T a b l e o f c o n t e n t s

Community involvement...... Main Findings...... 2 49 Key findings...... About this project...... 3 50 Reccomendations/ further questions...... Our approach...... 4 51 Wider determinants of health...... Our respondents...... 5 59 Key findings...... What we have learned- the big picture...... 6 60 Reccomendations/ further questions...... Me and my local area...... 9 61 Can you support yourself financially?...... Key findings- general...... 10 62 Are you happy with your home/ where you live?...... Key findings- environment and safety...... 11 66 Do children get the best start in life?...... Reccomendations /further questions...... 12 70 Health and social care services...... Is your local area a good place to live?...... 14 75 Key findings...... Do you feel safe in your local area?...... 25 76 Reccomendations/ further questions...... Can you breathe clean air?...... 31 77 Focus on localities...... Health, happiness and well-being...... 34 80 Focus on inequalities...... Key findings- initial engagement...... 35 81 How Covid-19 changed things...... Key findings- Covid-19...... 36 82 Digital inclusion...... Recommendations/ further questions...... 37 91 Key findings...... Happiness and well-being...... 38 92 Reccomendations/ further questions...... Making healthy choices...... 42 93 Using NHS services online...... Focus on inequalities...... 45 94 Who is excluded?...... Focus on Covid-19...... 46 98 Main findings

Clean, safe outdoor spaces are extremely important to people’s health and wellbeing; both in parks and on housing estates. How people can be encouraged to use these in a socially distanced way may be key to protecting local people's physical and mental health throughout the Covid-19 pandemic.

A move to digital engagement with health, social care and community services has had benefits for the majority of residents. However, a small minority are finding it more difficult to access the services they need. Projects to tackle this are essential to avoid inequalities of health outcomes for some of the most vulnerable; and it is crucial that those directly affected are involved in co-designing them.

Disabled people show poorer experience across almost all areas of health and well- being and significantly poorer in relation to health and care services. More work is needed to understand who these groups are and what would help tackle these poor outcomes. More work is also needed to understand how financial inequalities impact peoples experience of their local neighbourhood.

Many local people benefit from strong community connections and peer support. Neighbourhood informal mutual aid groups and volunteering initiatives started in the wake of the Covid-19 pandemic appear to meet a need to stay connected to others in a time of crisis. About this project

Neighbourhood conversations COVID-19 engagement In December 2019, we asked local people Between March and June 2020, we created what makes their neighbourhood a good a survey to engage with local people on place to live and how we can support them how they stayed healthy and well during to live healthier lives. They took part in the Covid-19 pandemic and their structured interviews at four locality experience with services.It was carried out events in local libraries on the main market online and by telephone. days in the area. About this project Our approach

The initial project used the Tower Hamlets Together's "I statements" to engage residents on what was important to them for a healthy life.

H e a l t h y l i f e s t y l e s a n d b e h a v i o u r s W i d e r d e t e r m i n a n t s o f h e a l t h I h a v e a g o o d I am able to support myself and my family I understand the ways to a healthy life. l e v e l o f h a p p i n e s s a n d financially. I am supported to make healthy choices. w e l l - b e i n g I am satisfied with my home and where I live. I play an active part in my community. I am supported to live the life I want My children get the best possible start in life. A n i n t e g r a t e d h e a l t h c a r e s y s t e m P l a c e s a n d c o m m u n i t i e s

I feel services work together to provide me with good care. I can breathe clean air in my local area. I believe money is spent in the best way to I feel safe from harm in my community. deliver local services. I believe trust, confidence and relationships are in place to work together with services to decide the next steps for our community. About this project Our respondents

The initial engagement COVID-19 engagement

w e r e p a r e n t s w e r e p a r e n t s o r e x p e c t i n g o r e x p e c t i n g 36% p a r e n t s 22% p a r e n t s

w e r e c a r e r s f o r w e r e c a r e r s f o r 5% a n a d u l t 5% a n a d u l t

h a d a l o n g t e r m h a d a l o n g t e r m 25% c o n d i t i o n 27% c o n d i t i o n What we've learned The bigger picture Local people's vision for a good neighbourhood

Well supported children and youth Material security Children's centres and early years support for new Availability of jobs that pay parents; youth clubs giving Access to services decent wages; social security young people guidance and for those who can't work; good something to do. Ability to access health and affordable housing with social care services sufficient space. promptly and conveniently when needed; clear information; digital inclusion. Friendly, safe community A good life in Good environment Knowing and trusting your a good local neighbours; taking part in Access to nature, green spaces community events; people area and good food; good air quality from different backgrounds achieved through reducing car interracting; feeling safe. traffic; clean, safe public spaces. What we've learned The bigger picture O b s t a c l e s , r i s k s I n e q u a l i t i e s Local people's vision for A s s e t s Younger people and those in precarious Air pollution- heavy road traffic housing find it harder to eat healthy and a Poor hygiene and safety- public keep healthy lifestyles. spaces Parks and open spaces People in the borough's poorest wards Restrictions to use of parks- Covid- Open markets experience more air pollution. G o o d e n v i r o n m e n t 19 lockdown Leisure centres Younger people and private renters feel Population churn, gentrification less connected to their local area. Faith groups Perception of poor safety, antisocial Women and people living in housing association estates feel less safe. G o o d c o m m u n i t y Community. Volunteering behaviour organisations Cancellation of events/ closure of People with poor mental health are at Self-organised Covid-19 mutual socialising spaces- Covid-19 higher risk of social isolation. Women, people from BAME backgrounds, support groups lockdown younger people and parents of disabled High cost of housing, esp. private children felt less able to support renters and first time buyers themselves and their families financially. Local businesses, job creators Loss of jobs, difficulty finding work Renters were less happy with their homes Schools, professional training in the Covid-19 pandemic than homeowners; adults living with their M a t e r i a l s e c u r i t y Housing associations General economic recession in the parents were the least happy with where Part-own part-rent housing schemes Covid-19 pandemic they lived. Advice charities (debt, employability) Difficulties getting specialist appointments promptly; over- People from BAME backrounds, older people stretched services and those with more complex medical needs (particularly those with mental NHS services Cuts to social care services; health issues) were less satisfied with Social care services gatekeeping evaluation process services. A c c e s s t o s e r v i c e s Local and national health and advocacy Impact of Covid-19 pandemic on charities services. In the pandemic, those who are digitally exculded find it harder to access services. Digital access tools Air pollution, poor access to nature Gang crime, drug dealing, poor Younger people (under 24), White respondents and parents of special needs Youth clubs, sports clubs safety C h i l d r e n / children were less likely to think children Children's centres Social isolation and lack of y o u n g p e o p l e get the best start in life. Schools, libraries opportunities to play/ Children in overcrowded, deprived or Exercising facilities socialise/take part in activities due to Covid-19. digitally excluded households are more affected by the Covid-19 pandemic. What we've learned

Post Covid - 'New Normal' Community events and group activities for all ages (including: families with children, young people, older people) are essential for community cohesion and for individuals' well-being; and cannot be Health and social care services, fully replaced by online-based activities. A gradual return to local authorities, public services, provision of group activities, starting with things that can be done amenities, businesses and while socially distanced, should be a priority. voluntary sector organisations have had to adapt to functioning There is little tangible benefit for encouraging people who can work in the Covid-19 pandemic. well from home to return to primarily working from offices. Provision of local co-working hubs may be a solution post-pandemic for those who dislike working from home or haven't got the appropriate space. In some cases, this meant It is also important to encourage people who work from home to spend reducing services or functioning leisure time outside the home; by offering a variety of community sub-optimally; while in others events and activities. efficiency increased and/or user experience improved, suggesting When accessing medical services, an efficient online booking system- that the changes and innovations including triage via e-consult forms or AI symptom checker- can increase efficiency. Some routine appointments- such as medication would be worth maintaining after reviews- and in limited cases some appointments for acute issues can the end of the pandemic. be dealt with via telephone or teleconferencing. Remote advice is less appropriate for patients dealing with new and unexplained symptoms; but shifting the appointments that can be done remotely has the potential to free up capacity for those who need to be seen in person. My local area My local area

Key findings

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Improved safety of public spaces Most people find their local area is the No.1 change people would a reasonably good place to live. like to see in their local area.

