Brighton and Hove Rocks THE REPORT This report provides an account of the information collected for "Brighton & Hove Rocks", an exercise in "community" involvement, to influence priorities within the new "Health Improvement Programme" (which we call a "HIMP") held at Hove Town Hall on 21st September 1999.

Back to Brighton and Hove Rocks

1.1 The Process - Who?

In June 1999, East Sussex Brighton & Hove Health Authority approached the new Brighton & Hove Voluntary Sector Forum for assistance in identifying a process, for consulting the "community", to identify and integrate their priorities, into a new local Health Improvement Programme.

The Forum is new and has yet to create a structural way to respond to the flood of invitations to participate in local consultation exercises. It was therefore decided that a team of voluntary & statutory organisations should work together, to maximise this new & exciting opportunity.

The team was led by the Scarman Trust & included development workers from the Coalition 4 Youth, Health Authority, Sussex Community Internet Project, Working Together Project & the Voluntary Sector Forum.

"Local community action has a key role to play in alleviating the democratic deficit, assisting in the regeneration of poorer areas, combating youth alienation, getting people back into work, preventing the use of drugs and many other such issues. Community level activity also has a key contribution to make in promoting social inclusion, particularly in relation to ethnic minorities. The growing movement arguing for a transfer of both money and property assets into the poorest areas will support the government’s emphasis on assisting areas of multiple deprivation" Community Development Foundation

As a team we are familiar with the wealth of research and consultations that have been undertaken by statutory agencies and the resulting frustration within local neighbourhoods & communities of interest, that such exercises are costly in terms of peoples time & are widely believed to be cosmetic.

The Health Authority has agreed to provide:

• Information updates
• Further opportunities for participation
• Details of decisions made
• A timetable for action.

Consulting the "Community"
This event was targeted at representatives from community groups & small voluntary organisations, from neighbourhoods & communities of interest, plus "users" of services provided by voluntary organisations.

We would like to thank all those who participated in Brighton & Hove Rocks for your valuable time, knowledge, experience, energies & enthusiasm.

Top

Quotes from "Developing the HIMP" "Over the last ten years the gap in health status between rich and poor has become wider and wider. To tackle the issue, the Government has launched a range of initiatives setting out a whole new approach to social regeneration and – especially- to tackling social exclusion." "A Health Improvement Programme is a co-ordinated programme to improve health and to reduce health inequalities." "There is a close relationship between social and economic factors and the health of the population. Diseases are, in part, manifestations of underlying causes. We need to understand this relationship so we can identify why some sections of the community suffer more ill health than others, work out what needs to be done and clarify those areas or issues where the NHS alone cannot bring about results. "To make an impact, we must therefore deal with the underlying causes, as well as making NHS treatment services more accessible and effective. Joint action is always more likely to achieve change than more piecemeal approaches."

Central Government has identified four national priorities to be included in the HIMP which are:

• Heart disease and stroke
• Cancer
• Accident
• Mental health

The other priorities are to be agreed locally.

Top

1.3 The Process ~ How?

Holding a centralised public meeting was initially our least preferred option to undertake a consultation, however until a strategic community development framework is in place to support local "infrastructure" for grassroots communities, we decided it was of primary importance that we developed a "model", which could be used in other areas & would work on a variety of different scales.

"Brighton & Hove Rocks" was designed to be:

• fun, useful, informative & creative.
• accessible to all who wished to get involved, through written surveys, the internet, workshops, video & legislative theatre.
• an open and wide ranging discussion, in plain language, with trained facilitators
• accessible for people who speak a range of community languages, through the provision of translated information & interpreters at the event

Top

2. A Strategic Framework

Across Brighton & Hove a number of key programmes are being created which seek to identify and integrate community priorities. It is vital that a structure is identified at the beginning of developing a HIMP to clarify the potential roles that the "community"can play.

This checklist of key points is drawn from the Community Development Foundation a national voluntary organisation.

Purpose or vision
Does the purpose or vision include the active involvement of the community?

