Knowing health and wellbeing outcomes of regeneration

1
Knowing health and wellbeing outcomes of
regeneration

• Chris Mitchell
• Corporate Research, Fife Council

2
Knowing we are making the right difference

• Context to the issue and Fife
• three knowledge projects
• Fife Public Health Dataset
• Fife Social Justice Analysis System
• Fife Regeneration Health and Wellbeing Study
• some conclusions

3
(No Transcript)
4
The challenge

• No regeneration without social justice -
• health inequality for every one person who dies
  before they are 65 in Dalgety Bay, 6 people die
  in Mountfleurie, Levenmouth
• Abbeyview - lost 3,000 of its 12,000 people in
  last 5 years of regeneration activity
• unequal people or places? SID03 work data
• Fife has 31,500 employment deprived people of
  working age
• 65 of employment deprived do NOT live in most
  deprived 20 of wards

5
(No Transcript)
6
(No Transcript)
7
Fife Public Health Dataset

• Comprehensive web based dataset of social,
  economic and health indicators to evidence public
  policy
• Jointly funded and managed by NHS Fife (Public
  Health) and Fife Council Children Services and
  Corporate Reseqrch
• Full-time Co-ordinator plus support

8
Fife Public Health Dataset Background

• PAT 18
• State of Fife Index
• PHIS PHDP Pilots
• Fife pilot phase May2002 - May2004, now
  mainstreamed FifeNHS and Fife Council Childrens
  Services
• now a substantive Community Planning resource -
• aim to complement Scottish Neighbourhood
  Statistics by adding local admin data
• Data warehouse for other tools analysis

9
Aim of the dataset
To build and promote the use of a broad range of
social, economic and health indicators in order
to evidence healthy public policy decision-making.
10
(No Transcript)
11
Whats included?

• Over 250 indicators
• Presented at Ward, LHCC, Fife and Scotland,
• Presented as Excel spreadsheets
• Dataset website also includes project papers,
  discussion documents etc.
• Converting now to Datazones, Access and GIS
  capability

12
Hows the information organised?

• Arranged in 9 domains
• population
• social environment
• physical and biological environment
• education, skills and training
• lifestyle and behaviour
• income
• economic indicators
• services
• disease, wellbeing, health and function

13
Indicator within a domain
14
1
Hows the information used?

• Informing Strategic Partnerships eg. Joint
  Health Improvement Plan, Childrens Services
  Group, Older peoples Framework
• Monitoring ROA
• Sourcing needs and outcomes data for Fife Social
  Justice Analysis System
• Long-term monitoring of regeneration areas
  Regeneration Health and Wellbeing study

15
Whose indicators?

• Are Public Health Dataset (or SNS, ROA etc)
  indicators what disadvantaged people would use to
  measure their wellbeing?
• SHS proofing study - focus groups
• Health Wellbeing complex and understood its
  more than absence of ill health
• add relationships, friendships, exercise
• PHDP domains reflect what people think
• Lifestyle, health and function ranked high
• age more than gender explained different
  perspectives

16
Fife Social Justice Analysis System (FSJAS)

• Longstanding question - do we bend main
  programmes to follow social justice, community
  plan policy and urban aid etc?
• ROA in Fife 2004-5 1.8 million
• Local mainstream public expenditure in Fife in
  2004-5 1.5 billion
• Do we put our money where our mouth is?
• Fife Partnership engaged Prof, Glen Bramley,
  Heriot Watt Univ. to help us find out

17
Tanshall Community Budgeting Pilot

• Small Stitch in time regeneration area in
  Glenrothes - what do we spend on children?
• Joined up picture of spending from finance and
  case records (unit costs and modelling),
  alongside needs analysis
• per capita health spend gt Fife average, lt
  Glenrothes
• primary education gt Fife
• nursery and secondary education lt Fife
• Social work 3.7 times Fife average
• Area Resource Analysis CAN be done

18
(No Transcript)
19
FSJAS Main Study

• Analysis of spending by service, client group
  geographical area
• Create shared database to provide routine,
  flexible access to this information
• Integrate with data on needs, performance and
  outcomes
• In the process, - review concepts framework-
  review applications elsewhere- comment on
  initial findings on spend patterns- advise
  partners on development of info systems

20
(No Transcript)
21
Estimating Local Spending

• Mainly interested in spend by place of residence
  of service recipient- sometimes by facility -
  on the ground
• Budget accounting systems dont record this
• They go down to cost centre level (e.g. school,
  area team, local office)
• Need to use client records (postcodes)
• Unit cost (adj for client characteristics) is
  link
• Environmental etc. services more difficult- on
  the ground sample surveys - modelling

