Anna Hartley |
| Director of Public Health, Wakefield Council |
We live our lives in neighbourhoods – so it makes sense for them to be the starting point for how we think about services. Working at a neighbourhood level – with communities who understand both the challenges local people face and the strengths they have to overcome them – can help find creative solutions to seemingly insurmountable problems.
Councils can support good neighbourhoods in two main ways: by sustaining local places and spaces, and by working with local organisations to support social interaction. In so doing, they can tap into the strong local networks and trusting relationships that have been built up over time – and are ready to be drawn on when a crisis hits.
What gives you a good life? When I was a first-time mum – struggling to keep my head above water with what felt like endless nappy changes, sleepless nights and an overall sense of dread – it wasn’t the weekly baby clinics or the occasional visits from the midwife. No, what kept me going was my local neighbourhood. It was the library at the end of the road where I could pop in whenever I needed to get out of the house for 10 minutes. Or it was the park which I walked around to soothe a screaming baby. Best of all, it was the parent and child group on a Monday morning where I met new friends and got advice and support on topics as wide ranging as weaning and the best family days out.
My own personal experience of my neighbourhood helped me reflect more deeply on what I have known for some time. What I’ve learnt from my five years working in a community organisation in one of the most deprived areas of Leeds, to my role now in a local authority as part of the team responsible for the health and wellbeing of 340,000 people. Good neighbourhoods are vital; an essential building block to create and maintain community health and wellbeing. Good neighbourhoods help people have good lives.
Working at a neighbourhood level with communities who understand both the challenges they face, and the strengths and assets that can help meet those challenges, can help find creative solutions to seemingly insurmountable problems. It seems an obvious point, but neighbourhoods are where people spend most of their time. So by working in them and with them, we can have greater reach and impact.
How local authorities can support good neighbourhoods
Neighbourhoods which promote a “good life” need both access to physical assets such as parks, shops and places of worship, and access to social opportunities measured by things like levels of volunteering, sports clubs and community groups. The statutory sector, along with partners, has an important role to play to ensure physical assets are created and maintained including green space, walking routes and community spaces. We can support social interaction too, by working with the third sector and other partners effectively. This may be through commissioning social models directly or by embedding social value into all of our procurement processes.
For example, in Wakefield, we commission a social prescribing programme based on the “Five Ways to Wellbeing” model developed by the New Economics Foundation which supports isolated people to engage with their local neighbourhood. This also includes grant investment directly into the voluntary sector to increase community wellbeing in response to what residents say that they need in order to have a “good life” in Wakefield. We also ensure that all of our procurement contracts have explicit scored criteria for promoting volunteering and maximising the “Wakefield pound”.
Research from the general household survey shows that people in more deprived communities have lower levels of social connectedness. So the other way that the statutory sector can help is by ensuring that people living in deprived neighbourhoods are allocated proportionately more resources (Michael’s Marmot’s concept of proportionate universalism) so that they have their fair share of physical and social assets. Investing in those assets can be a protective factor for those deprived communities with social connectedness being linked to resilience, better mental health and even lower premature mortality rates.
Providing solutions to “wicked” issues
Neighbourhoods can help unlock solutions to “wicked” issues. The last few years have been extremely tough for local areas. The enormity of statutory sector budget cuts, the austerity agenda and increasing demands from residents has presented a huge challenge. The socio-demographic make-up of our neighbourhoods is also changing with an ageing population, a rise in single person households and associated social isolation and loneliness.
In Wakefield, we recently interviewed nearly 700 older people and 40% of them said that they didn’t have as much social contact as they would like. A huge figure! On top of this, the impact of national changes, including changes to welfare benefits, have put increasing pressure on individuals and families. A quarter of children in Wakefield live in poverty.
Sometimes it’s hard to know what you can do at a local level to support people when so many of the things that impact on them are not in your gift. However, working effectively in neighbourhoods and engaging local communities in problem solving is a huge step in the right direction. The challenges that we face need shared minds and shared perspectives, shared conversations. They need people who contribute an ability to shift the perception of problems and with that an ability to contribute solutions from outside the usual domains: people who can sit with what’s presented and join up the dots in new ways.
Neighbourhood working in action
An example of the power of neighbourhood working has come out of some tragic circumstances that we have recently experienced in Wakefield. St George’s is a Locality member based in an area where there have been a number of suicides in recent months, predominantly among young people.
