Memorandum by Groundwork (WP 23)
Groundwork welcomes the opportunity to submit
written evidence to the Health Select Committee's inquiry on the
Public Health White Paper. This submission provides information
on Groundwork's activities and provides comments on the specific
proposals in the White Paper and the broader debate on public
health.
GROUNDWORK
1. Groundwork is a federation of 50 locally
owned Groundwork Trusts in England, Wales and Northern Ireland,
between them working with over 100 local authorities to deliver
"joined-up" solutions to the challenges faced by our
most deprived communities.
1.2 Groundwork has 23 years' experience
of engaging and involving communities in practical projects to
improve quality of life and promote sustainable development.
1.3 Each Groundwork Trust is a partnership
between the public, private and voluntary sectors, with its own
board of trustees. The work of the Trusts is supported by the
national and regional offices of Groundwork UK and Groundwork
Wales. Groundwork works closely with the Government and devolved
assemblies, local authorities, RDAs and businesses. Groundwork
also receives support from the European Union, the National Lottery,
the landfill tax credit scheme, private sponsors and charitable
foundations.
1.4 Groundwork's projects are organised
into local, regional or national programmes embracing six themes:
communities, land, employment, education, youth and business.
Groundwork recognises that people, places and prosperity are inextricably
linked and therefore aims to design projects that bring benefits
for all three at once. We believe this integrated approach is
vital if we are to bring about sustainable development.
GROUNDWORK AND
HEALTH
2. The Public Health White Paper states
that there are "unacceptable differences in people's experience
of health between different areas and between different groups
of people within the same area". It proposes a number of
measures including investment an new initiatives to promote local
action on public health and partnerships between the public and
voluntary sectors to help extend the opportunities for people
to choose healthier lifestyles. Over the past twenty years Groundwork
has been working on a wide range of projects at the heart of communities
aimed at creating better environments for people to live in and
providing services in the community to provide support, skills
and education to help people develop and improve their own quality
of life.
2.1 There are two key ways in which people
can be helped to lead a more active and healthy lifestyle. The
first is providing the facilities and infrastructure to allow
them to do so, be it a decent public transport system, with adequate
facilities for cycling and pedestrians, or safe and attractive
public parks and play areas. The second is giving people the education,
knowledge and confidence to make the personal choice to lead a
healthy lifestyle. Groundwork's activities focus on addressing
both of these issues in the context of the country's poorest neighbourhoods—tackling
inequality at its roots.
2.2 Groundwork undertakes setting-based
approaches, working in informal public spaces, parks and places
where people live. We try to connect people with the importance
of the environment for health, not just as a setting for interventions,
but in its own right—making places safer, cleaner and greener.
As a result, there are an increasing number of people within the
Groundwork Federation with health expertise. Groundwork also brings
significant amounts of resource into the health sector through
accessing non-NHS funding sources for projects that contribute
to public health and well being.
2.3 Groundwork's activity impacts on health
in a number of ways by:
The most accessible forms of exercise—cycling,
walking and enjoying the open air—are at the heart of many
Groundwork regeneration projects. In areas of high density housing,
play spaces or "kick about" areas may be the solution
and increasingly these are being developed to offer coaching facilities
as a way of encouraging long-term use. Other regeneration projects
will provide a new route to work, a safe footpath to school or
more formal facilities for weekend sport.
Those recovering from medical problems or undergoing
treatment also benefit from improved physical surroundings. Groundwork
has developed partnerships with primary care trusts and local
health groups across the country to deliver therapeutic activities,
often linking with GP referrals for "exercise on prescription".
(ii) Health through horticulture
The environment can be a powerful remedy for
helping people recover from ill health or helping others cope
with a long-term disability. Working with specialist local partners,
Groundwork is making a real difference both to people's health
and their quality of life.
(iii) Making homes safe and healthy
Groundwork has developed a wide variety of local
partnerships to address the health and welfare issues that are
caused by unfit housing and poor quality living environments.
(iv) Creating a healthier workplace
Groundwork has been working in commercial and
industrial environments for many years. Supporting healthy workplace
practice reduces the risk of accidents and the associated personal
and financial costs. Health and risk lessons learned in the workplace
are also taken home by employees.
(v) Education and healthy food
With Groundwork's support, many people are now
growing their own food while others are benefiting from local
community facilities serving up healthy meals. This approach offers
a range of outcomes. Older people are given the opportunity of
exercising or passing on almost forgotten skills. People with
no means of accessing land for their own allotment are given their
own space and young people are discovering that good food doesn't
have to come from a supermarket or takeaway.
Groundwork also works in schools to pass on the
healthy eating message to tomorrow's decision-makers as part of
the national curriculum through its network of education specialists.
(vi) Reaching out to young people
Young people can often be the most difficult
group to reach with a health message and their relationship with
their local environment can have a major impact on their physical
and mental well-being.
Groundwork has a track record of reaching out
to the most marginalised young people and engaging them in activities
which help them understand the health consequences of their actions
while providing facilities that help them stay well and safe.