Disabled respondents were less Local people also wanted to see likely to find it a good place to cleaner public spaces, more live than abled-bodied people. green areas and family-friendly community events. My local area

Key findings- environment and safety

Local people tend to feel safe in their local area - however those women living in housing association estates, and poorer people felt less safe.

Drug dealing and using was a major safety concern for local people. Poorly lit streets and the presence of young people (particularly boys) made people feel unsafe.

Local people are dissatisfed with the air quality in the borough, and see car traffic as primarily responsible.

Knowing their neighbours and being familiar with the local area made people feel safe.

Local people would like more visible policing of streets. My local area

Reccomendations and questions

Recommendations Further questions

Assess and improve the How is the experience of living in 1 accessibility of green spaces for 1 Tower Hamlets different between all sections of the community. thouse with a good level of financial stability and those in precarity? As the borough comes out of 2 Covid-19 lockdown, return to At neighbourhood level, how do the organising community events and 2 most deprived areas of of the activities in public spaces. borough compare with the wealthier ones in terms of access to amenities Engage more with churches and and their affordability? 3 mosques specifically on projects to aleviate poverty; develop What do young people perceive to be partnerships between faith groups 3 the assets of their local area, and and anti-poverty support how would they change it? charities. My local area

Reccomendations and questions-cleaner, safer community

Recommendations Organise groups similar to Victoria Park Rangers and Community Wardens 1 to empower local people to directly take charge of safety and environment locally.

Recruit young people to these groups and organise intergenerational teams. Link these groups with the local police to ensure awareness of 2 police work.

Further questions

How safe do young people feel in their local area? 1 WhatE mmapkheass tihseem i sasfuee osr duinrseacfet?l yWhat would make them feel safer? a f f e c t i n g l o c a l r e s i d e n t s , s u c h 2 How adso etsh pee rccuerprteionnt oaf satihr mquaa leitpyi vdaermy wi ci,th car ownership? i n r e l a t i o n t o m e a s u r e s a i m e d a t My local area

Do you think you local area is a good place to live?

100 Absolutely

64 69 66 69 61 60 54 48

0 Not at all Young Older Most Most SCALE Women Men people people Disabled Everyone affluent deprived (under (over 65) wards wards 24)

240 29 48 119 82 24 34 12 respondents respondents respondents respondents respondents respondents respondents respondents My local area

Do you think your local area is a good place to live?

People most likely to find their neighbourhood a good place to live

Home-owners Older women

Living in St In good health Katharine & Wapping People least likely to find their neighbourhood a good place to live

In working class Childless jobs

With a disability Living with housemates in rented housing Young men My local area

Do you think your local area is a good place to live?

Respondents with different demographics brought up different aspects, reflecting upon different priorities and life experiences.

People most likely to say People most likely to say People most likely to say People most likely to say local amenities make transport links and location their local community makes the environment makes their neighbourhood a make their neighbourhood their neighbourhood a good their neighbourhood a good place to live: a good place to live: place to live: good place to live: Aged under 65 Live in more affluent areas Women Women Parents of children under 18 White ethnicities (British or other) White ethnicities (British or other) White British Good level of financial stability In work Aged 65+ Good level of financial stability Good level of health Homeowners Not private renters Good level of financial stability Not in work Good level of health People most likely to say People most likely to say People most likely to say People most likely to say their local area schools and education healthcare providers make faith groups make their being safe or quiet makes make their neighbourhood their neighbourhood a good neighbourhood a good it a good place to live: a good place to live: place to live: place to live: Men Students and their parents Women Bangladeshi Aged 65+ Women Bangladeshi Aged under 50 Private renters Bangladeshi Aged under 50 Poor financial stability Live in more affluent areas In low skilled occupations Live in the most deprived areas In highly skilled occupations Living in assisted living housing or in multigenerational households. My local area

What would make your neighbourhood better?

There should be less traffic. Keep the area clean, rubbish is There are huge SUVs pouring dumped everywhere. At night time,

Re R out diesel and leaving their Reduce duc GPs noise ov e p e crime goes up. We need more street cr er- d Jobs/ owd o u ing l c e education lu e uc / t engines running all of the ed ty 6% 3% i G patrols. R er ty 4 o ov ali % 1 n s p qu % p r e e 7 2 e time. v g in a a o H e r in % % c c p s 8 E c n u Y n e Im o E e % M A N t s h O ITY V 1 a o s , 9 IL L I t s We should deal with the youth anti- t N B u c r R i A l o O T 8 p D r b We need more open spaces, s R O u C e n H p 0 a % F % r E social behaviour, they're sitting in front t F N 6 A g less car use and less n i R I k M h m of blocks smoking and doing drugs. This r % E a S T 3 7 P y pollution. R E p g s 9

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S N i 4 m We need more council housing I T h Y a the development of high end flats, as Improve3 % c f y and affordable housing. 1 it 5 n d it does not help the community. We safety % % 1 u n Ex a c er m s s fa isi - 7 t c ng % % m e il n c iti 0 o e a need more police presence in the area es F 1 C v p or 10% e s olde pe r or and outreach teams to deal with anti- ople F g It needs to be cleaner, some Local oun y ple social behaviour before things shops peo council houses need renovation, escalate. Invest in schools and would be good to have more stores- activities for young people. Invest in diverse products (Eastern keeping the roads and areas clean. European, Asian etc.) My local area

What would make your neighbourhood better? Focus on localities

Assets Areas for improvement

Residents of the North East were most likely to say their Residents of the North East were the most likely to express local community makes their neighbourhood a good place a desire for better provision of services/amenities for North East to live, but least likely to name safety/quiet as a factor. children and families, as well as a reduction in traffic and The area is highly diverse and well-served by amenities pollution, reflecting proximity to the A12 Highway, that can serve as socialising spaces. Blackwall Tunnel Northern Approach and Whitechapel Road.

Residents of the North West were more likely to say local Residents of the North West locality were the most likely to amenities make their neighbourhood a good place to think their local area needs better services and amenities live.The area is well-served by a variety of shops, for older people. St Peters' ward has the highest North West restaurants and cultural venues. Faith groups were also concentration of older people in the borough; and the mentioned; local mosques and churches play a key role in locality overall has a large population of older Asian organising community support activities. residents.

Residents of the South East were more likely to say faith Residents of the South East locality were the most likely to groups make their neighbourhood a good place to live, express a desire for green spaces, local shops and parking South East reflecting the active involvement of local mosques and spaces. Poor provision of shops is an issue in Bromley by Bow churches in the community. Several churches serve as and some parts of Lansbury, such as Aberfeldy Village and venues for older people's clubs and the Limehouse Mosque Teviott Estate/ Limehouse Cut. is a community hub for the Bangladeshi population.

Residents of the South West were more likely to say Residents of the South West locality were most likely to South West environment and safety/quiet make their neighbourhood a mention a need for measures to reduce poverty/inequalities good place to live; reflecting its access to the Thames and provision of NHS primary care. This reflects the contrast riverfront and green areas around it, including the King within the locality between the deprived Shadwell and the Edward VI Memorial Park. affluent St Katharine & Wapping. My local area

North East Priorities

Improve safety 34%

Improve cleanliness 20%

Children Families 18% Too many drugs, not enough The area needs to be There should be less cut-through law enforcement. All around cleaner, some council traffic and less traffic on main roads. Reduce Pollution 14% St Pauls way. Ackroyd Drive, houses need renovation. (Bow West resident) Bow Common Lane. Need We need more stores with something for the young diverse products- Eastern More community patrols are needed, drug dealing is the main problem. Green spaces 11% people to do. More youth European, Asian etc. centres.(Bow West resident) (Bow East resident) (Mile End resident)

Less traffic 11% There are too many gangs on the It's quite crowded. We There should be education for parents. street. Maybe nore centres to need better provision for (Bow West resident) help those struggling with drug under 5's, and less traffic Young people 8% addiction could be opened. (Mile End resident) They should clean the underpass areas (Bromley North resident) Stop crime, knife attacks, more. (Bow West resident) Older people 8% pickpocketing and bicycles More educational events for kids The outside of blocks should be on pavement. (Bow West resident) (Mile End resident) Community events cleaned- they haven't done it in & spaces 8% 50 years! Club for pensioners to I'd like to have more There should be more street parking. improve literacy, cause some community centres, youth (Bromley South resident) Local shops 8% people can't read well. clubs and Children's Centres. We need more sessions for kids in (Mile End resident) (Bow East resident) the park, such as football. (Bow West resident) My local area