Area/ Population Targeting & Beneficiaries

• Does the programme proposal concentrate on an appropriate geographical area and/or target population? Is the area and/or population clearly defined?
• Would the activity and funding proposed make a direct and substantial impact on that area and/or population?
• Would the benefits of the scheme enable the community to develop in a way which is self identified, including specific parts of it such as ethnic minorities, women, young people, people with disabilities, unemployed people?

Consultees/Representatives

• How are the beneficiaries of the programme & others with an interest, for example local businesses, voluntary organisations and community groups, including faith communities, involved in working it up?
• Will they be kept involved and informed of progress throughout the life of the initiative? Will they have a continuing say in how money is spent?
• Does the scheme show how consultation will be extended during the programme period to reach new groups and sections of the population?

Sources of community activity

• Does the programme build on an informed profile of the local community & voluntary sector?
• Does it ensure support for community activity to flourish?
• Does it support a wide range of community groups as well as voluntary organisations?

Programme deliverers

• Does the programme allocate delivery roles to community & voluntary organisations wherever feasible?
• Would it strengthen community & voluntary organisations over time to take on increased delivery roles?
• Does it give key roles to community social, economic & environmental initiatives?

Long term partners

• Would the programme enable the development of structures in the community to continue work after it had ended?
• Would it help community groups and organisations to build up assets?
• Would it strengthen and sustain community participation in the long term?

Top

The participants were divided into 10 workshops with approximately 15 people in each. Participants were asked to brainstorm their ideas under three broad headings:

1. The social causes of ill health
   Community initiatives that would effect change either through "self help" or activities taking place within communities
2. Influencing change in policy
   In the afternoon participants had an opportunity to see all the ideas around community initiatives and policy change displayed on the walls. Each participant was given 10 sticky red dots and asked to place them by the ideas they felt were most important. The numbers after the community or policy suggestions represent the number of dots placed by that idea.
3. Identifying the social causes of ill health
   The purpose of the brainstorm was to help people focus and to hear the views of others in their workshop. Within a ten minute slot the workshops produced ideas that fill five sheets of A4 paper!

An analysis of the key words presents a diverse picture. In terms of the HIMP it will be essential to tackle these issues effectively by agencies working together across all sectors.

It is important to consider individuals and communities who experience one or more factors, causing multiple forms of deprivation.

Top

Comment	No.
Community development projects to combat social exclusion encourage ownership and responsibility, reduce isolation and support people, to provide free/cheap resources and information	23
Small local centres with access to services and information e.g. information point in Doctors surgery	16
More Community Transport Facilities	13
More localised community facilities - eg. leisure, theatre, etc, activities opportunities for social interaction - wheelchair accessible - everywhere!!	13
Advocacy and Befriending from within the community	10
Benefits which enable people to live decently within society	10
Friendship/Buddy schemes - supported by the council, especially for disabled young people to help them access mainstream activities	10
Healthy Living Centres - need to be accessible (in local vicinities), holistic with large range of services, in different communities for those communities and crossing over different health issues and communities	10
Residential place (a house) able to accommodate women, with or without children, escaping domestic violence, but who also have alcohol/drug addition(s) - respect, integrity, support, safety, etc	10
Zero Tolerance Campaign around all forms of discrimination - being more tolerant, less judgmental - eg. young single parents, age, etc	10
Celebratory events Community Festivals - increase participation	9
Communities already providing advocacy, but needs more co-ordination and resources (eg. paid worker) plus voluntary resources already there	9
Detox Centre which is residential well serviced	9
Parenting skills in schools	9
Places to meet - Access - with childcare	9
Food co-ops : nutritional foods at affordable prices	8
Foster sense of citizenship from an early age	8
Training communities in community development with key members, raising self esteem, confidence - community-led training, trainers drawn from local community - peer-led training	9
"LETS" scheme - more localised exchange of skills to support needs/wants/desires of others - ways in which people can easily do this	7
Credit Unions / Community Banking	6
Health Outreach Workers	6
Housing support services to help people maintain tenancies and good maintenance services Respiratory disease - damp housing - reduce costs for heating homes or give more money for this	6
More services for older teenagers/young adults	6
More Youth Clubs / After School Clubs	6
Building on existing good practice and recognising importance of community leaders through mentoring, befriending etc. Voluntary schemes with more funding	5
Community homes and flats for those who need it - older people, disabled, mental health, young people, etc	5
Community safety initiatives - reducing abuse (physical/verbal) - eg. educational approaches to change attitudes in schools, and communities and organisations - gay and lesbian community – race	5
Early intervention and preventative measures need to be incorporated into all community initiatives	5
Outreach which goes into people’s homes - using alternative therapies as a way in to addressing other issues	5
Overnight provision for homeless people	5
People within community with disabilities "visiting" others. Peer support, mutual, flexible	5
Broad health education for young people / parents - eg. food, budgeting, childcare	4
Food Projects (Growing) – Allotments	4
Holistic Approach incl. western medical, complementary and other approaches	4
Learning relaxation and meditation in schools : how to be healthy : emphasis on preventative medicine	4
Ask people how an organisation is run (not just Government/State provision bad at this but also voluntary organisations)- Users Determine	3
Communities to organise events such as these to say what they want - need help from community development workers to organise	3
Community clinics/centres where people can seek help but not stigmatising like family centres - combining community care, health centre and social services	3
Cookery lessons - simple recipes - near people’s homes - eg. Get Cooking	3
Free/cheap gyms and health studios	3
Full time and paid community development workers	3
Health professionals need training in how to work with and provide relevant services to different client groups	3
Healthy Living Centres led by communities sort of idea. Opportunities to talk and feed back which would be local and formal	3
Improved and affordable (free) transport : geographical boundaries should be broken down	3
Mental Health - lack of services for young people - preventative services	3
Parenting Skills and understanding relationships - supported by Social Services (children and families) - Also At School	3
Sense of community, responsibility, respect, more neighbourhood orientated	3

