ISSUE NO. 7
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In this issue
Farewell to the Newsletter
A Note from the Editors
How is the NHS run in Scotland?
Health related issues in new community schools
Involvement in Health Agencies
Examples of good practice
Scottish Health Promoting Schools Unit article
A day in the life of a school nurse in a new community school
Framework for Nursing in Schools
Farewell to the Newsletter
This will be the final issue of the New Community Schools Newsletter - at least in its current format.
When the first new community schools were set up, the concept was not only a novel approach but very few people, other than those directly involved, understood how new community schools were expected to function. The Newsletter was aimed at keeping all involved with new community schools in touch with developments, provide information on pilot projects and advise on developing best practice.
The Prospectus which was issued in 1998 stated that new community schools were expected to:
- make integrated provision of school education, family support and health education and promotion services;
- have clear management arrangements for the integrated delivery of these services;
- adopt strategies to encourage pupils and parents, together and separately, to develop positive attitudes to learning;
- focus support on the family unit to encourage and bring out the best in both parent and child through family learning and the development of positive parent-child interaction.
These are still the stated aims and it is expected that these principles will continue to be applied, as the new community school approach is rolled out to all schools. In a message in the first edition which appeared in June 1999, Sam Galbraith the then Minister for Children and Education stated " It is an idea whose time has come". Since then considerable progress has been made, and in the last three and a half years every local authority in Scotland has participated in the pilot programme.
It is intended that every school in Scotland will have adopted the new community school approach by 2007. The Scottish Executive is providing additional funding for roll out of 78 million over the three years up to and including 2005/2006. But it should not be forgotten that the Scottish Executive contribution is only part of the overall package. It was made clear to local authorities when they were invited in December 2001 to bid for roll out funding, that they and partners, were expected to make financial commitments to help with the new community schools roll out process.
It has been suggested that there is no longer a need for a publication of this nature in view of the progress that has now been achieved. The main focus will in future concentrate on best practice. This can only be achieved if all involved in new community schools continue, as they have done in the past, to forward information that can be placed on the website. The main benefit of course is that information can readily be updated and those who access the website will not have to wait six months for the next update as is the case with the Newsletter.
So, it's goodbye from the Newsletter and thanks to all who contributed to its success during its lifetime. But please do not forget our website. www.scotland.gov.uk/education/newcommunityschools
which contains a discussion forum as well as information on contacts in new community schools. We look forward to hearing about examples of best practice, events and anything else which you think should be included.
This is the real "water of life"
A Note from the Editors
Firstly, the editorial team would like to thank all of the authorities who have taken the time to contribute to Issue 7 of the NCS Newsletter. We have received an overwhelming number of responses for this issue.
The theme for this edition is "health", with particular emphasis on examples of good practice in relation to the Health Promoting School concept. This issue also explores the barriers encountered when attempting to widen the involvement of health agencies and outlines how some of the initial difficulties were overcome. Also included is an article from the Scottish Health Promoting Schools Unit, which we hope, you will find both interesting and informative.
We hope you enjoy reading about the many exciting developments underway across Scotland.
Once again, many thanks for all of the contributions, without these, there would be no Newsletter!
Bernadette Duddy, Hugh Carswell, Tricia Illsley
HOW IS THE NHS RUN IN SCOTLAND?
- background information provided by colleagues in the Scottish Executive Health Department
NHSScotland is made up of a number of different organisations, all working together to provide health care for the people of Scotland. They include:
As of 1 April 2003, there will be 15 NHS Boards and 24 NHS Trusts in Scotland. There will be unitary (ie combined Board and Trust) NHS organisations in Western Isles, Orkney, Shetland, Dumfries & Galloway and in the Scottish Borders.
NHS Boards are responsible for all NHS services in their area. They are expected to secure the efficient, effective and accountable governance of their local NHS system, focusing on health outcomes and people's experience of the NHS.
NHS Trusts run hospitals, primary care practices and mental health services in many parts of Scotland. They receive funding from their local NHS Board. On the Scottish mainland, there are two main kinds of NHS Trust providing health care to communities.