North West Priorities

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Improve publlic transport 10%

Improve green spaces 10% More space for kids and We need more facilities It would be a better area if better transport would and support for students. there is better policy to be an improvement. Community events/spaces 10% Spitalfields and combat litter. The houses (Bethnal Green resident) Banglatown resident) have to be more secured. (Weavers resident) Young peoples 10% Get rid of the anti- social behaviour and Having a shopping drug dealing on the To reduce air pollution, Improve housing 10% I'd like to br able to centre would be good. Victoria Park Estate and we should make all travel to other areas Somewhere that will down Sugar Loaf walk public transport more(St Peter's bring people closer Reduce pollution 10% next to the Camel Pub. electric and plant more Reduce pollution 10% resident) together. More centres Tower Hamlets Homes is trees along the for the youth to crap. If you have roadways so they soak socialise in a safe Older people 10% concerns they put it all up the C02 (Weavers environment. And more out to a call centre. resident) activities for the 50+ They need to deal with (Bethnal Green anti-social behaviour resident) and repairs on the estate. (Bethnal Green resident) My local area

South East Priorities

Improve safety 44% Green spaces 23% More trees. More green We need more secondary The area should have more greenery, be spaces. Less noise from A12 Improve cleanliness 21% schools. Also, young more open to the people and a lot and less air pollution. More children are fighting and cleaner. (Poplar resident) Children and families 18% community spaces that are there are gangs. open in the evenings and (Blackwall and Cubitt We need more youth clubs and Local shops 14% 18% don't rely on alcohol. Town resident) (Lansbury resident) solve the parking problem! Parking 14% (Canary Wharf resident) I'd like to have a safer The council should be much stricter environment and a Improve housing 12% cleaner neighbourhood. The streets should be cleaned. I'd like on dog walkers not cleaning up after to see more people caring about the their dog. Less redevelopment- this is Control crime, drug Community events 11% area. (Poplar resident) getting really silly now. It is having a abuse, bike parking, big impact on services such as getting control dangerous driving We need a market in our area, more Young People 11% a doctors' appointment. Think more and noise. (Limehouse parking and more activities for carefully about bus routes. Eastferry resident) children. (Blackwall and Cubitt Town Public Transport 11% Road is so narrow and yet double resident) decker buses are running down there. The Chrisp Street market Reduce traffic 9% When there are Mexican stand offs should be improved. More security More transport links - with buses and cars in the narrow (Lansbury resident) underground and bus. More community Reduce Poverty/ stretch of road near the Nelson pub- cohesion. More social gatherings More inequalities 9% what is that doing to the lungs of the police patrolling. (Lansbury resident) people living down that road? Reduce Pollution 9% (Island Gardens resident) We should have a swimming pool and more activities for We need more social housing, more Exercising facilities 9% families. (Island Gardens green spaces with trees and more resident) police. (Island Gardens resident) My local area

South West Priorities

Improve safety 33% Improve cleanliness 31% Green Spaces 15% Improve the air quality, as we live by the motorway. Community events 10% Less people- less density of St Katharine & Wapping buildings, that would make my resident) Reduce Poverty/ inequalities 10% I don't have a proper local area a better place; and supermarket near me and small less rubbish. (St Dunstan's Reduce Pollution 9% shops are expensive. I'm I wish people didn't throw resident) worried that my home may be rubbish around. Someone from the posh houses across the GPs/ Primary care 8% broken into so I wanted to put My local area would be better metal bars on our door, but the road put a rubbish bag on the if people learnt to be tidier council doesn't like it. opposite side of the street. It and quieter. There are loads of Young People 6% (Shadwell resident) was there for 4 weeks those silver canisters (Shadwell resident) everywhere around Barnardo Local Shops 6% Gardens Estate. (Shadwell resident) Cycle routes 6% Fewer cars would be great. People drive their kids to school when it's only 10 mins walk away. Better access to Canary Wharf and The swamps that are left are City jobs for local kids. They get a good education but they don't causing rats and mice (Jamaica seem to be able to access the good jobs. Creating better street). The council could get networks for them with people who have made it in to the high to the cause of the problem paying jobs. (Stepney Green resident) (Stepney Green resident) My local area

Inequalities

Most affluent areas Most deprived areas Disabled residents Priorities varied (Canary Wharf, Island Gardens, St (Mile End, Limehouse, Lansbury, Katharine & Wapping) Poplar, St Dunstan's) between different Services for children Improve safety 35% 33% groups, and famlies 34% Green spaces highlighting health Improve Improve 24% and social safety cleanliness 21% Improve hygiene 33% inequalities, as Reduce 13% Green 17% poverty/ Improve well as the diverse inequalities 22% spaces safety needs and practices of Older people different groups. Young people Parents (under 25) (65+) Improve safety 33% Improve safety 51% Improve hygiene 32%

Improve cleanliness 25% Improve 26% Improve 24% Young cleanlines safety 13% people s Reduce Local Families/ 22% 18% 13% 13% children traffic shops My local area

Inequalities

More likely to be mentioned More likely to be mentioned More likely to be by women by men mentioned by Black British respondents Reducing poverty/inequalities Education Community building/integration Community building/integration Local shops Cycling routes and facilities Education Services for Exercising facilities Housing children/families Reducing car traffic Services for young people More likely to be mentioned More likely to be More likely to be by White non-British mentioned by Bengali mentioned by White respondents respondents British respondents

Green spaces/access to nature Hygiene of public spaces Hygiene of public spaces Local shops Safety Reducing air pollution/ Public transport Services for children/families traffic My local area

Do you feel safe in your local area?

100 Absolutely

63 64 61 60 59 56 58 51 40

0 Not at all

Mental SCALE Home- Private Social Everyone Women Men Parents health Disabled owners renters renters condition

240 119 82 54 29 108 86 35 12 respon respon respon respon respon respon respon respon respon dents dents dents dents dents dents dents dents dents My local area

How Covid 19 changed things

V i s i o n Challenges Mitigations

A g o o d p l a c e t o l i v e n e e d s M u t u a l s u p p o r t g r o u p s t o h a v e : C l o s u r e o f c o m m u n i t y a p p e a r e d . v e n u e s . C o m m u n i t y e v e n t s . L o c a l c o m m u n i t i e s S e v e r e l y l i m i t e d S p a c e s f o r o r g a n i s a t i o n s a d a p t e d t o s o c i a l i s i n g . p o s s i b i l i t i e s o f p r o v i d e s e r v i c e s o n l i n e . o r g a n i s i n g e v e n t s . A c t i v i t i e s f o r g r o u p s ( o f a l l a g e s ) . A s l o c k d o w n i s g r a d u a l l y L i m i t e d o p p o r t u n i t i e s e a s e d , c o m m u n i t y e v e n t s t o m e e t , c o n n e c t a n d a n d s p a c e s n e e d t o b e s o c i a l i s e . b r o u g h t b a c k w i t h i n p o s s i b i l i t i e s . My local area

Feeling safe

What makes local people feel safe? People who felt Feelings of safety were L o c a l c o m m u n i t y / 33% the safest in their associated with: n e i g h b o u r s neighbourhood Knowing and trusting your 10% L knowing the Men neighbours. area Black or Bangladeshi Being around open spaces and Highly skilled large groups of people. 9% In good health visible A visible police presence. policing Living with house mates What makes local people feel unsafe? People who felt the Feelings of unsafety were Drug dealing/ using 39% least safe in their associated with: neighbourhood The presence of young people Antisocial (particularly boys) behaving in ways behaviour 19% Women perceived as disruptive or intimidating. Groups of Aged 18-24 Unkempt or dirty public spaces; noise. young people 13% Living alone Secluded or poorly lit areas. Living in a council/HA estate Gangs 10% My local area

