Early Adopters Scotland (EA)

The original early adopters were North Ayrshire, Dundee and East Region. The East Region made a local decision to test the approach in five areas namely Fife, East Lothian, Midlothian, Scottish Borders and West Lothian. At the outset of the EA programme six short-term outcomes were identified to be reached over the next five years.

• Communities are engaged in the approach
• Action is taken to address the upstream drivers and determinants of health
• Systems thinking practice is being integrated across the local partnership
• Collaborative working across departments and organisations
• Actions are jointly prioritised and aligned across the local system to address diet and healthy weight and to reduce inequalities
• Learning is being captured and shared.

Public Health Scotland evaluated the EA in late 2022 and came to the following conclusions:

What worked well

• Strategic Positioning and Alignment

In different ways, the local areas positioned their WSAs to connect with local strategies and structures. The benefits of this are multiple. It gave the WSAs a status and gravitas that fed into support for the working group, it encouraged and helped sustain stakeholder engagement and, more generally, it raised the chances that whole systems working will develop and continue into the future.

• Stakeholder Engagement and Participation

Broad base of stakeholder interest has been created and sustained around the WSAs, helped by both the existence of previous partnership working in the localities and by having already very well-connected local leads who could draw on these networks to assemble stakeholder contact lists. It has also required sustained hard work by local leads who have used communication tools and tactics innovatively and effectively.

• WSA Model and Guide

The PHE model helped to get the WSAs off to a good start. It offered a logical framework and path to follow – one that engaged participants in a well-structured, collaborative and deliberative process. Importantly, the model demanded a common focus from a wide mix of participants from different backgrounds, it supported the development of a shared understanding and vision and enabled a more in-depth, collaborative analysis of the problem/challenge than stakeholders were used to.

• Workshop Experience

Many positives were identified, with positive feedback forthcoming from all WSAs. Workshops were highly collaborative, high-energy events, thoughtfully planned and designed, as well as open and inclusive. In workshop activities, people were going beyond good partnership working. They were starting to work differently. Some ‘lightbulb moments’ drove home the message that a WSA is more than good partnership working and requires action to address upstream drivers and determinants of health.

• Tailoring to the Local Context

The model has proved capable of being adapted and tailored to suit local needs. While some WSAs largely stuck quite closely to the PHE model process, others felt the need to adapt and have done so with some success.

• Support from National Partners

Local working groups received valuable help over the process from two national partners, OAS and PHS. Both supported the working groups to prepare for and deliver the WSA workshops, assisting with the facilitation of breakout groups. Working groups have also benefited from skills share sessions organised by OAS, workshops providing a forum for WSA leads from each area to get together and share experiences and learnings.

Difficulties

• Capacity of Local Leads and Other Stakeholders

Staff capacity to deliver the process has been a challenge across the programme. The time demands associated with preparing for and delivering WSAs were heavy, particularly on local leads and administrative support, but also on working group members and other stakeholders actively involved.

• Stakeholder Engagement and Participation

This has proved to be a challenge, which as manifested in several ways. Potentially important players have not been actively involved and continuity of stakeholder involvement has been difficult. Reasons include: the specific demands associated with COVID-19; limited capacity; difficulties encouraging parts of the system to recognise their role and influence; and stakeholder fatigue with the overall demands placed upon them.

• Engagement of Local Communities

The WSA process has not significantly engaged local people with ‘lived experience’ of the issues addressed. The ‘community view’ has been largely inputted by local practitioners who know their communities well. The limited degree to which communities have been directly engaged is widely (though 8 not universally) seen as one of the main limitations and failings of the process to date.

• PHE Model and Guide

For some, the process felt overly academic and unnecessarily complex. There were some critical reflections on the PHE model including: lack of community engagement; being over theoretical and inaccessible at points; concepts being time-consuming and difficult to grasp; and the process not moving quickly enough to address more relevant, interesting and important issues.

• Workshop Experience

Criticisms of a practical nature included: a loss of interest and momentum between the two main WSA workshops; too much time being devoted to presentations; feeling slightly overwhelmed by the level and complexity of some workshop activities; and struggling to prioritise themes and develop actions. More fundamental concerns included: a perception that the stakeholders attending were not sufficiently senior to make decisions on the priorities and actions developed; and that the output of the workshop activity was over-dependent on attendance on the day, especially if some important players were not present.

PHS also concluded case studies for the Early Adopter Areas of Dundee, Scottish Borders, North Ayrshire, East Lothian, Aberdeenshire, Dumfries and Galloway and Fife. Each case study was a ‘free-standing’ report that the local leads were able to share with stakeholders. Comments were fed back to SMG and each case study was revised accordingly until the local leads were happy that it reflected an accurate account of their story.

You can find out more detail through the links on the right hand side of this page.