Making systems change meaningful in Midlothian

We all have a right to live in communities where decisions to exercise and eat healthily are easy, and an enjoyable choice to make. That’s why stakeholders in Midlothian – including residents, clinicians, public servants and local businesses – have come together to tackle the causes of obesity and improve the diet and healthy weight of people in Mayfield and Easthouses. This community pilot is one of five others across the region and will also test out Scotland’s emergent Whole Systems Approach (WSA) to public health. Sarah Archibald, a Public Health Practitioner at Midlothian Health and Social Care Partnership, is leading the Midlothian pilot and so we caught up with her about all of the progress and systems working to date.

1. A Whole Systems Approach (WSA) to diet and healthy weight is being adopted by local areas across Scotland and will be used to pilot community interventions. What does this mean in practice and from your experience to date in Midlothian, how do you feel a WSA can help us to support local communities to lead a healthy lifestyle and reduce their risk of developing Type 2 Diabetes?

The WSA isn’t a new concept and has been used in other areas such as mental health and youth justice. In practice, it’s essentially about everyone recognising their role and doing their bit – to ensure that we take the right steps to improving the diet and healthy weight support across the region. I quite like the quote: “the sum of the whole is greater than the sum of its parts.” I always feel like this describes it really well. We have been and continue to be in a reasonably strong position in Midlothian – whereby there is already a Community Planning Partnership commitment to Type 2 Diabetes (T2D) prevention. That has been the product of a lot of hard work from colleagues, the community and third sector – over a number of years.

From my experience to date, the WSA has been a useful tool in helping us become a bit more comfortable with the complexities of diet and healthy weight. It has helped us to have a better understanding of some of the challenges citizens face in achieving health and wellbeing that’s meaningful to them. It has also helped us to better understand the unintended consequences of interventions and programmes of work – albeit well-intentioned but perhaps sometimes ill-informed. There is no longer a place for over simplified approaches, underpinned by the message of ‘it’s just a case of eating less and moving more’. The national T2D Framework and WSA to public health recognises that this is just as much about (if not more!) improving the environment in which people live as it developing new services.

Of the nine core characteristics – all of which are important and critical to the WSA – purposeful meaningful engagement with Midlothian citizens continues to stand out. Communities should be involved directly in decisions that affect them. More often than not the people who know most about the experiences of living in a particular community or system are the people living in that community or experiencing that system. It is an area that we have and continue to try and strengthen. This has certainly been helped by the membership of our core working group – which is made up of representatives from across the local community and allows us to reflect. This includes the manager at the local development trust and the local community lifelong learning senior practitioner.

2. You held your first pilot workshop on the 18 November where stakeholders came together to discuss and identify local causes of overweight and obesity. How did participants find the session and what were the key outcomes?

We ran our first workshop back in the middle of November – it was great to get the work moving again! The workshop was well attended, with around 35 people from varying backgrounds and council departments including education, planning and active travel. We also had representation from the NHS, Health and Social Care Partnership (H&SCP), third sector and community council members. Some people fed back that it was a great opportunity to have conversations with people they wouldn’t usually have them with – and challenge some misconceptions! It was also a chance to begin to find common areas of work to progress.

Our discussions concluded that our risk of obesity in Mayfield and Easthouses was primarily caused by the amount of money in our pockets, the quality of food available to us and the amount of exercise we do. Through our deliberation, we also concluded that each of these three causes have their own determinants.  And, that these cannot be said to be mostly a matter of individual choice. Rather, they are determined by the environment, economy and society in which we.

Our causal maps have informed a framework for next steps and future action which we look forward to progressing over the next few months.

3. How has Covid-19 impacted the adoption, design and roll out of a whole systems pilot in Midlothian? What are the challenges and opportunities?

Covid-19 has affected our pilot in many ways.  Understandably, a lot of our stakeholders were redeployed to the emergency response. This was evident across the system for a prolonged period of time and our work had to be paused as a result of that. I was in awe but not surprised by the community response of our citizens in supporting one another, particularly through the community resilience hubs. It re-emphasised the need and importance of communities making decisions which affect them in their day-to-day lives as they experience it. We are here to work alongside and support communities not to tell communities what they should and shouldn’t focus on. We are members of communities ourselves – there’s no us and them, it’s just we.

Some positive things have come out of Covid-19. Responding to a crisis of this scale has meant – by its very nature – that we’ve all had to come together and pool resources at pace, getting to know people and work in different ways across organisations and communities. This has allowed us to build new, positive and trusting relationships – whilst strengthening those that already existed.

4. How are you working with other early adopters in the East of Scotland and across the country to share learning?

Really well! There have been many valuable opportunities to come together with other early adopters in the region – allowing us to reflect, share and support one another. There is a lot of commonality and overlap with some of the experiences and challenges, both in terms of the approach and current circumstances. It has been great to hear how colleagues elsewhere are overcoming these and progressing the work. It’s been great to have the support of Nicky and the programme team, along with our national WSA coordinator Fran, who have facilitated these forums and opportunities.

5. Tell us about your next steps and what you hope to achieve over the coming months…

Our core working group will continue to develop a draft narrative and future action plan based on the outputs of our first workshop. Part of this involves working with members of the network to consider links to existing local priorities, alongside other planned services and support.

It’s critical that we create a robust plan for purposeful and meaningful citizen engagement which takes into consideration the impact of Covid-19, current restrictions and learning from our first workshop. We hope that the action plan will therefore reflect what really matters to people in Mayfield and Easthouses – and that this ultimately will allow us to deliver change which is sustainable.