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Faced with stubborn health inequalities and poor health in some communities Scotland’s largest health board is currently taking a fresh approach to try to reverse the trend.

NHS Greater Glasgow and Clyde have embraced the public health priorities and whole systems working, with its first every public health strategy helping to take a message to communities that change is coming. Linda de Caestecker, Director of Public Health at NHS Greater Glasgow and Clyde shares her experience…

Surprisingly the biggest health board in Scotland had never had a stand-alone public health strategy. We had had individual topic strategies such as Physical Activity or Tobacco, and although public health was included in various health board plans, there was no overarching plan. 

In 2017 our relatively new NHS Board Chair, knowing the poor health statistics in the area and the widening inequalities in some parts, asked the obvious question ‘why not?’ I asked myself the same question and started to work on a strategy which was approved in August 2018.

The Board had recently established a new standing committee on Public Health which included not only non-Executive members but also Chief Officers of HSCPs, GP representatives, an acute director and directors of Health Scotland and the Glasgow Centre of Population Health.

We held a development event when we agreed that a major aim of the strategy would be to bring prevention to every part of our business and thus the title “Turning the Tide through Prevention” was born. 

Later we agreed that our approach shouldn’t just use the tried and tested approach of action plans and activities. Instead, we took the brave step of setting a goal to accelerate improvements in Healthy Life Expectancy (HLE) in Greater Glasgow and Clyde (GGC) and reduce the gap in HLE in GGC and between GGC and the rest of Scotland.

We also agreed that the ‘how’ would be more important than the ‘what’. The rationale was the acknowledgement of a need to improve whole system working and our desire to work more effectively with communities themselves as well as community planning partners.

We therefore developed a strategy with high level goals and programmes, with the intention to use this approach to provoke discussion and co-production with communities and partner agencies on specific actions and interventions.

We want to truly engage local groups and communities in the actions required to improve health
Image caption We want to truly engage local groups and communities in the actions required to improve health

At the same, the national public health priorities were being developed. Due to the timing and the engagement with stakeholders that had previously taken place, we chose not to completely restructure the strategy around the national priorities but to show the read-across to them. This allowed us to show that all the national priorities were reflected.

The engagement by the Public Health Reform team on the national priorities facilitated the interest and involvement in our local strategy, particularly with local authorities and the third sector.

The strategy has provoked some reactions about needing more detail and clear actions with milestones and KPIs. However I stand by our decision to concentrate more on the ‘how’ than the ‘what’.

We want to truly engage local groups and communities in the actions required to improve health, we want community planning partnerships to engage with the further development of the strategy in an honest and sincere way based on local needs and resources.

The main work to date of using the strategy has therefore been taking it to Community Planning Partnership groups, clinical fora, local authority summits, third sector organisations and local groups such as community councils to discuss their views and priorities as our work continues to address inequalities in our area.

At the same time we have developed a performance framework to ensure the Board’s CMT and the Board itself have confidence that public health priorities are being addressed. So, with the ‘how’ and the ‘what’ being dealt with concurrently our fresh approach to tackling inequality is now in place, with the ultimate aim of delivering better lives for our communities.

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