St George’s have worked in this community for over 20 years, building relationships with local individuals and families. Two years ago they noticed a rise in anti-social behaviour and in response started working intensively with a group of young people. This was not easy. It took time and patience but they brought together a group of partners at neighbourhood level to work through the challenges together, including local schools, housing, the local authority, police, ward councillors and the voluntary sector. Over the two years they have built relationships with young people and families – they are trusted and they have an in-depth knowledge of their lives and stories.
When a number of young people took their own lives they were ideally placed to be able to lead a community response with support from statutory sector partners. They brought professionals and young people together in a familiar environment and listened to what the young people wanted. School nurses were able to attend the existing youth café and spend a full session just getting to know the young people. By working together a support plan was created, devised by the young people, which, among other things, involved using “kitchen table conversations”, as a way to bring people together to discuss the tragic events in a supportive and informal environment.
The importance of relationships
The above story also illustrates to me another important point about neighbourhood working. In order to work meaningfully with communities you need to build relationships. This can take years and normally happens by repeated contact in a neighbourhood setting. As a general rule the statutory sector doesn’t have the ability to do this. They see people infrequently and for set, pre-arranged appointments. Often in the course of an interaction, for example pregnancy, you will see a whole host of different individuals making it harder to build trust and knowledge. One of the frequent complaints by patients and service users is how many times they have to tell their story. However, organisations like St George’s and other neighbourhood assets are there every day and can generally be accessed on a drop- in basis, whenever that person wants or need some social interaction. Stories don’t have to be repeated in that context.
I think of the example of another community organisation in Wakefield – the St Swithun’s Centre who run a community café. Joyce is a 94 year old local resident who comes for her lunch every day and has done for nine years. Not only are they assured that she has a decent meal, they also monitor her wellbeing and, should she not arrive for lunch, find out why. If the café is closed for the holidays they provide frozen home cooked meals for every day that they are not open. That kind of continuity of relationship, cemented by mutual benefit, is hard to replicate in other settings. By working in neighbourhoods with neighbourhood assets, the statutory sector can harness all of that good will, established relationships, trust and knowledge like it did in response to the tragic events described above. This is invaluable if we wish to be effective and genuinely reach the populations that we serve.
Changing the default
Given that the case for working in neighbourhoods is so persuasive why don’t the statutory sector look first to the “power of community” as their default? Why do commissioning processes often make it harder for small organisations to apply to deliver contracts and why is there often so little dialogue between statutory sector commissioners and voluntary sector organisations?
I think there are a number of reasons for this
Firstly, there is still a real lack of knowledge and understanding about what the voluntary sector is and what they can offer. There are ways to address this. In Wakefield we ensure that we have VCS organisations represented on all of our health and social care boards. This has fostered dialogue and understanding and resulted in significant resource being moved into the sector particularly through our integrated community teams.
In Wigan, as part of the “Wigan Deal”, statutory partners are offered minibus tours through their local neighbourhoods – stopping off at community organisations to get to know their work.
A second challenge is that statutory sector commissioners are often commissioning services over very large footprints – a whole city or an entire district. It is easier just to do that in one block rather than a number of smaller lots. The pressure then falls to neighbourhood organisations to create coalitions and bid together. Given the reduced resources in the statutory sector, there is less capacity for creative approaches and often tight deadlines to get services re-procured.
To change this commissioners need to be able to embrace more creative ways of working and be persuaded that the extra effort required to facilitate neighbourhood contracts will make a big difference to the success of the contract. This requires leadership to be advocating for the value of a neighbourhood approach and encouraging staff to commission differently. Policy changes like embedding scored social value into all procurement processes also help create system change.
Good neighbourhoods, good lives
Sometimes it can be very frustrating working in public health and caring passionately about giving people a “good life”, when so many of the fiscal, legislative and socio-economic levers that would make a difference are outside of your control. I can’t stem the rise in single-person households, reverse benefits changes or introduce legislation to create more green space. However, one thing that I can do – in partnership with local residents, councillors, the third sector, planning colleagues, the NHS, housing and so many more – is work to create vibrant neighbourhoods. Neighbourhoods with physical assets like beautiful parks, community art, libraries, community buildings and park benches. Neighbourhoods with social assets like volunteering, community organisations, sports clubs, knit and natter groups and festivals.
We’re really starting to see the benefits here in Wakefield of putting neighbourhoods at the heart of our approach. It’s not always easy and often it means going against the grain of deeply embedded cultures and systems. But it’s the collective shift we as councils need to make to overcome the huge long-term challenges we face – and help people have good lives.