Worcester Strengthening Healthy Communities

Transcription

Worcester Strengthening Healthy
Communities
Research report
Version
1.1
1.2
Date
17 June
2013
1 August
2013
Turning Point
Turning Point
The Exchange
Manchester
M1 4HN
www.turning-point.co.uk
Update
First draft: Research findings
Author
Rosemary Wallbank
Final version: Steering
committee approved
Rosemary Wallbank
Worcester Strengthening Healthy Communities – Final Research Report
Acknowledgements
This version of the report has been produced with comments from the commissioning and steering
group. This group is comprised of:
Dr Felix Blaine, GP Commissioner, South Worcestershire Clinical Commissioning Group
Rosemary Williams, South Worcestershire Clinical Commissioning Group
Dr Frances Howie, Department of Adult Services and Health, Worcestershire County Council
Helen Perry, South Worcestershire Clinical Commissioning Group
Menna Wyn-Wright, South Worcestershire Clinical Commissioning Group
Nina Warrington, Worcester City Council
Francesca Davies, Worcester City Council
Edd Terrey, Worcester Community Trust
Katie Carver, Worcester Community Trust
Becky Jeynes, Community Champion
Marilyn Furlong, Community Champion
Gemma Bruce, Turning Point
Amanda Preece, Turning Point
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Contents
1
2
3
4
5
Introduction ................................................................................................................................ 4
1.1
Background to the project ................................................................................................... 4
1.2
About this report ................................................................................................................. 5
1.3
Background data................................................................................................................. 6
Community Champions.............................................................................................................. 9
2.1
Building community capacity............................................................................................... 9
2.2
Recruitment and training ..................................................................................................... 9
2.3
Focus on Community Champions ..................................................................................... 10
Questionnaire development and research framework .............................................................. 13
3.1
Questionnaire development .............................................................................................. 13
3.2
Research framework......................................................................................................... 13
Community Research findings ................................................................................................. 15
4.1
Self reported health and lifestyle ....................................................................................... 17
4.2
Health and wellbeing ........................................................................................................ 29
4.3
Long term conditions sub-sample ..................................................................................... 36
4.4
Health services ................................................................................................................. 42
4.5
The use of A&E ................................................................................................................ 48
4.6
Community ....................................................................................................................... 53
Workshops............................................................................................................................... 62
5.1
6
Community asset mapping ............................................................................................... 62
Recommendations to the Steering Group ................................................................................ 64
6.1
Recommendations ............................................................................................................ 64
6.2
Next steps......................................................................................................................... 65
3
1
Introduction
1.1
Background to the project
Turning Point was commissioned by South Worcestershire Clinical Commissioning Group
(SWCCG) in late 2012 to deliver a 12 month programme of community engagement, service design
and social action in Worcester City.
The Strengthening Healthy Communities project brings Turning Point‟s Connected Care model to
the communities of Warndon, Gorse Hill and Rainbow Hill in the north east of the city. Turning Point
is working with residents and front line staff in these areas to look at ways to strengthen the
community, improve health outcomes and reduce health inequalities. The project seeks to
understand in detail the factors that influence lifestyle choices, health and long term condition
management and how people engage with local services.
The information in this report will be used to inform the development of a number of proto-type
community led initiatives to tackle some of the key health issues locally and respond to the
difficulties facing local residents, building on the assets and skills within the community.
The emphasis is on developing initiatives that are responsive to the residents‟ preferences, needs
and values, encouraging patient centred care in community settings and promoting selfmanagement. As such the project is closely aligned to the objectives of South Worcestershire
CCG‟s five year strategy (2013-18).
The project is overseen by a commissioning group and steering group, comprised of
representatives from South Worcestershire CCG, Public Health, Worcester City Council,
Worcestershire County Council, Worcester Community Trust, Turning Point and Community
Champions.
So far, the project aims have been achieved through the recruitment of a team of Community
Champions, local residents whose role involves speaking to others in the community to identify
needs and develop community-led support services. A team of 17 local people were recruited and
trained by Turning Point to become Community Champions. The Community Champions used a
range of research methods such as questionnaires and workshops to explore local assets and
needs in the community, engaging with 314 local residents in the process.
In addition, Turning Point has also engaged with the wider community to explore existing groups,
services and projects. Frontline staff were invited to attend workshops and events to share their
views on how to improve health outcomes in the study areas.
Following the dissemination and reflection on this report, Turning Point will support the Community
Champions and others in the community to pilot a number of community-led initiatives to respond to
the issues raised in the research and improve health outcomes. The specification of the initiatives
will be informed by a number of service design workshops delivered by Turning Point in July 2013.
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1.2
About this report
The purpose of this report is to present the findings from the community champion led research and
from a workshop with front-line staff to inform the development of initiatives in the area that respond
to the objectives of the project.
The report sets out the context of the project, drawing on background data and existing service
provision to set the research findings in this context and to make recommendations based on these
understandings. The purpose of the recommendations is to provide the steering group with a
starting point for the design of the community led initiatives.
Section 1 provides a profile of the study areas of Warndon, Gorse Hill and Rainbow Hill.
Section 2 describes the role of the Community Champions.
Section 3 describes the data collection process and questionnaire development.
Section 4 presents the findings from the community research focusing on:
o
Self-reported health and lifestyle
o
Health and wellbeing
o
Long term conditions
o
Health services
o
Use of A&E
o
The community
Section 5 presents details of the workshops and findings from the asset mapping workshop
Section 6 makes recommendations to the steering group in response to the findings in report
A separate document to this report contains the appendices as listed below.
The project is overseen by a commissioning group and a steering group. These groups meet at
least twice monthly. Membership of these groups can be found in appendix 1.
A list of stakeholders who attended the asset mapping workshop can be found in appendix 2. These
included representatives from local doctors‟ surgeries, health trainers, community groups, faith
groups, council staff and councillors.
Detailed background research into the profiles of the wards of focus can be found in appendix 3.
This provides detail gathered from current existing data sources including local area profiles, ward
profiles, 2011 census data and the JSNA and expands on the summary of information included in
the body of the report in “background data” (1.3).
Details of existing assets and service provision in the local area can be found in appendix 4.
Information on engagement as part of the research with local organisations and stakeholders can
be found in appendix 5. Over fifty different places were visited as part of the research to ensure
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people were given the opportunity to participate from a variety of sources. This included formal
groups such as the stop smoking service to informal venues such as pubs and using the
Community Champions‟ own networks of friends and family.
A full copy of the questionnaire used in the research can be found at appendix 6.
Detailed information on the sample in the questionnaire including age, gender, ethnicity etc. is
included at appendix 7.
1.3
Background data
The areas of Gorse Hill, Rainbow Hill and Warndon have been chosen as the focus for the
Strengthening Healthy Communities project. Together the area has been identified as one of six
Areas of Highest Need (AoHN) in Worcestershire, designated as such due to the high levels of
deprivation and poor health outcomes amongst local residents.
The three wards are located to the north east of Worcester city centre and contain a total population
of 16,853 (ONS mid year population estimates, 2011) which is roughly 17% of the Worcester
population. The wards are each divided into four Lower Super Output Areas (LSOAs).
Table 1: Population of the wards
AREA
Gorse Hill (South West Gorse Hill, Elbury Park, Old Warndon (Grasmere
Drive / Borrowdale Drive area), Warndon, Windermere Drive)
Rainbow Hill (Tolladine, Rainbow Hill, King George‟s Field area,
Brickfields area, Cedar Avenue)
Warndon (Brickfields, Cranham Primary School area, Old Warndon, East
of Cranham Drive, Blackpole)
6
POPULATION
5,291
5,800
5,762
Figure 1: Map of study area highlighted
The wards are relatively deprived overall, but there is also significant variation within the wards, with
each having areas that are more affluent and other parts which are amongst the most deprived
areas in England.
A full breakdown of the desk research by ward can be found in appendix 3. This information is
based on existing and recent data which sets the context for why the project is being undertaken in
these areas.
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Summary – Areas of focus (Areas of Highest Need):
The data shows that all three wards faces significant challenges in terms of health outcomes,
income and crime rates.
Deprivation
The area of Old Warndon, East of Cranham Drive (Warndon Ward) is ranked as the most
deprived area in Worcestershire and 97.1% of the residents there are described as being „hard
pressed‟. South West Gorse Hill (Gorse Hill Ward) which covers part of Tolladine is within the
10% most deprived areas in England. Tolladine (Rainbow Hill ward) is within the 10% most
deprived nationally with 89.1% of residents described as „hard pressed‟ (ACORN, 2012).
Employment and education
Many residents in all three wards live on low incomes and a significant proportion are in receipt of
out of work benefits including Jobseekers Allowance, Employment Support Allowance and
disability benefits. In Gorse Hill ward, over a tenth of the working age population are unemployed
and a fifth of young people are unemployed. There are a considerable number of young people
classified as NEET (Not in Employment, Education or Training). (ONS Census, 2011)
Educational attainment is also low with half of the population aged 16-74 having no qualifications.
Crime and anti social behaviour
Crime is a key issue, particularly incidents of anti social behaviour.
Crime within the areas of focus is double than the average rate for Worcester. Anti social
behaviour is a particular issue within Warndon ward. (West Mercia Police, 2012)
Health indicators
20.9% of people in Warndon, 21.4% of people in Gorse Hill and 18.5% of people in Rainbow Hill
have a limiting long term illness compared to 16.2% in Worcester and 17.6% in England (ONS
census, 2011).
The self reported health of residents shows that 23.4% report as “not good” in Warndon, 25% in
Gorse Hill and 20.6% in Rainbow Hill (ONS census, 2011). 20.7% of the population in Warndon,
9.1% in Gorse Hill and 24.6% in Rainbow Hill are classified as „Healthy‟ (Health ACORN, CACI,
2012)
Over half of the population are categorised as being „Future problems‟, (57.8%) in Warndon,
34.7% in Gorse Hill and 35.8% in Rainbow Hill compared to just 10.0% in Worcestershire. The
percentage with „Existing problems‟ is 11.8% for Warndon, 38.6% for Gorse Hill and 25.4% in
Rainbow Hill. Therefore, the areas contain a high proportion of people with existing problems and
future problems compared to the general population.