All 2 comments

All 1 comment

Comment	No.
Recognition of the value of complementary therapies. Alternative complementary medicine accessible through NHS - not private	65
Ongoing involvement for us in the policy making with reasonable timeframe, listen and respond to local voices/needs from all sections. Community demanding accountability from the powers that be	26
Revolutionise concept of health, from illness, visiting the doctor to holistic promotion of positive health, mind, body connection. Treating the whole person – person centred. NHS needs to shift focus from disease to prevention - this is structural	25
Build up trust in the community - one way is continuity of workers and funding, More long term funding for projects and not always funding for new projects otherwise what happens to successful projects after 3 years?	23
Training of People - front-line services, receptionists, policy makers, GP’s, social workers, interpersonal & cultural skills, person-centred approach to eradicate preconceptions, travellers, young people	22
More needs let support to families with disability - family focus	17
Better understanding of Dyslexia/ADHD - 1 in 30 children - Improved Services and Change of Attitudes Needed	10
GP referrals to wide range of ‘generic’ services - eg. gyms, alternative therapies, holistic/medical. Do this in other places (Chichester)	10
Low priority given to maintenance services - eg. speech, OT, physio, dietician	9
Equal Opportunities with teeth!!	8
Higher priority given to counselling - support around relationships and mental health (low cost) and integrated into other services	8
Women’s needs of different ethnic minority groups, Some women working long hours	8
CAMHS - need to start delivering services people want - lack of partnership working - do not consult - need team working - not in isolation	7
Hospitals provision of culturally appropriate meals	7
Provide practical support to communities - buildings, skills, other resources	7
User participation / forums with residents / community of interest / including for Young People	7
Advocacy schemes supported by policy to enable ethnic minority people to access services	6
Concessions for carers or free (eg. Eastbourne is 60p for disabled swim and carer free) - free parking	6
Learning Disabilities - more services needed after leaving school - gap - appropriate help needed	6
B&H underwrite mortgages to allow families (with a disabled child or relative) to move into more social housing (and not be trapped in inappropriate accommodation) especially built for disabled people	5
Better access to health care for socially excluded	5
Health Minister should have to live on streets for a month	5
Increase funding for self help	5
Leisure and fitness made more accessible by not contracting out these services to profit makers - or various concessions to disadvantaged groups	5
Primary Care Groups formally asked to look at combination of complementary therapies - especially areas doctors can’t deal with e.g. anxiety/depression/asthma/eczema/self-injury	5
Personal Social Education - curriculum to include emotional health issues - bringing in voluntary sectors	5
Co-operation between statutory bodies to prevent the criminalisation of certain kinds of behaviour in the community	4
Legislate for recycling - Government responsibility - should be free service	4
Access to contraception in schools mandatory as part of curriculum - presented correctly	3
Awareness of mental health, education - training issue not just for users	3
Build on local GP surgeries with community development workers - mini healthy living centre - more holistic service	3
Co-ordinating funding applications and needs analysis Help for communities to get funding More pressure on business to fund and review of match funding requirements	3
For Benefits Agency to value volunteer work - to allow people to carry on with valuable voluntary work and not have to go to Job Club etc	3
Getting Fit - cheap non-exclusive accessible leisure centres with crèche facilities	3
Holistic Health Care - assessment for people as individuals	3
Integrating work with communities of interest into geographical communities	3
Look at Administration of Anti-Depressants to pregnant women - related to birth defects	3
Look at the culture of Prescribing Drugs … … Do People Need Drugs!! - maybe time, listening, attention is also necessary (are all prescribed drugs used)	3
More accessible shopping areas re. people with disabilities, elderly, parents with children	3
More Advocates	3
More Parenting Skills	3
Provide Helplines	3
Refurbishing derelict properties Government Council Speed up and expand existing service	3
Schools open up facilities to the wider community - there could be a community liaison worker	3
Transport - cheaper and more accessible	3
Addiction is a health issue - not a moral or criminal issue

