Peeling the Onion Learning, Tips and Tools from the Health Inequalities Scrutiny Programme
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Peeling the onion Learning, tips and tools from the Health Inequalities Scrutiny Programme ucation, in , ed co ng m si fr e, u ie li o nd fe h s s , e a t g t n y a d le in s im n n l , n e c c i a g l , o n h p h e b e r o s d l i u i o r h n s c , , , w c t r o e o m l l p - m s b u e d n n i i n t a y , e r g c u u t l , e n v i r t o n n e m The Centre for Public Scrutiny Health Inequalities Peeling the onion May 2011 Contents Foreword 4 Editors introduction 5 Section 1 Scrutiny and health inequalities The health inequalities challenge and scrutiny 1.1 Scrutiny and health inequalities - a public health perspective 1.4 A benchmark for effective scrutiny of health inequalities 1.7 Section 2 Key attributes Vision, leadership and drive 2.1 Community and stakeholder engagement 2.6 Partnership working 2.11 Local understanding 2.16 Being systematic 2.23 Monitoring and evaluation 2.29 Section 3 Scrutiny tools and techniques 60 Understanding health inequalities 3.1 Health scrutiny partnership protocol 3.4 Select committee top tips 3.12 Prioritising review topics 3.13 Mini-scrutiny review model(s) 3.19 Scrutiny and Appreciative Inquiry 3.25 Scrutiny and Open Space 3.27 Scrutiny and GPs 3.28 Section 4 Scrutiny Development Area case studies The case study gives an overview, the project journey gives further detail. Blackpool Minimum pricing of alcohol Case study 4.1 Project journey 5.1.. Cheshire Health inequalities in rural areas Case study 4.2 Project journey 5.3.. Chesterfield Geographical health inequalities Case study 4.3 Project journey 5.5.. Dorset Cardio-vascular disease Case study 4.4 Project journey 5.7.. London Housing, health and the environment Case study 4.5 Project journey 5.9.. North East Ex-service community review Case study 4.6 Project journey 5.24 Portsmouth Alcohol admissions to hospital Case study 4.7 Project journey 5.26 Sefton Geographical health inequalities Case study 4.8 Project journey 5.28 Staffordshire Mental health services Case study 4.9 Project journey 5.30 Warwickshire Ante and post natal services for teenage parents Case study 4.10 Project journey 5.33 Section 5 Appendices Project journeys 5.1-5.34 Links and references 5.35 2 CfPS Health Inequalities Peeling the onion - Contents The Centre for Public Scrutiny Health Inequalities Peeling the onion May 2011 The Centre for Public Scrutiny The Centre for Public Scrutiny promotes the value of scrutiny in modern and effective government, not only to hold executives to account but also to create a constructive dialogue between the public and its elected representatives to improve the quality of public services. In recognition of the value that scrutiny can bring, in 2009, the Centre received funding from the Healthy Communities Programme at Local Government Improvement and Development, via the Department of Health, to deliver a programme that examined in more detail the benefit that scrutiny can bring to tackling health inequalities. This publication is the learning so far from the programme, the views expressed in this publication are those of the contributors to this programme and not necessarily those of the Department of Health. Acknowledgements This publication has been introduced and edited by Su Turner, CfPS. We are very grateful to the following people for their assistance in creating this publication: Andrew Lawrence Brenda Cook Hugh Annett Judith Emanuel Maria Duggan Linda Phipps Mike Grady Sally Brearley Shaun Gordon Sheila Marsh We would like to thank Councillors and Officers from the 10 Scrutiny Development Areas, as without their hard work and commitment – this publication would not be possible. We would also like to thank members of the National Reference Group for their advice and guidance. CfPS is a registered charity: number 1136243. 3 CfPS Health Inequalities Peeling the onion - Acknowledgements The Centre for Public Scrutiny Health Inequalities Peeling the onion May 2011 Ministerial foreword Local authorities are crucial for the success of our proposals to tackle the many lifestyle and society-driven health problems we face, and reduce inequalities. We need councils to continue to provide strategic leadership for public health and to work in partnership with the new local NHS structures and across the public, private and voluntary sectors. Adopting the new role through Health & Well-being Boards as system leader to encourage coherent commissioning strategies, promoting the development of integrated and joined up commissioning plans across the NHS, social care, public health and other local partners. Our new approach will place local communities at the