Leith Neighbourhood Partnership

HEALTH AND WELLBEING ACTION GROUP

WEDNESDAY, 8 APRIL 2009 at LEITH CTC, 12 JUNCTION PLACE, EDINBURGH

MINUTES

1. Present and Apologies

1.1 The following attended the meeting:

John Palmer (Chair) Edinburgh CHP (NHS)

Lesley Craise Dr. Bell’s

Jenny McKenzie Leith Central Community Council

Julie Boyle Aberlour Outreach Edinburgh

Anne Nixon Home – Start

Linda Wilson Out-patient Team Manager, Leith CTC

Michael Gray Access to Industry – Transition

Anne Munro Pilmeny Development Project

Sam Anderson The Junction

Jaki Wood Public Health Nurse Team Leader

Anne Dey CEC Development Manager, Older People’s Day Care

Alison Wilkie Leith Links Community Council

Neena Agarwal MILAN

1.2. The following gave their apologies:

Anne Conafray ELCA

Linda Newlands Persevere Community Health Flat

Fiona McRae NEECS

Joyce Gegan Port of Leith HA

Mary Elton Sure Start (Speech and Language Therapy)

Helen MacFarlane Edinburgh Leisure

Ewan Blain CEC Health & Social Care

Judith Craven Substance Misuse Locality Clinic

Lynne Bradford Community Drugs Problem Service

Patricia Burns Alcohol Problems Service

Madi Martin NE LHP Care Co-ordinator

Heather Elliott District Nurse Team Leader

Sian Fiddimore Access to Industry – Transition

David White Assistant General Manager, Edinburgh CHP

Loraine Duckworth Partnership Development Officer, Leith NP

Joyce Gegan Port of Leith HA

2. Minutes of the meeting of 12th February 2009

2.1. Agreed as a correct record

3. Matters arising from previous minutes

3.1 John regretted he had not yet met Vivienne Robinson, head of Working for Families to discuss childcare vouchers

3.2 Neighbourhood Partnership sub-groups

There was some confusion as to whether the Children & Families sub-group had met. Jenny said she had attended a meeting on 10th March; others had been unaware of this. It was important to cross-reference the two groups; John to clarify with Christine Mackay.

Action: John Palmer

3.3 Survivors of Domestic Abuse group

John reported the LHP wondered whether it was best for this group to continue meeting in Leith CTC. It was supported by Women’s Aid and he was discussing a way forward with them; whether they could advertise themselves a bit more and where to meet. Lesley and Anne N both offered their premises.

4. Drugs and Alcohol

4.1 John said he had circulated the up-dated Drugs and Alcohol section of the plan, reflecting the discussion held at the last meeting. It included potential actions and ideas to be followed through. He had received additions from Turning Point and Bethany. He had also had a discussion with GPs, whose experience had very much reflected that of the sub-group.

4.2 John added the Edinburgh DAAT was meeting this afternoon to confirm the allocations made from the monies for which it invited bids last November. This affected both city-wide and local services; when these were public it would be important to try and influence how city-wide services were provided in Leith. Sam said The Junction had been invited to discuss a second round of bidding to ensure local services were properly catered for.

4.3 Julie asked why the plan included an action of increasing support to families affected by substance abuse, when Aberlour Outreach’s funding had been cut. John replied this had been the subject of considerable discussion at the last meeting and including it would hopefully draw the sub-group’s concern to the attention of the Neighbourhood Partnership.

4.4 Anne M asked about the issue of alcohol misuse and older people, particularly men. There was some discussion about whether it should go in here or the Older People’s section. It was agreed it should be added to the Drugs and Alcohol section, with a cross reference to the Older People’s section.

Action: John Palmer

4.5 Lesley raised the issue of women misusing substances also suffering from unresolved traumas and PTSD. What services were available to help them? Julie said they mostly used counselling. Lesley wondered if this was the most effective method; she wondered also about the effectiveness of body techniques, which mostly had to be purchased privately.

It was agreed more knowledge was needed on the subject. Lesley and Julie would provide John with research they were aware of. John would also raise the subject with colleagues in the Public Health department and get some expert advice.

Action: John Palmer

4.6 Anne M raised the issue of substance misuse among the BME communities, both the newer East European ones and the longer-term South Asian and Chinese ones. There were many cultural issues that meant a single-stranded approach might not suit all. Others thought this would apply across a lot of issues across the whole Health Action Plan. It was agreed:

1. To have a separate BME section in the Health Action Plan

2. To call a meeting to tease out the main issues.

Action: John Palmer

4.7 John said the South East LHP had a Drug and Alcohol Practitioners’ Forum that drew in NHS, Social Work and voluntary sector workers from Gracemount to Portobello. He wondered whether we should create a similar forum in North East LHP, who would be charged with drawing up plans to implement the suggested actions in the Plan. People thought this would be a good idea, as it was a specialist area; the forum could then report back to the Sub-group. It was agreed to arrange a meeting in the second week of May.

Action: John Palmer

5. Early Years and Support for Families

5.1 John explained the logic model he had circulated was an attempt at a quicker, easier to read version of the Early Years section in the Action Plan. This latter had now been up-dated with the outputs received from the five voluntary sector organisations; he thanked them all for their input. On Indicators he was working with Ailene Preston to get accurate figures of the assessments done by Health Visitors of children up to their entry to Primary School.