- Primary Care Trusts (PCTs)
- Acute Hospital Trusts (AHTs).
Both types of Trust report to their local NHS Board.
West Lothian and Yorkhill operate integrated trusts, combining Acute and Primary Care services.
Health and New Community Schools
What do Primary Care Trusts do?
PCTs are responsible for delivering all the primary care and community care services in most mainland NHS Board areas. These include mental health services, services for older people and groups of GPs and other allied health professionals in primary care practices who often work together in Local Health Care Co-operatives (LHCCs). They are also responsible for creating close relationships with local authority social work, education and housing departments in order to improve the way community care is provided.
Local Health Care Co-operatives are voluntary groups of family doctors and community healthcare professionals who have come together to form Local Health Care Co-operatives as part of Primary Care Trusts. Each group of professionals works together to plan how local healthcare services can best be provided to its community.
What do Acute Trusts do?
Acute Hospital Trusts are responsible for the delivery of hospital services in most mainland NHS Board areas. Trusts are found in most large cities and towns and provide a range of services to meet local peoples' needs. Some, such as Yorkhill in Glasgow, may focus on a particular aspect of health such as caring for babies and children; others are attached to universities and provide teaching for students.
What is Health Promotion?
It is seen as a process of enabling people to take control of the factors which address their health and would involve the development of
- awareness of health-related information
- skills such as decision-making in weighing up choices
- self-esteem and confidence
- positive attitudes to health
A major priority for NHSScotland is reducing inequalities in health. Much of the activity in health promotion is therefore targeted at communities of the greatest need.
In the NCS context this is reflected in the health promoting school to which we are aspiring; working on the ethos, environment and curriculum to support the well-being of all in the school community.
What is the Health Improvement Fund?
Health improvement is the process of trying to pre-empt ill health, by promoting better life circumstances and lifestyles. The Health Improvement Fund is one of the mechanisms for helping to achieve this. It is notable because, for an initial 4-year period, it is seeking progress towards national targets (including reducing Coronary Heart Disease, Strokes, Cancers and Mental Illness) by making available to NHS boards and other agencies 100m directly derived from the "Tobacco Tax". Boards have used some of this to help develop the health dimension of NCSs.
How are Boards, Trusts and LHCCs expected to engage with the NCS approach?
NHS Boards are expected to "encourage effective joint working among partners and with communities to maximise the positive impact of all their activities on the health of their population within the framework of Community Planning and the joint health improvement plan." As children and young people are priority groups it would seem obvious that NHS Boards would be key partners at strategic and operational levels. How this manifests itself at a NCS level will depend on local partnership working. All NHS Board Chief Executives are joint signatories, with Chief Executives of local authorities of the formal plan submitted by each education authority for the roll out of the new community school approach.
HEALTH RELATED ISSUES in New Community Schools
Local authorities were asked to provide feedback on the health related issues involving new community schools. There are a number of common themes across new community schools and across authorities in Scotland. These are related to the following areas:
Underlying Themes and Principles
Communication has been a key factor. A health promoting school is more than a school which delivers a range of health promoting programmes. It includes a focus on good relationships and fosters those between home and school. It promotes positive self-esteem within the whole school population. New community schools have raised the profile of health promotion and highlighted the relationship between health and learning. They have helped assess and identify need across schools and communities but schools approach health promotion in a wide variety of ways.
Target Areas and Priorities in the Health Promoting School
A selection includes:
- Mental health and well being.
- Staff health.
- School environment and ethos including valuing self and others.
- Oral health.
- Health and Safety.
- Safer routes to school.
- Personal Learning Plans.
- Issues that help pupils feel good about learning.
- Parent health.
Organisation and Framework
Many new community schools have taken the same approach to encouraging the adoption of the health promoting school concept. A Health Action Group, Steering Group or Working Group has been formed to take forward an Action Plan for Health Promoting Schools. Some authorities also have School Nutrition Action Groups in each school, and some have taken a whole authority approach and offered formal recognition or accreditation for Health Promoting Schools through awards schemes or 'kite marks'. One authority has tied Health Promoting Schools to quality assurance mechanisms carried out by multi-agency teams. Some Councils have placed a high priority on the development of the Health Promoting Schools model across all schools and health promotion is included in all school development plans.