THE WHITE
PAPER—"CHOOSING
HEALTH"
3.1 Groundwork fundamentally supports the
central tenet of the White Paper—that Government should
provide the framework within which individuals can make informed
choices about their personal health and lifestyle. We are now
keen that the actions and initiatives set out in the White Paper
will be fulfilled so that that people living in our most deprived
communities have access to the same facilities, education and
support that will allow them to make those choices as everyone
else.
3.2 The White Paper takes an important step
further forward in providing people with the opportunities and
infrastructure they need to adopt healthier lifestyles. We firmly
believe that a sustainable community is, by definition, a healthy
community, and that the key challenges we need to address continue
to revolve around tackling inequalities. Improving the health
and well-being of residents in those areas has always been a central
component of our holistic approach to regeneration and local sustainable
development.
3.3 "Choosing Health" outlines
proposals for establishing a network of community health trainers
to offer support to people in making decisions about their health
and lifestyle. We welcome this initiative and believe it will
be an effective way of seeking to promote good health at community
level. Groundwork has an extensive network of links with community
organisations within the most deprived neighbourhoods and we are
keen to work with the Government to help support the delivery
of this initiative.
3.4 The White Paper sets out the importance
of Children's Trusts to the planning and delivery of health services
to young people. We support this initiative and the introduction
of Children's Centres at heart of communities. We are keen however
that these arrangements ensure that service delivery at a local
level is co-ordinated and works with existing projects and initiatives
for young people, and with the involvement of the local community.
We would also like to see a consideration of the provision of
decent open space for young people as part of the planning and
co-ordination of service for young people by Children's Trusts.
This is key to any public health strategy for young people and
is essential to improving health outcomes for those living in
the most deprived communities.
PUBLIC HEALTH—WHAT
WE ASK
OF GOVERNMENT
4. The NHS is a precious national institution
that should both be preserved and supported, but the current burdens
placed on it will jeopardise its long-term survival, unless Government
policy undergoes a radical refocus. We believe that there is a
crucial need to move the UK's health debate away from an over-concentration
on NHS acute facilities and towards a focus on the long-term solutions
and strategy for the public health and well being of the population.
By tackling health inequalities in a sustainable way, the burden
on the NHS will be alleviated for the long term, providing better
health for the population, and for the nation's finances.
4.1 Improving public health is also essential
if we are to achieve social justice. It is self-evident that the
poorest communities live in the worst areas. This is reinforced
by Environment Agency research which demonstrates that there are
five times as many industrial sites in wards containing the most
deprived 10% of the population, and seven times as many emission
sources, than in wards with the least deprived 10%.[60]
4.2 By improving health and well-being in
our poorest areas, it will be possible to deliver a multitude
of other outcomes that lead to the long-term regeneration of an
area. Groundwork believes that by tackling the quality of local
environments and infrastructures we can build the framework for
the long-term well being of the nation.
4.3 What we would like to see:
(i) A change in the nature of the debate
The White Paper should be followed by a series
of immediate, but sustainable, changes to the way in which the
health debate and approach to health policy is framed.
The current NHS funding regime prioritises acute
care disproportionately in comparison to health prevention and
inequalities initiatives and there is consequently a lack of power
and clout for public health within the NHS.
In addition, the primary care sector is not taking
the long-term agenda seriously, mainly due to the emphasis placed
on achieving central targets and the short-term nature of funding
streams.
(ii) Assistance for the environmental sector
in evidencing the health benefits of their activities.
As mentioned above, the link between environment
and public health is for many people intuitive and self-evident.
More needs to be done, however, in order for the environment to
be taken seriously as a determinant of health.
The environmental delivery sector needs support
in order to fully evidence the impact and value of the links between
environment and public health, and to identify good practice.
Evidence synthesis, evaluation and dissemination are therefore
important, and Government should be providing support for this,
especially by funding qualitative and quantitative evaluation
of the health outcomes from programmes and initiatives.
(iii) Supporting both the health and the
environmental sector to work more closely together, in particular
by encouraging collaboration and providing training, leading to
an increased understanding of needs, priorities and what works.
The health and environmental sectors have a real
potential to deliver major quality of life improvements, but this
will be done only in partnership and by sharing lessons and learning.
Effective partnerships must be build at all levels to maximise
this very real potential.
for those in NHS and other public health functions
to have secondment and learning opportunities within the regeneration
and environment aspects of public health are also important. This
will drive cultural sharing and the development of the distributed
leadership necessary to join up programmes effectively.
The attached Annex gives examples of Groundwork
projects which are focused on improving public health.
January 2005
Annex
GROUNDWORK IN ACTION FOR HEALTH—CASE
STUDIES
PATHWAYS TO
EMPLOYMENT—PATHWAYS
TO HEALTH
Employment is important as a means of supporting
lifelong health. [61]People
who experience the worst inequalities in health, and worst health
outcomes, are often those who are unemployed or who find pathways
into employment most difficult to access[62]
Groundwork runs Intermediate Labour Market or other employment
projects in 26 of our Trusts. These programmes provide people
with sustainable ways into employment and have direct health outcomes
from improving activity and income to providing important settings
for addressing a range of health challenges faced by this population.