Data shows that there is a very high mortality rate for respiratory conditions in the area. Hospital
admissions for COPD, stroke and diabetes are high. Connected to this, Warndon has the highest
smoking related mortality rate in Worcestershire.
Alcohol related hospital admissions are the highest in Worcestershire from Warndon and the
highest amongst men from Gorse Hill.
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2
Community Champions
2.1
Building community capacity
Turning Point have facilitated a programme of community engagement in order to help shape a
number of new community-led initiatives in response to the issues identified through the research.
This process, as well as ensuring the new initiatives are responsive to local need, also builds
capacity within the community so that local people will play a key role in the design and delivery of
the proto-type initiatives. Our aim is to ensure the test initiatives are genuinely community led,
building on the skills and knowledge of the local community to address fear and resistance to
change and build buy-in and ownership from the outset.
2.2
Recruitment and training
Twenty local people from the areas of focus were recruited and seventeen people completed the
training to become Community Champions. Their role was to administer the questionnaire with 300
local people aged from 18 upwards and to engage with the local community to promote the project.
The Community Champions were specifically recruited because they lived in the areas, knew the
areas well and/or had good local contacts.
A further key element of their role was to identify and make links with local organisations or services
within the wards or that were used by people living in the wards. This would start the process of
developing a database of existing local provision within the area.
The mandatory training consisted of six modules:
Module 1: Introduction to the project – to develop an understanding of why the project was
being conducted.
Module 2: Understanding the local health profile, existing services and organisations
Module 3: Co-production and long term conditions management
Module 4: Community action research
Module 5: Research methods (including ethics)
Module 6: Communication skills
The training modules foster team working among the Community Champions, developing
confidence over time and creating an understanding of how to conduct research. This training,
together with some additional follow up sessions will result in an accredited qualification for
Community Champions.
Feedback from the Community Champions on the training:
“I found it all fantastic. Very informative and interesting. All trainers were interesting, helpful
friendly and had lovely humour. Thank you!” Becky
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“The training was very useful as the different modules taught us the qualities and skills in
becoming part of a research team and how to deliver these skills and make use of them
within the community.” - Sanne
Figure 2 – Community Champions at a training session.
2.3
Focus on Community Champions
The Community Champions came from a range of backgrounds and different levels of experience.
The only prerequisite for participation was that they understood the local area and had an interest in
the research and the local community. Their ages ranged from 17 to retirement age. By using a
wide age spread and people in the community, the research was able to engage a wide range of
people, including hard-to-reach groups who might not necessarily engage in conventional research
by using the personal networks of some of our Community Champions.
Some of the Community Champions explain why they got involved:
“I felt that I could offer a lot to the job as I have lived in the area all my life and worked in full
time employment as a sheltered housing manager for over 25 years before my retirement.”
Mal
“I wanted to make a difference to the community and I wanted to gain more experience.”
Sassa.
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“I got involved because I wanted to make a difference in the local community and to meet
new people.” Hannah
“I wanted to help make a difference within the community where I live and within people’s
lives and to gain an understanding of the needs of people’s lives or lifestyles within the local
community I wanted to achieve a much more positive way of living within the community by
everyone working together.”Sanne
“As I grew up and lived in the area all my life, I wanted to be part of this and get involved,
find out what other people in the community need. I want to make a difference to our
community. What better way than asking local people what is really needed, rather than
officials deciding what they think is needed.” – Becky
“I got involved as I had been out of a job for almost 2 years. I wanted to get out of the house
and into a routine of work. I was interested as it involved communicating with members from
the community itself. There is also a positive end to the work that we have participated in as
local initiatives are being set up.” Parminder
Figure 3: The Community Champions
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2.3.1 Outcomes for Community Champions
Evaluation of the project will be included in the final report, which will also specifically look at
outcomes for Community Champions. However, it is worth noting at this stage the value Community
Champions have personally found from the project so far.
“I have gained more confidence and better communication skills. I have also gained new
friends”. – Hannah
“I have gained more confidence in talking to people and feel happier in myself”.-Zoe
“Being more involved in the community – I feel more confident in myself”. – Sassa
“I have gained strong team building skills, listening and communication skills. I have also
learned that I am a far more confident person than I thought I was. I am now able to engage
with people on all levels. I have also gained much more understanding into the needs of
people’s lives by becoming a community champion.”- Sanne
“I have gained a lot more confidence and more knowledge of my community. I have also
learned not to be so judgmental of people. If I can make a difference to people’s lives then I
will feel that I have succeeded”. – Becky
“I have gained research skills and met some very interesting people and widened by
communication skills”. - Parminder
This demonstrates the effect the project has had on local people‟s confidence in particular and how
the Community Champions are invested in the project and want to see it as a success.
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3
Questionnaire development and research framework
3.1
Questionnaire development
The research framework and questionnaire were developed by a sub-group of the steering group
comprised of:
Rosie Wallbank – Project Manager, Turning Point
Jamie Keddie – Research Manager, Turning Point
Dr Frances Howie – Assistant Director of Public Health, Worcestershire County Council
Rosemary Williams – Director of Practice Engagement & Service Development, SWCCG
Katie Carver – Health & Families Coordinator, Worcester Community Trust
Helen Perry – Social Marketing Manager, SWCCG
The questionnaire format was a mix of open and closed questions with an emphasis on trying to get
a clear picture about people‟s lives and the reasons behind why they manage their health and
lifestyles in a particular way.
Sections of the questionnaire:
Section A – Existing health services in the area
Section B – Health behaviours and lifestyle
Section C – Long term conditions
Section D – Managing your own health
Section E – Getting involved/community engagement
Section F – Personal information
Section G – Prize draw and chance to get involved.
3.2
Research framework
The following aims were set to ensure a good spread of the population, a high level of quality
outputs and to increase participation in the research.
Geographical representation – to aim for a roughly even split across the three wards.
Long-term conditions representation – to ensure that management of long term conditions
was understood through including a specific sub-section but allowing undiagnosed
conditions or “future problems” to be captured by focussing the questionnaire on the whole
population.
Sampling technique – a mixture of snowball sampling and purposive sampling was used.
The recruited Community Champions allowed for a natural breadth of research participants
as part of the snowball sampling strategy. Through employing people from within the local
community to undertake the research, their own networks and contacts were used which is
intended to have a snowball effect to reach as many different people in the community as
possible.
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Purposive sampling was used by identifying existing community services where interviews
would be conducted, together with identifying more informal ways of reaching people – e.g.
through pubs etc. to ensure that the participants were from as broad sources as possible
and not just confined to people already engaged in the community or already attending
services.
Quality checks - weekly meetings between the Community Champions and the Turning Point
research advisor were used to check that the questionnaires were being completed to a high
quality and to discuss any issues or areas of inconsistency. These meetings also allowed a
weekly dialogue about where the Community Champions were undertaking their research.
This avoided overlap and maximised resources.
Quality checks on a sample of questionnaires were also undertaken by the research advisor
directly with participants.
Chances to get involved and incentivised participation - All participants had the opportunity
to be entered in to a prize draw to win high street shopping vouchers. This has been used in
previous projects as a way to encourage and reward participation.
Participants were also encouraged to volunteer to be involved further in the project by
volunteering to participate in case-study research or focus groups and by volunteering to be
kept informed about the project going forward. This is designed to encourage and develop
community capacity and to ensure that the community are included in the planning of the
new initiatives if they wish to be.
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4
Community Research findings
Summary of research findings
Self reported health and lifestyle:
The self-reported physical and mental health ratings are lower than the national average.
However, most people think they are managing their health successfully on their own. People
appear to have low expectations of what “good health” is.
Smoking levels are high (38.9%), and many people have either been personally affected or have
had a family member who has been directly affected by the misuse of drugs and alcohol
(32.5%).
Health and wellbeing:
Wider lifestyle factors seem to be important regarding health including the influence of family
members, stress, anxiety, money worries, unemployment and the prevalence of bereavement of
family members, often through misuse of drugs and alcohol.
Increasing motivation appears to be key to people making positive lifestyle changes.
Feeling supported and reducing social isolation appears to be linked with wider health and
wellbeing.
Long term conditions:
There is a higher rate of long term conditions than the official statistics suggest – the most
common being depression/anxiety.
Most people feel they are able to manage their condition independently but they haven‟t modified
their behaviour since diagnosis.
There appears to be a reliance on medication rather than lifestyle change to manage long term
conditions. Coupled with this, the use of services outside of the GP surgery is low.
Informal support networks and reliance on others appear key to people‟s perception of how they
are managing their conditions.
Health services:
People are relatively satisfied with the placement of health services and the service they get
from their GP, however, there are concerns over the availability of appointments and being able
to speak to the appropriate person when required.
There is low usage of health services other than the GP surgery, pharmacy and A&E, in
particular low levels of use for NHS Direct, the GP out of hours service and the walk-in centre.
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Use of A&E:
A&E is seen as more accessible than other services and is used when there is dissatisfaction
with the GP service or when someone has reached crisis point.
There is a link between mental health, drugs and alcohol and trips to A&E.
The level of advice people think they have been given when attending A&E is low and most
people do not think their visit to A&E was preventable.
The community:
Most people are ambivalent or apathetic about belonging to a community and the level of
volunteering is low. However, there is a significant minority that do want to be further involved in
the community and the level of informal volunteering, such as helping neighbours and friends, is
high.
There are clear benefits for people who have used community groups particularly regarding
socialisation, confidence and mental health.
Communication needs to be targeted through informal networks to appeal at a neighbourhood
level.
Barriers to getting more involved in the community include money, time, stress and feeling
isolated.
Detailed findings from the research are illustrated below. These findings are based on 314
questionnaires that were conducted with participants over 18 who lived in Warndon, Gorse Hill or
Rainbow Hill. Further information on the demography of the sample can be found in appendix 7.
The findings will feed directly in to the development of local initiatives to ensure they are directly
responsive to the community‟s needs.
After each section, some key questions to the steering group for initiative development are asked.
These questions are directly generated from the research findings and are intended to focus the
steering group‟s thinking on key areas to help the design and development of the initiatives.
