Select Committee on Health Minutes of Evidence



  From the Black Country the Committee will meet:

Valerie Little

  Currently Director of Health Planning at Sandwell Health Authority where she has been responsible inter alia for the Health Improvement Programme. In January 2001 Valerie will take up post as Director for Health and Regeneration—a joint appointment between Walsall MBC and Walsall Health Authority. We believe this to be a unique post. From January to July 2000 Valerie worked on a part-time secondment basis for West Midlands NHSE examining ways of strengthening the links and joint working between the WMNHSE and the Regional Development Agency—Advantage West Midlands (AWM). Valerie is the recently elected chair of the Black Country Health and Regeneration Task Group.

John Goalby

  John is a public health worker with Walsall West HAZ. Having previously worked on City Challenge projects in Wolverhampton, John has been able to employ community development practices and philosophy to the public health agenda in this deprived area.

John Parkes

  John is one of the two voluntary sector representatives on the West HAZ Steering Group, working for the Pool Hayes Community Association, which is run by local residents.


  The Black Country is a sub-region of the West Midlands, located to the north and west of Birmingham and comprising the metropolitan boroughs of Dudley, Sandwell, Walsall and Wolverhampton. It takes its name from the colour of the ground, lying across the famous 10 yard coal seam. 1.1 million people live in these boroughs, which consist of traditional interdependent industrial towns and urban villages. Over one tenth of the population are from ethnic minorities, with especially significant Indian, Afro-Caribbean and Pakistani communities. The area is having to adapt rapidly to changing global economic pressures. This notwithstanding, there remains a substantial manufacturing sector in the economy of the sub-region. The majority of the 36,000 businesses in the Black Country are small firms employing no more than 24 people. These firms experience skill shortages, while in the resident population there are low rates of educational achievement, exacerbated by poor access to training.

  A century and a half of heavy and basic extractive industry, together with cataclysmic changes in manufacturing over the last 20 years have left a legacy of poor health, which shows through in higher than national average heart disease, cancer, and early childhood mortality rates. There is a high percentage of low birthweight babies and some of the highest teenage pregnancy rates in the country. Approximately a quarter of 10-15 year olds are regular drug users, with 60 per cent of acquisitive crime assessed as drug-related.

  Three of the four boroughs—Sandwell, Walsall and Wolverhampton—are Health Action Zones.

  Led by the four Local Authorities, a wide range of statutory agencies, together with the voluntary sector and business community have recently (January 1999) formed a Black Country Regeneration Consortium, recognising the added value of collaboration at sub-regional level on the substantial regeneration agenda which the area faces. A Black Country Regeneration and Health Task Group has recently been established.


  Walsall Council, with Government assistance via the Single Regeneration Budget, has developed a unique system of local neighbourhood committees in some of its most deprived neighbourhoods. This was a radical attempt to introduce a form of resident self governance at neighbourhood level, which was not without political controversy. By the end of December 1998 17 local committees had been established, all based on a model of democratically elected local committee members, each representing approximately 100 households. The number of committees has since been extended by a further two.

  Walsall is a second-wave HAZ. The neighbourhood committees have provided the bedrock of community involvement in the Health Improvement Programme and HAZ funded projects. As there is not full coverage of neighbourhood committees across all parts of the borough, a series of "Health Watch" Groups has been set up to fill the gaps. Each of Walsall's four PCG areas has a HAZ Steering Group, comprising neighbourhood committee and Health Watch group representatives, together with PCG and voluntary sector representatives, supported by a public health worker. Decisions on HAZ spend have been determined by the local Steering Group.

  West HAZ Steering Group, for example, prioritised:

    —  Young people (teenage pregnancy/sexual health).

    —  Domestic violence.

    —  Transport links to services (out of hours GP services etc).

    —  Drugs, alcohol and substance abuse.

  On drugs, local people identified the feelings of helplessness and isolation often felt by the parents, partners, brothers and sisters and other family members of people with drug abuse problems. They determined that "every community should have someone they can talk to locally to gain informal information on drug issues and access to drug services". The Group has:

    —  Commissioned an audit of locally available services and established gaps in provision.

    —  Provided basic drug awareness sessions for 331 local community residents.

    —  Offered a programme of "Listening in the Community" accredited skills training.

    —  Launched an outreach project "Talking Shop" for young people using arts workers.

    —  Worked with the over 50's in the community to produce a video of their views on the consequences for them of drugs issues on the estates, for discussion with youngsters in a schools-based programme.

  As a further example, East HAZ Steering Group identified the problem that many local men pay scant attention to their health and are certainly rarely seen in the doctors surgery. The project has taken health checks to where the men are—pubs and clubs.

  They used the Walsall "Arts into Health" programme to help design and implement the programme which included a stand-up comedy routine on men's health issues delivered in pubs, accompanied by nurse administered health checks at the same venue.

  The initiative captured considerable media coverage, both locally and from Canada and the USA!


  The NHS National Plan focuses heavily on NHS service delivery. There is some concern on the ground that this may lead to a loss of momentum on the wider health inequalities agenda.

  Walsall's neighbourhood committees would not have got off the ground without SRB funding. Will the new focus on a more narrow economic agenda set out for RDAs and regeneration funding following the CSR, mitigate against such community based initiatives in the future?

  The Walsall HAZ public health workers have acted as catalysts for public health action on the ground. The role is new and is being formally evaluated. It may well provide a model for other areas.
December 2000

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