The Scottish Government

« Previous | Contents | Next »

Listen

LEARNING TO MAKE A DIFFERENCE

HAVE A HEART PAISLEY

PROVIDING A UNITING FOCUS FOR ACTION ACROSS A BROAD FRONT TO PREVENT CORONARY HEART DISEASE, PROMOTE GOOD HEALTH AND REDUCE HEALTH INEQUALITIES IN PAISLEY, SCOTLAND'S LARGEST TOWN.

About Have a Heart Paisley

Paisley has one of the worst coronary heart disease (CHD) records in Scotland. In some parts of the town, the CHD death rate is up to 50% higher than Scotland as a whole. HaHP aims not only to prevent CHD from developing in the first place but also to promote recovery, prevent worsening of CHD and reduce the risk of recurrence of heart attacks in people who already have the disease. Have a Heart Paisley (HaHP) is striving to make healthier choices easier to make and maintain for the people of Paisley. It aims to influence the lifestyles of individuals, families and communities. Vitally, it is concerned with protecting against CHD through issues of life circumstances, environments, and local services, with a specific focus on reducing health inequalities.

Because of the many influences on CHD and the wide-ranging improvements in environment, lifestyle and services needed to prevent it, the solution requires close working between various agencies and sectors, and all the communities and people of Paisley. HaHP is working through existing services and networks and building new ones where they are needed. From the earliest planning stages, HaHP has been a partnership initiative involving a range of organisations and groups, including: Argyll and Clyde NHS Board, Renfrew and Inverclyde Primary Care NHS Trust, Argyll and Clyde Acute Hospitals NHS Trust, Paisley Local Health Care Co-operative (LHCC), Renfrewshire Council and numerous community groups. While different partners take the lead role for particular strands and projects, the emphasis always is on collaboration and co-operation between partners.

HaHP aims to apply lessons learned from elsewhere and at the same time test new activities and ways of working. HaHP's approach comprises five main strands of work:

• Call to action.

• Building community capacity.

• Opportunities, environments and lifestyles.

• Developments in health care and health information.

• Learning and development.

These strands are being woven together to create a new Paisley Pattern of better health. Much has been achieved in HaHP's first year.

Key achievements

Call to action

If HaHP is to achieve the necessary step-change in action for CHD prevention it must capture the imagination of all the people of Paisley; promote self-belief among individuals, families, agencies and the town as a whole that they can do something to put Paisley on the health map; and win their commitment. Wide-ranging communication activities over the year have aimed to raise awareness of Have a Heart Paisley, promote healthy lifestyle messages and encourage community participation in community events and projects. The local response to these activities has been good - preliminary information suggests that 73% of the Paisley population recognise HaHP as a 'community project to reduce heart disease'. Wider interest in HaHP is growing. In its first year, the Have a Heart Paisley web site - www.haveaheart.org.uk - received around 130,000 hits.

Community capacity

HaHP is building on existing initiatives which are improving the health of people living in Paisley's more deprived neighbourhoods and delivering wider regeneration. Paisley has been sectored into four locality networks, each with its HaHP co-ordinator whose job it is to facilitate the development of community activities and strengthen links between agencies and community groups. A major aspect of encouraging and supporting community participation has been the funding of community-based projects. In its first year, HaHP invested around 350,000 in over 50 local or Paisley-wide community projects, initiated and implemented by members of the community to address their specific health needs. The aim of the projects is to provide healthy advice and activities at a local level that relate to the three main causes of heart disease: unhealthy eating, lack of physical activity and smoking. Some examples include:

• Health on Wheels: a mobile food initiative that provides local communities with easy access to affordable, healthy, good quality food. The project was formed in response to research carried out by Renfrewshire Food Federation which showed that many communities in Paisley could not buy basic, healthy produce (such as fruit and vegetables) locally. Recipes and food packs are also available to encourage healthier cooking skills and eating habits.

• Parents at Play: encourages children to be active at break times, providing safe and constructive play opportunities every day during term time. Parents have been trained in constructive play and act as play leaders to run the play sessions and ensure playground order. They are also able to pass on this training to new parents who volunteer to assist.

• Hot Hoops: a major partnership initiative involving HaHP, Paisley Partnership, Paisley and District Basketball Association and other local organisations. Backed by Lindsay Lang, the People's Award Winner for Sport in the Community, the scheme provides basketball hoops in local areas. The aim is to create a series of 'safe zones' where young people can shoot hoops, get formal training or simply meet friends. By the end of Year 1, weekly sessions were being run in five community venues, and 26 local people, including some community police, had been trained as coaches. A Kool Hoops indoor project is planned for the winter months and additional venues will expand this innovative scheme in spring 2002.

• Beechwood Busters: offers local counselling and group support for smoking cessation and weight control.

• Lifeline Blackhall: focuses on healthy eating, with cookery classes and fun activities such as line dancing.

• Heartfelt Activities: provides a programme of physical activity for adults, with instruction and equipment available at the local community centre.

Developments in health care and health information

Early intervention and assistance for those with or at risk of CHD is vital. In HaHP's first year:

• a ground-breaking CHD register has been created to help ensure that more people affected by heart disease, and those with a high risk of developing it, receive the best, up-to-date treatment available

• an innovative menu-based cardiac rehabilitation programme has been established at the Royal Alexandra Hospital, allowing four times as many patients to benefit

• hospital and primary health care teams have developed local clinical guidelines to improve services and care pathways for CHD patients.