The Health Promoting Schools concept has been underpinned by framework documents, policy guidelines and resources in some authorities. These documents include 'Putting People First', 'A Route to Health Promotion' and the 'Steps to Excellence Programme'.
Partners in health promoting schools include the school's health promotion staff, school nurses, community services, the police, health improvement teams, school boards, healthy living groups and many more.
Helpful staffing structures have included Health Development Officers for new community school clusters. These structures include health co-ordinators in each school, the secondment of health promotion specialists and health advisers, with members of senior management in each school driving forward initiatives. Funding for some of these have come from NHS Boards, and many pilots have used NCS funding for health workers or health promotion workers.
No need for the Discipline Task Group here.
Some new community school pilots have held health promotion days for staff to reflect on their own health and for children, parents and committee members to take part in healthy activities.
Involvement of Health Agencies
The general impression of new community schools regarding the involvement of health agencies is that, although barriers were evident early on in the pilots, many of these have been or are being overcome. Those pilots, where the Health Board were involved from the start and were represented by people from different parts of the Board, seemed to have been the most successful. A funding commitment by health agencies has also been an important factor.
Some of the main barriers have been:
- Lack of shared values and understanding across services.
- Difficulty in identifying the right people with decision making authority to be involved in steering groups (NHS structures)
- Shortages of health staff (Health Visitors, Dieticians, Child and Family Psychologist, Therapists and School Nurses) and staff time or funding to take part in staff development or joint planning.
- At operational level, issues in relation to roles, remits, present provisions and management of areas of work. Concern about NCS workers duplicating health professionals' work.
- Schools setting the priorities, being insular, rather than treating health as an equal partner and thinking across a wider area. Competing health priorities.
- No financial input from health.
- Difficulties in rural areas regarding involvement of different agencies.
- Lack of understanding of changes to the school nurse role by schools.
- Recruiting difficulties and employment conditions (term-time only contacts, working hours).
- Confusion about the roles of health promotion workers and school nurses.
Difficulties were overcome by:
- Time spent building relationships with individual health professionals. Establishing a shared vision and common values.
- Joint training opportunities for health professionals and school staff. Multi-agency events with health focus.
- Health Promoting School structures and project developments organised on a cluster basis.
- Health agencies included in all planning meetings with new community schools and steering groups.
- Commitment to joint service delivery.
- Role of Health Co-ordinator or Health Development Officers (funded by NCS) in facilitating collaborative practice.
- Health Boards who are supportive in terms of advice, partnership working and resources.
- Involvement of NHS at strategic level.
- Local GP involved in direct work with schools.
- Involvement of School Nurses and Health Visitors and Health Promotion Specialists.
- Health needs assessments.
- Health focus groups.
- School nurses co-located in school along with other additional support staff. Their remit expanded to meet the needs of the pupils and their families as well as supporting the wider Health Promotion agenda.
A few Health Boards were named as particularly supportive with funding, joint funding of posts, commitment and encouragement.
This section highlights the extent to which different authorities have involved NHS agencies in the planning process and the delivery of services in NCS clusters throughout Scotland.
Overall, the responses we received suggest a high level of integrated planning and working across the board. A number of key features emerged from the responses:
Children's Services Planning has provided a platform for developing better integrated children's services. Several local authorities have built on the Children's Services Planning Structure in order to progress the NCS agenda. In some local authorities, this has involved integrated funding of certain posts, as well as integrated management arrangements. There is certainly a growing recognition that NCS are being seen as a central part of the overall approach to improving health and addressing health inequalities.
Several authorities reported strong links between NCS staff and Health Improvement Advisors . There are lots of examples of Integration Managers contributing to Joint Health Improvement Plans and working closely with Health Improvement Advisors to progress health targets. This includes examples of participation in joint health action teams, health improvement strategy groups and integrated meetings of Chief Officers.