  All 2 comments

All 1 comment

Top

All 2 comments

All 1 comment

Top

Within the community involvement for the HIMP, we were presented with a unique opportunity to conduct an experiment in consultation through ‘legislative theatre’. This is an innovative, accessible method of exploring an issue in an enjoyable and challenging way.

This part of the report documents the methodology, the suggestions for change prompted by the play ‘Staying Alive’ and people’s responses and experience of this experiment in legislative theatre in this context.

Top

Augusto Boal was an elected Councillor for Rio de Janeiro in Brazil. He invented legislative theatre, through his work with people at the grassroots from various communities of interest and geographic communities all over Rio. He enabled them to devise plays about issues that concerned them. Each community showed the play they created to their own community, as well as touring it to other communities, to exchange perspectives and different experiences. A team of people then collated the results of these and the information became drafted laws that went to Rio’s legislative chamber. Thirteen new laws were passed during Boal’s term in office using this way of working.

In Brighton and Hove the situation was rather different and the methodology required some radical re-thinking and compromises. There was only 3 months available over the summer between the Health Authority contacting us and the Government’s deadline for the Health Improvement Programme to be written. Ideally we would have liked to work with a range of geographic communities and communities of interest, enabling each to create their own piece of theatre to explore issues of relevance to them. However, reality meant a compromise had to be made and we chose to create one play with a group of people from various grassroots communities in Brighton and Hove. It is extremely important that the play or ‘model’ accurately reflects the reality of the group’s experiences as the issues it raises are used as the stimulus for discussion with the wider community. We chose to focus on one character experiencing social exclusion, in the hope that this would resonate with various communities across the city.

The other difference in methodology was through the audience interaction with the ‘model’. In Boal’s legislative theatre the play is shown to the audience once and then the audience are asked to stop the action and replace the central character to try other ways of behaving to solve the problem. The emphasis is firstly on the individual’s responsibility and their possible behavioural choices, secondly on what could be changed in society through legislation to improve that person’s life.

The creation of a HIMP involves a shift away from a culture of emphasis on individual’s lifestyles, to one where we as a society are being encouraged to look at how society impacts on our health in it’s holistic sense. Therefore it is more empowering in this context to ask people to think about community initiatives or policy change which would have a positive impact on the central character. We chose to alter the methodology for this event, asking people, ‘If you had the power, what would you change?’ People were asked to shout ‘Stop!’ and shout out their ideas before being given 30 seconds to write them down. Their inspirational ideas are recorded here.