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4.1
Self reported health and lifestyle
Summary of self reported health and lifestyle
People‟s self reported physical and mental health is lower than the national average.
However, most people believe they are managing their health successfully on their own.
Physical health and mental health ratings do not decrease with age and the younger population
report poorer health. There appear to be issues around expectations of health management and
what people accept as “good health”.
The rate of substance misuse is high with a third of respondents reporting that they or a family
member have been directly affected by the misuse of drugs and/or alcohol.
There is a higher rate of smoking than nationally and generally people are still trying to give up
on their own – 58% of current smokers in the sample have tried to give up. Successful motivators
appear to be the influence of friends and family and deteriorating health with barriers being
mental health, and the worries and stresses of life.
Diet appears more of an issue than physical activity and there is no one clear area where people
want to improve their health and wellbeing, suggesting that health promotion initiatives should be
focussed on improving health and wellbeing generally rather than targeting specific issues.
4.1.1 Physical health
44.9% of the sample record their physical health as “not good” (fair or below). This is much higher
than the ward statistics in the 2011 census where 25% describe their physical health as below
“good”. The findings also indicate that Rainbow Hill is the healthier ward.
Interestingly, the physical health self ratings do not correlate with age – the poorest self-reported
health is for the 45-54 age range with less than 50% reporting good health. Similarly, the self
reported physical health of 18-24 year olds is lower than for 55-64 year olds and the amount of
people recording their health as poor or very poor is higher for the 18-24s than for the people over
65. This suggests that physical health may be related to perception of what good health is but also
demonstrates that it is not necessarily age related.
Perhaps, unsurprisingly, the physical health ratings are significantly lower for people diagnosed with
a long term condition compared to respondents who haven‟t been diagnosed.
Table 2 Q. How would you describe your physical health?
Ratings
Percentage
Very good
22.6%
Good
31.8%
Fair
30.3%
Poor
12.4%
Very poor
2.2%
Base: 314
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Table 3 Physical health self-ratings by age
Age
Very
good/good
18-24
57%
25-34
71.8%
35-44
56.3%
45-54
44%
55-64
54%
65+
36%
Fair
Poor/very poor
27.7%
16.7%
37.4%
32.7%
33.3%
47.3%
17.9%
11.5%
10.9%
23.1%
12.5%
16.4%
Base: 314
When respondents who rated their physical health as „very good‟ or „good‟ were asked to explain
their ratings, most referred to activity levels, diet or just “having to get on with it”. Whilst the main
issues for respondents who rated their physical health as „fair‟ to „very poor‟ relate to physical
health, the quotes demonstrate that there are other lifestyle issues that contribute to these ratings,
such as work, money, depression and stress.
Table 4 Q. What are your reasons for this answer? Ratings of „very good‟ to „good‟.
Reason
Percentage
Active/do a lot of exercise
49.7%
Have a good diet/eat well
20.6%
I have to be ok/just get on
with it
8.2%
Percentages relate to respondents who answered „very good‟ or good‟
Multi response question – Base: 171
“I’m generally fit and healthy. I eat healthily regularly and exercise at least five times a
week.” Female, 55-64, Warndon
“I have good days & bad days. I have to cope with things as I am a one parent family.”
Female, 45-54, Rainbow Hill
Table 5 Q. What are your reasons for this answer? Ratings of „fair‟ to „very poor‟
Reason
Percentage
Problems related to long term
conditions
Mobility issues
50.4%
Could do more exercise
17.7%
Smoking/alcohol related
issues
Could eat better
11.3%
Being overweight
9.9%
17.7%
9.9%
Percentages relate to respondents who answered „fair‟ to „very poor‟
Multi response question – base 141
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“COPD is the big problem.” Male, 65+, Gorse Hill
“I could be fitter. I try and eat healthily, but it seems expensive and I haven’t always got the
money.” Male, 25-34, Gorse Hill
“I don’t exercise because I struggle to breath. I am very overweight which causes me stress
& I get very upset.” Female, 25-34, Gorse Hill
“I’m overweight. That makes me feel depressed. I’m asthmatic, I have bad knees and my
weight adds to my problems.” Female, 45-54, Warndon
“Age is creeping up on me. I smoke. I’ve always got a cough but that’s my own fault. I work
odd hours so I get sleep deprived & I just don’t feel as energetic as I did or want to feel.”
Male, 45-54, Rainbow Hill
4.1.2 Management of physical health
The findings at table 6 demonstrate that over a quarter of respondents are currently receiving
support from health services in relation to their physical health. However, only 2.5% are attending a
support or community group for help with their physical health. This suggests a dependency on
traditional health services rather than successful engagement and support derived from within the
community.
Furthermore, almost 60% report that they are managing their health successfully on their own; even
though this is more than report they have good physical health. This suggests there is a gap
between what people consider to be successful management of health and what constitutes good
physical health.
One of the Community Champion‟s observations on conducting the research may be relevant in this
area:
“People seem to accept what they have, be it good or bad.”
Table 6 Q. How are you managing your physical health?
Answer
Percentage
Managing health
59%
successfully on my own
Receiving support from
26.5%
health services
Attend a support or
2.5%
community group
Multi-response question, base: 314
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4.1.3 Mental health
Just under a third of participants describe their mental health as “not good”. This is lower than that
for physical health, suggesting that mental health levels are better. However, 21% of the sample
state they have been diagnosed with anxiety and/or depression, which is the most prevalent long
term condition in the sample accounting for 40% of all people with a long term condition diagnosis.
Again, these self-reported ratings of mental health could be related to people‟s expectations for
what constitutes “good” mental health.
Furthermore, the data shows that mental health is a bigger concern for younger parts of the
population. The poor/very poor levels are highest for 18-34 and 45-54 year olds with older 65s
reporting the best mental health.
Table 7 Q. How would you describe your mental health?
Rating
Percentage
Very good
31.5%
Good
32.8%
Fair
21%
Poor
11.1%
Very poor
2.9%
Base: 314
Table 8 Mental health self-ratings by age:
Age
Very
good/good
18-24
59.6%
25-34
61.5%
35-44
71.0%
45-54
44.2%
55-64
71.0%
65+
83.6%
Fair
Poor/very poor
21.3%
20.5%
16.4%
36.5%
12.5%
16.4%
19.2%
18.0%
12.7%
19.2%
16.7%
0%
Base: 314
When participants were asked to describe their ratings, the following reasons were most frequently
occurring. The quotes again highlight how wider issues in particular, money and employment
concerns and family and relationships, affect mental health.
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Table 9 Q. What are your reasons for this answer? Very good/good ratings
Rating
Percentage
I don‟t worry
29.7%
Have coping strategies
21.3%
I have problems but I have
14.9%
them under control
I have little or no stress
6.4%
Rely on friends/family
5%
Has a good social life
5%
Percentages relate to respondents who answered very good or good
“After having CBT and the support of my GP & family I now feel I can deal with most
situations.” Male, 18-24, Warndon
“I have hardly any worries if I do have I talk to family and friends and sort things out and not
dwell on them.” Male, 65+, Gorse Hill.
Table 10 Q. What are your reasons for this answer? Fair to very poor ratings
Ratings
Percentage
Suffer from depression
31.9%
Suffers from stress
23.4%
Suffers with anxiety
13.5%
Other mental health issues
12.8%
affect them
Loss of family/bereavement
9.2%
Percentages relate to respondents who answered fair to very poor
“I do suffer mild depression and anxiety, but only when something bad happens in my life. I
have been fine for years, but my mother died just before Christmas, so it is bad at the
moment.” Female, 55-64, Rainbow Hill
“I don't think my mental health is very good. I am on antidepressants; I am low in mood &
can't be bothered.” Female 25-34, Gorse Hill.
“I have bouts of depression. I was an alcoholic. I don't drink much anymore. I used to take
drugs & I am on medication from my GP. All my problems arose from the death of my wife
who was 32. My life went downhill from then.” Male, 35-44, homeless.
“My relationship broke down & I went into deep depression took drugs & drank.” Male, 2534, homeless.
21
“I'm a worrier. I get stressed a lot and get depressed a lot due to everyday life and not
getting any help with my weight problem. It gets me down.” Female, 18-24, Warndon.
“I get depressed not having a job, which then has a knock on effect, with no money. I
always seem to be in a bad mood. I never used to be like this when I was working. I have
no enthusiasm.” Male, 25-34, Gorse Hill
“I do feel down a lot. I lost both my parents in the last 2 years so I often get a bit depressed
about it. I have also been in & out of work for the last 3 years so I worry a lot i.e. paying the
bills & losing the house.” Male, 45-54, Rainbow Hill
“Mental health [problems are] hereditary & my mother suffered depression & had a mental
break down. I started getting mental health problems when my mother died 25 years ago.
Then I went into an abusive marriage & after having children I had post natal depression.
After I lost 3 babies I had a breakdown I lost my dad 8 months ago. So I am very depressed
at the moment. I'm waiting for counselling.” Female, 45-54, Gorse Hill.
“I do have a lot of stress in my life but don't we all. Until you asked me this question I didn't
realise stress was a mental health problem.” Female, 45-54, Rainbow Hill.
4.1.4 Management of mental health
Just over a fifth of the participants are receiving support to manage their mental health which is less
than the number of people stating they have had a diagnosis of depression/anxiety in the long term
conditions section of the questionnaire (21%) and is well below the number of people describing
their mental health as “not good” (35%). This suggests that there are a significant number of people
struggling to maintain positive mental health but not accessing help for this and believing that they
are managing successfully on their own. Again, this suggests there is a difference between the
definition of successful management and having good mental health.
Below are the figures for how people self report they are managing their mental health.
Table 11 Q. How are you managing your mental health?
Answer
Percentage
Managing health
61.1%
successfully on my own
Receiving support from
20.4%
health services
Attend a support or
3.2%
community group
22
4.1.5 Management of general health
Overwhelmingly, people reported that they think they can have at least some control on their health
with over three quarters believing that they can have a lot of control. This appeared to correlate with
the presence of support networks and employment; half of the participants who responded “none at
all” to the question about “how much control do you think people can have on their own health” had
family members involved in drugs/substance misuse and a third had experienced problems with
health services. Furthermore, 83% of the participants who responded “none at all” do not work. This
suggests that a person‟s belief about the control they have over their own health might be linked
more to wider issues outside of health condition specific management.