Feeling safe - focus on localities

N o r t h E a s t N o r t h W e s t S o u t h E a s t S o u t h W e s t

Areas perceived as safe are: Areas perceived as safe are Areas perceived as safe are: Areas perceived as safe Globe Road around the Brick Lane and generally Canary Wharf, Poplar and are: Wapping, St police station, local Idea the main high streets, Island Gardens. Katharine's Docks, the Stores, main streets, which are busy and well lit. Thames waterfront, N o r t h E a s t shopping areas including Churches and mosques are Watney Market, the Roman Road Market and Victoria Park is seen as safe seen as safe spaces. residential streets of leisure centres. during the day; opinions are Stepney Green. divided about its safety at Areas perceived as unsafe Areas perceived as unsafe night. are: the Aberfeldy Estate, Areas perceived as unsafe are: Parnell Road/ around Teviott Estate, Limehouse, are: Jamaica Road, Leman the Eastern side of Roman Areas perceived as unsafe Crossharbour and Manchester Street and parts of Road Market, the area are: Roman road around Road.The Aberfeldy Estate Shadwell including the around Mile End Station, St Bethnal Green and some has poorly lit alleyways and Barnardo Estate and the Stephens Road, Globe Road council estate grounds, there are reports of knife area around Ropewalk further away from the police where violent crimes have crime around it. Gardens. station, Tredegar Road and been reported. The entire Merchant Street. There are Bethnal Green area has There are reports of drug There are reports of gang reports of gang activity, somewhat of a reputation dealing around York Square activity around Stepney drug dealing and violence in for being unsafe. in Limehouse. Green park and St John these areas. Cass school. . My local area

Feeling safe- how Covid changed things

As rules and regulations were imposed to curb the spread of infection, concerns around antisocial behaviour and young people congregating took on a new form: concerns about groups of people breaking lockdown rules and spreading disease. Feelings of mistrust between local people potentially intensified.

I called the police tonight and they My flatmate keeps going out, came, for the same problems of 25 meeting friends, sleeps somewhere There has been a growing people partying and screaming at else and comes back in the I visited a local theme park and concern that joggers and night yesterday! I think I wanna move morning. We talked to him and he it was rammed. OK so not as on-pavement cyclists are now I am really tired of this, I wrote a becomes aggressive and makes our much as pre Covid but being inconsiderate when complaint letter to my lettings agent life difficult and especially he absolutely no distancing at all. using the pavement which is today, I have a contract of one year ignores us and keeps contravening And despite hand gel in loads of supposed to be for walking, though, but they need to move us, I the lockdown. locations, I didn't personally for their own use, such as am on the edge see much getting used as I running or cycling. would expect. And that was I was aghast to witness the prior to summer holidays Furthermore, many have I get so angry when people don't lack of social distancing in officaily starting. argued that some joggers wear masks in the tube and in Victoria Park on Sunday and cyclists breathe very shops. Washable masks are easily I truly feel for my nursing heavily while not wearing available, cheap and the best way colleagues who have been and masks, which puts others to protect each other. are in the thick of it. around them at risk of potential infection of COVID-19. My local area

How can we make our local areas safer?

30% Visible policing, 7% 4% 6% crack increase crack crack down on crack down on crime down on down on dangerous policing drugs ASB driving

Safer 13% 10% 4% street building/ environment parking lighting CCTV security

Youth and 11% education, 6% community building youth engagement community clubs

Safer A lot more control of It would be nice (though Reduce knife crime, kids is needed- where I accept unlikely) to see create more jobs for community are their parents? the occasional policeman youngsters, more youth Massive need for walking or cycling in the clubs, projects. better street lighting. area. My local area

Can you breathe clean air in your local area?

100 Absolutely

47 41 34 34 29 19 15 Not at all 0 Most Most White Everyone Bangladeshi SCALE affluent deprived (British Parents Disabled wards wards or other)

240 29 48 71 75 86 12 responde responde responde responde responde responde responde nts nts nts nts nts nts nts My local area

Breathing clean air

While people living in the poorest wards Wards most satisfied with air were less satisfied with air quality than quality those in the most affluent wards, St Katharine and Wapping respondents with a good level of financial stability/in highly-skilled occupations were 44% St Peter's less satisfied with air quality than those in s a i d a i r Island Gardens economic precarity or traditionally p o l l u t i o n working class; and respondents of White ethnicities were less satisfied with it than a f f e c t s Wards least satisfied with air Black or Bengali respondents. This points t h e m quality towards possible differences in awareness p e r s o n a l l y Limehouse of air pollution and expectations. Poplar

A i r p o l l u t i o n l o c a l l y

North East North West South East South West Mile End Road, Bow Road and Roman Road gets congested Commercial Road and Roman Road are busy. Air pollution is particularly around Bethnal Green. bad around the East India Whitechapel Road are busy and Congestion on the A12 between Some local schools are congested. The area is affected Bow Roundabout and the Dock Road/Limehouse area situated near busy roads with and around the A12, the A13 by traffic coming in from the Hertford Union Canal is pushing a lot of traffic- such as Olga East London suburbs through to cars onto smaller streets,such and Blackwall Tunnel. Primary School near Roman Construction sites for new central London. as Tredegar Road and Coborn Road or Morpeth Secondary Garages and car services shops Road. builds in Poplar and Lansbury School near Globe Road. cause dust and noise. under the arches on Barnardo Garages in the Mile End area are Street are a site of car idling. a site for car idling. My local area

How can we get cleaner air in our local area?

Most residents saw car traffic as the main culprit for poor air quality in their local area; and proposed solutions centered around reducing car usage.

Reduce car traffic 33%

Electric cars 15% Proposed solutions Encourage cycling 14%

Encourage 13% 59% public transport Plant trees/ 13% car-related 25% green spaces not car- Encourage 12% related walking Health, happiness and wellbeing Health, happiness and wellbeing

Key findings - neighbourhood conversation

According to local people, a healthy The extent to which local people diet, physical exercise, access to felt supported to make healthy nature, mental wellbeing and good choices in their local area varied- relationships in the community are with young people and those in the key ingredients of a healthy life. precarious living and working conditions finding it the hardest. Most local residents feel they have a Grocery stores/open markets, good level of happiness and well- exercising facilities and parks being. were the key resources empowering healthier choices.

Disabled residents, some ethnic Fast food shops, air pollution and minorities and sexual minorities the expense of healthier choices reported lower levels of happiness were the main obstacles. and well-being. Health, happiness and wellbeing

Key findings - Covid-19 conversations

During lockdown, community A third of respondents felt socially events and group exercise classes isolated and more than half felt were cancelled, leisure centres sad about missing out on travel, were closed and even access to leisure and socialising. Young nature was reduced. This posed people, people struggling with significant challenges to staying mental health conditions and those well. advised to shield are more likely to experience social isolation. Local people found new ways to stay physically active. Some A third of respondents worried continued socially distanced about their health during the exercise outdoors (walking, pandemic; but over half worried running, cycling) and some about the health of loved ones. exercised at home, using online resources such as apps and videos. Health, happiness and well-being

Recommendations and questions

Recommendations Further questions

Use parks and open spaces for a Has consumption of fast food gradual return to organised changed during the Covid-19 1 community activities, to the extent 1 lockdown? Is there scope for a feasible during the pandemic. sustainable decrease in fast food Consider adapting previous plans consumption? 2 for a walking campaign to the current conditions. What are the obstacles that 2 people face to cooking more at Support and promote the use of open home and how do they intersect markets for fresh ingredients' ensure with class inequalities? 3 access to them is consistent during the pandemic and in other Which strategies for staying well challenging conditions. employed in the first weeks of 3 lockdown have been sustainable Promote safe online exercising and maintained throughout the 4 programmes. pandemic? Health, happiness and wellbeing

Do you have a good level of happiness and wellbeing?

100 Very good 76 70 73 68 65 59 61 54 41

0 Very poor

Other Good Gay, SCALE Every-one Bangladeshi White Age 18 to Age 65+ BAME British financial lesbian or Disabled 24 stability bi

240 71 61 59 24 34 64 13 12 respon respon respon respon respon respon respon respon respon dents dents dents dents dents dents dents dents dents Health, happiness and wellbeing

Do you have a good level of happiness and wellbeing?

People with a family and a good level of financial stability reported higher levels of happiness and wellbeing. Older people, those in poor health and low- skilled, precarious work reported lower levels.

