My name is Nicola Sewell and I'm Health Improvement Lead for The Borders
Healthy Living Network and I'm delighted to have been invited here today
to share Healthy Living Network's experience of working with people and
communities or, in other words, to illustrate 'Assets in Action'.
At first sight, The Borders appears to be quite a picturesque region
with breathtaking views traditionally seen as a nice place to retire to.
On the surface, it would appear to be a prosperous place until
you dig a little deeper. Poverty in The Borders is hidden and it is
dispersed with pockets of deprivation in areas that do not score highly
on the traditional deprivation index. There is a strong culture of
being proud against a backdrop of a rurality and its associated
higher costs of living. Thirteen percent of children live in
benefit dependent households. To give you an example, one town in
The Borders ranges from 0 to 44% demonstrating the significant inequalities
gap within the same community. Recent local work estimates a £9m loss in
income through the welfare benefit reforms. This will have a significant impact
on The Borders economy in addition to its children and families.
Work to offset this negative impact includes prioritising youth employment and
renewing the tackling poverty and financial inclusion strategy.
Work around the Early Years Strategy to break cycles of poverty and
disadvantage and locality based work in communities makes an important
contribution to the bigger picture. Our healthy living network was established
in 2003 with 4 years funding from the Big Lottery fund.
The project's main aim was to address health inequalities by establishing
and developing a network of community based health improvement programmes
in the five regeneration areas of the Scottish Borders: Burnfoot, Eyemouth, Langlee, Selkirk and Walkerburn.
We use a community development approach which, as you know, involves
starting from where the community is at, identifying what the health
improvement priorities are in each area through consultation and building
health programmes that meet identified need. We work in partnership in order
to maximise our resources and opportunities. We developed a network of
opportunities located outwith traditional health settings in comfortable
environments that the community could relate to. The HLN staff team worked
hard to build a reputation to create a diverse programme in each area
ranging from weaning for parents and babies, physical activity and food
and health opportunities for young people, through to lunch clubs and
gentle exercise for older people. At the end of the Big Lottery funding
period the HLN approach was highly valued by the partner
agencies that had driven it forward and mainstream funding was
allocated through NHS Borders. Post-Big Lottery days we have a
small staff team and all staff are part-time. The main aims of Healthy
Living Network, at their simplest, are to reduce health inequalities
and to increase community capacity for health improvement.
So how do we do this? We work with established groups in the wider
community to identify health priorities. We take part in joint planning at
an operational level with health, education, social work, community learning
and development in other local agencies. We also participate in relevant local
meetings and use that opportunity to influence or bring a health
improvement element to their meetings. We have developed core health
improvement programmes over the five areas and although they're different
in their delivery and their activity, they do relate to the same themes.
We use a holistic approach but in order to fit in with our departmental
objectives, we have identified five key themes to which our work relates
and this includes food and health, physical activity, parenting, capacity
building and community development. Within these key themes we attempt
to work with the community to address poverty by focusing on, for example,
maximising income by budgeting in our food and health sessions,
offering energy advice and support through fuel efficiency workshops and
providing low-cost food and health provisions. Our current situation is that
we have a bottom-up approach with support from the top-down.
We have programmes that meet need and although referrals come through
agencies most participants engage voluntarily and word-of-mouth
is our strongest promoter. We've addressed some of the barriers
to participation in communities by providing childcare, offering free taster
sessions, listening to the times and locations that suit participants and
tailoring our programmes to meet needs. We have local people involved in
various ways in a decision making processes that affect the health
improvement programmes in HLN and some volunteers are trained in
participatory appraisal techniques to consult with their communities.
Our evaluations reflect, time and again, the learning experience for participants.
Participants report an increase in their knowledge, skills and confidence
alongside changes in their behaviour. They are able to discuss with
confidence the health issues that are important to them as well as the health
benefits of participating in programmes. Participants also report subjective
improvements in their physical and emotional well-being and our evaluations
are geared up to specifically capture this information. Central to this work is the development
of our community infrastructures and this varies from area to area
and has taken time to develop. I'm going to focus on food production
as this has taken up a significant amount of my working time
over the last few years. Food production has been a lasting
trend with more and more people seeing it as a way to save money at one
level and in another to protect our environment by reducing the food
miles associated with importing goods. There are undoubtedly health benefits
associated with growing your own produce and communities have embraced
the opportunity to do this. I work over two of the HLN localities
- Walkerburn and Selkirk - and have taken an active role in supporting
food production work to differing degrees over both areas.
I've worked in partnership on both occasions and, what I've discovered
is like all community programmes, the huge social element related
to working with food. In order to find out what the communities
needs were, we used participatory appraisal techniques to consult
with both communities and I'll go on to discuss these in more detail.