In some local authorities, Integration Managers, along with their health colleagues, have been involved in developing Healthy Living Centre bids, which aim to tackle health related issues at the local level.
Several NCS have reported involvement in the shaping of Health Services . Many Integration Managers have participated in the 'Nursing in Schools' review and some have been involved in reviews of Health Promotion Department functions. Integration Managers are also involved in a variety of working groups across the country along with health colleagues, for example:
- Children's Services Planning
- Local Health Care Co-operatives
- Social Inclusion Partnership Health Strategies
Overall, it would appear that there is real enthusiasm for working together, and that much has already been achieved through collaboration with health professionals.
Nothing like healthy competition.
Examples of Good Practice
There was an excellent response to this section with 28 authorities providing in excess of 100 examples of good practice relating to NCS and Health.
The main themes were:
- Healthy Lifestyles - Physical, Mental and Sexual Wellbeing
- Alcohol and Drugs Education
- Environmental Developments - Eco Schools
- Young People's Involvement
- Parent/Carer Involvement
There is a huge range of initiatives including:
- Health Clinics/Drop-In Service
- Community Food Initiatives
- Transition Support - eg Primary to Secondary
- Breakfast Clubs
- Healthy Tuck Shops
- Breast and Testicular Cancer Awareness Raising
- Relaxation Sessions
- Health Promotion Events
- Health in the Curriculum
- School Nutrition Groups
- Family Learning Events
- Introducing Sports Co-ordinators
- Publications on Health
- Healthy Living Centres
- Healthy Eating Programmes
- Curricular Developments
- Anti bullying initiatives- drama, poster campaigns and support groups
- Safety - safer routes and danger detectives
Health Co-ordinators have been appointed by a number of authorities using NCS, mainline health or other funds. Their role varies from one authority to another, although they tend to establish health need and co-ordinate individual, group and community supports. They are involved in, or lead, Nutrition Groups which promote healthy food options/choices at breakfast clubs, tuck shops, cafeterias and vending machines.
Links are established with other health specialists, teaching, leisure and community education staff to ensure the health promoting school principles are adhered to. This has led to enhanced curricular support on mental well being and breast and testicular cancer awareness to name but a few.
At times of transition, young people are supported by ensuring support and communication links are
in place and effective which again affects their wellbeing.
Health Clinics/Drop-In Services have been established to allow young people, staff and the wider community to access health services locally. The range of services available are wide and varied including relaxation sessions, family planning, oral health and health/fitness checks.
Through NCS and related funds such as New Opportunities Fund (NOF), Healthy Living Centres have been established. In some areas, the Healthy Living Centre is static, whilst in others, a mobile provision exists. Each Centre audits health need in the school or community and then co-ordinates a response from existing resources or organises a new method of service delivery. In a number of areas, for example, a general practitioner referral scheme has been established where healthy eating and activity sessions are offered on prescription. This may include cookery demonstrations on 'Healthy Eating on a Budget' or rely on the Health Co-ordinator offering individual exercise classes to improve fitness and wellbeing.
Aromatherapy to ease the day's tensions.
In one area, a curricular programme focusing on citizenship and health awareness has been developed using the Arts. This includes a teaching pack, travelling gallery, video and theatre workshop.
Alcohol and Drugs Education
In some areas, young people involved with alcohol and drugs have been offered activity/health-based input to encourage them to develop 'personal fitness profiles'.
Drugs Awareness Events have been organised
for young people, parents, staff and the wider community with input from health, police, voluntary organisations and others to raise awareness and allow people to understand the effects of alcohol/ drug dependency and the support available to avoid this or break the cycle.
The NCS initiative has allowed this issue to be tackled using local inter-agency groups to deliver strategic objectives. This may involve Health Visitors co-ordinating support packages for families with very young children affected by alcohol/drug dependency.
There has also been curricular input on these topics to encourage young people to make healthy choices.
Links between NCS and agencies involved in the support of families affected by drugs and alcohol are strong, for example, many NCS link with their local Alcohol and Drug Action Team. This has involved NCS being involved in National Drinkwise Campaigns including being part of a themed float to raise awareness.