People most likely to have a good People least likely to have a good level of happiness and well-being level of happiness and well-being Bangladeshi Self-employed Aged 18 to 24 Childless Good financial stability Asian non-Bangladeshi Married or living with partner Ages 65+ Home-owners Gay, Lesbian or Bisexual Parents Low-skilled occupation In poor health Disabled Health, happiness and wellbeing

What does a healthy life look like? 10% closeness 8% 8% to nature 8% safety, work life clean security balance air 19% 23% 30% 26% community, mental healthy meaningful wellbeing physical relation-ships eating activity Ingredients of a healthy life Health, happiness and wellbeing

Resources and obstacles

In November 2019, we asked local people about their level of happiness and wellbeing, about what a healthy life means to them and whether they feel supported making healthy choices in their local area.

Vision of a healthy Resources in the local area Obstacles in the local area and happy life

A healthy diet Healthy food in open markets, Fast food shops, takeaways, supermarkets, local shops. higher expense of healthier food choices. Physical activity Gyms, leisure centres, sports courts, parks and green Price of gyms, closure of some spaces. leisure centres, air pollution. Feeling unsafe in my local Access to nature Parks, green spaces. area; loneliness and isolation. Community, Friendly local Dirty public spaces, air mental wellbeing communities; families pollution, feeling unsafe using and friends. parks and open spaces. Health, happiness and wellbeing

Do you feel supported to make healthy choices in you area?

100 F e l t m o s t s u p p o r t e d Absolutely Aged 65+ 65 61 62 Black or Asian 55 53 In good health 50 42 F e l t l e a s t s u p p o r t e d 0 Not at all In precarious housing or homeless White Every- Black White Aged 18 SCALE Bangladeshi non- Aged 65+ one British British British to 24 Aged 18 to 24 White non-British 240 71 24 59 16 24 34 respondents respondents respondents respondents respondents respondents respondents In precarious work or unemployed Health, happiness and wellbeing

Influences on health, happiness and wellbeing

Positive influences Negative influences

Healthy food shops/markets 29% 42% Fast food/takeaways

Gyms, leisure centres 28% 25% Environment/air pollution

23% Expense of healthy Parks, green spaces 26% living

Community 16% 14% Safety

Health services 10% Cleanliness 13% Health, happiness and wellbeing

Influences on health, happiness and wellbeing

Resources and obstacles are experienced in different ways, highlighting health inequalities.

Healthy food shops/ markets Ubiquity of fast food outlets Were more likely to be named as a Exercising facilities Was more likely to be named as an obstacle resource by Bangladeshi residents Were more likely to be named as a by people living in the most deprived and social renters. resource by people living in affluent areas, parents and private renters. areas and White British people.

Friendly communities The expense of healthy living Were more likely to be named as a Air pollution Was more likely to be named as an resource by BAME and White non- obstacle by parents, by people living in Was more likely to be named as an British respondents, people with a social housing or house-shares; and those obstacle by White British people and good level of financial stability. who were unemployed or in less than people with a good level of financial stable employment. stability. Parks and green spaces Were more likely to be named as a People living in the most deprived areas resource by people living in the most (Mile End, Limehouse, Lansbury, Poplar, St Dunstan's) deprived areas, people aged 50 to 64 were the least likely to name healthcare services as a and those in full-time work. resource in their local area. Health, happiness and wellbeing

Focus on inequalities

Half of local residents we spoke to found home We asked local people whether they can cooking with healthy ingredients affordable. afford to make healthy choices Fruit and vegetables from open markets are often mentioned as ingredients for healthy

meals.

e

n o

y On the other hand, only a quarter found it easy r

e to afford healthier choices when eating out or

v E at takeaways. While restaurants and cafes serving healthier options may be available, they cannot compete in terms of prices with the fast food outlets that people on low incomes tend to

rely on. w

o This inequality could be further compounded by

l

s

e access to cooking facilities, knowledge and

n o

m time. People on low incomes are more likely to

o

e work irregular shifts or perform exhausting

c

l n

p manual labour; to live in house shares with i

o shared kitchens or in accommodation with poor e

P access to cooking facilities, as well as to struggle to afford cooking equipment. Health, happiness and wellbeing

How Covid-19 changed things

In May 2019, we asked local people about their One year later, in March-June 2020, we asked favourite way of staying physically active local people how they stay physically active during the Covid-19 pandemic and lockdown

24% Of those who exercised at home used apps or online lessions.

Activities that promoted healthy living centred around The pandemic reduced opportunities to walk, be outdoors being outdoors (walking, cycling, running, using parks) or and do community activities. Digital tools met this need, as being in the community (exercise classes, playing sports people became more likely to exercise at home and with friends, going to local gyms or leisure centres). connect with each other remotely. Some benefited, but People would rather engage in physical activity together not those digitally excluded. with others than on their own. Health, happiness and wellbeing

Mental Health

Local people experienced different levels of 16% of survey respondents suffered from a challenges during lockdown regarding their mental health condition mental health; and used different strategies to cope The COVID-19 pandemic impacted them significantly more severely 3% 17% engaged in used a website mindfulness or app for their 3% meditation mental health engaged in worship or prayer 13% 3% engaged in learned a hobbies and new skill leisure activities 3% maintained 1% a routine rested or relaxed Health, happiness and well-being

Influences on health, happiness and well-being

8% of survey respondents felt that there was very little they could do to maintain a good level of health and well- I have a bad leg so I can't do much; when I used to go being during the pandemic. on trip with my friends before lockdown that would be my exercise. But since lockdown I can't walk to their house or anything so it's difficult. I can feel my leg begin to get sore, so I try at home but I don't have that

: More likely to be disabled much space and I'm not as young as I used to be. r e or in poor health r e e h I live in an overcrowded home, it’s really taking an effect

t on my mental health not having much privacy. I can't do w More likely to have a o much because the fear has caused my mother to make

y mental health condition things difficult if anyone tries to leave the house. h e t i h

t I feel very stressed and bored; having small children

w Less likely to be working

doesn't help. s or t d financially secure e n

r Can't do much. Still need suitable wheelchair so I'm not e

a bed-bound. I'm feeling increasingly ill so I can't socialise at d More likely to feel

p all. n socially isolated o m I tried doing an exercise tutorial on Youtube, but p o couldn't last for five minutes with the kids. s C

e More likely to be digitally r excluded I feel like I gave up a long time ago. I keep dozing off- I can't go out. Community involvement Community Involvement

Key findings

The extent to which local people felt they Taking part in community activities played a part in their community varied; motivates people to make healthier homeowners felt the most connected, choices and contributes to their mental while young people and private renters wellbeing. Not feeling part of a local were less likely to feel they play a part. community is detrimental to people's mental wellbeing.

Friendship groups, volunteer groups and During the Covid-19 lockdown, local faith groups help local people connect people stayed in touch with friends and with their community. family online and via telephone.

Population churn, gentrification and lack Mutual support groups, informally of integration between different ethnic organised on social media, as well as and social groups makes people feel less charities and voluntary sector connected. organisations, had a positive impact on community life during the Covid-19 lockdown. Community Involvement

Recommendations and questions

Recommendations Further questions

Support faith groups and housing 1 estates to develop self-organised How do different groups engage and mutual support groups. 1 keep in touch using technology? How can different support networks Involve young people in more be better linked with each other? 2 volunteering based on local self- organised support groups. How can young people be better As much as possible within social engaged in shaping and actively 3 distancing rules, gradually return to 2 participating in their local organised community activities. community? Community Involvement

Do you play a part in your local community?

100 Absolutely 67 61 54 57 53 51 51

38 23 0 Not at all White Aged SCALE Everyone Bangladeshi Black British (British Aged 25 to Aged 65+ Home-owner Private renter or under 24 64 other)

240 71 24 75 24 117 34 54 29 respond respond respond respond respond respond respond respond respond ents ents ents ents ents ents ents ents ents Community Involvement

Do you play a part in your local community?

Factors that encourage community involvement Results of good community involvement

Friendships Motivation to make healthier Volunteering, contributing choices Faith groups Better mental wellbeing

Factors that discourage community involvement Results of poor community involvement

Gentrification Lack of integration Poorer mental wellbeing Feeling unsafe Dissatisfaction with council/ democratic deficit Community Involvement

Do you play a part in your local community?