With reference to the assets approach I've called this slide
"Growing our own assets" because that's essentially what we've been doing
in HLN over the last eight years, through our programmes and community
health volunteering opportunities. While I can't say all of our work is assets
based, I can say that as a team we probably aspire to do this.
One example I can talk you through is the Walkerburn Community Growing Project.
When I started in Walkerburn, you could say, on the surface, it was asset
deprived until you got in there and realised that they were very rich in assets.
They were particularly limited in terms of their access to fruit and vegetables
and that was one of the first priorities that we set out tackling.
Over time we supported the village by working in partnership with the
Post Office, which was their only shop, offering fruiting groups and cooking
sessions and food and health programmes. We trained up volunteers and a new
partnership followed with Healthy Living Network, the community and social
work's Criminal Justice team. We recruited, trained and supported volunteers
to distribute vegetables grown by people on community service back
to the community to those who needed it most, for example those on
low incomes, older people and children and families.
We worked with community health volunteers as they sat closer to the people
who needed them most and we chose Walkerburn due to its size
and enthusiastic volunteer network. The first year was a pilot and in
the second year there was an expectation. By year three the volunteers
asked themselves why couldn't they develop something locally in Walkerburn.
We'd had a good experience and we could build on this.
We undertook some more participatory appraisal research and the enthusiasm for
food related work and solutions followed through. I got together with the Community
Development Trust who had a new work with the time and remit and they
took on a bid for £85,000 to the Climate Challenge Fund to develop an
allotment and a community garden. This was supported in the community 00:08:01.00 ,00:08:05.98 with a steering group of 25 local people. We approached the social housing 00:08:06.00 ,00:08:09.98 association who were keen to work with us and soon we had a 20-plot
site and community growing space. The Locherburn allotment garden
has been formed and we have a volunteer group who meet together to work
and plan for the community and the garden. We have just met to finalise a local
action plan for 2012 and this includes actions to address poverty through
establishing links with Job Centre Plus to offer places to unemployed people on
their horticulture training and community garden. The overall ethos of the garden
is based around an exchange system, exchanging labour for training, skills and produce.
The original idea is still ongoing as we distribute vegetables in year two.
Central to the success of this piece of work has been the development
of local leadership. The key point I'd like to make here is
that the land was always there in Walkerburn. It had been there for years.
It was the people, their enthusiasm and their commitment that brought it to life.
Bannerfield was a very different area for us. The food and health research 00:09:09.00 ,00:09:13.64 highlighted the same issues as the other communities but the community themselves
were not as engaged in the process. This was due to a variety of reasons
including the fact that our reach wasn't as significant and our
infrastructure was less established. Having actioned the food and
health interests of participants we got together with community learning
and development and hit the street to meet people and ask them what
their health needs were. Most people responded with an interest
in growing and gardening. And on turning up at the sessions
we asked them why and they told us they saw it as a way of saving money.
This work is developed with links to the allotment project in Bannerfield
but it hasn't really got the same strengths as Walkerburn and I think
that's due to the fact that the infrastructure is not as established.
Although Bannerfield successfully recruited participants, the results were not
immediate enough for the hard to reach group that we had engaged. 00:09:58.00 ,00:10:02.98 Had the infrastructure been developed the outcomes may have been significantly different.
Healthy Living Network's real strength is engaging people.
The communities are all different and therefore have different needs.
We pride ourselves in undertaking meaningful engagement with people in
order to build trust and follow through with what we say we will.
We have a range of diverse programmes that meet the needs and build
community capacity for health improvement with volunteers trained to
support breakfast clubs, lunch clubs, food in health work in schools and to
promote activities and engage participants. Opportunities for community health
volunteers vary in relation to levels of engagement including those
who might want to help in what they feel like a small way or
those who want to fulfill employability aspirations.
Through training, support and development we have a committed volunteer team
who promote our work and raise the consciousness of their communities.
Communities are consistently evolving and they appear to move
faster than ever which I suppose is in keeping with society at large.
Key to the process approach is the idea of time as it does take time to build
relationships and trust and often this presents a challenge particularly for us
in the NHS, alongside the qualitative nature of our evaluation information.
In the future, we would like to build on our success to date.
We would like to continue to grow our own assets for health improvement
which would involve strengthening our layer on the ground, the people.
We'd like to work creatively with our partners, in particular with voluntary
sector so we can combine our resources and meet demand in a way that
maximises our opportunities. We are engaging with the wider equalities
agenda through our work with people with learning disabilities and
with groups of women. We'd like to work with our department colleagues
in NHS Borders to create a meaningful programme of training that builds
community capacity to support one another through what will be difficult times.
We do however take a realistic view of the work we do and recognise that
this requires an ongoing commitment at all levels. Community development is part 00:11:57 .02,00:12:00.98 of the Scottish Borders community planning partnership priorities around
places and communities and Healthy Living Network features within this.