Advice, support and referral on mental health, parenting, drugs
and alcohol, smoking, diet and sexual health are all to be found
in Groundwork employment programmes. A national study of our ILM
programmes will be reporting shortly.
There are specific partnerships with local health
economies too. Groundwork East London operates a Transitional
Employment Programme, in partnership with Homerton Hospital. The
programme recruits lone parents and asylum seekers to train for
NHS positions such as ward clerks, housekeepers, reception and
manual roles. Not only does this scheme help the NHS create a
sustainable workforce, but it helps to bridge the gap between
the service user and the service provider and supports some of
the most deprived Communities in East London. It has a 100% success
rate.
The scheme is now being rolled out into Newham
and Tower Hamlets, doubling its size. Groundwork East London has
also been invited to run a similar pilot with the local PCT and
a scheme with Homerton Hospital's community nursery to provide
trained staff and increase links with the local community.
ENCOURAGING EXERCISE
Groundwork Leeds worked with the South
Leeds Elderly Group, comprising a dozen men from the city's Pakistani,
Bangladeshi and Indian communities. The members had already decided
they needed to take more exercise but were having difficulty finding
somewhere they felt safe to walk, run or cycle. Groundwork Leeds
introduced the group to Rothwell Country Park, created on the
site of an abandoned colliery as part of Groundwork's millennium
Changing Places programme. Groundwork's project officers encouraged
the men to take part in guided rambles, which built their confidence
and fired their enthusiasm—to such an extent that they are
now a regular sight striding across Ilkley Moor.
Groundwork West Cumbria has delivered
a large number of cycle paths in the area, with a particular focus
on linking local towns with Sellafield, the biggest employer in
West Cumbria. This has been achieved by working in partnership
with local SRB programmes and community health workers.
The Wandle Trail in London was created
by Groundwork Merton in conjunction with a range of partners and
follows a 14 mile course through some of south London's most attractive
parks and open spaces. The route encourages walkers and cyclists
to use the trail for short or long distance trips. Many parts
are now wheelchair accessible and this work, together with safety
improvements, is ongoing.
The Wandle Trail now not only contributes to
local health generation and the environmental regeneration strategies
in the participating boroughs of Sutton, Merton and Wandsworth,
but also links into the national cycle network.
This partnership involving the three boroughs,
Sustrans, the Environment Agency and many different voluntary
organisations has allowed for a balanced approach to encouraging
greater use of the trail. Groundwork Merton promotes cycling and
walking along the trail whilst continuing to work with partners
to improve the biodiversity of the Wandle corridor.
HEALTH THROUGH
HORTICULTURE
Groundwork West Durham's Greenways to
Better Health programme works in partnership with local groups
and organisations, specifically targeting older people, people
with disabilities and those with health problems. The aim is to
increase local people's interest in the environment at the same
time as improving their health. In addition to organising "doorstep
walks", the Trust has helped create raised beds, sensory
gardens and community allotments.
Groundwork Thames Valley recently received
funding from the Healthy Living Initiative to work with New Deal
participants to make physical improvements to residential hostels.
The programme uses common ground and public space to engage hostel
residents and New Dealers to improve the physical environment
and undertake health promotion activities at the same time. The
health outcomes address mental health, accidents and falls, working
with older people and improving mental health.
In addition, Groundwork Thames Valley is running
horticultural therapy at a Study Centre in Hillingdon, funded
by Hillingdon PCT, in conjunction with their trained horticultural
therapist.
SAFE AND
HEALTHY HOMES
When research revealed that 23% of the population
of the East Midlands—742,000 people—were subjected
to fuel poverty, Groundwork Ashfield and Mansfield developed
an initiative to help. With the backing of the local authorities
and a number of other partners, a package of measures was identified
to support the most needy households.
EnProve, a training company owned by the Trust,
employs local people to carry out a broad range of home improvement
schemes that can mean a healthier living environment. Recent work
has included small-scale repairs, energy insulation, security
upgrades and the installation of accident prevention measures.
Projects are now running in three areas. Over
1,000 homes have benefited from insulation work and a further
800 houses have had child safety measures installed. One scheme
carried out with the Nottingham Health Authority to help those
in cold, damp houses has also won a National Energy Foundation
HENRY (Home Energy Rater of the Year) award.
60 Walker G, Fairburn J, Smith G and Mitchell G (2003)
Environmental Quality and Social Deprivation R&D Technical
Report, Environment Agency. Back
61
Report of the Independent Enquiry into Inequalities in Health. Back
62
Dept for Work and Pensions (2003) Research Report: Intermediate
Labour Markets in Britain. Sheffield: Dept for Work and Pensions. Back
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