1. Transforming Services an Assets Based Approach Karen Grieve SG Health Inequalities Branch

2. This Presentation: Why is Transformation required to tackle inequalities Assets v Deficits – why its worth trying Communities & Services together Simple Rules

3. Why is Transformation Needed? Used with permission from NHS GG&C Two boys at a train station. Do they have the right to be equally well in a modern and Fair Scottish Society? Or is it just life? Despite decades of effort, well intentioned policy and programmes, millions of pounds of investment into deprived communities, Scotlands health has failed to improve at the same rate as countries elsewhere in the UK and in Europe.

4. What Our Approach Has Been… Upstream – Downstream Deficits, prevention, intervention, treatment

5. Health Deficits Approach We focus on problems, needs and deficiencies in a community. We talk of deprivation, illness and health damaging behaviours. We design services to fill the gaps and fix the problems. We talk of clients. As a result, communities can feel disempowered. People become passive recipients of services rather than active agents in their own lives. We do things to people rather than with them.

6. Christie Commission Review of Public Services 2011 This suggests that a radical change in the design and delivery of public services is necessary, irrespective of the current economic challenges, to tackle the deep-rooted social problems that persist in communities across the country. A cycle of deprivation and low aspiration has been allowed to persist because preventative measures have not been prioritised. It is estimated that as much as 40 per cent of all spending on public services is accounted for by interventions that could have been avoided by prioritising a preventative approach.

7. The priorities identified included: Recognising that effective services must be designed with and for people and communities - not delivered 'top down' for administrative convenience Maximising scarce resources by utilising all available resources from the public, private and third sectors, individuals, groups and communities Working closely with individuals and communities to understand their needs, maximise talents and resources, support self reliance, and build resilience Concentrating the efforts of all services on delivering integrated services that deliver results Prioritising preventative measures to reduce demand and lessen inequalities Identifying and targeting the underlying causes of inter-generational deprivation and low aspiration

8. WORTHWHILE MANAGEABLE COMPREHENSIBLE health related behaviours opportunity, decent housing, social networks, self-esteem, sense of control consistent parenting, safe, nurturing early years, supportive education

10. In other words our Personal Assets

11. Collective Assets Build on the personal individual assets and potential Multiply that in a family And again in a Neighbourhood And onwards to larger communities People, place, community.

12. Health Assets A health asset is any factor or resource which enhances the ability of individuals, communities and populations to *maintain their health and sustain wellbeing. These assets operate as protective and promoting factors to buffer against lifes stresses * Create Morgan and Ziglio 2009

13. The Assets Approach Begins by building a trusting relationship – regardless of how long it might takeBegins by building a trusting relationship – regardless of how long it might take Helps individuals rediscover the skills and strengths they may have forgotten they haveHelps individuals rediscover the skills and strengths they may have forgotten they have Supports them in putting them into practiceSupports them in putting them into practice Builds networks and trusting communities in which people help othersBuilds networks and trusting communities in which people help others

14. When people care enough to ACT Institutions have reached the limit of their problem solving potential. They are stretched thin and need more skilful engagement with communities Institutions have reached the limit of their problem solving potential. They are stretched thin and need more skilful engagement with communities They are servants. Ask what people need, offer help, step back, create opportunity for action They are servants. Ask what people need, offer help, step back, create opportunity for action http://www.mike-green.org

15. When people care enough to act There are unrecognised capacities in every community. Find them and provide opportunities for people to offer them There are unrecognised capacities in every community. Find them and provide opportunities for people to offer them Relationships build a community. See them, build them and utilise them Relationships build a community. See them, build them and utilise them Citizens are at the centre. Engage them as actors, not recipients Citizens are at the centre. Engage them as actors, not recipients http://www.mike-green.org

16. Organisations are People We are all just people – being a professional or a public servant shouldnt separate from this fact. Its not a them and us… its only us!! We must transfer power and trust in the community We must stop hiding behind our systems and making our job about the system rather than its intended purpose of making life better. What can help….. Going back to SIMPLE

17. Organisational Cultures Simple rules Innovation Freedom to Act and Freedom to Fail Permissions and Trust Leadership Hunches, Learning Loops Time, Space, Very small amounts of £ Governance & Accountability Risk Aversion Lack of Trust Hierarchy, over management Small £ not freed up to frontline Outputs Outcomes Guarded partnerships Generative partnerships

18. Good Enough Vision and Minimum Specifications Hunterdon Medical Center (USA) Need: Community health initiatives Approach: Nursing committee Observation: After 6 months, committee had not yet gotten out of the hospital!

19. Good Enough Vision and Minimum Specifications Instead... Simple rules –A nurse can schedule up to half-day per week to work on community health initiative –Dont do anything illegal –Remain within the project budget (all expenditures publicly posted)

20. Created by Brenda Zimmerman and Bryan Hayday

21. THANKS! http://equallywell.ning.com http://www.scotland.gov.uk/Topics/Health/ health/Inequalities/inequalitiestaskforcehttp://www.scotland.gov.uk/Topics/Health/ health/Inequalities/inequalitiestaskforce http://www.healthscotland.com/documents /5342.aspxhttp://www.healthscotland.com/documents /5342.aspx http://www.gcph.co.uk/publications