Memorandum by Brent and Harrow Health
Authority (PH 49)
Interoperation of Health Action Zones, Health
Improvement Programmes and Community Plans
An innovative local approach to the publication
of complex planning documents across multiple agencies.
1. LOCAL CONTEXT
1.1 Brent and Harrow Health Authority is
coterminous with the London Boroughs of Brent and Harrow, and
there is a long history of joint working between the three organisations.
1.2 In Harrow, the Harrow Partnership is
a multi-agency strategic group covering four themes: Strengthening
Communities, Health and Social Care, Lifelong Learning and Environment
and Economy. A simple committee structure links the work within
these themes to the strategic direction of the Partnership as
a whole. Within health and social care, a series of strategic
action groups (each dealing with a priority care group such as
elders, mental health, children/young people) reports to the main
health and social care committee (the Health and Social Care Strategy
Group). This enables work being carried out to implement service
plans and major parts of the Health Improvement Programme to link
into the Partnership structure. At all points there is good representation
from the voluntary sector, users, carers, and the different cultural
1.3 In Brent, the Health Action Zone (HAZ)
is being brought into a structure in which the management of its
own initiatives and the work of the borough-wide strategic action
groups is unified, linking upwards to an inter-agency group. The
HAZ's strengths have included engagement with the wider community
and the establishment of local coalitions for action to improve
health and reduce inequalities.
1.4 These two borough structures have enabled
effective sharing of objectives and approaches between partners
in the NHS, the local authorities, and especially the representatives
of voluntary organisations, users, carers and the cultural communities
which are so important in our district. It has also made it easier
to discuss together how best to link strategic planning across
2. HEALTH IMPROVEMENT
2.1 In our view, the Health Improvement
Programme (HIMP) is a critically important document, enabling
sense to be made of the shared agendas between the NHS, social
services, education, housing, environment, transport and regeneration.
Ideally (and over time) the HIMP should form the majority proportion
of the local community plan.
2.2 The challenge is to ensure that all
partners appreciate that the HIMP is not simply about the NHS,
and that all local partners should have a say in its content,
and (more importantly) its implementation.
2.3 At present the areas which are seen
to be most relevant to health improvement are those of health
care, social care, education and housing. In our view, there is
a need for central government to appreciate that inner city regenerationa
major priority for both our boroughs, particularly Brenthas
significant impact on health. The HAZ has, for example, recently
performed a health impact assessment of the proposed new Wembley
National Stadium, using a toolkit developed by the London Coalition
for Health. This is a good example of the link between work on
health inequalities and inner city regeneration. Ideally, then,
action on regeneration should be seen as part of the HIMP, led,
of course, by the local authorities. Similarly, action to improve
the environment (including local transport policies) should also
be seen to have health impact.
2.4 We would welcome this perception at
the centre. If a wide interpretation is taken of health impact,
then community plans and health improvement programmes can be
seen to be virtually the same.
3.1 The agendas addressed in community care
plansmostly health and social care (through Joint Investment
Plans) and housingclearly overlap substantially with the
HIMP. In both our boroughs, a decision has been made to merge
the Brent and the Harrow Community Care Plans with the HIMP from
4. A CRITICAL
4.1 When our local community care plans
and the HIMP merge, the result will inevitably be a large document,
potentially intimidating to readers. However, this problem can
be bypassed if the whole business of creating these documents
is given a new slantelectronic publishing, using existing
4.2 Our plans for this are briefly described
below. We commend them to the Committee as one solution for what
is going to become an increasingly difficult problemthe
growth of ever more complex planning documents as the agendas
of health agencies and local authorities converge.
5. THE E
-HIMP AS MODEL
5.1 In Brent and Harrow we are currently
piloting a new format for the HIMP document, whereby it is possible
for a reader to enter easily at any point and be navigated through
a menu of information on local/national priorities and detailed
local action, linking to sources of research evidence, national
policy documents, advice, bulletin boards and e-mail addresses.
This electronic or "e-HIMP" will be available through
the health authority website, and those of local PCGs, NHS Trusts,
both boroughs, voluntary sector organisations and community groups.
5.2 An introductory section (written in
accessible style) will guide the reader to a table of contents.
Each chapter will have a brief front summary, with a link to the
5.3 The main innovation is the structure
of the document, which contains frequent references to other sources
of information as hypertext links. For example, the section on
mental health will link to the summary of "Our Healthier
Nation" on the Department of Health website, the National
Service Framework website and that of the National Institute for
Clinical Excellence. The section on carers will link to national
policy initiatives, and also to local websites of voluntary sector
organisations. A reader can move in and out of all these resources
at will, with one click of a computer mouse.
5.4 The result of this structure will be
that the reader can turn a complex planning document into a resource,
using it as a map or network. It will also be possible for readers
to contribute to on-line discussion groups, or to e-mail comments
to individuals listed in a local directory.
5.5 National policy documents are frequently
readable via government websites, and can be downloaded in "pdf"
format. The essential difference in our model is that our document,
written in the same "pdf" format, contains the hypertext
links which turn it into a network. There is no intrinsic reason
why national policy documents could not be similarly constructed.
6.1 We believe that the strength of our
local partnership working in Brent and Harrow enables us to work
well together in the creation of local strategies to improve the
health and welfare of our communities, and to develop action plans
which lead to effective changes in services. It will be possible
to merge these plans between health and other agencies, so that
they become synergistic in effect.
6.2 As local plans and strategies merge
they will become more complex and larger, creating a paradox whereby
the better the joint work the less accessible the documentation.
A solution to this problem is the design of electronic versions,
available via websites (or on CD-ROM) which enable a reader to
navigate freely within each plan, but enabling links to national
policy and local sources of information.
Consultant in Public Health Medicine, Lead for Health
Improvement Programme, Brent and Harrow Health Authority
5 July 2000