Many authorities have engaged young people, staff and parents in Playground Developments and other school environmental initiatives.
All these initiatives have centred around the needs of the young people, establishment or community. Examples include:
- Murals with a health theme.
- Playground developments
- Upgrading cafeterias and toilets.
- Improving the environment - garden creation.
Young People's Involvement
Each initiative, which appears to work, has centred on the needs of young people. They have contributed to the health agenda and making it a success.
Circle Time has been used to allow young people to promote self-esteem and a caring attitude as well as having their say on issues affecting them which has included health.
Older young people lead play for the younger children in their school encouraging physical activity and positive co-operative interaction.
Student Councils have ensured health is on their agenda and there is a flow of information within class groups and across the school. In many areas, young people are core group members of Operational/Nutrition groups which influence decisions affecting how health matters are dealt with in NCS. Personal Learning Plans are completed by young people who outline their health needs/ targets and how these should be met. Peer research and health surveys have been adopted to ensure local health services are set up to be attractive to young people and ensure their needs are met.
Examples of good practice in this area included:
- Starting early with a 'Fit Baby' Programme and post natal support groups.
- Family Learning Workshops and programmes.
- Health focused Personal and Social Development programmes.
- Community Health Initiatives - health checks, healthy lunchbox, cookery classes (parent/family).
- Involving parents/carers in breakfast clubs.
- Parenting support for parents of young people who have presented challenging behaviour.
- Links between NCS and Childcare Partnerships allowing parents to access quality/ affordable childcare, which allows them to re-enter employment or training.
- Publications on 'Your Child's Health' and Health Newsletters
Overall, there has been a great deal of enthusiasm and innovation used when NCS have joined or formed partnerships with others to assess, plan then meet health needs from cradle to grave. It is evident from the number of good practice examples, that Health is integral to all NCS work.
Healthy eating starts here.
The following is an article on the Scottish Health Promoting Schools Unit by its Director, Margaret McGhie
The Scottish Health Promoting Schools Unit was established on 1 May 2002, initially for a period of three years, in response to the commitment given in the Scottish Executive documents Towards a Healthier Scotland and Our National Health: a plan for action, a plan for change (December 2000).
Throughout its initial three year period the Scottish Health Promoting Schools Unit will work with its many partners, in particular the new community schools initiative, to contribute to the Executive commitment to encouraging every school to become a health promoting school by 2007.
The Unit operates as a partnership between Learning and Teaching Scotland, who host the unit in Dundee, the Health Education Board for Scotland and CoSLA, with the close involvement of the Scottish Executive Education and Health Departments, who also fund the Unit. It is staffed by a Director, a Project Officer and an Administrative Co-ordinator and receives its strategic direction from a Steering Group which is accountable to Ministers. It is also informally supported by a group of critical friends, including children and young people.
The remit of the Unit is to take a key national leadership role in promoting and supporting the implementation of the health promoting school concept throughout Scotland. Its focus will be on providing strategic and practical support, based on sound research, to local authorities and advisors and to others, such as NHS boards, Community Planning Partnerships and Integration Managers as they work together to achieve the National Priorities and targets for education and health. The specific detail of the Unit's policies will take careful cognisance of Scottish Executive policies and initiatives, of current best research and of the needs of schools and young people living in Scotland.
Principal Aims of the Unit
Though the three principal aims of the unit - championing, facilitating and supporting the development of the health promoting schools concept - are presented separately for practical purposes, it is essential to understand that they are, in reality and in practice, inter-linked and mutually dependent.
Championing - promoting the ideas and the concept
Championing will involve both promoting the concept of wellbeing, and encouraging debate and participation by all involved in the learning community, both in national and international arenas. The Unit will listen to and respond to the views of all partners and focus on the goal of encouraging every school to be a health promoting school, and of enabling all young people to achieve and to do well.
This will be achieved by:
- developing a shared understanding of the health promoting school concept based on current research.
- clearly articulating the meaning of the health promoting schools concept to a wide community of interests
- supporting the development of the health promoting school concept
- promoting and supporting new initiatives in the field of health promotion.