The new, purpose-built, Health at Heart Centre has enabled the cardiac rehabilitation service to be extended to all patients seen in the hospital who have a new diagnosis of heart disease (including angina or heart failure) or who experience a change in an existing condition. Previously, the service could accommodate only those who either sustained a heart attack or had an angioplasty or coronary artery bypass surgery. Patients now access a wider range of exercise and information services that are tailored to their own individual needs, including assessment at a one-stop clinic. Links forged between the various health professionals and the local community are helping to continue the rehabilitation process by providing a support network outwith the hospital environment.

Improving opportunities, environments and lifestyles

Paisley-wide strategies have been developed to help make healthier choices in relation to eating, tobacco and physical activity more acceptable and easier to make. In HaHP's first year,

• a range of smoking cessation services has been established, including Call it Quits, a support service for people wanting to stop smoking

• the number of Paisley pharmacists able to provide a tailor-made service to customers who wish to stop smoking has risen from nine to 14

• innovative work with pharmacies has resulted in a unique new scheme being launched in the Paisley area in October 2001: formed in partnership with Argyll and Clyde NHS Board, the scheme allows pharmacists to prescribe nicotine replacement therapy (NRT) for the first time.

Call it Quits forms part of a wider plan aimed at reducing smoking in Paisley. Prevention, education and workplace smoking policies are all part of this work, as is reducing the amount of passive smoking. By the end of Year 1, 17 small businesses were working with HaHP to develop smoking policies for their workplaces. Projects are also underway that look at the specific needs of groups of people, such as young people and pregnant women.

Renfrewshire Council is taking forward several initiatives in schools, neighbourhoods and workplaces that focus on the needs of vulnerable groups, such as children and the elderly in care. Current initiatives include:

• Moving forward with Health Promoting Schools: taking forward the successful Quality of Life Project this encourages students to exercise regularly and aims to build the social skills and self-confidence of over 13,000 school children.

• Healthercise Prescription for Life Scheme: building on the Living Plus Scheme, this encourages increased physical activity indoors and outdoors and targets people living in priority areas with low activity levels.

• Healthier Eating and Exercise for Community Care Clients: linked to Healthercise, this raises awareness of the link between good nutrition and a healthy lifestyle among a vulnerable group.

• Healthy at Work, Healthy for Life: focusing on the local authority workplace and targeting manual workers, this guides volunteers through lifestyle changes.

Learning and development

HaHP's learning and development strand aims to equip members of the community and professionals involved in the prevention and treatment of heart disease with the appropriate knowledge, attitudes and skills to participate in the project. A wide range of learning events has taken place and an innovative Paisley Heart Awards scheme has been established.

Challenges faced

Establishing Have a Heart Paisley, with its various partner organisations and component projects looking at very different, but overlapping, areas of heart health, has been challenging. Early challenges have included:

• establishing effective strategic partnerships and becoming more familiar with partners' cultures and ways of working

• ensuring effective communication between HaHP's various partners

• ensuring that HaHP's key components are delivered synergistically and simultaneously

• working through confidentiality issues involved in establishing HaHP's disease register

• developing robust planning, monitoring and evaluation arrangements.

Early lessons

Have a Heart Paisley's partners have identified a number of early lessons:

• Partnership working: familiarity with partners' cultures and ways of working has improved partnership working over the past months. In particular, communication has improved since the beginning of the Project.

• Working jointly and simultaneously is hard work!: HaHP is undertaking a systems approach to heart health in a focused area, involving the community and various partner agencies. Doing it all at the same time is difficult. Some things do have to get off the ground first in order to get started. Ensuring that different aspects then 'catch up' has been challenging and important management lessons have been learned.

• Evaluation journey: it is vital to collect baseline information before projects start! The poor response to the evaluation team's baseline survey suggests that the local community may have had its fill of traditional research - it has been important to respond to this and to find other ways to measure change (for example, through qualitative case studies). It is important to clarify the respective roles of independent and in-house monitoring and evaluation teams at the outset. Early feedback from the independent evaluation team has helped inform current and future plans.

• Flexibility: imaginative approaches are needed to tackle major risk factors (such as smoking) in ways that are in line with the community's priorities, expectations and desires.

• Confidentiality: lessons learned in working through the confidentiality issues associated with HaHP's disease register will be of value in any attempt to replicate this, or similar work.

Informing policy and practice

Fundamentally, Have a Heart Paisley aims to demonstrate that an integrated, synergistic approach to CHD prevention can make a real difference to heart health in Scottish communities. The Project will offer important lessons regarding:

• effective strategies to improve heart health, such as the value of a system-wide approach, what the right policy mix is and what the keys to success are

• effective interventions and service developments (e.g. how health information improvements between primary and secondary care can act as platform for improved working, the benefits of patient pathways and the Health Promoting Health Service)

• how to work in partnership with other agencies and disciplines and with local communities to make a real step-change in the heart health of communities, and how to mobilise and support community capacity around heart health issues

• organisational development issues e.g. the value of joint health improvement plans and approaches to performance assessment; community planning and integrated delivery at all levels; and the development of Primary Care Teams and Local Authorities as public health organisations

• how to facilitate change at community, professional and organisational levels.

Looking to the future

In its first year, HaHP has initiated action across a broad front. Years 2 and 3 look promising. Have a Heart Paisley offers a unique opportunity to make a lasting impact locally and, in time, stimulate and inform action in the rest of Scotland.

« Previous | Contents | Next »