People most likely to feel they are a People least likely to feel they are a part of their local community part of their local community Gay or In poor health Low skilled Private lesbian renters Black Young people Home- British Studying or (under 24) owners working part Adults time White Full time (25 to 64) (British or Living other) workers alone

My neighbours are always asking for I can get help any time from my I used to get involved in my local my help, to fix things. Everyone neighbours with my learning and with community, but I don't anymore. I trusts me where I live. I have looking after my children. I have feel like the area has been taken access to the security alarms. I am good friends in the community. over by gentrification. Lots of an active person among my people have moved away now. neighbours. We don't talk to each other, don't Moved to Kent or Essex. It's nicer know each other but we don't have Being part of the local community there. Too late to move now. any issues . I think I am a good makes me happy; it alleviates my I have no attachment to my mother, and that helps me feel more depression. neighbourhood, I do not care. connected. Community Involvement

Obstacles to community participation

Gentrification, population churn and lack of integration between the borough's diverse groups hinder local people's ability to feel part of their local community. About a third of respondents felt they were unlikely to continue to live in Tower Hamlets long term, seeing it as an area they were passing through rather than their long-term home.

In five years from now, would you still be M o s t l i k e l y t o M o s t l i k e l y t o m o v e living in this neighbourhood? i n t e n d t o k e e p a w a y f r o m T o w e r l i v i n g i n T o w e r H a m l e t s : H a m l e t s : Residents of the poorest White non-British people. wards Young people (18 to 24). Asian people. Financially well-off Older people (65+). people. There is definitely segregation in the neighbourhood where people Homeowners. Private renters. living in private housing are in their own utopia and have access Parents. Unemployed people to better services than the rest of the neighbourhood. We need to stop gentrification! Retired people or stay at looking for jobs. home parents. People in poor health. My lack of connection to my local community makes me want to move somewhere else; Hackney has better services than here. I am socially isolated. I contribute It's been important to have people in our a lot to the local community surrounding area that we know, unfortunately I My neighbours and I don't talk to each other, don't know each other but we don't through my work and volunteering. must say that it still doesn’t feel like a have any issues . I think I am a good mother, and that helps me feel more But on a personal level I am very community here. Its very divided. connected. isolated. There is no sense of community. My neighbours are always asking for my help, to fix things. Everyone trusts me I have no attachment to my neighbourhood, I Sometimes I run into people I where I live. I have access to the security alarms. I am an active person among my don't really care about it. know in the library; people are neighbours. very friendly, this is community. Community Involvement

How can we play more of a part in our local community?

"More community events and activities" was the most offered solution by local people

Active More community events/ activities Friendlier, safer community community For children participation For young people Knowing your neighbours For older people Improved Safety Promotion of events Volunteering/contributing Spaces for socialising Community Involvement

How Covid-19 changed things

Being part of a local community, taking 46% of survey respondents stayed well by socialising remotely with friends and family. part in community events and taking advantage of local amenities to socialise 71% of those who did, used the internet for it. are important for local people's happiness and well-being. As the Covid-19 lockdown 26% of those who did, used phone calls for it. severely reduced opportunities for these, local people resorted to technology to compensate these losses and keep themselves well; however, not everyone had access to online solutions and, even where they did, they could not fully 34% of survey respondents have been feeling replace in-person socialisation. socially isolated. 14% of respondents sharing a house with other people said their relationships were tense or unpleasant. Young adults, women, Bangladeshi people, those who needed to shield and those living with mental illness were more likely to experience social isolation. Community Involvement

How Covid-19 changed things

13% asked a People aged 25 to 49 were the most likely to join friend, family these groups. member or 26% of survey acquaintance for Non-British White people and those of mixed respondents joined help with shopping ethnicity were the most likely to join; Bangladeshi an online local Covid- or errands. and other Asian people were less likely to do so. 19 support group. 21% helped a Older people and Black people were more likely to 4% asked someone friend, family ask friends or family to help with errands; parents from a support group member or of children under 18 and people aged under 50 with for help with acquaintance with a long-term condition were more likely to resort to shopping or errands. shopping or the online support groups for help. errands. 10% helped someone from a support group Bangladeshi young people aged 18 to 24 were the with shopping or most likely to help friends or family members with errands. errands; White British people aged 25 to 49 were more likely to do so for members of online support groups. Wider determinants of health Wider determinants of heatlh

Key findings

Most people are reasonably happy Women, people from BAME backgrounds, with their home and where they younger people and parents of disabled live. children felt less able to support themselves and their families financially.

Homeowners were happier with Availability of good jobs, cheaper housing and their homes than renters. Adults advice on money matters are seen as solutions living with their parents were the to people's financial worries. least happy.

Overcrowding and issues around Children's centres and youth clubs are seen as outdoor tidiness and rubbish were valuable resources for giving children the best people's main complaints about start in life. their homes. Wider determinants of heatlh

Recommendations and questions

R e c o m m e n d a t i o n s F u r t h e r q u e s t i o n s

Support advice charities to develop 1 comprehensive services around debt, What kind of activities, skills and support benefits, renters' rights, employability and 1 would young people like to have from workers' rights. Promote them to local youth clubs? people.

Develop a skill sharing and mentoring How will Covid impact on people who are 2 scheme, in which professionals from various 2 in precarious employment e.g. zero- fields teach practical skills to young people hours contracts/self-employed. and share advice about working in their field. Encourage people who work from home to What is the impact of multi-generational 3 engage in physical activity outdoors. 3 households on lockdown? Wider determinants of heatlh

Can you support yourself and your family financially?

100 Absolutely 73 67 69 65 62 60 50

39 23 0 Not at all

most most Aged Parents of SCALE Every-one affluent deprived Men Women under 24 Aged 65+ Parents disabled wards wards children

240 29 48 82 119 25 34 86 6 respondents respondents respondents respondents respondents respondents respondents respondents respondents Wider determinants of heatlh

How our finances impact our well-being

People who felt they can support themselves and their family Because my job pays well, I can financially well enough afford healthier food, my flat, Men going out, paying tax. London is expensive but I am comfortable Aged 65+ enough. White (British or other) I did get anxious when I was Highly skilled retired. I have a small pension, but Employed full-time, self- because I have good savings I couldn't get benefits. I will need employed or retired * as % of total participants to go into a care home at some Home owners point. This makes me anxious about spending my savings even if I People who felt they struggle to could live more comfortably now. support themselves and their family financially I don't think it is affecting me- but it is affecting my children. They Women are asking me tor things I can't Under 24 afford. Living alone If we had more disposable income I Unemployed and looking for would have more options for staying jobs physically active- better variety of exercise classes BAME * as % of total participants If need to budget and plan, it Low Skilled makes me worried. Wider determinants of heatlh

What would help you manage better financially?

10% 6% 6% availability out of Increased higher work of good wages benefits incomes jobs

8% 4% 4% 2% cheaper cheaper Affordable cheaper basic cheaper necessities healthier childcare living housing choices 8% Advice financial and info advice

Managing I can't really change the things that I have five kids. better would make a difference to me. I have to Getting into part- They cut my pension pay a large council tax as a single person time employment in half; I should be financially in a tiny flat; I'd like to have cheaper would help me getting more money food options- good food is expensive. manage better. in benefits. Wider determinants of heatlh

How Covid-19 changed things- jobs and money

of economically active survey 33% 2% respondents were dismissed from of Covid-19 survey their jobs respondents worried about 8% said their hours and pay were cut their jobs or finances of self-employed respondents and 74% business owners lost income or clients T h o s e i n u n s t a b l e j o b s i t u a t i o n s w o r r i e d t h e said their workplace closed m o s t 20% temporarily

of them received no pay during this 37% time of those in work missed work to self- 6% isolate 15% of them received no sick pay for it

Jobseekers, freelancers and home-makers depending on their partner's income are the most worried about their finances during the pandemic Wider determinants of heatlh

Are you satisfied with your home and where you live?

100 Absolutely 69 72 72 63 60 61 60 62

41

0 Not at all Adults Good Poor Living alone Living w. living w. SCALE Every-one financial financial Home-owners Private Social or w. house- renters family their stability stability renters mates parents

240 64 71 54 29 108 45 158 14 respondents respondents respondents respondents respondents respondents respondents respondents respondents Wider determinants of heatlh

Are you satisfied with your home and where you live?

