Worcestershire County Council: The neighbourhood approach to addressing health inequalities

Worcestershire County Council has focussed on community development work in individual neighbourhoods to tackle health inequalities in the most deprived areas. Grants are being given to committees of residents and local agencies to support the work. It launched two years ago as a pilot in one housing estate and after encouraging early signs is now being expanded to another 13 areas.

 “Everyone has access to universal services, but we wanted to give these places extra. I liken it to a hose pipe and turning it from sprinkler to jet stream – you focus the water on one area to have maximum impact” - Dr Lisa McNally, Director of Public Health

Worcestershire can feel cut off from much of the surrounding area. This sense of isolation has contributed to the health inequalities local residents face. People living on the estate have a life expectancy that is 11 years lower than those in neighbouring Droitwich South East.

But thanks to a community development project supported by Worcestershire County Council’s public health team, there are early signs the life chances and health of residents appear to be on the up.

The project was launched in summer 2023 as a pilot to test a new way of working with communities. It started with a film made by local residents called “We are Westlands” and from there a £90,000 pot of money was devolved down to a committee of local residents to support work that would improve health outcomes.

Westlands was identified as an area with high levels of unmet need through an analysis of emergency admissions data by the public health team. 

“When you think about emergency admissions it is basically a proxy for needs not be addressed – it suggests chronic health conditions that are not being managed or risky behaviours,” said Director of Public Health Dr Lisa McNally.

“An important predictor for emergency admissions is the neighbourhood – LSOA – you live in. So we divided the county up into hundreds of neighbourhoods and identified 14 with the highest levels of emergency admissions.

“Everyone has access to universal services, but we wanted to give these places extra. I liken it to a hose pipe and turning it from sprinkler to jet stream – you focus the water on one area to have maximum impact. That is what we decided to do.”

Dr McNally said: “Westlands had a really bad reputation, but when I went there, I was struck by the sense of community and pride. So that is why one of the first things we did was to produce a video of the place, interviewing people who lived and worked there. What came across was the community spirit – it helped to change attitudes.”

 Working with a local district councillor and a woman involved in running the estate’s wellbeing hub, a committee of residents and key local people, including the primary school headteacher was put together. They were supported by a public health development worker to oversee which projects to fund.

The money went on a variety of projects, including:

• Securing the future of the wellbeing centre that was under threat of closure – it has subsequently gone on to provide new support on mental health and domestic violence.
• A bike repair scheme to increase active travel in the area, which was spearheaded by a young person who had previously struggled with his mental health and was disconnected from his peers and education.
• A parent-led after school club for children with additional needs.
• An outdoor reading space at the school.
• A walking trail with benches to stop at encouraging residents with limited mobility to walk and move.

Latest figures suggest the project has already started to have an impact. Data on emergency admissions shows a 7 per cent fall over the past year for residents on the estate, compared to a 5 per cent rise across the rest of the county.

There has also been a significant drop in child in need referrals on the estate - down 13 per cent in the past year, far outstripping the county-wide trend which showed a small fall.

Dr McNally said: “We can’t claim causation, but it’s certainly encouraging. And it has also opened up access to more funding from elsewhere with lottery money now being invested into the estate. By giving the area that initial boost it is much easier to attract investment as funding bodies can see the benefit of what is being done.”

Pip Cavilla, the co-manager of the wellbeing hub, said the impact has been profound. “On a personal level, it has saved the wellbeing hub from closure. It means we are able to help people who are struggling – we are still living with the legacy of Covid on Westlands.

“But it goes much further than that - there is a ripple effect. The aspirations and expectations of people are changing. While the funding has now ended, we think it will have a lasting legacy because it is the community that has driven it. That is why this place-based sort  of work is so valuable.”

Worcestershire is now looking to build on the success of the work done in Westlands by expanding the work to the other 13 areas identified through the analysis of the emergency admissions data. That is already under way with a £150,000 grant awarded to some neighbourhoods in Redditch, an area that takes in three of the LSOAs. The rest should be following during the 2025-26 financial year.

Dr McNally said: “We took our time with Westlands because it was a pilot and we wanted to learn from what we were doing, but we are now confident we can do this at a much quicker pace.

“We’re delighted with how it went – in fact, it went better than we originally expected – but we’ve learnt things along the way. I think we were a little slow to get local agencies involved, like the local family hub. Normally councils do this to the expense of residents, but we were so focussed on getting residents involved we probably overcompensated.

“And one thing we are now doing – and I wish we had done earlier – is to run events that will bring people into the area. We’re looking at running an arts fair or sports event. We have changed perceptions of the Westlands, but now we want people to come and see it in person.”

“But the number one thing you need to do is to never stigmatise. We were hypersensitive to it. For example, we thought very carefully about the video we produced. We even changed the music, initially it was a bit quirky but we wanted something strong to signify pride.

“Also think about the language you use – we refer to high unmet need, not high need which suggests it’s the fault of the individual. It is so easy to fall into the trap of stigmatising, but it can set an area back.”

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