Partnership In Action – Experiences of Manchester, Salford and Trafford Health Action Zone

Edna Robinson – Health Action Zone Director

David Acton – Leader Trafford Borough Council

Manchester seminar Tuesday 6 March 2001

The following notes were taken from the presentations. Every attempt has been made to be accurate but no quotes should be made from this material without checking with the originators.

Edna Robinson

1. Do you want to be in my gang?

HAZs were a vision of Frank Dobson. They were set up across the country 3 and a half years ago. Manchester, Salford and Trafford did not have a good partnership. The health system felt that a HAZ might help with cohesion. They made a successful bid. There are now 22 HAZs across the country and they all vary. Ours covers 1 million people. Some cover as few as 120,000 people. All are very creative at looking at issues of inequalities. But all working in different ways which makes for a nightmare in the civil service mind. For Manchester, Salford and Trafford working in partnership has had huge benefits as well as challenges. There has been a great deal of energy and commitment to tackling inequalities.

2. What is our core business?

2.1 Policy

Encouraging use of targeted resources.

– campaign for changes in legislation that encourage poverty trap eg Benefits Agency, NHS Prescribing

2.2 Service Design

Modernising services in areas of highest health need.

Four development sites:

  • walk in centres
  • primary physician schemes
  • pharmacists evaluation
  • nurse led services

2.3 Organisational Development

  • training and awareness eg Local Authority scrutinising role
  • fellowships
  • dowries for change
  • secondments

2.4 Community Development

  • social entrepreneurs club
  • millenium awards
  • healthy living centres
  • Let’s Get Serious

3. What have we done?

  • developed a meaningful dialogue about poverty, inequality, poor service standards across 5 different organisations
  • invested in new ways of providing solutions to long term problems eg teenage pregnancy, socially excluded young men
  • driving modernisation of the NHS for the people most in need of it eg cardiac services
  • made the NHS more understandable and accessible to local government

4. What are the ongoing challenges?

  • Health Action Zone funding is slowly disappearing into other institutions that may not prioritise inequalities
  • service design work and motivating people to take their life chances takes longer than 3 years
  • continuous reorganisation in the partner authorities means the Board may have little continuity
  • Health Action Zone has provided ‘space’ for thinking time and design – will statutory organisations be able to do the same?

What is important is that the work continues in some way.

David Acton

HAZs were established to look at how we look at health provision across the board. It challenges all of those involved. We have had to face up to the realities and self-reflect as organisations. The previous government had set up silos of organisations across the NHS. Frank Dobson’s idea was to try to break down these barriers. Initially the forces that were around wanted to replicate the bureaucracies that were around but this was resisted. If you combine your energies, you will be much more effective. Doing it is a different matter however than recognising this. If you are able to combine your actions then you have a real chance of providing better services that connect in a real way to the benefit of communities. We have to recognise that some of our services have been poor. There is also an issue with the government short term political priorities over such things as waiting lists.

We have developed huge local political support including that of the MPs. We have been through the phase of people being defensive about their organsiations. A good example is that we used to have four types of trees in Trafford – a Highway Tree, an Education Tree, a Parks Tree and a Housing Tree. Now we only have one tree so someone reporting a problem is responded to straight away. A good example of having to take action to tackle inequalities is that of Parkington where mortality is around 10 years worse than elsewhere and yet local people express great satisfaction with the health service. We can agree now that they are getting seriously shortchanged by services.

Questions/discussion

Q. What is the approach to tackling inequalities – do you set morbidity targets?

A. Strategies for tackling inequalities are very underdeveloped. We feel it is important to tackle both the public health agenda and modernise services. Interestingly the health service has been more defensive.

Q. You said you have been supporting the school for entrepreneurs. What did this mean?

A. The CHC in Salford were keen to set up a social entrepreneurs club. The people were chosen through a range of local networks. Interestingly they were all women. All had something they wanted to do in their local community. We gave them opportunities to go to conferences, meet others, paid a salary to do what they wanted to do. They are all in full time employment now. This released their potential. We were the catalyst. We now give millenium grants of up to £8k to individuals for good ideas. Seed corn funding.

Q. This recognises these people?

A. We almost gave up as it was so difficult. The millenium fund required us to have a client group. So we told them we didn’t want the money. Then they released it. We decided on a geographical basis of distribution.

Q. How did you communicate to these areas?

A. We used existing systems eg SRB, New deal etc so that we were not setting up a new bureaucracy for distribution of the cash.

Q. You also funded things like Working for Health in Wythenshaw.

Q. Central PCT have set up forums – what was your involvement?

A. We helped them set up a kind of governors arrangement in these forums; we also have helped a GP practice set up a board of governors for the practice; we are also looking at a community tendering and winning a contract to run a health centre.

Q. Is it possible for the usual statutory agencies to do the sort of things you describe?

A. It is what is right and a recognition that we have not always got it right in the past. There is lots of scope now that local authorities have to produce a community plan. The management of the media is the big issue we have to become more sophisticated about.

Q. How much has the culture changed with regard to councillors and their allowing you to go to communities not through them?

A. There is a big culture change but councillors have new roles to be leaders in communities instead of paper readers and committee sitters. Councils have frankly ignored communities in the past.

Q. How will you continue the good work?

A. There is still a great level of energy in the Board which includes Chief Executives, leaders and lead councillors. The policy issues will still be around. Inequalities resources will still be in the system. There will remain huge obligations to individuals. What will be hard is to keep the entrepreneurial spirit and environment.

What do you think?

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