Table 12 Q. How much control do you think people can have on their own health?
Rating
Percentage
A lot
77.4%
A little
16.2%
None at all
1.9%
Don‟t know
3.5%
Base: 314
The following quotes are from two of the respondents who answered “none at all”.
“My dad has always gone to the pub after work and doesn’t come home until he’s drunk. My
brother is a heroin addict. He no longer lives at home because he has robbed off all of us”.
Male, 25-34, Gorse Hill
“[The one thing that would help to improve by health and wellbeing is] for the doctors to
listen to me and help me.” Female, 45-54, Warndon
4.1.6 Impact of substance misuse
Just under a third of respondents report that they or a family member have been affected by alcohol
and drugs misuse. Furthermore, significantly more of the participants affected by drugs or alcohol
misuse have been diagnosed with a long-term condition suggesting a link with this lifestyle and poor
health.
Table 13 Q. Have you or anyone in your family been directly affected by the misuse of drugs
or alcohol?
Answer
Percentage
Yes
32.5%
No
66.9%
Not answered
0.6%
Base: 314
23
Table 14 Breakdown of “yes” answers from Table 13
Answer
Percentage
Alcohol misuse
38.2%
Drugs and alcohol misuse
32.4%
Drugs misuse
29.4%
Base: 314
The following quotes illustrate the complexity of people‟s lives and how interrelated issues are, in
particular how bereavement, worry about family and friends and worry about money and
unemployment can have an effect on people‟s behaviours and mental health.
“I lost a parent to alcohol abuse. It was a problem all his life and although tried to stop many
times never succeeded. He never had any support and had never been to rehab.” Female,
45-54, Warndon.
“My mother turned to alcohol when she got into a lot of debt & she died young.” Female, 2534, Rainbow Hill
“Mum drinks a lot of alcohol daily; I feel it’s a problem for her. But she does not see it as a
problem. Brother smokes cannabis I see he has a problem but he can’t see it.” Female, 2534, Rainbow Hill.
“My dad was an alcoholic & died. Three friends died from alcohol and my mum used to be
addicted to speed. I also take lots of drugs and drink lots of alcohol.” Male, 18-24, Gorse Hill.
“I drink to block out things, but then I’m nasty to my family.” Female, 45-54, Gorse Hill.
4.1.7 Smoking habits
The percentage of smokers within the sample is significantly more than nationally – 19% of the
population in England smoke (ASH, 2013). 60% of this sample have smoked at some time during
their lives and 39.2% currently smoke.
Smoking is more prevalent in the younger population with over half of people aged 18-34 smoking.
Unsurprisingly, people diagnosed with long term conditions are more likely to be smokers or exsmokers than those who have never smoked. For instance, of the 44 people who have been
diagnosed with asthma, only 12 people have never smoked and half of the 44 still continue to
smoke with asthma. Thirteen have tried to give up unsuccessfully.
Table 15 Q. Do you smoke?
Answer
No, I have never smoked
Yes I currently smoke
No, but I used to smoke
Percentage
39.2%
38.9%
21.3%
Base: 314
24
Table 16 Answer to Q. „Do you smoke?‟ by age
Age
Yes I currently
smoke
18-24
53.2%
25-34
51.3%
35-44
33.9%
45-54
48%
55-64
37.5%
65+
7.8%
No but I used to
smoke
12.8%
18.0%
21.4%
19.2%
20.8%
36.4%
No I have never
smoked
34%
30.8%
44.6%
32.7%
41.7%
56.4%
Base: 314
Table 17 Q. If you still smoke, have you tried to give up before?
Answer
Percentage
Yes
58%
No
42%
Base: 314
Of the people that currently smoke but have tried to give up, it is roughly even as to whether they
had help or they tried to give up on their own. The following quotes pull out some of the approaches
taken:
“The chemist gave me patches and put me on a course. When I went the second time to
the chemist I was asked if I’d had a cigarette since the last time I’d been. I told the truth that
I had had a couple when I felt a bit stressed, so the chemist told me I could not stay on the
course. So without the help I started smoking again.” Male, 18-24, homeless.
“I tried patches prescribed by GP but they were a nightmare. [I had] tablets prescribed by GP
– with the tablets I got to 2 cigarettes a day. Because I was down to 2 a day my GP wouldn’t
prescribe any more tablets because I hadn’t given up altogether. [Because of this] I gradually
started to smoke more. [I still smoke] today”. Female, 45-54, Rainbow Hill.
The most common reasons for people starting to smoke again was related to stress and lack of
willpower/motivation, the following quotes illustrate this finding:
“I tried giving up on my own and managed very well for a few years. Following a stressful
time after losing a friend and my Dad I started smoking again.” Female, 45-54, Warndon.
“I went cold turkey but it did not work. I have not got any will-power. I pack up for a few
months but always go back to smoking as soon as I get stressed.”Female, 45-54, Gorse Hill.
“I gave up but came back to smoking due to stress regarding my conditions”. Female, 25-34,
Warndon.
This reflects that wider stress has an effect on smoking and that, anecdotally, support from health
services have taken a strict approach without focussing on the role of stress.
25
The most common way that people gave up smoking was on their own without any support. Having
the pressure of family members asking them to, witnessing family members‟ health deteriorate due
to smoking or being pregnant were also big motivators for quitting. Few people had accessed
support for giving up and this mainly seemed to be after their health had deteriorated and giving up
becoming “necessary” due to health.
“I gave up after I was ill (stress Pneumonia) & my son begged my before he died to give up
smoking so I have respected his wish.” Female, 65+, Rainbow Hill
“As I started to feel stronger from suffering with depression I took a look back and realised
how unfit and unhealthy I had become. So I decided to give up smoking, start exercising a
couple of times a week and eating healthier. I used patches bought from the chemist as the
appointment was too long away.” Male, 25-34, Warndon.
“I was really bad and kept having chest infections, and was diagnosed with COPD, and
doctors said my life would be very short if I didn’t pack up, so I just stopped.” Male, 65+,
Rainbow Hill.
4.1.8 Eating habits
There is a belief amongst almost 70% of the participants that their average daily diet is at least quite
healthy even though only 15% eat the recommended daily amount of fruit and vegetables and over
half the sample have less than three portions of fruit or vegetables a day. Only 21.5% of the people
who state their diet is „quite healthy‟ or „very healthy‟ state they eat the recommended daily amount
of five or more portions of fruit and vegetables. This suggests that there is a gap between people‟s
understanding of a healthy diet and what their diet actually is. However, significantly, over 25%
acknowledge that their diet is not healthy.
People with long term conditions are also more likely to rate their diet as less healthy than people
who haven‟t been diagnosed with a long term condition.
Table 18 Q. How healthy do you think your average daily diet is?
Answer
Percentage
Very healthy
16.9%
Quite healthy
52.5%
Not very healthy
25.8%
Very unhealthy
3.8%
Base: 314
26
Table 19 Q. How many portions of fruit or vegetables do you eat on an average day?
Answer
Percentage
None
10.5%
One to two
42.4%
Three to four
30.9%
Five or more
15.3%
Base: 314
Table 20 Percentage of people who state they are “quite or very healthy” who eat more three
or more portions of fruit a day.
Answers
Percentage
Answered “very healthy or
21.5%
quite healthy” and eat five or
more portions of fruit and
vegetables a day
Percentage relates to respondents who answered “quite healthy” or “very healthy”
Base: 218
4.1.9 Exercise
Over a quarter of respondents report that they exercise every day. However, 17.5% do little to no
exercise. Unlike the data about eating habits, there is no significant difference to people‟s reported
exercise levels between those diagnosed with a long term condition and those who have not been
diagnosed.
Table 21 Q. How many days a week on average do you spend a total of 30 minutes on
physical activity at a moderate pace or above?
Answer
Percentage
None
12.1%
One
5.4%
Two
9.2%
Three
14.6%
Four
12.1%
Five
12.4%
Six
5.7%
Seven
27.4%
Base: 314
Participants were told “moderate exercise means you‟re working hard enough to raise your heart rate and start to sweat.
This can include activities such as walking to work, doing strenuous housework, or attending fitness classes or playing
sport”.
Furthermore, there appears to be some link between mental health ratings and physical exercise –
over 50% of the people who rate their mental health as poor or very poor report they exercise three
times a week or less, whereas over 50% of the people who rate their mental health as fair or above
exercise more than three times a week.
27
The following case study highlights someone who is dealing with many conflicting factors on their
health and wellbeing. Please note, all case studies have been anonymised.
Kyle: 25-34, male, White British, works full time
Kyle is a regular visitor to the GP and really likes the fact that he has always had the same GP
as it helps with understanding his situation. However, he finds that he has to wait too long for
appointments over the phone. Kyle thinks that his physical health is good and he frequently
attends the gym, however he feels his mental health is fair as he has been through a bad patch
in the last few years. Kyle feels that he has dealt with this successfully himself.
Kyle currently smokes and has never tried to give up. His father died from alcohol poisoning.
Kyle thinks people have a lot of control over their health and he would like help with improving
his diet. However, he has not approached any services for advice with this and he thinks that
“no one can help currently”.
He has previously been to hospital as an emergency due to being involved in a brawl when
drunk. He woke up in hospital after the incident after having stitches. He was given advice
about responsible drinking but he didn‟t find it helpful as he wasn‟t ready to take notice. He
does not think that this incident could have been prevented as it was just “one of those
situations”.
He strongly feels part of the community but he does not currently volunteer. He does help
friends and family with DIY. The only thing that would make him want to be more involved in the
area is by “moving all of the residents out of the area”. He does not attend any voluntary groups
or community groups as he doesn‟t want to. He finds out about what is going on locally through
friends and family.
The main issues that he feels affect his general health and wellbeing are a lack of public
transport, housing problems and unemployment/lack of job opportunities.
4.1.10 Key questions to the steering group for initiatives
 How can people‟s expectations for their physical and mental health be raised so that they want
their health to be better and want to make positive changes?

