Presentation slides for this item will be published on the day of the meeting.
Minutes:
A presentation on Health Inequality and Priority Neighbourhoods in Redditch was provided by representatives from Worcestershire County Council (WCC) Public Health department, Citizens Advice Bromsgrove and Redditch and Redditch District Collaborative. In the presentation the following points were raised:
· WCC Public Health focused on small geographical area approach to health inequalities within Worcestershire. This was based on Lower layer Super Output Areas (LSOAs) which were geographical units of between 1,500 to 3,000 people, representing neighbourhood-sized units.
· The WCC Public Health Team focused their resources on priority neighbourhoods that were identified as having the highest level of unmet health need. Intensive community development work would take place in those neighbourhoods.
· Health outcomes for an area were a combination of level of need and the level of service provision.
· To identify LSOAs / neighbourhoods where there was highest unmet need three non-elective emergency admissions measures were used, which were all emergency admissions, emergency cardiovascular admissions, and emergency respiratory admissions. These measures were deemed to provide the best proxy for where there was highest unmet need.
· Statistical process control analysis was used to select priority neighbourhoods within Worcestershire and these were neighbourhoods / LSOAs with three standard deviations above the mean for the county in terms of non-elective emergency hospital admissions.
· Based on the analysis, 14 priority neighbourhoods were identified within Worcestershire. All districts within Worcestershire apart from Bromsgrove had at least one priority neighbourhood, and Redditch had the most priority neighbourhoods of all Worcestershire districts at eight.
· This approach was presented to and met with the approval of England’s Chief Medical Officer. Since then, the priority neighbourhoods approach was piloted in the Westlands Housing Estate, Droitwich.
· The work piloted in Westlands, Droitwich focused on identifying where the health priority was and deciding what would be done about it. In that pilot, Public Health team collated in depth data and worked with resident groups, elected members, voluntary sector partners and health professionals (e.g. primary care) to build a picture of the issue and reasons behind elevated levels of hospital admissions.
· Significant budget was devolved by Public Health to a local committee in the case of Westlands which was composed of the Westlands Housing Estate Residents Association, the local headteacher, residents who worked in the community centre, and local professionals, the local Housing Trust and voluntary sector, consequently allowing the building of local trust in this project.
· The budget and public health grants was used by the local committee in Westlands to fund various programmes, including saving the local wellbeing hub, which had now become self-sustaining, a local parenting group, a nature trail project including benches for people with limited mobility, and a bicycle repair project.
· A review of the pilot work undertaken in Westlands saw a reduction in emergency admissions in the area of 7 per cent, in the same time as emergency admissions went up across Worcestershire as a whole by 5 per cent.
· Children’s social care referrals decreased by 14 per cent in the Westlands area and by 24 per cent in the specific LSOA targeted by this pilot.
· Asset Based Community Development was used which focused on what is already strong in the area and what strengths can be built upon. This focused on the ideas emanating from within the community guided by evidence.
· Based on this work, other agencies across the county, including the NHS had changed the way they work within priority neighbourhoods, striving to work collaboratively with community groups.
· Grants represented a major tool used by the WCC Public Health to encourage community-based development and there was an interactive map on the WCC website showing all the grants provided by Public Health across the county. These grants enabled funding to be directed exactly where it was needed, to develop projects which then became self-sustaining.
· The examples of public health initiatives that were already being supported in Redditch were covered, which included:
o Healthy Worcestershire Programme had four initiatives within Redditch.
o Inspire Community training – including working with Karen to build capacity in the Winyates Hub that includes baby bank, mental health etcetera which included provision of flexible grants to build up capacity, skill up volunteers and extend café offer at Winyates.
o Batchley Support Group through smaller targeted funds.
o Work with Redditch Self-Defence within Woodrow to extend self-defence offer to women’s groups.
o Working with Citizens Advice to support community advisors who were doing targeted community work in Redditch.
o To extend support offer at Sandycroft including support to Imaan Youth Club at Sandycroft, a volunteer-led group to support young people from the Muslim faith to access youth provision and activities.
Following the presentation, the Portfolio Holder for Community Services and Safeguarding Responsibilities was invited to speak and in doing so explained that the presentation document, which would be circulated to Members, provided great detail on the methodology and how the data was categorised by small area units to see local level issues. The Portfolio Holder explained that the data was worrying as it showed a lot of work remained to be undertaken, however, it was hoped that this Member presentation would provide an impetus for elected members in Redditch to continue and increase their involvement with community-based health initiatives.
The Deputy Mayor and last year’s representative on the WCC Health Overview and Scrutiny Committee (HOSC) was invited to speak and in doing so commented that he was pleased to see the recent development going on in addressing health inequalities at a local level in Redditch. The Deputy Mayor noted that addressing high health inequality in Redditch required dealing with a complex set of problems that could best be addressed by involving people and communities affected directly in developing the solutions.
Members subsequently discussed the presentation in detail and in doing so commented on the following areas:
· How smaller community groups could access public health grants and support and what it could be used for – It was commented that the Redditch community groups quoted within the presentation were all relatively well-established groups which were well versed in how to access grants. It was asked how provision of grants and support was facilitated to smaller community groups or even individuals who might not have time or struggle to fill out applications.