5.2 Lesley reported the Leith Early Years Forum has met twice since February. It mainly consists of practitioners from Nursery schools and Children and Family Centres and the voluntary sector. They had thought through the needs they perceived in the area and had established a number of working groups:

1. Mental health of parents and children

2. Bi-lingual families

3. Informing and involving parents and developing a directory of services

4. Joint training with Public Health Nurse colleagues on the roll-out of the Team Around the Child.

5.3 Jaki reported the Public Health Nurses monthly meeting had been informed about the roll-out of Team Around the Child. This follows the publication by CEC Children & Families and Edinburgh CHP of the ‘Parenting and Caring Framework’ for the city. John had also presented the work of the NP, the Health and Wellbeing sub-group and the Early Years Forum. He was now asking them to describe their services and their views on gaps to be added into the action plan.

5.4 Jaki added the PEACHIE programme, which works both ante- and post-natally with vulnerable mothers, is about to run a programme at Dr. Bell’s. Alison, whose baby, Reuben, also attended the meeting, said she had received fantastic support from services in the area, including the breast feeding group at Dr. Bell’s and the mother’s group at Ocean Terminal. She knew about these groups from a leaflet she had received from the midwife when she was discharged from hospital. She asked about the composition of the breast feeding group at Dr. Bell’s. Lesley said they kept careful records of people attending and they got a good proportion from the deprived parts of the area.

6. Care of Older People

John explained the section circulated was very much an outline, although when he had originally drafted it he had consulted with Ewan Blain and other staff in CEC Health & Social Care. He had also added references to older people that appear in other sections, such as Physical Activity and Mental Health. There was lively discussion of the following points.

6.1 Age barriers

· Providing different services based on historical age cut-off points, as happens within the NHS and Health and Social Care, is institutionally discriminatory and not person-centred. The example was given of moving people from adult mental health services when they are 65 years into geriatric services, when the latter are not well-resourced to meet the person’s needs.

· What constitutes old age is culturally determined, and what is considered old in one community may not be the case in another.

· People with long-term conditions do not fare well when age barriers are applied.

6.2 Re-ablement

The sub-group would welcome sight of any evaluations of the introduction of re-ablement. They felt however it was being introduced to resolve the issue of bed blocking and delayed discharge from hospital, and not as a preventative measure to help reduce higher level need. The emphasis should be changed to greater prevention.

There were also concerns that the 6 weeks package might not be sufficient for some patients. They wondered too how well it provided for people with long-term conditions and whether appropriate assessments were made of people’s abilities. There were also gender and cultural issues to be considered in re-ablement.

They felt re-ablement did not help re-able people in a social sense; i.e. help them overcome their social isolation.

6.3 Discharge Planning

Considerable disquiet was expressed about perceived inefficiencies in the discharge planning system. Points raised were:

· Lack of forward planning

· Discharges without proper co-ordination with the family and not taking into account gender and cultural issues

· Discharges on Fridays without proper social care support in place, resulting in people being at home without support until Monday

· People living alone being discharged to empty houses, with no preparation being made in the house – food, warmth etc.

· Discharges without effective connection to voluntary and community services.

It was thought discharge protocols could be further looked at, and that information sharing and joint training sessions could be arranged between NHS, CEC Health and Social Care and voluntary organisations and patient representatives.

6.5 Directory of Services

Anne D said the Portlee Healthy Living Group was collecting information about voluntary and community organisations providing local services and hoping to publish this on a web-site. John said there was a web-based database available, held by Craigmillar Ability Network, a copy of which should be suitable for this purpose. Julie questioned how accessible this would be for older people. Anne M acknowledged this, but said they were hoping to recruit community groups to act as ‘champions’ for the directory and help those without web access to use it.

6.6 Other older people’s issues raised were:

· The Portlee group has received funding for a pilot study to look at a ‘community connector’ post. John said Craigmillar Ability Network had such a post, both to develop the database and recruit volunteers to help people get to the services to which they have been referred.

· Older carers of older people and their support needs

· The new Adult Protection legislation and the possibility of joint training between statutory and voluntary organisations on the issues; there was a particular concern about financial abuse.

· Fuel poverty and the choice between heating and eating; Anne M said she was working with Changeworks and the Care and Repair service on this.

· Food and nutrition for older people; John said he would check whether this has been raised in the city’s Joint health Improvement Plan food and health section.

· The design and provision of ‘housing for life’; this was something that could be taken up with the Housing and Built Environment sub-group.

· Advocacy services for older people; with the demise of SAGE there was now nothing available. Anne M said however the council had been considering this and she thought a report was going to committee in May.

· People with learning disabilities are now living longer, and although the age barrier for them to receive appropriate services has been reduced to 55 years, this may not meet all their needs.

6.7 John suggested, as there was a large agenda here, the Portlee Healthy Living Group could be charged as a reference group for the issues; to look at prioritising them; proposing appropriate actions; and drawing up plans to implement these actions. It would report back to the Health and Wellbeing sub-group on its progress in the same way as the Early Years Forum and the proposed Drug and Alcohol Practitioners Forum. Anne M said she thought the group would welcome this and she would liaise with John over the membership. This was agreed.

Action: John Palmer, Anne Munro

7. AOCB

John reported on the following services and conferences:

· Lifeline Pregnancy Counselling and Care, 24a Haddington Place, 0131 557 2060

· Leith Baby Co-operative, Leith Acorn Centre YMCA, 1 Junction Place, every Wednesday 11.30 am -12.30 pm; buy cheap named baby products, parents group

· ‘Better Breaks for All’ – Shared Care Scotland, 23 April, Dunfermline.

· Blood Borne Viruses, 19th June, Dundee.

8. Date of Next Meeting

8.1 John reported there had been a request from community representatives to hold evening meetings to enable those who work to attend. He said he was experimenting with an evening meeting in Craigentinny & Duddingston NP and would consider how this went before making a decision on the timing.