How can the motivators of friends and family be used to improve lifestyle behaviours?
 How can the social behaviours of smoking and substance misuse within the community be
challenged by positive role models and focussed advertising?
 What existing resources can be used to tackle stress?
 How can existing provision incorporate a focus on mental health outcomes?
28
4.2
Health and wellbeing
Summary – health and wellbeing
Wider lifestyle factors seem to be important regarding health including the influence of family
members, stress, anxiety, money worries, unemployment and the prevalence of bereavement of
family members, often through misuse of drugs and alcohol.
Increasing motivation appears to be key to people making positive lifestyle changes.
Feeling supported and reducing social isolation appears to be linked with wider health and
wellbeing.
The level of debt and worry about money in the community is high and affects health and
wellbeing.
There is not one clear concern for people regarding their health and wellbeing. Also, significantly,
21.4% of people do not want to improve their health and wellbeing. Therefore, there needs to be an
appreciation of a lack of willingness for some people regarding making changes. Furthermore, this
does not set out a clear way to structure initiatives but rather suggests that there are many things
people may like to improve and that these might not necessarily be specifically health based but
wider lifestyle changes such as tackling debt, or reducing social isolation.
Table 22 Q. Thinking back on what you have said so far, what is the one thing you would like
to do to improve your health and wellbeing?
Answer
Percentage
Improve my diet
24.3%
Nothing
21.4%
Do more exercise
18.8%
Stop smoking
17.5%
Other**
11.8%
Cut down on alcohol
6.1%
Base: 314
**Other includes:
Sort out undiagnosed health issues: 1.6%
Lose weight: 1%
Stop taking drugs: 1%
Reduce anxiety: 1%
Socialise more: 0.6%
Nobody had approached the Expert Patient Programme, community matron or the healthy lifestyles
hub and most respondents hadn‟t approached any services for help. When they had asked for help,
it was through the traditional routes and again, relying on friends and family.
29
Table 23 Have you approached any of the following services for help with this?
Answer
Percentage
No help or support asked for
12.1%
GP
6.1%
Nurse
6.1%
Pharmacist
6.1%
Friends and family
6.1%
Health Trainer
1.9%
Stop smoking service
1.6%
Family support group
1.3%
Health visitor
1.3%
District nurse
0.6%
Domestic abuse support
0.3%
service
Multi-response question – base 314
When asked what would help to improve their health and wellbeing, the following answers were the
most frequent. Whilst some of these are physical health specific, a lot of them relate to money
worries, worries generally and broader mental health/wellbeing goals.
The most frequent two answers show that increasing motivation for respondents is key to making
improvements, as is the role in support and guidance from services.
Table 24 Q. What would make it easier to improve your health and wellbeing?
Answer
Percentage
Having more motivation
17.8%
Receiving more support and
guidance from services
Cheaper healthy food
14.6%
Having more time to cook
7.6%
Cheaper gyms
7%
More money
7%
Reduce stress
5.4%
Having more peer
support/social structure
3.8%
9.9%
Percentages relate to number of respondents who answered the question
Multi response question – Base 297
30
The following quotes illustrate the findings further.
“I'm aware that there are groups for stopping smoking and that my GP would help me. I just
don't feel like I've ever been ready to quit yet.” Female, 45-54, Warndon.
“To have someone to help 24/7 as my will power is so low. I need to be pushed all the time.”
Female, 25-34, Warndon.
“If I could give up smoking but it's so hard. Other than that I feel ok. I have a stressful life so I
never feel I have the strength to give up & I am concerned it will make my anxiety & stress
levels worse.” Female, 45-54, Gorse Hill.
“I need to lose weight. As a person with depression I find it hard to get a job & it makes my
depression worse. If the medical profession could liaise with the employment agency to get
people with mental health back into work & get confidence back that would help with lifestyle
& give me self worth & help with depression. People need to work together.” Female, 45-54,
Gorse Hill.
“Maybe having access or be able to go somewhere to be directed further for my needs,
having a support group for depressed people & knowing who to ask in the first place for
help.” Male, 45-54, Warndon.
“Not suffering with anxiety. Not having family members/ friends who smoke. Not being bored.
Having a job.” Male, 18-24, Warndon.
“I probably could give up with the use of patches etc., but fags help me getting too stressed.
Maybe if I had a job I wouldn't be stressed and unhappy.” Male, 25-34, Gorse Hill.
These quotes demonstrate that the barriers to improving health and wellbeing are linked to stress,
money worries, employment worries and lack of support.
The prevalence of mental health and wider lifestyle pressures was noted by one of the Community
Champions:
“Mental health came out as a massive issue and lack of support for this is – I found – a BIG
BIG problem. I want the project to achieve help for mental health with more accessible help
locally. I think a local walk-in counselling team is needed. Stress, anxiety and depression I
found is so widespread in this community and affects other health issues i.e. smoking,
drinking, drug abuse is harder to control when your mental health is affected. It is a circle
that goes on and on. Also, more help for family and carers for people with mental health
issues is needed. More help with bereavement is also needed”.
31
The following case study highlights some of these issues regarding motivators and barriers to
maintaining a health lifestyle. Please note, all case studies have been anonymised.:
Rob: Male, 25-34, White British, Unemployed
Rob is on medication for a diagnosed mental health condition and suffers from depression. He
says that the medication he is on has bad side effects which affect his daily life. He wishes that
he had a more personal relationship with his GP and that he was able to book appointments
more flexibly.
Rob presented at A&E with pains in his lungs and was found to have pulmonary embolisms.
He was given advice to cut down on fatty foods and give up smoking. Whilst he found this
advice helpful, he still continues to smoke and only eats two portions of fruit and vegetables a
day.
Rob tries to keep himself fit by going to the gym regularly. However, he feels that he needs
more determination and will power to stick to exercise and diet goals. He thinks he would eat
more healthily if healthy food was more affordable as he finds it cheaper to buy unhealthy
options.
Rob currently smokes but has tried to give up in the past and was successful for 20 days using
patches and chewing gum. He found that the urge to have a cigarette became too great. He
thinks that the support was there but his willingness to use the support was not enough.
Rob doesn‟t volunteer in the community but does help out friends and neighbours. He would
like to get involved by making and keeping the community tidier. He did not know of any local
groups and did not know about the “what‟s on guide” but was keen to find out more about how
to get involved. He currently only finds out about what is going on locally through friends and
family.
Housing problems, anti-social behaviour and money problems/debt were the main things that
Rob found affected his health and wellbeing.
32
Table 25 Q. Can you select the three issues that have the most impact on your health and
wellbeing?
Please rank them 1= most impact, 3 = least impact
Issue
Score
Money problems/debt
Anti social behaviour
Unemployment/lack of job
opportunities
Drugs/alcohol problems
Feeling isolated
Housing problems
Access to GPs
Affordability of public
transport
Lack of support from family
and friends
309
220
210
Number of people choosing it in top
3 issues
45.2%
30.6%
36%
178
125
123
95
80
24.9%
20.7%
19.7%
13.4%
16.6%
72
12.4%
Base: 314.
Score has been calculated with weighting for whether people ranked 1,2 or 3 for an issue as participants were asked to
rank in order of impact.
4.2.1 Money and unemployment
Overwhelmingly, the most important issue people think affects their health and wellbeing is money
problems and debt, with 49% of the people who answered this question stating this was in their top
three issues, and 20% of participants ranking this as the most important factor to their health and
wellbeing. Linked to this, unemployment/lack of opportunities for jobs was a top 3 factor for 39% of
participants, suggesting that the issues of money and employment are key concerns for
respondents in these communities.
As evidenced elsewhere, this is a broad emerging theme throughout the research that worries about
money, debt and job security are having an effect on the physical and mental health of the
participants; the theme has emerged regarding dependency on smoking, drugs and/or alcohol and
as reasons for not getting more involved in the community or as barriers for respondents to
changing their lifestyles.
4.2.2 Substance misuse and ASB
The issues of ASB and drugs and alcohol misuse also feature significantly in issues affecting
people‟s general health and wellbeing. This demonstrates the role the wider community
environment has on health. Again, these themes have been drawn out in the research, for instance,
in the high number of respondents affected by drug and alcohol misuse and people struggling to
beat addiction to smoking.
33
These themes were picked up by the Community Champions in their experience of conducting the
research:
“I think we need better services to help people to get a job and experience. Also, where
teenagers can go and do something so they will be off the stress so crime and vandalism
would stop.” Zoe
“I want the project to achieve new health services that do services for different ranges of
people and ages e.g. a service that tries to encourage younger people not to do drugs and
also I think you should have younger people to engage with them. I think if you had someone
to say about their experiences with drugs it would turn them against them.” Hannah
4.2.3 Social isolation
“Feeling isolated” was a top three issue for 21% of the participants, with 12% of participants
choosing lack of support from friends and family as a top three issue. This is also a recurring theme
throughout the research findings – and where people feel lonely or isolated or lack support, this
contributes to mental health concerns, management of health and a lack of feeling in control of their
own health. This theme is also one picked up by several Community Champions:
“I feel there is a strong sense of belonging to a community by some, but for others, they felt
isolated” – Mal.
“What surprised me was how isolated people felt”. Sassa
The top three issues demonstrate that reducing health inequalities and increasing healthy lifestyles
of people in these wards needs to be looked at through an appreciation of the context of people‟s
lives, in particular, the stresses they are experiencing, their expectations and the amount of formal
and informal support they have as individuals.
34
The case study of Liam, who is homeless, brings out some of these themes. Please note that all
case studies have been anonymised:
Liam – male, 35-44, homeless, unable to work due to health reasons
Liam is a frequent visitor to his doctor‟s surgery which is the walk in centre and feels that
everything about this surgery is good. He also thinks that all health services are where he
needs them when he needs them.
Liam has been to A&E as an emergency on several occasions, including for detox and most
recently was taken there by the police as he hurt his wrist due to being involved in a fight.
Liam describes his physical health as fair and his mental health as poor. He is currently
accessing support from services for his physical and mental health. Liam is an asthmatic and
he currently smokes, has tried to give up in the past and would like to give up again as a
priority.