· It was responded that support was facilitated through the Community Development approach taken by Public Health, whereby grants and budgets were devolved directly at local neighbourhood to smaller community and voluntary groups. WCC Public Health had community development experts who were able to assess local ideas and were able to support local community groups in co-designing and developing their ideas before grant funding was approved. This was a different approach to that of traditional formal grants application route which was a competitive application assessment process, where the grant provider would provide little support and would make less distinction between size of voluntary organisations.
· It was highlighted that community leaders such as elected members were vital in identifying where there was the need locally and voluntary groups which could provide the solutions in local areas. Elected members also had the ‘know-how’ to ensure grant funding received was sustainable. Ward Councillors were encouraged to contact WCC Public Health if they were aware of a community group / groups within their ward that was doing community work that had a link to wider health and wellbeing, including physical, mental health or social care.
· Implementing Asset Based Community Development (ABCD) as a system-wide approach – It was asked why the grassroots approach was not used more widely within the wider health and public sector system. In response it was hypothesised that this might be due to organisations providing programmes and giving grants being apprehensive about the potential loss of control over the direction of the initiative / project. Often communities could not solve their problems and needed other agencies to support them, but it was commented that the ABCD philosophy was that it was the communities themselves who needed to lead initiatives in their own communities.
· Citizens Advice Community Workers and their approach to community development – An example of Citizens Advice in Redditch was provided in terms of how their community workers identified specific communities and individuals who were struggling and and joined those people / communities to already existing community initiatives or provided the individuals with micro-grant or other small-scale support to help resolve a local problem. This could take the form of providing small level grants of £100-£200 to kick start a project, for example through providing the necessary starting funding for equipment etcetera.
· How was Public Health Grant funded and how long funding would be in place for in Worcestershire – It was explained that the Asset Based Community Development (ABCD) public health initiatives were funded from the Public Health Grant through a person-centred approach. As the future of the Grant funding was uncertain, the initiatives which were funded needed to show or work with community development officers to develop plans to become self-sufficient in terms of funding. Alternatively, these community initiatives would need to show that they were able to grow to apply for other funding sources.
· It was highlighted that Redditch Borough Council also operated a Voluntary Sector Grant Scheme based on the principles of ABCD in terms of how it distributed grants.
· Asset Based Community Development (ABCD) training – Members were asked to note that the Council provided training on ABCD to staff and elected members.
· Community Interest Company (CIC) and accessibility of small-scale grants to businesses – The Chair commented that local businesses were often in a position to provide a key piece of infrastructure for community activities (e.g. equipment, event/gym space) but that the voluntary sector grants were restricted to voluntary groups and charities which were CIC. It was explained that Public Health would be open to extending the grant to businesses where applicable, however, there were issues from governance and legal point of view which would need to be resolved if this was to be extended.
· Progress in Redditch with regard to community development schemes – The WCC Director of Public Health commented that from her perspective Redditch was not new to Asset Based Community Development (ABCD) work with many great community initiatives being supported by voluntary organisations and through the Council. The Director of Public Health stated that perhaps what was still missing was a systematic approach and full commitment from budget holders, such as Public Health, to work in this community development way as opposed to commissioning services in a prescriptive way.
· The importance of wider factors in improving health outcomes within Redditch LSOAs where health inequality was high was highlighted including education, opportunities for progression to better-paid employment, and building aspirations within communities.
· Challenges around small volunteer groups setting up CIC – The Vice-Chair highlighted that for many small volunteer groups setting up CIC bank account and details was a particularly arduous task with their limited resources. It was asked what grants and resources individuals undertaking community projects could access without needing CIC status.
· It was responded that the WCC Public Health provided some very small grants which included:
o Stay Connected Programme which required a CIC but where applicants were provided with support from Public Health to set it up during the application process.
o Micro Grant Scheme – This scheme enabled any Worcestershire resident to apply for up to £250 and requests came in directly to the Public Health team and this micro grant would be paid directly into someone’s bank account.
o In both of these schemes, applicants were encouraged to think about sustainability and applicants were linked up with partners such as community hubs for example.
o The Public Health team tried to link up more established voluntary sector groups with smaller community groups or individuals doing projects within their communities in Redditch.
· Working with elected members in Redditch – The importance of Public Health working in partnership with Redditch Borough Council elected members as well as County Council councillors was highlighted.
· Worcestershire Lower-layer Super Output Areas (LSOAs) – It was noted that there were circa 350 to 400 LSOAs in Worcestershire, with 14 priority neighbourhoods, in terms of being three standard deviations above the mean for the county average in terms of non-elective emergency hospital admissions, with Redditch having 8 of those 14 LSOAs.
· It was highlighted that Redditch areas as a whole were outliers across Worcestershire in statistical analysis identifying incidence of non-elective emergency hospital admissions. This pointed to issues with wider determinants of health in Redditch. It was underlined that data on non-elective hospital admissions was taken over four continuous years, which meant that the LSOAs identified maintained consistently high (close or above 3 SD above the mean) level of non-elective hospital admissions over that period.
· Bromsgrove and Redditch Network (BARN) – The Redditch Partnership Manager explained that BARN supported voluntary sector organisations locally within Redditch, making sure that voluntary sector was aware of the funding opportunities available and training opportunities on areas such as writing funding bids.
The Committee asked that Public Health provide an update Health on Health Inequality reduction work within Priority Neighbourhoods in Redditch in 6 to 12 months. The presentation was noted by the Committee.