Facilitating - enabling the process.
The Unit has a key role in enabling the development of health promoting schools throughout Scotland by:
- establishing means by which informed discussion on issues of health promotion and education can take place between and among interested parties.
- making and maintaining connections with appropriate support agencies, facilitating the network process.
- making links with local and national networks, while taking advantage of new opportunities as they arise.
- connecting with work in new community schools.
Supporting - offering help in implementation
Effective schools understand that where the health promoting schools concept is integrated into all educational processes, this creates and maintains a positive learning environment for all concerned. By helping schools to recognise and establish these links the Unit will support the dissemination and implementation of health promoting schools processes in local contexts by:
- disseminating a re-statement of the health promoting schools concept
- establishing and supporting the implementation of the health promoting school concept as a key organising principle for the life and work of the school.
- establishing the health promoting school concept as a key connector between and among a range of on-going and future health promotion initiatives, for example, on diet and nutrition, physical activity, mental health, sex and relationships education and drugs education.
- providing means by which schools can assess their progress in health promotion.
- seeking out and disseminating good practice.
The objectives for year one concentrate on updating and embedding the concept of the health promoting school, on making and extending helpful connections, and on offering opportunities for discussion and feedback.
Three regional seminars have recently been held at which delegates were introduced to the work of the Unit and offered opportunities to discuss issues of partnership working, as well as key ideas that might inform an updated position paper. A report of the outcomes of the seminar is expected shortly, as is an initial draft of a paper for development and discussion by the Steering group.
If you would like additional information about the work of the unit please contact Rosemary Arnott, Administrative Co-ordinator, Tel: 01382 443684 E-mail: R.Arnott@LTScotland.com
A Day in the Life Of a School Nurse in a New Community School By Anne Bianchi, School Nurse, Hawick, Borders
Starting the day off at a whole school staff meeting, 08.45 which happens weekly and the chance to buttonhole members of staff who usually skulk around their own departments. Information about specific pupils needing support, and forthcoming staff events.
The school behaviour support group meets to update and plan interventions which will help manage pupils with specific needs or behavioural difficulties. My input is often required in relation to managing children with Attention Deficit Hyperkinetic Disorder or providing home school liaison when relationships have otherwise broken down. Children who are "looked after" might also come into this category.
On the spot work - asked to see a S5 pupil who has fainted several times in school past few days. Teaching staff reporting that she isn't eating and exercising each lunchtime in PE. Following discussion with student and parent, she has agreed to see GP, but on her own. Worried she can't say what is wrong- I can help liaise with GP to make appointment easier.
As part of planning and delivery of health in the curriculum, supporting class teacher to deliver personal safety in class.
Lunchtime at the "Drop In" clinic where large numbers of regulars come in for advice on a range of issues from sexual health to family breakdown.
Meeting with Senior Health Promotion Officer (sexual health), and Assistant Head Teacher in the High School which I arranged to discuss developing sexual health curriculum. Persuade him that we agree a strategy to include parents and students in this planning. Plans and dates made for first stage of staff training.
Drop in to guidance area to pick up messages, answer e-mails and book a room for training staff and parents on administration of intra-nasal Midazolam used in epilepsy.
Framework for Nursing in Schools
The Scottish Executive Health Department is publishing a new Framework for Nursing in Schools. The framework seeks to deliver an earlier commitment to modernise the school nursing service alongside the development of New Community Schools. Development of the framework was overseen by a multi-disciplinary group including professionals from both health and education, and included extensive discussions with school nurses about their role and how it might be developed.
The new framework, a first in the UK, sets out a clear direction for the service, building on the experience of New Community Schools and the ethos of the Health Promoting School. It is laid out in the form of a set of standards that the service should seek to deliver and is intended to be used as a working document to support development of the service. The intention is that the framework should be implemented alongside the local roll out of New Community Schools over the next four years.
Copies of the framework are being made widely available by the Health Department to professionals in health and education services. It can also be found under the heading "Publications - Other" in the New Community Schools website www.scotland.gov.uk/education/newcommunityschools