“I have bouts of depression. I was an alcoholic. I don't drink much anymore. I used to take
drugs & I am on medication from GP. All my problems arose from the death of my wife. My life
went downhill from then.”
Liam would like to live in a place with people who share his illnesses so he could have his own
space but feel supported. He feels he currently needs a lot of support but hopes to be
independent when the treatments kick in. He is also eager to be involved in the community and
feels that he could volunteer by helping other drug addicts as he understands what they are
going through. Liam has no formal qualifications.
The issues affecting him the most are drugs/alcohol, money problems/debt and affordability of
public transport.
4.2.4 Key questions to the steering group for initiative development
 How can a holistic approach be taken to improving health and wellbeing including wider lifestyle
issues of debt, anti-social behaviour and reducing isolation?
 How can the existing knowledge within the community, of living successfully with competing
demands on health, be harnessed?
 How can motivation be encouraged together with making people feel more connected to their
community?
35
4.3
Long term conditions sub-sample
Summary of long term conditions
There is a higher prevalence of long term conditions than the official statistics suggest.
The most common long term condition is depression/anxiety.
Most people feel they are able to manage their condition very well independently and
understand their condition well but there is scope for further understanding.
Most people haven‟t modified their behaviour since diagnosis and there appears to be a focus
on medication rather than lifestyle change.
Informal support networks and feeling supported by health services in managing their
conditions is key to the perception of successful management.
When diagnosed, most people have only accessed traditional methods of support and the use
of services outside of the GP surgery is very low.
4.3.1 Long term condition diagnosis
Just over half of the sample state they have been officially diagnosed with a long term condition
(53.5%). The most prevalent long term condition is depression/anxiety with 21% of all respondents
stating that they have been officially diagnosed with this.
When participants who solely have a mental health long term condition are excluded from the
sample, the number of people with a long term condition is 45.9% of the entire sample and only
16.9% have any of the six key long term conditions; either asthma, hypertension, diabetes, stroke,
COPD or heart disease.
Table 26 Q. Have you been officially diagnosed with a long term condition?
Answer
Percentage
Yes
53.5%
No
45.9%
Base: 314
36
Table 27 Percentage of people diagnosed with
LTC
Other
Depression/anxiety
Asthma
Hypertension
Diabetes
Stroke
Other mental health issue
COPD
Chronic Heart Disease
Prefer not to say
a long term condition split by condition
Percentage
39.9%
39.3%
26.2%
19.6%
13.1%
7.1%
7.1%
4.7%
3%
1.8%
Percentages relate to respondents who have been diagnosed with a long term condition.
Multi-response question, base 168.
Table 28 Further information on the “other” long term conditions (most commonly occurring,
two or more respondents)
Long term condition
Percentage
Arthritis
6.5%
Underactive thyroid
4.2%
Fibromyalgia
4.2%
Irritable bowel syndrome
2.4%
Epilepsy
2.4%
Angina
2.4%
Chron‟s
1.8%
Cancer
1.2%
Percentage relates to respondents who have been diagnosed with a long term condition.
Multi-response question, base 168.
4.3.2 Management of long term conditions
Two thirds of the sample think they are able to live independently and therefore, the assumption is
that they need no extra support and believe they are managing their health successfully.
The quotes below suggest that the presence of support from friends, family and services is key to
respondents‟ feelings of whether they can manage their conditions. Where there appears to be a
level of social isolation, people feel less able to manage. This theme was picked up by the
Community Champions in their opinions from conducting the research:
“I would like to see the people who felt isolated encouraged to participate in activities that
are available in their community. People need help in areas that are not catered for or are
difficult to access. These things need to be made more accessible for them”. Mal
37
Table 29 Q. How much do you agree with the statement “generally I am able to live
independently and access all the help I need to manage my condition”
Answer
Percentage
Strongly agree
39.6%
Agree
37.3%
Neither
13.6%
Disagree
6.5%
Strongly disagree
3%
Percentages relate to respondents who have been diagnosed with a long term condition
Base: 168
The following quotes illustrate these findings:
“I live on my own but socialise when I can & have good family around me. I need for
nothing.” – Female, 65+, Rainbow Hill.
“As I am able to manage on my own with my prescribed inhalers I take for my Asthma.
I only go to the doctors when I need to. I’m independent”.- Male, 35-44, Warndon.
“Because my doctor knows my history so is there if I need support” Female, 25-34, Rainbow
Hill.
“I can still do my normal everyday living activities. A family member collects my prescription
which chemist automatically re-orders my tablets every month. My son does a little food
shopping.” Female, 25-34, Gorse Hill,
“Because I had a lot of family support & I know I can live independently.” Female, 45-54,
Gorse Hill.
The following are quotes from people who did not agree with the statement:
“Any financial problem, it takes a long time to be sorted out as I am fairly new to the area
(2yrs) I don't know what services are available to me. No one has told me where there is
help for my condition.” Female, 65+, Gorse Hill
“Because I struggle sometimes on my own with being overweight and find it hard being on
my own.” Male, 55-64, Rainbow Hill.
“Because you can't get to see the doctor when you need to, medical help or advice is not on
hand when you need it.” Female, 45-54, Warndon.
“I feel I need to have more support & feel doctors just want to pass you off & chuck pills at
you.” Male, 25-34, Gorse Hill.
“I get lonely on my own sometimes.” Female, 25-34, Gorse Hill.
38
4.3.3 Understanding of long term conditions
People think they have a good understanding of their own long term condition, although, a third of
the sample would like to find out more about their conditions.
This should be viewed in the context that most people think they are able to manage their condition
successfully and independently. Again, this may be linked to the understanding of what successful
management is and to what extent people feel they need to understand their condition.
This is compounded by the findings from behaviour or lifestyle changes at table 31. Just over half of
respondents with a long term condition have taken action to change their behaviour since this
diagnosis, but almost half of the sample who have been diagnosed have carried on without any
lifestyle modifications, even though most of these people believe they completely understand their
condition and are able to manage it successfully. Drawing on the qualitative data, this may be linked
to a reliance on medication to manage their conditions, rather than changes in lifestyle:
Table 30 Q. How well do you feel you understand your condition?
Answer
Percentage
Understand completely
65.1%
Understand a little
20.7%
Would like to understand more 13%
Don‟t understand
0.6%
Don‟t know
0.6%
Base: 168
Table 31 Q. Have you changed your behaviour or lifestyle since you were diagnosed?
Answer
Percentage
Yes
51.2%
No
48.%
Base: 168
The following quotes draw out the potential association between management of respondents‟ long
term conditions and medication:
“Because I receive help that I need - I'm on tablets to control it all so it doesn't stop me from
doing anything independently.” Female, 65+, Gorse Hill
“I take tablets and inhalers to control my illness.”Female, 65+, Warndon.
“I get on with it. Stick a smile on my face. The only time I need to see a GP is when I need
more tablets.” Female, 35-44, Warndon.
“Because the blood pressure is being managed sufficiently by medication”. Female, 65+,
Rainbow Hill.
39
“Because I am on medication that controls my condition.” Female, 35-44, Warndon.
“I see the nurse once a fortnight to have BP checked & weighed. I have repeat prescriptions
for my BP medication. Otherwise I don't see anyone else.” Female, 65+, Gorse Hill.
When people have modified their behaviour, table 32 shows the common ways these changes have
been made. However, as table 33 demonstrates, fewer than 10 people have accessed any other
services for support with their conditions other than the GP, pharmacist, nurse or friends and family.
Again, this highlights the importance of informal support networks of friends and family, and a need
to increase the use of non-traditional services for assistance with their health management.
Table 32 Lifestyle modifications made after diagnosis of long term condition
Modifications made
Percentage
Changed diet
48%
Exercised more
29%
Lost weight
24.4%
Stopped smoking
15.1%
Cut down on drinking alcohol
14.0%
Stopped drinking alcohol
12.8%
Joined a support group
11.6%
Cut down on smoking
8.1%
Percentages relate to respondents diagnosed with a long term condition and have made lifestyle modifications
Multi-response answer - base 86
Table 33 Q. What services have you accessed in relation to your condition?
Service
Percentage
GP
96%
Pharmacist
66.3%
Nurse
52.1%
Friends and family
28.6%
Family support group
7.1%
District nurse
4.1%
Expert patient programme
3.6%
Stop smoking service
3.6%
Community group or support
3.6%
group
Health visitor
3.6%
No services accessed
2.4%
Slimming groups
2.4%
Domestic abuse service
1.8%
Psychiatrist
1.8%
Health trainers
1.2%
Healthy lifestyles hub
0.6%
Percentages relate to respondents diagnosed with a long term condition and have made lifestyle modifications
Multi response answer - base 86
40
The following case study highlights a respondent who feels isolated and is dealing with long term
conditions, including depression. Please note all case studies have been anonymised:
Mary: female, age unknown, white British, rents from Nexus Housing, unable to work
due to health reasons
Mary was very complimentary about the service she gets at her GP surgery and could not
think of anything that needed to be improved. She rates her physical health as very poor. She
reports that she doesn‟t exercise as she struggles to breath. Mary is very overweight which
causes her stress and upset. She is currently receiving support from health services regarding
her physical and mental health. She also reports her mental health as very poor – she is on
anti-depressants, has low mood and “can‟t be bothered”.
The main thing that she would like to do to improve her general health and wellbeing is to
improve her diet but she has not approached any services for help with this. Mary thinks that
she could be helped by having more money to buy healthier food.
Mary has been diagnosed with COPD and high blood pressure but feels she can still do her
normal every day activities. She has accessed support from the GP, nurse, pharmacists and
friends and family in relation to these conditions but would like to understand more about the
actual conditions. Mary used to smoke until she was diagnosed with COPD. She was able to
stop with help from a nurse at her surgery and used patches and gum.
Mary does not currently volunteer in the community or help out neighbours or friends but she
would like to join a support group for COPD to learn more about it and to get out of the house.
She has never been to any local groups because she doesn‟t know what is out there and has
difficulty getting around outside. She finds out about what is going on locally from friends and
family and the newspaper. However, she feels very isolated, relies on one family member who
gives little support and relies on public transport to get around anywhere.
