / public services workforce refers to all organisations within the third, public or independent sectors, that provide a service (directly or indirectly) for the good of the public. By using this collective term, the aim is to further emphasise the wide reach of this plan and reinforce the need for all sectors to recognise their roles and responsibilities towards taking action to reduce health inequalities. There is recognition that the public services workforce is extremely diverse. As such, the learning plan (pages 11-14) is flexible and adaptable to meet the needs of a wide range of organisational contexts for example organisations of all sizes, statutory/non statutory, paid and unpaid workers national local or community-led etc. The logic model (page 4) provides an overview of the activities, outputs and expected outcomes of the entire programme of work. Therefore some activities have already been achieved. 3

4 4

5 2. The collaborative learning framework The learning needs identified through the research were used to inform the development of the framework (shown below). The framework consists of four learning need areas with the knowledge, skills and attitude competencies for health inequalities aligned to each. It is important to note that while three main learning needs emerged, action was identified as a gap and was included in the framework. The rationale for this is that understanding does not always translate into action or how we do things differently (including participatory approaches with service users and partners) to achieve the change we want to see. The purpose of the framework is to achieve a coordinated approach to the design, development and delivery of learning opportunities on health inequalities. From a user perspective the framework will also: Enable efficiency and flexibility for organisations and their staff. It does not assume that everyone has the same learning need and / or are starting from the same point. This has been reflected in the proposed collaborative learning plan (see pages 11-14). Act as guidance for both employers and staff as to what competencies they should be seeking to achieve from a learning activity associated with any of the learning needs areas and enable them to plan the best ways of meeting these needs 5

6 Figure 2: Collaborative learning framework 6

7 2.1 What you told us about your learning needs Findings from the learning needs assessment identified three main learning needs as follows: 1. Foster a shared understanding of health inequalities, its causes and impact on society, not only within the third sector but as part of the wider public services that will result in action to reduce health inequalities. A better understanding of health and health inequalities for all staff. Frontline care staff have to understand the role they can play and that health inequalities can be tackled by everyone not just the NHS and the Government. A better understanding of the root causes and differences between inequality and health inequality. More information on what works and why it works would be useful, particularly on how to localise these and make them work for each area in Scotland. Quotes from survey respondents 2. An improvement in demonstrating the impact of an organisation s contribution towards tackling health inequalities. Awareness of different models that have been successful in demonstrating impact on health inequalities. Increased awareness of the use of qualitative and quantitative evidence in tackling health inequalities. Lack of investment in building capacity of community-led health organisations in supporting them to demonstrate their impact on health inequalities. Quotes from survey respondents 7

8 3. Leadership development for the third sector: to provide support in both strategic planning with public and independent sector partners and collaborative influencing at Government level. Being linked in with other national/local organisations. Working collaboratively with government and national public bodies to influence social change in tackling health inequalities. There is considerable scope for the third sector to be more coherently and consistently involved at a more strategic level with NHS Boards and Scottish Government policy makers in the joint pursuit of reducing health inequalities. More involvement with strategic planning with NHS colleagues. Quotes from survey respondents 3. Mapping of existing initiatives Following the learning needs assessment, the project team carried out a mapping exercise of existing learning initiatives, tools and guidance currently available and accessible to third sector organisations. A database of existing health inequalities learning initiatives and resources (aligned to upstream / downstream continuum) was created. The database shows that there is a variety of learning opportunities available, with varying costs associated, but the majority can be accessed free of charge. It is recognised that cost will be a contributing factor for many organisations / individuals to accessing training. This factor has been considered and has informed the proposed learning plan. While it is acknowledged that the database (in its current state) is not a full representation of the learning solutions currently available on health inequalities and related areas, it does provide an overview of what is currently available and provides the basis for gaps in provision to be identified. The database is intended to be a live document, updated regularly and hosted on HS virtual learning environment (VLE). 8

9 The database will be structured according to the four learning areas ( understanding, action, impact and leadership ) outlined in the learning framework and will meet the following objectives: contribute to assessing the current provision and inform gap analysis, which will be used to inform the development of the learning plan. offer individuals and organisations information on a pool of resources and learning solutions with specific focus on inequalities and related areas. provide a platform for organisations to promote their own learning opportunities and resources. The intention of providing both the database of information and the associated collaborative learning framework is to empower individuals / organisations to make an informed decision about their own learning needs and select the best learning opportunity suited to these needs. It should also be noted that NHS Health Scotland is sharing information on what learning opportunities are available and not endorsing any learning opportunity listed on the database. 3.1 The development of the learning plan (pages 11-14) The development of the plan below is supported by the principles mentioned in the introduction and is also informed by the following considerations: Preferred learning methods: Based on feedback from the learning needs assessment, participants rated face to face learning solutions more favourable than online and e-learning initiatives. As a result, blended learning approaches have been proposed. Release of staff to attend training/funding for backfill: Under the current climate this remains a very real challenge for many organisations. Selfdirected and experiential learning opportunities (such as action learning sets and coordinated exchanges) will be explored. Timescales for the delivery of the plan have been set for three years. No deadlines have been set in anticipation that a continuous improvement approach using small tests of change will apply. 9