Respondents' living situation Problems with housing in Tower Hamlets

Overcrowding, lack of space 13%

Cleanliness, rubbish outside 13%

76% Live with their families House prices, availability 9% 17% Living alone 6% Living with housemates Heating, insulation, damp 7% 27% Lived in multigenerational households Faulty appliances 7% 26% of them were adults living with their parents Building security 7% 11% of them were young people living with their parents 61% of them were adults living with their adult children Wider determinants of heatlh

Are you satisfied with your home and where you live?

Most likely to mention Most likely to mention Most likely to mention Most likely to mention lack of space: outdoor rubbish /cleanliness: house prices/availability: heating, damp or disrepair: Black or Asian. Living in the most Good levels of financial Aged 65+ Aged under 50. deprived wards of the stability. Low-skilled Poor financial stability, borough. Homeowners, private occupations. but highly skilled. Low-skilled renters or those in Private renters or Living in rented occupations. precarious housing; people in precarious accomodation (private Self-employed. but not social renters. housing. or social). Private renters or Childless. Single or divorced, but Living alone or with people in precarious In work. living with family (incl. family. housing. In poor health or single parents). Parents of children Childless, single or disabled. Parents of special aged under 18. divorced,but living needs children. Economically inactive: with family. Living paycheck to home-maker or unable In poor health. paycheck. to work. Working part-time or self-employed. In poor health or disabled. Wider determinants of heatlh

How Covid changed things-housing and home

77% of survey respondents who Tower Hamlets is a high cost of living area, in large part due to were in work worked from high housing costs. Local people who became worse-off because home of the pandemic worried about affording housing.

A few of those who did, found it My partner became Renters are insufficiently supported in challenging, particularly those with unable to work because this pandemic, particularly in London children or caring responsibilities, and of his illness. I'm where rents are unusually high. If my those experiencing low moods. concerned about paying income - the only one in my family - an already extortionate were to be interrupted, my family would rent when my partner be thrown deep into debt within a short can no longer work - time, regardless of the wage guarantee combined with piecemeal made by the government, because the I am still working from Low moods. Lots to do and ineffective slow rent burden is very high in comparison. home, my at work but feeling benefits system. working/leisure time has like I can’t be blurred so I am looking bothered. A lot of at work at all hrs even at things seem pointless The economic impact of the pandemic on those weekends. Zoom and I’m wishing away already in a precarious economic situation increases meetings are exhausting. the days. I've had to take days out the risk of homelessness. In turn, homeless people already to try to centre I feel less are more vulnerable to COVID-19 and other poor myself. It's not been productive- I need health outcomes. great for my to work from home mental/emotional while homeschooling health. I'm a very social my children. person. Wider determinants of heatlh

Do children get the best start in life?

100 Absolutely

64 60 58 54 50 52 37 45 32

0 Not at all

Parents of Aged under Parents of Single Parents of SCALE Everyone Parents children children 5 Bangladeshi White (British 24 (all) parents special or other) under 5 to 18 needs kids

240 24 86 45 56 27 6 71 75 respondents respondents respondents respondents respondents respondents respondents respondents respondents Wider determinants of heatlh

How can children get the best start in life?

Existing resources Resources children in Tower Hamlets need 26% 13% more 14% 9% Education/planning clubs/ invest in early Children's education years centres for the future activities

12% 11% 8% 6% 4% Healthier parks/ play- Clubs and sports safety clean activities community grounds air 10% 7% 6% financial advice/ Schools Support for support 10% parents info Libraries We need more youth clubs; somewhere Childcare provision shuld be Better they can go. Make 'play' a priority, get improved- make it easier start in life children off phones. Give them life for parents of under 3's who skills; teach them about the wildlife work or want to work. and the environment, and road safety. Wider determinants of heatlh

How can children get the best start in life?

Priorities according to parents of children under 5 Information for parents Early years/nurseries More youth clubs/activities Exercising facilities and organised sports Better air quality Priorities according to parents of children 5 to 18 Information for parents Information on healthy living for children More youth clubs/activities Nurseries/early years Schools/education Priorities according to young people (under 24)

More youth clubs/ activities Exercising facilities & organised sports Wider determinants of heatlh

How can children get the best start in life?

Youth clubs and extracurricular activities (as well as children's centres for younger children) play a central role in local people's vision of giving children the best start in life:

Keeping Reducing antisocial teens Organised behaviour and improving usefully safety occupied sports, exercising facilities, More play-grounds physical activity/ Youth clubs/ access to activities nature Learning Better health about healthy lifestyles Learning a skill, Improved employabilty and informal preparedness for adulthood education Wider determinants of heatlh

How Covid changed things- children and young people

I worry about my son (who is almost 2) and his lack of interaction with other children as he is an only child. If this pandemic has us all The Covid-19 lockdown brought about closure of youth clubs, children's isolated for a long time he will have almost centres and even schools. While some educational or hobby activities forgotten how to interact with other children. offered by youth clubs were suspended, many continued online. In I understand the measures are entirely particular, apps and Youtube tutorials were well-used by young people necessary but it still makes me feel sad when for staying physically active while at home. I think about the potential impact on his and other children’s development. Young people were less able to socialise; despite access to online As a teacher, I worry about having less tools, many felt isolated, or sad about missing out on leisure activities. contact with my students, some of whom are Small children were far less able to play and interact with others their very vulnerable. age.

These are anxious times for everyone, but As parents were expected to more actively support their children's especially if you were struggling before. It's learning while schools were closed or moved online, the risk of difficult for the children too- they struggle. My eldest one -age 15- has some mental unequal learning outcomes increased, hitting children in overcrowded, health struggles, he's been having deprived or digitally excluded households the worst. breakdowns. Health and social care services Health and social care services

Key findings

In December 2019, opinions Following the Covid-19 pandemic, multiple of GP services were mixed; services, including GP surgeries, hospital while hospital services, consultants and psychotherapists have started psychotherapists, and social providing more services remotely (online or via services supporting phone). In some cases, the change has been recovering addicts and the welcome, but the scope of what is doable remotely homeless were positive. is limited.

People from BAME backgrounds Patients waiting for routine dental treatment, and those with complex elective procedures or consultant-led outpatient healthcare needs were less treatment experienced delays and cancellations likely to have a positive because of Covid-19. Mental health patients were experience with services and to also affected. find them accessible. Health and social care services

Recommedations and questions

Recommendations Further questions

Make appointment and cancellation How does the experience of BAME information more readily available, 1 people with health services differ from 1 using the NHS app and websites of GP that of White British people? Are there practices, hospital trusts etc. Regularly any obstacles specific to BAME update websites with changes to communities that could be tackled? appointment systems.

What is the experience of patients in Provide information about how patients 2 relation to services being moved 2 can manage their conditions while they online? In which situations would it be wait; including referal to trusted sustainable for the change to become websites and e-leaflets. permanent? Health and social care services

Health and care services in Tower Hamlets

Royal London Hospital 2 sexual health clinics 33 primary care dentists 36 GP surgeries

Reset Drug and Alcohol Community Mental Tower Hamlets Tower Hamlets Adult Mile End Hospital centre 2 Health Teams Talking Therapies Social Care Team Health and social care services

Are health and care services working for you?

Feedback on services used- December 2019 0 Not at all 100 Absolutely

SCALE

Regardless of who I am I can access physical and 67 mental health services

I can access safe and high quality services 64 when I need them I am confident those providing my care are competent, happy and 70 kind I feel like services work together to provide me 61 with good care Based on: TOTAL 297 comments, 1103 issues. Hospitals 72 Money is spent in tne comments 274 issues. GPs 191 comments 682 issue. best way to deliver 51 Dentists 11 comments 47 issues . Social care 5 comments local services 26 issues. Mental health 11 comment 49 issues. Children's health 9 comments 44 issues. Health and social care services

Focus on localities

All services Hospitals GPs In December 2019, we asked local people to give feedback on any health and social care services they used locally Health and social care services

Focus on inequalities

White British people gave more positive feedback than BAME people

Younger people and those in good mental health gave more positive feedback than those in poor health, particularly those suffering from a mental health condition

Those with a good level of financial stability gave more positive feedback than those in financial precarity Health and social care services

How Covid changed things-GP Surgeries

As part of the Covid-19 survey, we asked local people if they used GP services during lockdown and what their experience was like

Most people who need to see a GP are able to do so promptly.