The main issues having an effect on her health and wellbeing are: money problems and debt,
feeling isolated and a lack of support from friends and family.
 How can support networks be fostered for people who feel socially isolated?
 What existing provision can be used to change perceptions of successful long term condition
management away from a reliance on medication towards lifestyle modifications?
 How can low level mental health needs be addressed coupled with other lifestyle issues?
 How can existing capacity from within the community be harnessed to promote successful
lifestyle management by buddying/peer support?
41
4.4
Health services
Summary of health services
In general, people seem to be relatively satisfied with the placement of health services and
with the service they get from their GP.
However, there appears to be significant concerns regarding when services are available
demonstrated through unhappiness with the availability of appointments at their GP surgery
and use of A&E because of convenience and availability.
There also appears to be a low usage of NHS Direct, the GP out of hours service and the
walk-in centre. The findings suggest that people find it difficult to access the GP out of hours
service.
People seem most happy with their health services when they can easily get to see a GP of
their choice, who they have a personal relationship with and who they feel listens to them.
Frustrations arise when they feel blocked from this by either availability or receptionists acting
as gatekeepers and performing triage style questioning.
The pharmacist appears to be a successful and positively thought of health service that is
frequently used and could be a key avenue for health promotion.
The dentist provision and use of the dental service in the area is low which could contribute to
or be an indicator of general wider poor health and wellbeing.
4.4.1 Availability of health services
Overall it appears that the majority of respondents (85%) think at least most services are available
where they need them. However, a quarter of respondents do not think many services are available
when they need them.
Table 34 Q. In general, would you say health services are available where you need them?
Response
Yes all services
Yes most services
Neither
No, not many services
No, none of the services
Percentage
29.6%
56.7%
4.5%
8.3%
0.3%
Base: 314
Table 35 highlights that a quarter of respondents do not think that health services are available
when they need them. This is reinforced in the qualitative data regarding attendance at A&E due to
a perceived inaccessibility of other health services:
42
“It was a weekend and didn't feel I could wait until I could see my GP” – presented at A&E as
they felt the medication they were taking didn‟t suit them. Female, over 85, Warndon
“I think if I could speak to a GP sooner and explain how I was feeling they may have been
able to talk me out of my panic attack but when you phone NHS direct or out of hours GP
you have to wait so long for a doctor to phone you back. Last time I phoned I was told I
would have to wait four hours.” - presented at A&E as they thought they were having a
heart attack and they were diagnosed with panic attacks. Female, 25-34, Rainbow Hill.
Table 35 Q. In general, would you say health services are available when you need them?
Response
Percentage
Yes, all of the time
22.3%
Yes, most of the time
53.8%
Neither
8.9%
No, not very much of the time 13.4%
No, none of the time
1%
Base: 314
4.4.2 Use of health services
The pharmacist is the most frequently accessed service, followed by the GP surgery.
However, the A&E department at Worcester Royal Hospital was more frequently used than the
walk-in centre, NHS direct, or the GP out of hours service. Nearly one third of participants don‟t ever
to go the dentist - a marker of people not looking after their wider health and wellbeing.
Table 36 Q. Over the past year, how often have you used any of the following health services
in general?
Name of service
Often
Sometimes
Rarely
Not used
Pharmacist
50.2%
24.4%
11.9%
13.5%
GP surgery
46.3%
29.7%
18.2%
5.8%
Dentist
9.9%
28.8%
32.9%
28.4%
WRH outpatients
8.1%
11.3%
19%
61.6%
WRH A&E
5.2%
8.4%
29.2%
57.1%
Worcester walk-in centre
4.2%
4.5%
17%
74.4%
WRH Inpatients
2.6%
5.8%
14.8%
76.8%
Ambulance or paramedics as 999
2.6%
5.5%
16.4%
75.9%
NHS Direct
2.6%
9%
17.4%
71.1%
GP out of hours service
2.2%
12.8%
20.5%
64.4%
Base: 314
43
Table 37 Percentage of people who have not used the service at all in the last year
Name of service
Percentage
WRH inpatients
76.8%
Ambulance or paramedics as 75.9%
999
Walk in
74.4%
NHS direct
71.1%
GP out of hours
64.4%
WRH outpatients
61.6%
WRH A&E
57.1%
Dentist
28.4%
Pharmacist
13.5%
GP
5.8%
Base: 314
4.4.3 Accessibility of health services
Whilst the figures below show that the same services are “hardest” and “easiest” to access e.g. GP
surgery and A&E, this is likely to be because these are some of the most used services. However, it
does suggest there is a polarised opinion regarding accessing the GP service and A&E.
Nevertheless, it appears that the pharmacist is regarded as being easy to use generally and the
dentist as being hardest to access.
Furthermore, WRH outpatients and the out of hours service appeared more difficult to access, even
though they were used significantly less suggesting that there may be confusion about how these
services are accessed.
Table 38 Q. Which one health service do you find the easiest to access locally? (no more
services were selected by above 5% of participants)
Name of service
Percentage
GP surgery
52.0%
Pharmacist
14.6%
WRH A&E
10.3%
Base: 314
Table 39 Q. Which one health service do you find the hardest to access locally? (no more
services were selected by more than 5% of participants)
Name of service
Percentage
GP surgery
30.9%
WRH A&E
12.4%
Dentist
11.8%
WRH Outpatients
7%
GP out of hours
6.4%
Base: 314
44
Concerns were raised by several participants regarding the provision of dentists in the area as
demonstrated by one Community Champion‟s notes:
“Dentists were a big concern – working people who don’t get free treatment never go as it is
the last thing they can afford.”
4.4.4 Access to GPs
The data shows a fairly polarised opinion between participants regarding the ease of getting an
appointment with an almost even split between people who think it is at least fairly easy to get an
appointment and people who do not. However, there were many more participants who think it is
very easy than very difficult.
Table 40 Q. How easy or difficult is it to get an appointment at your GP surgery when you
need one?
Rating
Percentage
Very easy
20.7%
Fairly easy
35%
Neither
12.7%
Fairly difficult
20.7%
Very difficult
9.9%
Base: 314
4.4.5 Satisfaction with the GP service.
The following figures at table 41 reveal a positive finding with two thirds of the sample being at least
fairly satisfied with the help they get from their GP and only 3.5% being very dissatisfied. This
suggests that there may be more of an issue with access to GPs than the actual GP service
provision.
Table 41 Q. Overall, how satisfied are you with the help you get from your GP?
Rating
Percentage
Very satisfied
35%
Fairly satisfied
38.9%
Neither
13.7%
Fairly dissatisfied
8%
Very dissatisfied
3.5%
Base: 314
45
When asked further about what respondents felt worked well at their surgery, the appointment and
booking service, the ease of getting an appointment and accessibility of appointments were
frequently cited. However, respondents‟ responses to what needed to be improved at the GP
surgery found frequent dissatisfaction with the appointment system with 35% of respondents
wanting it to be easier to make an appointment and frequently people wanted more flexible
appointments. Reception staff were also frequently cited as being barriers to GPs and respondents
reported dissatisfaction about what they felt was receptionists asking personal details and acting as
gatekeepers.
The quotes below highlight some varying opinions about the appointment system.
What works well:
“Better with new [doctor/phone call] system can see somebody that day instead of waiting a
week”. Elbury Moor
“I like how the doctor rings you back to see if you do need an appointment, stops people
wasting time.” Elbury Moor
“Booking system [is] very good. You are able to speak with GP on same day generally & see
them if needed. All staff are approachable & friendly. They give right advice & options.”
Elbury Moor
What needs to be improved:
“Making an appointment .Having to tell the receptionist your problems before you speak to
the Doctor.” Elbury Moor
“The booking system needs a change. You have to wait to be phoned back and sometimes
you can be waiting hours and never get an appointment with who you want, when you want.”
Elbury Moor
“The booking system if you don’t get through early you have to wait to be phoned back& you
can be waiting hours. The receptionist can be snotty wanting to know what’s wrong with you.
I don’t want to tell a receptionist I want to tell a doctor.” Elbury Moor
“The booking system – cannot get appointments. Receptionists – unhelpful, rude, arrogant,
nosey. GPs - feel rushed, palmed off with tablets”. Haresfield Surgery, turnpike
“Have to wait to get through by phone for an appointment. I don’t like the fact that the
receptionist asks many questions before being offered an appointment. I was offered a
prescription for antibiotics for a flu like illness over the phone .I would rather have had a visit
from the GP .I would have felt more content.” Elbury Moor
“The booking system is not very good, as you have to explain your reason why you want an
appointment with the receptionist before they tell you if you can have an appointment. And
46
they aren’t even doctors or even trained to tell someone if they need to see a doctor.” Elbury
Moor
“Hard to get face to face appointments, been told to go to A&E in the past.” Elbury Moor
The following quotes explain what people value about the GP service generally.
“I always get an appointment when needed. My own doctor is so nice, kind, helpful and
always willing to listen.” Albany House
“They listen to what you have to say. They are prepared to listen and give time to the
patient, and recommend further treatments or information.” Elbury Moor
“When I do get to see my own doctor he helps me, understands me, and knows my needs.”
Elbury Moor
 How can alternative health care provision be promoted more successfully to increase use
and appeal to the people living here?
 How can existing front line staff such as receptionists, or pharmacy provide sign-posting to
other services?
47
4.5
The use of A&E
Summary Use of A&E
Most people have been to hospital as an unplanned visit and most people believe that this was
not in relation to a long term condition.
Heart and chest related incidents and strokes are prominent reasons for attendance at A&E.
There is a significant number of instances related to mental health and wellbeing causing trips
to A&E as well as other lifestyle indicators to do with drugs and alcohol.
A&E is seen as more accessible and an alternative when the GP hasn‟t been able to help or
when someone has reached crisis point.
Under 50% of respondents state that they were given advice about how to prevent future trips
to A&E
Over half of the respondents (57.4%) think that their trip to A&E could not have been
prevented.
4.5.1 Prevalence of unplanned attendance at A&E
Most people have had an unplanned attendance at hospital. (51.9%) and most of these people do
not believe this attendance was related to a long term condition. When excluding accidents, the
data shows the prevalence of heart/chest related illnesses and strokes as reasons for these visits.