10 Links with existing strategic policies / plan have been identified and established to ensure that the learning plan is well connected and is able to deliver and / or feed into other work-streams under the same strategic priorities. Work on the leadership learning need will have a delayed start to ensure a well-connected programme and minimisation of duplication. 10

11 Table 1: Collaborative learning plan Understanding Action Impact Leadership Specific learning need Foster shared understanding of health inequalities, its causes and impact on society. Take action to reduce inequalities. Measure and demonstrate impact on health inequalities. Engage in strategic planning with partners and collectively influence Government to reduce health inequalities. Current position and gap analysis (summary) Current provision Online modules and briefings on health inequalities. Equality strand / inequalities topic-led training with some which have direct links with health (e.g. poverty awareness). Current provision Wide range of online modules, training courses etc. aimed at promoting inequalities sensitive practice and mitigating circumstances. Well-developed support available for community-led health approaches. Current provision Wide range of tools, guidance and training resources available and accessible, to support outcomes focused planning / delivery and evaluative approaches. Current position Extensive resources and leadership development initiatives delivered through formal and informal learning. Gaps Available learning opportunities to support reflection and application of learning with peers (e.g. teams, organisations and / or local partnership levels) are limited. Gaps Focus on upstream / prevention agenda is minimal, including learning support for impact assessments at service planning and design level. Gaps Learning opportunities on demonstrating impact and related areas tend to be generic and lack specific focus on health inequalities. Particularly in relation to what should be measured and how to go about it. Gaps Collaborative and adaptive leadership approaches need to be strengthened for delivery to public services leaders. There is a visible diversity in the types of leadership roles and a question about whether current initiatives actually meet their learning needs. 11

12 Understanding Action Impact Leadership Types of activities proposed to meet this need Short / bite-sized learning sessions designed to reflect on what this means for individual and / or collective roles within specific organisational / local partnership contexts. These bite-sized learning sessions will offer flexibility and could be used in workshops / seminars / provide framework for focused dialogues and discussions within teams / organisations and local partners groups etc. Facilitated sessions for crosssectoral audience to enable knowledge into action and improvement approaches towards tackling health inequalities. Set up small tests of change to support experiential learning and problem solving for local partnerships using action learning sets. Coordinate cross-sectoral learning exchange programme between partners (e.g. secondments, shadowing and coordinated swaps). Agreement to be sought on what to measure and appropriate methodologies to enable the demonstration of impact on health inequalities. Existing tools, guidance and learning initiatives (including workshops) to be refreshed and / or adapted to focus on demonstrating impact on health inequalities. Set up small tests of change to support experiential learning and problem solving for local partnerships using action learning sets. All proposed activities will be aligned to existing leadership development programmes as appropriate. Dual focus: individual and collaborative leadership development: Individual mentoring, coaching, 360-degree feedback, self-directed learning. Collaborative action learning sets, peer learning, workshops, shadowing. Start dates January 2017 January 2017 April 2017 June 2017 Strategic links established A fairer healthier Scotland; Health and social care integration; Public Health review support for the wider PH workforce; Workforce 20:20 vision action plan (3.1); A fairer healthier Scotland; Health and social care integration; Public Health review support for the wider PH workforce; Workforce 20:20 vision action plan (3.1); A fairer healthier Scotland; Health and social care integration; Public Health review support for the wider PH workforce; Workforce 20:20 vision action plan (3.1); A fairer healthier Scotland; Health inequalities learning programme for nonexecutive members and IJBs; Public Health review support for the wider PH workforce; 12

