The SOLACE lead for community wellbeing and Chief Executive of Ealing Council, Paul Najsarek, set the scene posing a series of questions about how we can create happy, flourishing communities.
Wellbeing is a very broad concept encompassing economic, social, environmental, cultural, spiritual, political, spatial and other elements. And a sense of belonging to a community and/or place is also important (as can be seen by the recent referendum in Catalonia, the Scottish referendum and the Brexit vote).
Paul highlighted the review by Professor Sir Michael Marmot (UCL) proposing evidence-based strategies for reducing health inequalities "Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England Post-2010" (“The Marmot Review”). It set out 6 key policy objectives, based around the social determinants of health:
- Give every child the best start in life.
- Enable all children, young people and adults to maximise their capabilities and have control over their lives.
- Create fair employment and good work for all.
- Ensure a healthy standard of living for all.
- Create and develop healthy and sustainable places and communities.
- Strengthen the role and impact of ill-health prevention.
All of the above would test the need for collaboration across range of public and community sector bodies if we are to deliver healthy, viable and sustainable communities. Part of the challenge is developing evidence-based policies and strategies to help decision-making, not just be based on price for the lowest common denominator, but building in the impact on the health and well-being of the population.
Steven Pleasant, Chief Executive of Tameside Council and Accountable Officer for Tameside CCG, then outlined some of the amazing progress being made in Greater Manchester, from the recent GM report on sexual intimacy between older people, to the real impact of the first 1000 days of a child's life being so formative of their destiny (irrespective of cognitive abilities) in those first few years. The programmes adopted over the last four years focusing on 0–5 year olds have resulted in a 20% increase in childrens' readiness for school, though still 12,000 children across GM are not 'school ready' when they attend.
Critical in the GM development was the Manchester Independent Economic Review undertaken in 2008 which recognised that most of the regeneration and transport schemes undertaken were not having any significant impact on the local population. Skills and worklessness were highlighted as an economic drag and there are still 236,000 of the population unemployed.
GM is now focussing on 10 priorities and 5 enablers with people at the heart of what is done and "communities in control". There are big questions about the health and well-being of the local population – not ageing well - with age 56 being the average age of people leaving the local economy and no longer being productive.
The health devolution deal signed on 25 February 2015 made GM "officially the most exciting place in the UK" according to the Guardian, with responsibility for the £6 billion health economy being devolved to the GM Combined Authority.
The forerunner to the STP in GM "Taking Charge of our Health and Social Care" sets out the fundamentally different approach across GM to Start Well, Live Well and Age Well. The plan also seeks to re-imagine health and social care for the future in "four bubbles and a sausage".
GM has benefited from £450M transformation funding and has supported the programme centrally by focusing on financial, workforce and information governance models amongst other things.
We then heard from Dan Jones, Director of Innovation and Change from the Centre for Ageing Better, who outlined their work in age friendly places and communities for promoting well-being in later life. As a charity the centre works for a society where everyone will enjoy a good later life, especially targeting those at risk of missing out. He talked us through these staggering facts:
- The population is ageing fast and by 2036 more than 25% of the population will be over 65. There are six areas of the country highlighted with poor life expectancy now, but this was likely to increase by 2036.
- Staggeringly 1.3 million homes are occupied by old people that are considered dangerous with serious and immediate risk to health or safety.
- 29% of people aged 50–64 are not working compared to 16% of 25–49 year olds. Yet the over 50s are more wealthy, and they spend over half of the household expenditure in the UK of around £320 billion.
Some of the programmes that Ageing Better are involved in revolve around supporting people to play active roles in their communities and also focus on issues around the built-environment (including transport, housing and outdoor spaces) and the social environment including respect and social inclusion as well as civic participation and employment.
Project examples included:
- Age friendly transport in Leeds being redesigned;
- Age friendly employment in Greater Manchester (46% people aged 50–64 in GM are out of work or low-paid); and,
- 'Take a seat in Nottingham' with 300 premises in 28 neighbourhoods signed up to engage older residents with local businesses, media etc and allowing older people to take a break whilst going about their business in their localities.
Attendees were encouraged to join the UK network and collaborate with ageing better by contacting Jessica.Entwistle@ageing-better.org.uk
As partner at Bevan Brittan, I then informed the room about some of the governance challenges arising from partnership working, particularly social care and health integration. I explored a number of ways of working together at different levels including:
- Strategically through the health and well being board;
- Jointly through section 75 arrangements, including the BCF;
- Parallel or concurrent decision-making with everyone in the same room;
- Delegation arrangements;
- Joint staffing arrangements under section 113 Local Government Act 1972; and,
- A range of alternative vehicles, including housing companies, children's trusts and social investment bonds.
I outlined the statutory duty for local authorities and CCG's to have regard to the joint strategic needs assessment and the health and well-being strategy when exercising any of their functions - not just the obvious ones. The need to manage risk and the inability to delegate ultimate responsibility and accountability for a function also need to be addressed in the arrangements.
I stressed the opportunities offered by the Public Services (Social Value) Act 2012 duty to consider at the strategic commissioning stage how what may be sourced can contribute towards the economic, social and environmental well-being of the area and then how that social value is secured through any procurement. Some organisations are allocating up to 20% of the marks on a procurement to social value and then go on to monitor contractors to ensure that social value promised is delivered. Support is available from the Social Value Portal.
‘Fantastic event , inspiring speakers an invaluable opportunity so thank you’
Head of Service, Borough Council
‘Fabulous speakers and lots of really valuable information’
Director of Communities, London Borough