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

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

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

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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 > Fife average, < Glenrothes primary education > Fife; nursery and secondary education < Fife Social work 3.7 times Fife average Area Resource Analysis CAN be done

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

21. Estimating Local Spending Mainly interested in spend by place of residence of service recipient- sometimes by facility - �on the ground� Budget & accounting systems don�t 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

25. Primary spend by policy intervention

26. Health and Social Care

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 M&E 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 People�s 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 what�s 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@fife.gov.uk or tel 01592 413267 Know Fife Findings