Top

4.2 Hove Town Hall – 21^st September 1999

The legislative theatre at Hove Town Hall involved over 150 people from various community groups and voluntary organisations from across Brighton and Hove. What follows is a summary of each scene in the play, followed by interventions from the audience of what would improve Julie’s health and stop her from reaching crisis point at the end of the play. The suggestions are grouped together in themes.

Scene1 – Julie’s House
We see Julie preparing for her presentation at evening class, when her childcare for that evening falls through. While she is trying to sort out some alternative, she sends her daughter to the chip shop, as her brother didn’t take her to ASDA yesterday. She tries asking her daughter to baby-sit, but this ends with the daughter storming out after a row. Her brother turns up ready to give Julie a lift to the evening class to find her completely stressed. He insists she should still go and says he and his wife will look after the kids. His wife comes in and refuses to help. Julie asks them all to leave, completely overwhelmed by everything. Then the power goes; the credit on the key meter has run out – she’ll have to put it on emergency.

Support for the family

• Parenting skills training
• Peer support/networking between single parent families
• Home management skills training
• Assertiveness training / conflict resolution training
• Free counselling (family/couple/individual)
• Bring back ‘Family Aid’ workers in Social Services

Access to healthy food

• Community run food shops selling good quality fresh food and home made ready meals
• Advice and training on setting up community enterprises/co-ops e.g. food co-ops, home care, community shop
• Community transport of food and people
• Cooking on low income course
• Community run mobile delivery of low cost healthy food
• Supermarkets should provide free transport

Childcare

• Access to emergency childminding (24hour)
• Baby sitting circle
• Fund a self-supporting childcare community group
• Free crèche facilities provided with adult education
• LETS scheme

Smoking

• Stop smoking initiatives in school
• Proof of age scheme
• NHS to provide free, locally delivered stop smoking groups

Electricity Payment Methods

• Budget meters to charge the same amount for electricity as other payment methods
• Lower rate of electricity payments for those on benefits (use profits to subsidize)

Scene 2 – The Park
Julie’s in the park with her son who’s off school with asthma. Her friend ‘Shell’ comes along and they discuss the state of the park. Her son comes running in with a beer can he’s found from the night before. They argue about where the kids are supposed to go at night. Julie wishes she could afford to get her son down to the new basketball pitch on the seafront when he comes running in having fallen over in dog’s mess!

Youth Work

• Structured activities in parks – must be well advertised
• Youth centres open every evening with support e.g. providing healthy meal cooked by young people
• Detached youth workers working with young people on the streets
• Decentralise facilities for young people – build equally high quality satellite facilities
• Create areas that young people want and enable them to take responsibility for it
• More funding for youth workers to co-ordinate a wide range of initiatives locally
• Play work opportunities for children in safe space in park

Transport

• Cheaper buses for people living on periphery estates
• Free bus passes for unemployed
• Transport policy re-think with education, health and social services, integrated transport policy
• Make centre of town a car free zone
• Improved community transport schemes

Public Spaces

• Free meeting places for different age groups – café and local community enterprises
• Management of parks shared responsibility between local community and local authority
• Re-introduce park keepers in parks – recruited from local community, men and women, not there to ‘police’ the park – more a developmental role
• Supported work schemes for people with mental health needs or disabilities can contribute to the local area - make it a healthy living centre
• Enforcement of fines for dog excretion
• Dog free areas in children’s parks
• Council planning dept should stop creating residential areas without high quality facilities
• Drop kerbs to ensure accessibility for people with buggies or in wheelchairs
• Green gym – conservation activities locally

Local Employment Opportunities

• Locally delivered training and advice for getting back to work
• Creation and support into jobs locally through community enterprises e.g. gardening, plumbing

Scene 3 – The Exercise Class
Julie arrives late to an exercise class. The instructor doesn’t notice her late arrival or her problems with some of the exercises. At the end of the class Julie asks about the pain she’s experienced in her legs and the instructor fobs her off saying she should exercise more regularly. She leaves with 2 mates lighting a cigarette on their way to the pub.