heart of public health. Local government will have the freedom, responsibility and funding to innovate and develop their own ways of improving public health in their area. There will be real financial incentives to reward progress on improving health and reducing health inequalities, and greater transparency so people can see the results they achieve. Local overview and scrutiny committees have a key role to play here. The Centre for Public Scrutiny (CfPS) recognises the expert role locally elected councillors have in helping public services to understand the issues that their communities face; and set out to demonstrate the active and vital role that ‘scrutiny’ can have in helping its partners understand issues so that gaps in inequalities can be narrowed. This CfPS publication is the product of two years work and includes the insight from 47 local councils in 10 Scrutiny Development Areas recruited from across the country to develop innovative solutions to long-standing problems. The scope of their work is very impressive, with innovation threaded through each review, as they have developed new or refined ways to use the scrutiny function. This publication highlights the key attributes that make reviews successful and includes learning and case studies to help other scrutiny committees to carry out similar reviews. I hope you will find this publication interesting and a source of ideas to inform the contribution of local overview and scrutiny to improving the health of people in your communities. Paul Burstow MP Minister of State for Care Services 4 CfPS Health Inequalities Peeling the onion - Ministerial foreword The Centre for Public Scrutiny Health Inequalities Peeling the onion May 2011 Editor’s introduction ‘Finding many layers - like peeling an onion’ This quote from a programme participant captures the complexity of understanding and tackling health inequalities. Scrutiny and health inequalities ‘Health inequalities’ is the generic term used to describe differences in the health and well- being of individuals and groups. A person’s well-being, how long they live and how well they are, is strongly influenced by where they live, and factors such as their social and economic background, income, employment and education. The link between health inequalities and the wider determinants of health can be better understood using the diagram below. It shows the widening circles of influence on people’s health. Of course these circles are not independent of each other, for example levels of income have a strong effect on lifestyle, and people themselves influence the circles by the choices they make. Local Government has a significant role in improving health; the services that are provided by local authorities can affect a persons’ health. Scrutiny provides a platform for members, officers, the community and professionals to come together to focus on and unpick the complexities of health inequalities. inants of heal erm th a et nd l d w ia e c ll so -b e e h in T g s t g r a n i t e k r g a i c p - h r a o c u t l r s s o e a i e c s c n i i r a n t d v g l l i d n n g e a i e s g o f o s c b r v c n s e u e g y i e c a r i a n h m d l l n i d r d c e u y m a i s o m t n a a l l i n h w e n b g i n e p r n e e o e r d s o r c a s c t q i d m o i r o u s o u j i i n t p o o e n l b n v a age, sex a g o b h s t u l e l o r r n i s s c r e t i n o i hereditary factors u y t k v a r p l e l r o e e r e o m f c a y e i k b i d s o b t r a e p a o r h l u s m a s n a n p g r t c a i v e r m i o m d V i t e r o o m s c T v o i n n r s p r e i n c C i s m s o e n n i m e i m c o s t C s i g i t i t f n r o e s n r t e f n b i e a b u s n s l m o p e t t u u o g p o a a l t e n s r s c r l s e s h p o p r i k h e o s d t t s c i s a c y s e r r t a , s v o i n t a a a n i v c s i m a y l c l P a v r e t e s i a h e m s r t l e m s e b s s t g c p g u r u a n e v p n s r h h n i s l o a t r c e s s e e e i e g e a c n ig t s n e e r a g y i m n ic i t i h l e c s p i s n s e t sh n o s s g w h n e e ce l y o t e f s n lt li e u z e t er v b h n t o a a a r r ed housing e p a r n y n a es d n e r s d t t a t s d io y ity n s i m s o m s n ou n e l tr t l o a th mu o s o e a p a f gro om m o ll r n e tr ups c op h e g e a ty ad el c d a n p n g in ev s e a a s e a g s c d d P s h n p m d tand omi de c e a e ul ards econ n es rm ls c n t c te t a te e t om ex u f a s s m ls ro ty w c pe unity schoo le n lim a o ed learning cyc u c st ns li co e er mit ces ol H d va s st y spa nt tr isp tio reet lighting pla me n e o o n a op co c w sa rea vel nt l s b le de e n rec iodive tainab pm l yc rsity sus elo e o ling dev r c hom and fe al e insulation planning if go a d ver ke nment can ma Ref Campbell, F.