Background

In 2009 BHF launched 32 Hearty Lives projects across the UK, inc. 3 in Scotland, in response to evidence that CHD, the biggest killer across the UK, is overwhelmingly connected to economic deprivation. There was clear evidence of health inequality in Tayside, particularly Dundee, with life expectancy lower than in other areas of Scotland. The original bid was developed jointly by NHS Tayside Strategy Department and the Social Dimensions of Health Institute (SDHI). As the project developed, Leisure & Culture Dundee (previously part of Dundee City Council) and the Volunteer Centre Dundee also became partners. BHF have invested a total of £1.2 million over five years – projects ended by 30th June 2014.

Overarching Aim

Hearty Lives was designed to reduce inequalities in heart health by focusing a variety of initiatives in “disadvantaged areas” where there is a higher risk of cardiovascular disease.

Hearty Lives Dundee Programme

The programme consisted of 10 project strands which have used a variety of delivery models. It purposely focused on specific groups including families and those on low incomes, where there may be practical or financial barriers, facilitating lifestyle change that can make a real difference. Evaluation was carried out at a national and local level.
 
1. Active Families – 4 funded post-holders (initially one post, increased to two, then four) 2010-2014
Active families uses a family approach to promote a healthy lifestyle, with the focus on increasing physical activity and healthy eating. Initially families were referred from a range of family support agencies. The coordinator assesses the family’s needs and tailors an individualised plan with agreed goals.
 
·         Successfully engaged with 427 families, the majority residing in deprived geographical areas 
·         High referral rate created demand beyond capacity and professional referral had a relatively high drop-out rate (particularly amongst families with complex issues) thus the number of posts was increased and the service redesigned to include self-referrals
·         Evaluation demonstrated families successfully increased their weekly activity levels: in adults this increased by 5.6 hours and children 4.8 hours, per family per week
·         40% of family members reported consuming more portions of fruit and vegetables
·         Evidence of a wider impact on participants overall health eg a significant group of adults reported they had stopped smoking or reduced the number of cigarettes they consumed
·         Evidence of a positive impact on wellbeing with improved self-esteem, confidence, mental health, family relationships and improved concentration and behaviour of some children in the classroom
·         Attracted additional funding to enhance nutrition support from Scottish Government
·         Influenced the development of a new programme “Eat well, Play well”
·         Influenced the approach taken to costing for leisure facilities which is being reviewed
 
2. Workplace Health Coach – 1 funded part-time Health Coach, 2011-2014
This project offered individualised tailored health coaching for people identified in the workplace on low incomes (under £20,000) who wish support to make lifestyle changes to improve their health
·         Majority of referrals came from linked services already working with those in workplaces
·         68% resided in the lowest 2 deprivation category areas
·         264 people engaged with this service and the drop out/non-engagement rate was low
·         Positive behaviour change was evident eg 75% had stopped smoking at 3 months and 33% lost ≥5% weight
 
3. Healthy Hearts Toolkit Project - 1 Community Worker funded, 2013-2014
The primary focus was to train interested individuals on how to use the interactive BHF Healthy Hearts Kit to raise awareness and understanding of coronary heart disease and risk factors, amongst a variety of community groups including eg BME communities.
·         68 volunteers from 36 different groups/organisations have now attended the 7 workshops delivered by the Community Worker. These volunteers now have the skills and confidence to deliver key heart health messages to their own communities
 
4. Healthy Communities Grants, 2012-2014
Community and voluntary groups were invited to apply for small grants of up to £500 for activities which tackle health issues such as smoking, healthy eating, physical activity and mental wellbeing and focus on reducing health inequalities
·         58 grants were awarded over the 2 years
·         Demonstrated positive change can be achieved with small amounts of money
 
5. Heartstart,  2013-2014
Some funding was allocated to back–fill the “Heartstart Discovery” Coordinator to allow her to expand emergency life support training for pupils, delivered by teachers, across Dundee schools. This involves schools becoming affiliated to BHF Heartstart.
·         7/9 secondary schools are now affiliated plus 23/36 primary schools , plus all 4 support schools
 
6. Programme management- 3 part time funded posts 2009-2014
This resource was central to ensuring appropriate management, coordination and support of the programme, including data analysis and evaluation
·         Overall the programme was delivered within scope of budget and time
 
7. Cardiology clinic in the Community, 2010-2012
This tested the feasibility and clinical effectiveness of delivering this service out-with hospital facilities and included full assessment and echocardiography by a Consultant Cardiologist
·         Demonstrated that a cardiologist led clinic can be delivered in community settings
·         Patients valued the service and the team felt that patients engaged with this informal, flexible, approach in a way that would not have occurred in traditional clinics
 
8. Cardiovascular risk clinic, 2009-2012
A Specialist Nurse-led service delivered in the community for people with potentially complex cardiovascular disease, living in areas of deprivation. Clinics were delivered in community centres, community pharmacy and general practice. The assessment included 24 hour ambulatory blood pressure monitoring (ABPM) and ASSIGN cardiovascular risk calculation.
·         Demonstrated improved access for some patients, who may not otherwise access hospital-based services.
·         Effective assessment and triage, and a skilled nursing team, resulted in only 2 out of 123 patients requiring referral to Cardiology Clinic  
 
9. Opportunistic health checks, 2009-2012
Healthcare Practitioners offered health checks in a variety of communities in areas of recognised deprivation in Dundee and in workplaces employing large numbers of low-paid workers.
·         Effective delivery of health checks - 2572 individuals seen
·         668 were referred for follow up of risk factors by general practice, 48 were referred for health coaching, 26 were referred to cardiology, 5 for respiratory follow up and 15 for cardiac investigations
·         At least 7 patients are known to have required either cardiac surgery or angioplasty
·         Effective engagement was made possible through a flexible, informal, supportive approach
 
10. Health checks for 40-44 year olds, 2009-2011
Those aged 40-44 years, living within targeted areas were offered a health check, including CV risk/ASSIGN 
·         Main factors which facilitated attendance were perceived need, flexibility of the service, timeliness and method of invitation
·         Non-attenders felt there was no need for a health check and often reported health was not a priority amidst complex social circumstances
·         This age group were incorporated into core service Keep Well provision
 
Key Themes have emerged over the course of the whole programme:
 
·         Targeting
All of the projects specifically targeted “communities” at higher risk of inequalities.
 
·         Engagement and Support 

 
Providing a variety of targeting methods and approaches resulted in high levels of engagement. The skills and approach of the staff are key to this eg being flexible around time and location, practical, relevant and non-judgemental
 
·         Partnership 

 
A wide range of partnerships have been critical to the success of Hearty Lives Dundee
Benefits have been gained from shared resources and expertise.
 
·         Workforce 

 
Staff were a key asset in all the project strands. The ethos of staff to work with individuals, families and organisations in such a holistic way had a very positive impact on the experience of, and outcomes for, those involved in the programme.
 
Participants Beneficiaries
 
·         More than 5000 people have participated in Hearty Lives Dundee
·         All ten project strands have delivered on their objectives and there is evidence of the impact 

 
Sustainability
 
·         This was a key consideration from the planning stages in 2008
·         The financial climate has been challenging and meant that some of the clinical projects and post-holders were not sustained by NHS Tayside
·         Opportunities may present to continue to influence and shape care/service delivery
·         Some projects have been sustained in part e.g. Active Families, by Leisure & Culture Dundee and the Workplace health checks and  coach by Keep Well
·         3 of the projects have focused on creating capacity in the community, through schools or community/voluntary groups and as such leave a lasting legacy