13 Understanding Action Impact Leadership Strategic links established Scottish National Action Plan (SNAP) for Human Rights. Scottish National Action Plan (SNAP) for Human Rights. Scottish National Action Plan (SNAP) for Human Rights. Health and social care integration; Workforce 20:20 vision action plan (3.1); Scottish National Action Plan (SNAP) for Human Rights. Anticipated outcomes (aligned to logic model see page 4) Short-term outcomes: Availability of and access to a range of relevant learning on health inequalities are increased. Learning from small tests of change at local partnership level has informed continuous improvements. Engagement of public services partners in collaborative learning is achieved. Short-term outcomes: Availability of and access to a range of relevant learning on health inequalities are increased. Learning from small tests of change at local partnership level has informed continuous improvements. Engagement of public services partners in collaborative learning is achieved. Medium-term outcomes: Application of newly acquired learning / skills on health Short-term outcomes: Availability of and access to a range of relevant learning on health inequalities are increased. Learning from small tests of change at local partnership level has informed continuous improvements. Engagement of public services partners in collaborative learning is achieved. Medium-term outcomes: Application of newly acquired learning / skills on health Short-term outcomes: Availability of and access to a range of relevant learning on health inequalities are increased. Learning from small tests of change at local partnership level has informed continuous improvements. Engagement of public services partners in collaborative learning is achieved. Medium-term outcomes: Application of newly acquired learning / skills on health 13

14 inequalities is happening. Shared understanding of health inequalities and agreed ways of measuring impact at local level are achieved. inequalities is happening. Shared understanding of health inequalities and agreed ways of measuring impact at local level are achieved. Public services workforce are able to demonstrate their contribution towards reducing health inequalities. inequalities is happening. Shared understanding of health inequalities and agreed ways of measuring impact at local level are achieved. Public services workforce are able to demonstrate their contribution towards reducing health inequalities. The capacity of public services leaders to work in partnership and collectively influence government on reducing health inequalities is increased. Monitoring and evaluation Learner reaction level feedback Service level agreements Case studies Learner reaction level feedback Learner journey Case studies Learner reaction level feedback Reports Repeat successful funding bids on inequalities Performance stories Learner reaction level feedback Learner journey case study Evidence of influencing at all levels. Evidence that health inequalities learning has been prioritised 14

15 4. Next steps Following consultation, the plan will be finalised and launched. It is proposed that three short life working groups, with representation from across all sectors, will be set up to lead the implementation of the plan for specific areas as follows: Awareness and action Impact Leadership The steering group will continue to provide governance for the implementation of the plan. The working groups will provide six monthly reports to the steering group. NHS Health Scotland and SCVO will continue to facilitate the effective delivery of the project including collating and sharing learning. 5. Resource implications The aim is to harness and utilise existing capacity and expertise (people, time, knowledge) from across sectors to ensure an effective implementation of the plan. NHS Health Scotland will provide limited resources to support the early stages of the implementation of this work. 6. Potential risks NHS Health Scotland and SCVO are committed to facilitating this programme of work. However, the successful delivery of this plan requires the full participation of the third sector as users and deliverers of this plan. The absence of this will result in the design and development of learning opportunities that do not meet the needs of the diverse target workforce. 15

16 Appendix 1 Third sector staff development needs assessment with specific focus on health inequalities: A summary of key findings (November 2015) 1. Introduction The purpose of the learning needs assessment was to identify the staff development needs of the third sector in Scotland with a specific focus on health inequalities. The ultimate aim of this study is to further enhance the contribution of the third sector towards tackling health inequalities which is one of the biggest challenges facing Scotland at the moment. Recent studies on the third sector have been carried out by a number of organisations 1. These studies have developed our understanding of: employee engagement within the sector the changing face of the sector and the wider context within which it operates the lived experience of health inequalities the contributions which the sector makes to the overall reform and improvement of public services in Scotland. However, this work contributes to a new and specific perspective to our understanding of the third sector. Mainly the key staff development needs with a specific focus on health inequalities and the conditions required for learning and development solutions to have their desired impact. The findings from this work were mainly based on a health inequalities learning needs survey which was disseminated using various channels. These included bulletins, third sector interfaces, s, and a web based tool. The intelligence gathered from meetings with key third sector partners during the planning of this work was also used. The survey was open to anyone who works in the third sector for three weeks running to 18 th September Population sample A total of 150 responses were received. However only 64 of the total responses were considered to have enough information and were used in the analysis The sample population was drawn from 44 organisations and 43% of these were national organisations 45% of the respondents were at senior management roles within the sector The most popular services which the population represented were: o Health, wellbeing and social care 1 Scottish Council for Voluntary Organisations, Voluntary Health Scotland, Glasgow Centre for Population Health, Institute for Research and Innovation in Social Services 16

