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Social Services North West and ADSS North West Joint Conference
SOCIAL CARE AND THE NHS PLAN
equal partnership in serving people and communities
Thursday 18 January 2001
INVESTING FOR BETTER HEALTH
Kath Reade, Chair of East Lancashire Health Authority
and a member of the North West Development Agency
I want to speak to you in the context of the North West region and multi-agency, multi-sector partnerships, for that is the context we have to operate in if we want to make a real difference. There is now a North West strategy which pledges to increase our wealth creation, attract investment, and upskill our workforce so that we are a more competitive region. The main regional agencies and sectors are the North West Development Agency, charged with doing the above, Government Office North West, which is the civil service, the NHS, the North West Regional Assembly, which is an assembly of local authorities with some private and voluntary sector membership, and could be, in the future, the embryo of regional government.
The days of doing our own thing in isolation are well and truly numbered. We are in a snowstorm of initiatives,
targets, and deadlines. If you are not confused, you are not well-informed!
The North West strategy, while emphasizing economic development, pledges to integrate three cross-cutting issues
into everything we do. They are social inclusion, health, and sustainable development. The north west region has
endorsed the World Health Organisation 'investment for health' approach known as ' The Verona Challenge'. It sees
a triangular interdependent relationship between economic, social and health development. This concept is far beyond
the boundaries of the NHS, in seeing that an investment in good health is not a cost, but an essential goal of
development. Healthy people are more productive, make fewer demands upon the health and social care systems, and
have more opportunities to participate in social, and economic life.
We must therefore raise our eyes and look beyond the boundaries of our own particular agency or sector when we realise that every policy decision has an impact on the health of the population. An investment in better housing or education, or a better environment, or improved employment prospects is also an investment for health.
So the challenge for the health and social care system is ;
- to recognise that health is determined largely by policies and actions taken outside of the health and care sector, and advocate that health should be a fundamental consideration in policy development undertaken by all sectors and organisations
- to coordinate and support the efforts of other agencies to improve the health of the population.
- To contribute as full partners to local, regional, and national development and regeneration programmes.
- To strengthen the research and evidence base on the determinants of health to support policy development and implementation.
- To reorient health services so as to place much greater emphasis on sustainable economic development, health promotion, and community health action.
-To ensure there are integrated local and regional investment plans which address economic, social, environmental, and health improvement.
-To engage the population in decisions about health and well-being, respecting cultural differences of minority social and ethnic groups.
While we might see the sense of all this, we know it is a huge challenge to the cultures of our organisations, and the bureaucratic inertia which seems to be able to frustrate us in making joined up action a reality. It is sometimes more a question of the three 'P's ; Partnership, Power-struggles, and Paranoia ! Already we see that after eighteen months of close partnership working on the North West Health Partnership between these agencies, the Regional Modernisation Board has been set up without including the NWDA for example,and it is a constant battle to join things up beyond the rhetoric.
I think one of the core principles of the NHS as expounded recently is a good machete with which to cut through the foliage; It is that the health and social care system must be shaped around the needs of the patient or client, and not the other way round. It goes on to say the NHS will work in partnership with others to focus on prevention as well as treatment, and reduce health inequalities. I have to say parts of the NHS still find it difficult to take the blinkers off in this respect, while others are well into looking beyond the agency barriers.
As I pontificate on in this way I am reminded of a line from Shakespeare's 'The Merchant Of Venice':
" I can easier teach twenty what were good to be done, than to be one of the twenty to follow my own teaching."
I am trying to contribute however. As Chair of the North West Health Partnership, I have worked with others to
get some practical mechanisms adopted to integrate investment for health. We have launched Health Actioneer North
West, a health at work pledge scheme for employers, both public and private, to take positive health action for
their workforces. I encourage you to get your organiation to sign up to it. The website address is www.healthactioneer.com,
or telephone 0161 237 2044. We have also pioneered the health impact assessment toolkit in the North West Development
Agency. Liverpool University have developed this and we have are piloting it as a way of getting people who are
working in areas not usually associated with health to take into account the health benefits and disbenefits of
what they do. So someone involved in putting land and property deals together for example or building houses could
be looking at health.
This is what we need to do, to help others across the piece to also be making investments for health and well-being, and in my capacity as chair of the East Lancashire Health Authority and vice chair of the East Lancashire regeneration partnership I am working on piloting these practical mechanisms at the sub-regional level across agencies and sectors. A north west health investment plan is being prepared for consultation around the region to attempt to bring coherence to these activities.
In this work I do not lose sight of the realities at grass roots level and I think that is important. After
centuries of hard times, it is not easy to impress people in the north west with just talk and no substance. You
may have heard the true story of two old men in a working men's club in Wigan, having a pint and watching the comedian.
One says to the other;
"Well Fred, what dost think t'turn?"
The other one replies:
"Well he's alreet….if tha'like laughing."
I think it is important to keep plugged in to how it really is out there, if you are involved in policy and planning.
