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Healthy Cornwall


Background to the Health Trainer Service

The aim of the Health Trainer Service is to reduce health inequalities, targeting the most disadvantaged areas, making it easier for individuals in the local community to make healthier choices, while stimulating and supporting local communities in actions, which will reduce health inequalities, improve quality of life and quality of opportunity for people experiencing disadvantage. 

An area of high deprivation and health poverty we are tackling health inequalities through the Health Trainer Service (HTS).  We take a two-layered approach in the development of the HTS in Cornwall whereby a Community Health Development Worker (CHDW) line manages and supports the HTs to provide a holistic service.  The CHDW works on a community development approach and assists in providing the HTs with ready participants wishing to make positive changes to their lifestyles.  The HTs provide the one-to-one support to individuals, while the CHDWs build capacity and health literacy in our communities.  For people to take their own health and well being as a personal responsibility we need to assist their development in terms of self esteem, confidence and empowerment a key strategic aim of Healthy Lives, Healthy People (HLHP), “approach that empowers individuals to make healthy choices and gives communities tools to address their own, particular needs”, as well as an aim to “build people’s self esteem, confidence and resilience,”.  This also reflects the Government’s core value of freedom, fairness and responsibility by “strengthening self esteem, confidence and personal responsibility; positively promoting healthy behaviours and lifestyles.” 

We also provide support to our communities in Cornwall and Isles of Scilly through the training we offer; in particular the Royal Society Public Health Level 2 Health Improvement and Level 1 Health Awareness.  We aim to deliver this in local business in line with the Government’s “Public Health Responsibility Deal, to improve health at work”. 

We are working towards the following Domains within the Outcome Framework og Healthy Lives, Healthy People White Paper: 


Outcome indicator

Work Programme

Domain 2:  Tackling the Wider Determinants of Health

D2.1 Children in Poverty

  • Supporting families through the Health Trainer Service
  • SGS to community groups

D2.14 Access and utilisation of green space

  • Walking groups through the Health Trainer Service

D2.20 Social Connectedness

  • Community Health Development Team, Health Trainer Service and CHAMPs

Domain 3:  Health Improvement

D3.2 Prevalence of healthy weight in adults

  • CHAMPs, Health Trainer Service delivery of Weight Matters, Shape Up, healthy cooking, walking groups as well as one to one work, SGS

D3.5 Percentage of adults meeting the recommended guidelines on physical activity

  • CHAMPs, Health Trainer Service and SGS

D3.8 Under 18 conception rate

  • C-Card scheme through the Health Trainer Service, CHAMPs

D3.10 Self reported wellbeing

  • Health Trainer Service, SGS and CHAMPs

Domain 4:  Prevention of ill health

D4.14 Health related quality of life for older people

  • SGS, Health Trainer Service

D4.16 Take up of the NHS Health Check programme by those eligible

  • Health Trainer Service, CHAMPs


 For many people from disadvantaged areas, health can often be seen as a luxury, while basic needs such as housing and debt management are more pressing issues. Case Study C shows that working with a family prevented them from becoming homeless due to being unable to read the changes in their rent and averting what could have had catastrophic impact on their family and ultimately on their health (see appendix).  Our aim is to support people with their own goals and work on the issues that most affect them; all of which have an impact on health inequalities. 

If clients are to engage with the HTS successfully, we must ensure that the service is appropriate for their needs, is flexible and individually tailored.  Some clients feel more confident in a group environment, whereas others only feel comfortable in a one-to-one situation.  

There are many reasons why people, especially those from hard to reach groups do not access services - limited knowledge on availability, ‘that’s not for people like me’, lack of confidence, poor previous experience, etc. Ensuring that the service is relevant to local people is the biggest challenge HTs have to overcome. By centering our service within local communities we ensure that HTs are accessible and approachable. 

We provide a unique structure in supplying support to people on their own terms, in their own locality. Project workers work in the community and don't expect clients to come to them, instead physically seeking clients out.  Although referrals are received from partners including CAB, housing associations and GPs, many clients self refer after word-of-mouth from colleagues, family and friends. 

HTs are one central point to provide support and access to knowledge and appropriate services. The ability to signpost clients to specialist support, but remain as a constant in often what can be very hectic lifestyles, is vital. 

Although it is imperative that clients do not become dependant on the support of HTs, often as the client’s confidence grows with their success so will their aims and goals. It is therefore possible for clients to see their HT on a fairly long term basis. This programme of support aims to react directly to the needs of the client and is not restricted through its own structure. 

An additional benefit to the project has been the empowerment and personal development of our HTs themselves. When we recruit HTs it is important that they are passionate about helping communities and people to make positive changes to their lives. We are not necessarily looking for people with a high level of education or previous work experience, but value contributions people make through volunteering.  Where possible we try and recruit from the local area so the HT has a greater understanding of the issues that people face locally.  All HTs go through the City & Guilds III Health Trainers Certificate and additional training as required.  Some of our HTs have had long periods out of work; some have no formal qualifications or recent work experience.  However, all our HTs are united in their passion and commitment to helping people achieve their aims successfully.  The HTs themselves are models of how, with support, people can make changes for themselves, step by small step. 

We help people to recognise realistic goals and to support their progress. We do not set goals for clients; doing this for themselves is more likely to result in success, this in turn promotes self confidence and the desire to continue to make positive changes in their lifestyle.  “I have my life back, I am in control, I can buy clothes in the high street shops and I am never at home, life is good.  I have a long way to go, but I am well into my journey thank you.” (Case Study E – See Appendix) highlights that JW has improved his health which has had a positive impact on his life as a whole.  

Each client will work out their own individual goals through support from their HT, ensuring they are SMART, providing clients with the best possible chance of success.  We use the following paperwork to assist and guide clients in making sustainable and appropriate changes:

  • Initial Registration Form – collection of demographic details
  • Health Behaviour Check - provides us with a baseline of where clients are in their readiness to make changes towards a healthy lifestyle.  This repeated at the end of the goal achievement to see the ‘distance travelled’ by the clients and changes they have made.
  • Goal sheet  including rewards and reminders
  • Progress Record – identifies what has gone well and what has gone not so well
  • Assessment Sign Off – identifying whether goals had been achieved and reason for sign off from the programme
  • Client Satisfaction – ensures that we are aware of their views on their experience of the HTS
  • Maintenance Check –carried out 12 weeks after the client has ‘signed off’ from the service.  This is an opportunity for us to see the impact of the HTS, whether clients have been able to maintain their goals and how this has impacted on their lives, allowing us to see if a client needs further support.


Useful Links:


Healthy lives, healthy people: our strategy for public health in England Public Health White Paper


Cornwall Health and Welleing Board


Kernow Clinical Commissioning Group

Kernow Clinical Commissioning Group is the new shadow commissioner of health services for people living in Cornwall and the Isles of Scilly.

From April 2013 our role will be to buy health services on behalf of local people, this is currently carried out by the Primary Care Trust.