Thanks for listening!
Thank you very much Nicola. Sort of crammed a lot in there certainly.
Well done, that's like some kind of competition there.
Yes, but you did, you got a lot of interesting information over there,
certainly about the hidden poverty that you talked about first of all
and it was interesting that you brought in the whole issue of
welfare reform and the impact of that quite early in your presentation there.
Strong focus on partnership, of course, as you've talked about,
and then some examples of literally people growing their own assets,
which I thought was interesting. I thought the most interesting part for me
certainly was this issue of infrastructure which we've already touched on
about what can kind of capacity and infrastructure is already there and
what the results of that are likely to be.
And you finished off with the point about the way in which communities 00:12:58.00 ,00:13:01.98 evolve over time and the importance of time, I think again, as Iain had
talked about, in terms of working things through and allowing things
to evolve and develop rather than jumping from time to time.
Before we go back to discussion amongst our tables then,
Are there any particular comments or questions for Nicola here?
I seem to have corralled all the microphones up here perhaps
somebody could come and rescue me and take it round-about.
That would be great.
There's a question at the table right at the back there, thank you.
00:13:32.00 ,00:13:34.48 Hi, thanks, I enjoyed the presentation it's good.
(Nicola Sewell) Thanks.
I just wanted to ask you, in terms of the allotments and the community garden
that you mentioned are they income generating projects for you or are they
self-sustaining or do they have that potential? Is that one of your aims for those projects.
At the minute, they are, yes. We've got the allotment site
which has 20 allotments and these are let out to people that live locally in
Walkerburn and then the community garden is funded through the allotment rent.
We've got a really minimal lease on the land that we have through the
Social Housing Association and that's over a long period of time to
allow us the opportunity to develop it and think about generating
income in the future. The produce we obviously can't sell that but
that is distributed to people on low incomes and through schools and
the different community groups. But that is part of their vision in the long-term,
is to look at more innovative ways of doing that.
Thanks.
(chair person) Okay, thank you.
(chair person) And so the staff support there, Nicola,
(chair person) you refer to that as being a part-time crew now
There is, yes.
(chair person) being main-streamed from what was the Big Lottery Fund.
That's right and our input is probably quite minimal it's more of a
supportive role at the minute. The community have really taken it on.
They've developed the Walkerburn allotments society and the volunteers 00:14:48.00 ,00:14:50.98 that run the community garden and really our support is to link them
into other statutory services, for example the Job Centre Plus or
wherever else and support them to do...
(chair person) Good, okay. Question form Sarah there.
(audience question) You were talking about - coming back to the question on
(audience question) infrastructure - if the infrastructure isn't already
(audience question) there what are you lessons from Bannerfield
(audience question) in terms of how to create and sustain?
I think what I found in Bannerfield, it was quite... we almost rushed in because
we got so much enthusiasm when we'd gone out there and spoken to people
and I think what I discovered is that you do need those people on the ground,
the layer, the enthusiasm, the people that are going to go out there
and promote and engage others and to just... going back to Walkerburn
about 10 years ago, we did a mapping exercise and really got people to think
about well what was the gaps in the area, what did they want to do about it.
And I think that's been our long-term vision, what we've worked towards over
those years and in Bannerfield we almost tried to do it the other
way around so I think it really to get that infrastructure established
is the key to our success in Walkerburn. Does that answer the question?
(chair person) Question here, if you don't mind Nicola, it's a very
(chair person) obviously very popular presentation with lots of questions here.
(audience question) I really enjoyed the presentation as well.
Thanks
(audience question) I thought one of the things that struck me was when,
(audience question) I think it was in the Bannerfield, the second one,
and people said they wanted gardening sessions I thought it was great you'd
gone on and asked why because I think too often you can just take things
at face value but the underlying issue there is clearly poverty and to save money. 00:16:25.00 ,00:16:31.80 But what I was going to ask you was what is the impact of the work...
has that filtered out into NHS Borders wider health improvement teams or is it
something that's been taken up and recognised within your own organisation?'
(Nicola Sewell) Hugely, I think we're now looking at service redesign
(Nicola Sewell) within the Health Improvement team
(Nicola Sewell) and possibly work around a locality approach
through our health and living network areas and in addition to that
thinking about the wider impact. Walkerburn 10 years ago was an area of deprivation.
It was one of the five key areas for support and now that doesn't fall
into the area of deprivation anymore. So although we can't say it's because of
Healthy Living Network it certainly has been contributory factor,
I would assume, to changing that community status.
(chair person) Okay, well that's interesting, bringing a place
(chair person) based focus into the NHS support work.
Huge shift.
(chair person) Any other comments or questions
(chair person) for Nicola specifically at this point?
No, okay I think then what we should do now is we should thank you very much.