17 o Learning, education and capacity building o Community development o Advice and information 3. Key findings The key findings were grouped into the following three main categories: Access to and availability of learning and continuing professional development Feedback from third sector staff Feedback from third sector senior managers Each will be detailed below. Access to and/or availability of learning and continuing professional development (CPD) opportunities on health inequalities and related subject by third sector staff vary immensely. This was influenced by various factors such as the size of organisation and/or its budget, the focus/scope of the organisation s work and where applicable the content of staff induction programmes. This study also found that apart from learning opportunities with a direct focus on health inequalities offered by NHS Health Scotland, CHEX 2 and a few local partnerships, specific learning and development support for this area were few and far between. However, a few third sector organisations (e.g. SCVO, ACOSVO, GCVS etc.) and other bodies (e.g. SHRC, EHRC) provide staff development opportunities on related areas to health inequalities such as equality, human rights, networking, collaborative working and related areas to health inequalities. Third sector staff rated both their abilities and development needs in relation to specific health inequalities and related competences as follows: High rated abilities were: Making evidence informed decisions Collaborative working to deliver integrated services Outcomes planning Empowering individuals and communities Low rated abilities were: Influencing change at government level in collaboration with partners Evaluating and demonstrating impact What works to reduce health inequalities Strategic planning with public sector partners 2 Community Health Exchange 17

18 It is important to note that correlation between the low rated abilities and high rated development needs were identified. The most popular preferred learning methods identified were: face to face courses, forums and conferences, e-learning blended learning Opportunities for stronger partnership working, additional resources (financial and time) and learning solutions were considered as key enablers for making a contribution to tackling health inequalities within their roles/organisations. The key constraints to tackling health inequalities identified were a lack of recognition of the contribution made by the third sector, time and resources, limited knowledge sharing and shared understanding of the most effective approaches. Third sector senior managers: considered strategic development, financial stability and workforce development as the most important requirements for sustaining their organisations contributions to reducing health inequalities. identified that shared understanding of health inequalities, the gathering and use of evidence were amongst the most important skill-sets required for their current work on health inequalities recommended that support with securing proper funding, demonstrating impact of organisations work, leadership development and increased workforce capacity were critical in meeting the future shared challenge of reducing health inequalities anticipated that the key barriers to meeting the future shared challenge in addressing health inequalities are that the third sector need to be acknowledged as equal partners by the public sector. Are kept up to date with developments within an under resourced sector. Funding development opportunities and the ability to release staff for development are maximised. commended the following workforce development approaches as effective for the third sector; reflective practice, shift from training to practice development, experiential approaches to staff development and learning networks. 4. Conclusions Health inequalities, their causes and effective ways of tackling them was judged by this study to be at varying levels of understanding and engagement, reinforcing the diversity of this sector. However, there was a strong call for support for the third sector in tackling health inequalities. The types of support suggested by respondents were not only limited to learning and development needs but also included wider non-learning issues (such as funding) 18

19 that will boost the outcomes from learning and development solutions and/or overall contribution to health inequalities. 5. Interim recommendations A level of shared understanding of health inequalities and what works to reduce health inequalities needs to be attained, not only within the third sector but at wider public services level to enable effective collaboration towards this shared goal. An improvement in demonstrating the impact of an organisations contribution towards tackling health inequalities. This is linked to the point above and may be easier to achieve if some level of shared understanding is achieved. Leadership development for the third sector to support them in both strategic planning with public sector partners and collaborative influencing at Government level. This is critical to well designed and delivery of integrated services. Facilitate a change in perception of public sector bodies on the added value which the third sector brings in tackling health inequalities. Support with influencing the funding infrastructure for third sector that will minimise duplication of services and maximise efficiency and effectiveness of public services. 19

20 Appendix 2 Steering group About the group We are here because: o We share the same interest around reducing health inequalities o We are committed to enhancing our workforce capacity through learning and development support o We have strong and positive networks across the third sector and beyond The group will work to ensure the development and delivery of an effective learning programme with and for the third sector Members will be strong advocates of the programme: taking on dual roles of both users and delivery agents of the work The group will be about active participation rather than engagement Members Pam Duncan-Glancy Chair / Senior Communication & Engagement Officer, NHS Health Scotland Michelle Fisher Employability and Civic Participation Officer, Inclusion Scotland Allan Johnstone Acting CEO, Voluntary Action Scotland (VAS) Fiona McHardy Research & Information Manager, The Poverty Alliance Lucy McTernan Deputy CEO, Scottish Council for Voluntary Organisations (SCVO) Susan Paxton - Head of Programmes, (Community-led health & Networking) Scottish Community Development Centre (SCDC) Claire Stevens CEO, Voluntary Health Scotland (VHS) Jill Walker E-learning Manager, Shelter Scotland Mark Willis Welfare Rights Adviser, Child Poverty Action Group (CPAG) Programme team Lovetta Williams Organisational Lead, Workforce Development, NHS Health Scotland Alana Neil Development Officer, SCVO / NHS Health Scotland 20