Qualified Instructors

• Train instructors in issues affecting people with illness or disabilities or speakers of other languages
• Communication/assertiveness training

Opportunities for Exercise

• Affordable choices for exercise run by well-trained instructors
• Free exercise classes
• Free leisure centre access for unemployed

Lifestyle Issues

• Alternatives to pubs locally for socialising
• Free stop smoking support groups locally

Scene 4 – The Post Office
Julie is in the post office queuing for her new benefit book. She bumps into Shell again and they talk about how Sam’s asthma is worse because the house is so damp and she can’t afford to dry her washing at the launderette, so she hangs it over the radiators. Then she bumps into an elderly neighbour who is in a lot of pain with her hip, she feels guilty and promises to go round and do her housework. When she gets to the counter her book has not arrived and she is told to go to the DSS despite the fact that she has no way of getting there and 2 kids in tow. She leaves on the verge of tears, frustrated and humiliated.

Post Office

• Training for front line staff in reality of some people’s lives and training in what other support is available for people
• Wheelchair/ buggy access to all public buildings
• More information in accessible places about statutory and voluntary services available locally
• Hotline to benefits agency from all PO

Housing Issues

• Agreed and well known time scales for council to act on to problems in housing
• Housing with ecological heating
• Housing department moving away from crisis management
• People living on estates employed to improve housing on estate
• Environmentally sound housing strategy
• Private landlords receiving housing benefit maintain properties to decent standard
• Launderette Facilities
• Community launderette – also meeting space – community café

Benefits

• Emergency fund available if benefits book not at PO
• Have a member of Benefits Agency staff at PO
• Higher rate of benefits – less red tape – increase amount can earn while claiming
• Departments should communicate better to make benefits more accessible

Scene 5 – The Doctor’s
Julie arrives at the doctor’s surgery with her son. The receptionist is rude and unhelpful, asking people to describe their symptoms in earshot of the rest of the waiting room. The doctor sorts out her son’s asthma and then reluctantly listens to Julie’s own health concerns. She comes to the conclusion that anti-depressants would be the best thing for Julie and prescribes her a 3-month course.

At the end of the play we see Julie alone again in her house. She reads aloud the list of side effects, which sound so similar to her current problems, she resigns herself to taking the first pill and starts crying.

Doctor’s Surgery

• GP surgeries becoming good health centres, accessible, holistic, self-help packs, internet access, information on other opportunities in community available there or even running from there
• Referrals to alternative healthcare / complimentary therapy available on NHS
• Training for receptionists in how to deal with people sensitively
• Free counselling
• Utilise skills of other staff e.g. practice nurses more
• Less emphasis on prescribing drugs

The GP

• Doctors focused on whole person not just ailment
• More doctors’ appointments available spread over different times of the day to accommodate people’s lifestyles
• Doctors to have more time available with patients
• Doctors trained in cultural awareness/counselling/listening/inter-personal skills
• Doctor to make more home visits

Services/Training to Make Surgeries more Accessible

• Assertiveness training in accessible settings using accessible methods
• Bi-lingual service available

  Top

The trial run at the Valley Social Centre in Whitehawk was organised in partnership with the New Deal for Communities Team to assist in their planning process for the Health, Families and Children Group.

The audience was made up of around 30 residents from Whitehawk and Moulsecoomb who had been invited by community workers and other residents who’d come into the bar and got involved as the evening progressed. There were also people who were acting as facilitators at Brighton and Hove Rocks who were there to see how it would work. The suggestions from this group of people are listed here.

Scene 1 – Julie’s House
Basics bank of food run by local people for local people; Local shops selling cheap healthy food; Free transport to supermarkets; Transport to and from the college; Delivery service from supermarket; Provide crèche at evening classes; Daytime classes with crèche; Community crèche / nursery; Provide vouchers to exchange for childcare locally; Local baby sitting circle with licensed helpers – backed up by training; Bartering or LETS scheme locally to help with childcare; Distance learning opportunities; Community education locally looking at assertiveness, health, parenting, food, smoking ; Parenting classes / Parent support offered locally; Anger management training; Negotiating skills training; Cooking skills classes for food on low income; Drop in centre – increase social opportunities; Cigarettes should be sold to over 18’s only; Proof of age scheme; Credit Union; Help / training / support with budgeting; Campaign to stop key meters being a more expensive way of paying for electricity than direct debit; Take utilities payments direct from benefits; Billing on a sliding scale according to ability to pay, end reduction for direct debit

