Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Brent and Harrow Health Authority (PH 49)


  Interoperation of Health Action Zones, Health Improvement Programmes and Community Plans

  An innovative local approach to the publication of complex planning documents across multiple agencies.


  1.1  Brent and Harrow Health Authority is coterminous with the London Boroughs of Brent and Harrow, and there is a long history of joint working between the three organisations.

  1.2  In Harrow, the Harrow Partnership is a multi-agency strategic group covering four themes: Strengthening Communities, Health and Social Care, Lifelong Learning and Environment and Economy. A simple committee structure links the work within these themes to the strategic direction of the Partnership as a whole. Within health and social care, a series of strategic action groups (each dealing with a priority care group such as elders, mental health, children/young people) reports to the main health and social care committee (the Health and Social Care Strategy Group). This enables work being carried out to implement service plans and major parts of the Health Improvement Programme to link into the Partnership structure. At all points there is good representation from the voluntary sector, users, carers, and the different cultural communities.

  1.3  In Brent, the Health Action Zone (HAZ) is being brought into a structure in which the management of its own initiatives and the work of the borough-wide strategic action groups is unified, linking upwards to an inter-agency group. The HAZ's strengths have included engagement with the wider community and the establishment of local coalitions for action to improve health and reduce inequalities.

  1.4  These two borough structures have enabled effective sharing of objectives and approaches between partners in the NHS, the local authorities, and especially the representatives of voluntary organisations, users, carers and the cultural communities which are so important in our district. It has also made it easier to discuss together how best to link strategic planning across agencies.


  2.1  In our view, the Health Improvement Programme (HIMP) is a critically important document, enabling sense to be made of the shared agendas between the NHS, social services, education, housing, environment, transport and regeneration. Ideally (and over time) the HIMP should form the majority proportion of the local community plan.

  2.2  The challenge is to ensure that all partners appreciate that the HIMP is not simply about the NHS, and that all local partners should have a say in its content, and (more importantly) its implementation.

  2.3  At present the areas which are seen to be most relevant to health improvement are those of health care, social care, education and housing. In our view, there is a need for central government to appreciate that inner city regeneration—a major priority for both our boroughs, particularly Brent—has significant impact on health. The HAZ has, for example, recently performed a health impact assessment of the proposed new Wembley National Stadium, using a toolkit developed by the London Coalition for Health. This is a good example of the link between work on health inequalities and inner city regeneration. Ideally, then, action on regeneration should be seen as part of the HIMP, led, of course, by the local authorities. Similarly, action to improve the environment (including local transport policies) should also be seen to have health impact.

  2.4  We would welcome this perception at the centre. If a wide interpretation is taken of health impact, then community plans and health improvement programmes can be seen to be virtually the same.


  3.1  The agendas addressed in community care plans—mostly health and social care (through Joint Investment Plans) and housing—clearly overlap substantially with the HIMP. In both our boroughs, a decision has been made to merge the Brent and the Harrow Community Care Plans with the HIMP from 2001.


  4.1  When our local community care plans and the HIMP merge, the result will inevitably be a large document, potentially intimidating to readers. However, this problem can be bypassed if the whole business of creating these documents is given a new slant—electronic publishing, using existing websites.

  4.2  Our plans for this are briefly described below. We commend them to the Committee as one solution for what is going to become an increasingly difficult problem—the growth of ever more complex planning documents as the agendas of health agencies and local authorities converge.


  5.1  In Brent and Harrow we are currently piloting a new format for the HIMP document, whereby it is possible for a reader to enter easily at any point and be navigated through a menu of information on local/national priorities and detailed local action, linking to sources of research evidence, national policy documents, advice, bulletin boards and e-mail addresses. This electronic or "e-HIMP" will be available through the health authority website, and those of local PCGs, NHS Trusts, both boroughs, voluntary sector organisations and community groups.

  5.2  An introductory section (written in accessible style) will guide the reader to a table of contents. Each chapter will have a brief front summary, with a link to the actual text.

  5.3  The main innovation is the structure of the document, which contains frequent references to other sources of information as hypertext links. For example, the section on mental health will link to the summary of "Our Healthier Nation" on the Department of Health website, the National Service Framework website and that of the National Institute for Clinical Excellence. The section on carers will link to national policy initiatives, and also to local websites of voluntary sector organisations. A reader can move in and out of all these resources at will, with one click of a computer mouse.

  5.4  The result of this structure will be that the reader can turn a complex planning document into a resource, using it as a map or network. It will also be possible for readers to contribute to on-line discussion groups, or to e-mail comments to individuals listed in a local directory.

  5.5  National policy documents are frequently readable via government websites, and can be downloaded in "pdf" format. The essential difference in our model is that our document, written in the same "pdf" format, contains the hypertext links which turn it into a network. There is no intrinsic reason why national policy documents could not be similarly constructed.


  6.1  We believe that the strength of our local partnership working in Brent and Harrow enables us to work well together in the creation of local strategies to improve the health and welfare of our communities, and to develop action plans which lead to effective changes in services. It will be possible to merge these plans between health and other agencies, so that they become synergistic in effect.

  6.2  As local plans and strategies merge they will become more complex and larger, creating a paradox whereby the better the joint work the less accessible the documentation. A solution to this problem is the design of electronic versions, available via websites (or on CD-ROM) which enable a reader to navigate freely within each plan, but enabling links to national policy and local sources of information.

John Hayward

Consultant in Public Health Medicine, Lead for Health Improvement Programme, Brent and Harrow Health Authority

5 July 2000

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