Those who had telephone or online consultations tended to be happy with them. Overall, patients are happy with the quality of their treatment and the attitude of all staff members.

Patients seek reassurance for doctors both about COVID-19 and about accessing care remotely; the extent to which doctors are able to offer clarity varies.

Diagnosing illness and prescribing new medicine is a challenge to do remotely. Patients who are not used to telemedicine feel disconnected from their own care.

Despite some admin and technical issues, receptionists deal well with online repeat prescription orders.

Some patients feel reluctant to attempt accessing GP services, which they perceive as overstretched. Health and social care services

How Covid changed things-GP Surgeries

Accessing GP services remotely- Covid19 surveys respondents Patient with a positive Patient with a experience negative experience 14% had a telephone consultation with a GP or practice nurse May have a previously Distrust telephone diagnosed, well and online consult 5% filled in an E-consult form to managed long term condition Have a low level of receive a call back IT literacy Has used the NHS app 3% had an online consultation before Is experiencing new, with a GP or practice nurse unfamiliar symptoms Perceives telephone and online consult as Needs blood tests, 10% ordered a repeat prescription efficient physical online examination or Needs information on significant changes managing symptoms, to their medication 1% accessed test results or repeat prescriptions referrals online or minor changes to their medication Health and social care services

How Covid changed things-NHS 111

Getting through on the phone can take 9% called the 111 advice line Patients' experience with 111 a long time, but the online app is useful.

111 dispatchers are 13% used the NHS 111 website reported to be polite and helpful, but the level of information they offer varies, with many patients still 20% looked up their symptoms online somewhere else feeling left in the dark. Health and social care services

How Covid changed things-other primary care

Routine dentistry and optician appointments are subject to cancellations. Some patients are concerned that delays in receiving care may put them at risk of acute or serious issues. There are also limitations to the extent to which acute dental issues can be treated.

People's experience with pharmacies has been mixed. Patients found pharmacy staff helpful and supportive, but communication issues were reported. Health and social care services

How Covid changed things-hospitals

Opinion of hospitals

Urgent Inpatients Outpatients- Outpatients- care waiting list and cancellations all other issues Health and social care services

How Covid changed things-hospital services-inpatients and urgent care

U r g e n t c a r e

At the beginning of lockdown, there was uncertainty around whether A&E's are still operational and the extent to which they are under pressure. People felt somewhat reluctant to call 999 if needed, knowing services are likely to be overstretched. People with Covid-19 symptoms reported waiting for up to an hour for an ambulance.

I n p a t i e n t s

Patients hospitalised with Covid-19 report that their care has been good. Their families praise hospital staff for allowing them to maintain contact remotely, deliver essentials to their loved-ones and stay invloved in their care. There were some reports of patients with other ailments being discharged early to make room for Covid-19 patients. Health and social care services

How Covid changed things-hospital services-outpatients and specialist care

14% 7% 12% spoke on the spoke online to experienced phone to a a consultant or disruptions to their consultant or another long-term hospital- another professional based treatment professional

Patients who had appointments Cancellations to planned with medical professionals over procedures and consultations the phone or online were happy leave patients feeling in limbo with their experience. There and worried about their health. are, however, limits to what For some, Covid-19 related can be achieved online or via cancellations occured after they telephone consultation. had already been waiting for a long time for appointments. Health and social care services

How Covid changed things-mental health services 16% 40% 29% of Covid-19 of those who used of people with a survey mental health mental health respondents services experienced condition said they suffered from a disruptions or couldn't access mental health cancellations. support to begin condition. with.

Some appointments and psychotherapy sessions are done by telephone. Some users are happy with this, others less so. In other cases, receiving support is delayed until the end of lockdown, leaving people in limbo. Communication of continuity of services has been poor, leading some to believe that the help they needed was not available, even when in fact it was. Health and social care services

How Covid changed things-social care services

10% 5% 3% 1% of survey respondents were carers for a received care from lived in sheltered received care at home family member or professionals in or supported from family or friends. friend. their own homes. accommodation.

Some service users were unable to get the care they needed during the initial lockdown.

Some reported concerns about their safety and their carers' safety. Digital inclusion Digital Inclusion

Key findings

In December 2019, opinions of GP During the Covid-19 pandemic, multiple services, services were mixed; while including GP surgeries, hospital consultants and hospital services, psychotherapists, psychotherapists have started providing more and social services supporting services remotely (online or via phone). In some recovering addicts and the cases, the change has been welcome, but the homeless were positive. scope of what is doable remotely is limited.

People from BAME backgrounds Patients waiting for routine dental treatment, and those with complex elective procedures or consultant-led outpatient healthcare needs were less likely treatment have experienced delays and to have a positive experience cancellations because of Covid-19. Mental health with services and to find them patients are also affected. accessible. Digital Inclusion

Recommendations and questions

R e c o m m e n d a t i o n s F u r t h e r q u e s t i o n s

Identify whether patients are digitally Are people using the NHS Test and Trace 1 excluded on their patient record and app, and if not, why not? Are the prioritise them for face to face 1 obstacles about distrust/data concerns, appointments if possible. technical difficulties, digital exclusion or reluctance to be tested? Work with social prescribers, care 2 navigators, advice/advocacy charities to support digitally excluded people and those Do digitally excluded people face longer with poor English to access digital services. waiting times and more obstacles when 2 accessing health and social care Invest in centralised, patient-controlled services? 3 technological solution for sharing records between health professionals. Digital Inclusion

Using NHS services online

In December 2019, we asked local people if they would consider using online tools to access NHS services.

67% w o u l d c o n s i d e r u s i n g a n N H S a p p t o a c c e s s N H S s e r v i c e s .

56% 59% 56 would have would access would look an online their test up their consultation results symptms with a GP online online Digital Inclusion

Using NHS services online- how Covid changed things

In March-June 2020, we asked local people whether they have accessed NHS services online

The groups of people most likely to say that they 5% filled in an E-consult form to receive a would use NHS services online in 2019 were similar call back from their GP to those who did use them in 2020

3% had an online consultation with a GP In work or practice nurse Middle class 7% communicated with another medical Aged under 50 professional online Parents 13% used the NHS 111 online website

looked up their symptoms online . . . w i t h o n e e x c e p t i o n 20% elsewhere People in poor health were less likely to say in 2019 that they ordered a repeat prescription online would use online NHS services and more likely to have done so 10% in 2020 than their healthier peers.This may be simply because accessed their test result or referrals people in good health may not have needed any NHS services, 1% online or because those in poor health accessed online services despite their reluctance. Digital Inclusion

Using NHS services online during Covid-patient experience of online tools

Patients who used e-consult or other forms of online consultations in their GP surgeries found it easy and efficient.

Medicine reviews and other less complex appointments can often be done by telephone or tele-conferencing with the same results as in person.

Online or telephone appointments are less likely to be suitable for patients with complex needs or those with new, unexplained symptoms. Digital Inclusion

Using online tools to stay well during Covid-19

32% 51% kept in used the 26% touch with internet to joined a friends stay informed local and family about Covid- support online. 19. group online 10% used a website 17% used a website or app for or app for staying their mental physically health active Digital Inclusion

Who is excluded?

Compared with other respondents they were:

38% 14% More likely to be of Black of November 2019 of 2020 ethnicities. neighbourhood Covid-19 conversation survey More likely to be older. participants respondents were digitally excluded More likely to be in poor health (had no internet access, no devices to or disabled. access the internet on or no IT literacy) Less likely to be working or financially secure. Digital Inclusion

Digitally excluded people in their community

100 Absoutely 66 67 62 55 54 45

Not Not Not Excluded Excluded Excluded Excluded 0 Not at all Excluded Excluded

SCALE Do you think your local Are you able to Do children in your area is a good place to support yourself and area get the best live? your family start in life? financially? Digital Inclusion

Digitally excluded people in the Covid-19 pandemic

Digitally excluded people relied on TV news and on friends and family members to stay informed about Covid-19.

Older people's charities and ethnicity-based local charities reached out to digitally excluded older people to offer practical support and befriending.

People who needed medical advice and could not use the 111 online service faced long waits when using the telephone service.