I have thirty years experience of working in deprived areas both as a social worker and an elected councillor.
I was a local authority social worker in Moss Side and Hulme in Manchester in the 1970s when it was a nightmare
concrete jungle. While I was there it had the highest rate of valium addiction and suicide in Europe. These rates
strangely dropped shortly after I left the area, I don't know why.
I was very naïve in those days, -armed only with a degree in sociology, I was pitched into 120 cases - children
at risk and in care, troubled teenagers, mentally and physically handicapped, mentally ill, and elderly people.
In those days of high fashion and several stones lighter, I was wearing a short shiny black mack and red velvet
flares, and I remember walking through the red light district earnestly clutching my social services files one
evening when I was stopped by a kerb crawler in a Mercedes. He offered me far more than Manchester social services
department were paying me but he just wasn't the kind of client a social worker has! That was the last time I wore
my shiny black mack to work.
The other coat I had at the time was a hippy embroidered goat-skin affair which, in the Manchester rain, smelled strongly of wet goat. I had to see a single mother of two small children who went on binges and left her children alone. As I climbed the five flights of concrete steps, lift broken as always, avoiding the discarded syringes and pools of urine common to the deck access block that has now, mercifully, been demolished, I came face to face with a pack of stray dogs that ran the walkways of the highrise flats. The smell of marakesh goat instantly inflamed their senses and they ran at me. I turned and ran for my life, totally losing my bottle. I jumped on a bus, oblivious as to its destination, and moments later stood dazed in the middle of Manchester, still clutching my file. But these were the more enjoyable experiences !
The sheer volume of human degradation, suffering and misery in those areas was crushing. The stress was so great that by Friday afternoon we, the social workers, were also cracking up. We would drink through the afternoon in a club that was a real den of iniquity. Builders labourers on their fifteenth pint, muggers in the toilets, old ladies out of their heads on sherry, and a stripper who had to put her own money in the juke box to strip by. All of human life was there. Thankfully Moss Side and Hulme have been transformed in many ways through a regeneration partnership involving the local residents and the public and private sectors, so I know we can make a difference.
In Burnley through the eighties and nineties as their councillor I worked alongside residents to get their concrete
jungle knocked down and to build houses with gardens that they could live in. For ten years we went through thick
and thin and I shall never forget them or their heroic sense of humour in adversity. The drug dealer who was the
only one who set up play activities for the young children in summer probably mainly to find something for his
own ten children to do.
Wayne the hardest lad in the area who worked alongside me to plant trees among the rows of terraced houses. I said:
"Wayne I'm a bit worried in case these trees get vandalised"
and he said, "They won't be", and they weren't. And black-eyed Sue expert in claiming benefits she wasn't
entitled to, always reliable in getting the whole area leafleted with community newsletters and organising fund-raising
jumble sales.
I will say that working alongside local people in some of the most deprived communities around I have met some of the strongest characters in my life, battling against the odds, and , surrounded by dereliction, crime and chaos, we have had some of our worst times and our best times together, and for those people, I have nothing but respect.
The government's social exclusion unit states that worklessness, poverty, poor education and poor health equals
social exclusion, but whatever we call it, we should analyse the causes or we will never progress from crisis management
and fire-fighting, which is not, or should not, be a long term strategy.. In this respect I hope we do not forget
our radical inheritance in this country of challenging the status quo, challenging the causes of poverty, injustice
and inequality. These things are to do with the consequences of the economic and social relationships in our society.
Some people will never experience poverty and some people will find it impossible to avoid. Working class more
than middle class; women more than men; black more than white. One thing is sure, many of our people are dying
before their time, merely struggling to exist in areas and estates where the drug dealers and loan sharks hold
sway, and where life expectancy is significantly lower than in more prosperous areas. This is unacceptable. It
was illustrated graphically for me when, recently, while I was still a councillor in Burnley, I was at a school
in one of the towns' most disadvantaged areas. I asked a little child,
"What are you going to be when you grow up then?" He looked up at me and said, "Me? I ain't going
to be nothing." We've got to see that this child can at least have a dream.
I would like to finish by quoting from a book called "The Ragged-trousered Philanthropists" written in 1914 by Robert Tressell:
Owen: "If it were proposed to make a law that all working men and women were to be put to death in middle age we would have an uproar of protest. Yet we submit tamely to having lives shortened by poor health, overwork, lack of proper food and housing,and poor education."
Easton: "I don't see how we're going to alter things."
Owen: " Do you think the affairs of the world are like the wind and the weather- altogether beyond our control?
Everyone who is not helping to bring about a better state of affairs for the future is helping to perpetuate the present misery and is therefore an enemy of his own children. There is no such thing as being neutral, we must either help or hinder."
Maybe life is more complex in 2001 than in 1914 when that was written but I believe the essentials are still the same, and when it comes right down to it, what you do even in a small way is what will make a difference. Progress consists of a thousand detailed acts. Good luck to you in your very important work, and if you have been, thanks for listening..
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