Scene 3 – Exercise Class: (Scene 2 had not been developed when we performed at Whitehawk)
Assertiveness skills training; Community exercise e.g. a walking group to also give more social contact ; Community groups get equipment and training; Crèche available at exercise class; Don’t reinvent the wheel on smoking – find out what has worked elsewhere; Free /Reduced cost exercise available locally ; Free directory of where activities are available; Fully trained exercise instructors – who regulates this?; New people attending exercise classes should be interviewed; Local forums on health and welfare use cancer patients to make anti-smoking message real; Non-smoking areas in community buildings; Places to socialise other than pub e.g. community cafe; Training for local people on how to help each other stop smoking

Scene 4 – Post Office
Free play areas at Post office/ DSS/ Doctor’s surgery; Clear ways to report things to authorities with time scales for action; Job swap! Senior benefits officer/ Health Authority Officer/ Doctor – should live on benefits for a week – person on benefits chance to understand decision making structures that affect them; Lobby for less red tape around benefits; Free phone facility from PO to DSS; One stop benefits shop with outreach; Benefits agency on estate; Community laundry facility; PO Counter staff should be able to solve situation of no benefit book; PR training for front line staff

Scene 5 – The Doctor’s
Better links between doctors and other social services; Free counselling; Receptionists trained in TLC; Receptionists trained in customer care; Receptionists trained in public relations; Receptionists should be recruited from the local community so they have an understanding of the issues for that community; Mobile doctor – more TLC; Standards of behaviour for all doctors; Doctors trained in wider health issues; Employ more doctors and make better use of nurses e.g. on the phone so not describing symptoms to receptionist to make decision; Doctors to fully explain about medication; Doctors to be trained in social skills; Doctors to meet regularly with community

Top

The overall response to this method of involving people in shaping policy was that it was vibrant, engaging, different, energising and accessible. People who performed in ‘Staying Alive’ have subsequently reported being stopped in the street, at the school gates and being spoken to on the bus by people who saw one of the performances – people wanted to continue talking about the issues!

In terms of improvements that could be made, the general feeling was that this technique would be more effective if used with various geographic and communities of interest, each creating their own play about their own issues. The performance in Whitehawk produced a more emotional and instinctive reaction, which led to powerful, imaginative suggestions based on people identifying with the reality they watched.

There was feedback from people from communities of interest who felt that their experiences had not been represented in the play. It was felt that if the HIMP was really to involve people from a number of communities in Brighton and Hove, the process should be repeated with plays produced by a variety of communities.

Top

5. To conclude

The Health Improvement Programme should reflect the views that social causes of ill health, for individuals & communities include:

• Abuse & Discrimination in society
• A breakdown of social structures at a neighbourhood or community level
• A breakdown within families
• Access to healthy food
• A democratic deficit between users of services, communities & policy makers
• Homelessness & inadequate housing
• Isolation, Insecurity, Fear & Stress
• Lack of access to learning, education & development opportunities
• Lack of access to services & support
• Low paid employment & poor conditions
• Poverty
• Unemployment

Throughout the day a number of themes emerged. It is important that the HIMP reflects "community" perspectives & beliefs:

• That a common understanding of "health" should change from curing illness and visiting the doctor, to a more holistic preventative vision, that makes a connection between peoples physical & emotional health and wider social factors such as their income, housing & access to opportunities.
• To formally recognise and build on what already exists in terms of community activities & services.
• That the considerable interest & enthusiasm for access to complimentary therapies & medicines is responded to.
• That community development as a process was identified as a major tool for community led regeneration & therefore fundamental to the implementation of the HIMP
• That the HIMP includes ideas to make healthy lifestyles more "attractive" to ordinary people
• An analysis of the findings demonstrates that it will be essential to tackle issues effectively by agencies working together across all sectors.
• It is important to target individuals and communities who experience one or more factors, causing multiple forms of deprivation.

  Top