22
CD Based Tool with 2 modes

• Profile - particular geographical area(s) of
  interest- preselected indicators- Fife
  Scottish benchmarks- thematic pages- printed
  reports
• Analyse- many or all areas of a given type-
  select any combination of measures- counts
  ratios- maps- download to Excel for further
  analysis

23
Primary Education Spend

• Reasonable expenditure estimates possible based
  on school budgets, pupil data on characteristics
  and postcodes
• Model makes assumptions about costs associated
  with particular pupil characteristics e.g. FSM,
  RON, out of mainstream provision
• Considerable variation in spend per pupil
• Spend generally higher in rural areas (small
  schools)
• ROAs only get 10 more spend than average

24
(No Transcript)
25
Primary spend by policy intervention
26
Health and Social Care

• Focus on particular client age group (elderly)
• Expenditure estimates for acute healthcare and
  homecare
• Compare with a variety of needs indicators-
  Census LTI, aged 75, living alone- specific
  health admissions (alcohol related)- SIMD
  general income deprivation- (mortality)
• Compare broader areas (LMUs)

27
(No Transcript)
28
(No Transcript)
29
Fife Regeneration Health and Wellbeing Study

• Abbeyview predicament - who would benefit?
• Social Exclusion Unit Some groups are last to
  benefit from polices designed to tackle social
  exclusion.
• 2003-04 150m of routine, remedial and
  regenerative local public spend on areas 1.5m
  SIP
• Fife Regeneration Health and Wellbeing Study
• Phase 1 Literature review and research design -
  St Andrews University and Fife Partnership
• Phase 2 10 year action research study in
  regeneration areas 3 components
• Aggregated quantitative analysis
• Aggregated qualitative analysis
• person centred tracking

30
Ph. 1 Literature Review Findings

• Overall, research limited and generally
  inconclusive is evidence to link damp, cold
  housing with respiratory disease but not much
  else
• Can associate depression, anxiety with
  overcrowding and deprived neighbourhoods
• Nature of these relationships, influence of other
  socio-economic factors make identification and
  direction of causation not straightforward.
• Process of regeneration can worsen mental health
  and resilience
• Need more research!

31
Phase 2 Fife Regeneration Study

• Began March 2005 - Hexagon consultants for first
  3 years
• Funding Communities Scotland, Fife Council, CRF
• Focus on five areas, all with ROA Datazones plus
  others to make coherent focus of regeneration
• West Fife Villages
• Abbeyview, Dunfermline
• Benarty and Lochgelly
• Dysart, Smeaton,
• Buckhaven and Methil
• Small project steering group
• Study will provide action research and monitoring
  for new Sustainable Communities Partnership Group
  

32
Phase 2 Objectives

• Baseline information about the key determinants
  of health and wellbeing for use over 10 years
• ME framework for policies, programmes and
  actions in regeneration areas
• Track experience of a structured sample of
  individuals and families, mainly most excluded or
  at risk assess risk/opportunities for action
  effectiveness of outcomes person centred
• Deliver guidance for regeneration activity to
  particularly maximise health and wellbeing
  benefits for most excluded or at risk
• Draw lessons for improving health and wellbeing
  and disseminate widely
• Inform and influence regularly the policy and
  practice of regeneration process at local and
  strategic levels - whole system action research

33
Where at now

• Constructing Baseline
• Quantitative indicators from Public Health
  Dataset and existing evidence base for ROA and
  wider datazone groupings
• Focus groups held to determine community derived
  measures of health and wellbeing
• Preparation of questionnaire for survey based and
  qualitative evidence of health and wellbeing
  includes panel recruitment linked to new Peoples
  Panel for Fife
• Monitoring and evaluation framework
• Drafting for consideration by Sustainable
  Communities Group

34
Tracking Study - First year pilot

• Qualitative, person focused, potentially action
  research and person centred planning
• recruiting 15 front-line workers across range of
  local services (health, education social work,
  employment, housing et al), preparatory workshops
• Each worker to recruit one or two local people to
  meet with 12 times in year one for semi
  structured interview or activity working through
• Understanding of study
• Developing a picture of health and wellbeing
• Imagining community
• Reflecting on services that impact on health and
  wellbeing
• Evaluation and whats next
• Ethics Committee submission underway

35
Conclusions

• Fife Partnership - building our evidence base on
  needs, spend, activity and outcomes to show
• comprehensive wellbeing data set
• resource data to inform priorities
• if we are making a difference to the people and
  communities with greatest needs now and in the
  long term.

36

• Systems do break some new ground
• Support analysis at wide range of geographies
  from data zone building block- but precision is
  variable
• All three systems are still developinge.g. more
  activity spend data for FSJAS
• Are starting to build longitudinal capacity so
  important for ensuring sustainable outcomes

37
More information

• www.fifedirect.org.uk - search on research and
  knowledge
• contact chris.mitchell_at_fife.gov.uk or tel 01592
  413267
• Know Fife Findings