However, other than these, the most common reasons are either mental health related or lifestyle
driven, highlighting again the needed to look wider at health and wellbeing.
A breakdown of the people who stated they were frequent attendees at A&E showed that 50% of
these respondents found it at least fairly difficult to get an appointment with their GP and also found
that services were not available to them at the time they needed.
Of these respondents who were frequent attendees at A&E, 81.3% described their physical health
as fair or below and 50% described their mental health as fair or below. 81.3% had also been
diagnosed with a long term condition, the most prevalent of which was asthma, with 37.5% of the
people who stated they frequently attended A&E stating they had asthma, followed by 31.3% having
depression/anxiety and 25% having diabetes and hypertension. Of these respondents, 62.5% did
not see their trip as preventable.
Whilst all age ranges feature in these respondents, there was a higher proportion of people in the
45-54 age bracket who were frequent attendees at A&E.
48
Table 42 Q. Have you ever had an unplanned admission/attendance to hospital? (as an adult
only)
Answer
Yes, called 999
Yes, took myself to A&E
Yes, sent by my GP
Yes, other route
No
Percentage
25.6%
25.6%
13.4%
4.2%
48.1%
Multi response question, base 314
Table 43 Q. Was the last time in relation to an LTC?
Answer
Percentage
Yes
36.1%
No
63.9%
Percentages relate to respondents diagnosed with a long term condition who have had an unplanned
attendance/admission at hospital
Base: 155
Table 44 Common reasons for going to A&E
Reason
Percentage
Accident
23.9%
Chest/heart pains
14.7%
Stroke
4.3%
Mental health issues
4.3%
Self harm/attempted suicide
4.3%
Alcohol related issues
3.7%
Ran out of medication/did not
control condition well enough
Drug overdose
3.7%
1.2%
Percentages relate to respondents who have had an unplanned attendance/admission at hospital
Base: 163
4.5.2 Advice and prevention
Over half of the participants state they either weren‟t given advice or didn‟t know if they were given
advice whilst at A&E. However, where they were given advice, they generally found this helpful.
49
Table 45 Q. After you were treated, were you given any advice about how to manage the
situation that led to you going to hospital?
Answer
Percentage
Yes
49%
No
44.6%
Don‟t know
6.4%
Base: 163
Nevertheless, that less than half report they were given advice could impact on whether they see
the trip as preventable and impact on subsequent behaviour - most people (57.4%) do not see their
trip to A&E as preventable.
Table 46 Q. Do you think this trip to hospital could have been prevented? E.g. could you
have gone elsewhere for treatment or could you have followed advice earlier to prevent the
emergency situation?
Answer
Percentage
Yes
27.7%
No
57.4%
Maybe
14.8%
Base: 163
The following quotes expand on some of the respondents‟ thoughts about their use of A&E. As
these quotes demonstrate, it appears that there is a reliance on A&E due to its availability all the
time and a lack of education or willingness to use other routes. There is also a suggestion from the
qualitative data that if health conditions were managed better earlier, such as managing medication
or managing lifestyle issues such as stress before they get to crisis point, some of these visits could
be prevented.
Quotes from respondents who do not think their trip to A&E wasn‟t preventable:
“The medication I was taking didn't suit me. It was a weekend and didn't feel I could wait
until I could see my GP.” Female, 65+, Gorse Hill.
“I attended A&E because of increased pain levels that the tablets weren’t helping with.
I was told to go to the GP to talk about it. Advice was not useful as the GP hadn’t been very
helpful. Nothing more I could do & I had to be seen immediately.” Female, 25-34, Rainbow
Hill.
Quotes from respondents who think this trip to A&E was preventable:
“I ran out of medication & pain was really bad. I could have used the out of hours GP
service, or been better at keeping tablets in stock.” Female, 45-54, Gorse Hill
50
“I had an infection in my foot, so took myself to A & E. I could have gone to a walk in centre,
but thought they would just send me to A & E, so I went there first.” Male, 18-24, Gorse Hill
“I had a panic attack but thought I was having a heart attack. I think if I could speak to a GP
sooner and explain how I was feeling they may have been able to talk me out of my panic
attack but when you phone NHS direct or out of hours GP you have to wait so long for a
doctor to phone you back. Last time I phoned I was told I would have to wait four hours”
Female, 25-34, Rainbow Hill
Quotes from respondents who are unsure whether the trip to A&E was preventable:
“When I was very low in my life I self harmed. If I had someone to talk to, to say how I was
feeling at the time. I had no one. I could only see self harm.” Female, 25-34, Warndon
“I had severe chest pain and difficulty breathing. If the doctor gave me the tablets I needed, I
wouldn't need to go.” Female, 45-54, Gorse Hill
“I had an infection for 3 weeks in my leg. I was told to attend my GP but I didn’t. It was
quickest at hospital.” Female, 45-54, Warndon.
The following case study highlights the complex needs of one respondent who has attended A&E
who has been diagnosed with physical and mental health long term conditions. Please note, all
case studies have been anonymised:
51
Shirley: Female, 35-44 White British, rents from Nexus Housing, unable to work due to
health reasons
Shirley is a frequent visitor to the GP, A&E and the pharmacist. She thinks that the doctors
and nurses are nice but she doesn‟t like having to tell the receptionist her problems before she
can make an appointment as it puts her off. She feels there is a big need for improvement with
the reception staff and the booking system.
Shirley thinks her physical health is poor and could be improved by doing more exercise and
eating healthily. Whilst Shirley doesn‟t eat any fruit and vegetables, she reports that she
exercises every day. She thinks she is managing her physical health successfully on her own.
She rates her mental health as very poor and has suffered from depression from the age of
15. However, she is not accessing any support for this and thinks she is managing her mental
health successfully on her own.
Shirley currently smokes and has tried to give up in the past but found it too hard. She thinks
that giving up smoking is the one thing she would like to prioritise. Shirley thinks the main thing
that would help her to do this would be to lead a stress free life. Shirley has also been an
alcoholic and drug user when she lost her mum.
Shirley has been diagnosed with asthma, depression and she has previously had a stroke.
She thinks people have a lot of control over their own health, she is able to live independently
and access all the support she needs, she feels she fully understands her conditions and she
has not changed her behaviour or lifestyle since being diagnosed with her long term
conditions.
Shirley attended A&E as an emergency when she had a stroke and reported feeling very
emotional. She does not see a stroke as being preventable and she felt she already knew the
advice they gave her which was to take it easy and avoid stress.
Shirley currently does not participate in any voluntary work, feels strongly that she is not part
of a community and does not want to get involved further in the community as she prefers “not
to get on with the people who live around here”. She feels that she helps out her family by
teaching her children to say no to drugs and to help elderly people. She also states that she
didn‟t know about the local services on offer at community centres. The only way that she finds
out about things locally is through the newspaper.
The main issues that Shirley feels affects her health and wellbeing are anti-social behaviour,
drugs and alcohol problems and housing problems.
 How can we create effective messages to break the social norm of attending at A&E?
 What mental health and stress management tools can be used to support people within the
community before crisis point?
 How can we make alternative health care provision feel more accessible to the community?
52
4.6
Community
Summary of Community
Most people are ambivalent or apathetic about belonging to the community and the level of
volunteering is low.
There is little desire to be more involved in the community – but a significant minority (24.4%)
do want to become more involved.
The level of informal volunteering within informal small community settings is high and is
something that could be developed.
When groups are used, the effects are positive, particularly in relation to increasing
socialisation, confidence and mental health.
Generally, people who don‟t already use groups do not see the benefit of them.
Communication needs to be targeted through informal networks but also thought needs to be
given to reaching out to socially isolated people.
Communication needs to appeal to people at a neighbourhood level.
There are many “life” barriers to getting involved including money, employment worries and
lack of time.
4.6.1 Current views of the community
There is polarised opinion about whether respondents feel part of the community, with a significant
number of people who do not have strong feelings either way, suggesting there may be apathy and
that these people could be encouraged to feel part of a community by targeting efforts appropriately.
Of the wards, Warndon have the most respondents who feel part of a community, whereas Rainbow
Hill have more respondents that are undecided about feeling part of a community.
Table 47 Q. Thinking about the area you live in, how much do you agree with the statement “I
feel part of a community?”
Answer
Percentage
Strongly agree
12.7%
Agree
23.6%
Neither
34.7%
Disagree
16.2%
Strongly disagree
11.8%
Base: 314
53
4.6.2 Current community involvement
The numbers for respondents who currently participate in voluntary work are low (17.8%). NCVO
(2013) reports that 39% of adults in England volunteered at least once in the last 12 months and
25% of adults volunteered formally at least once a month. Considering that a considerable amount
of this research was conducted in community settings, an assumption is that this reported figure is
higher than the general population for the wards.
Unsurprisingly, more people of retired age volunteer. However, the 25-34 age range is particularly
low. At the Ward level, rates of volunteering are low in Rainbow Hill, which is inverse to the levels of
health deprivation.
Table 48 Q. Do you currently participate in any voluntary work?
Answer
Percentage
Yes
17.8%
No
81.2%
Base: 314
Table 49 Percentage of people who currently volunteer split by ward.
Ward
Percentage
Warndon
17.9%
Gorse Hill
22.2%
Rainbow Hill
11.8%
Homeless
20%
Percentages relate to number of respondents from each ward
Base: 314
4.6.3 Current informal community involvement
Whilst the level of formal volunteering in the community is low, an interesting and promising statistic
is that 70.8% of respondents already support people at a neighbourhood or family and friends level
suggesting there is a lot of positive collaboration in the community at an informal level. This could
be useful in terms of how support or initiatives are structured to appeal to a neighbourhood/family
level rather than a “community”.
Table 50 Q. Do you give help or support to neighbours, friends or family in the local area?
Answer
Percentage
Yes
70.8%
No
29.2%
Base: 314
54
The following quotes illustrate some of the ways people give support to their neighbours friends or
family.
“I help anybody locally who needs help.” Male, 65+, Warndon.
“I help my neighbours, I walk the dog when very cold or if they are not well. They know I'm
there if they need anything. I'm always helping my parents as they are getting on a bit &
always on the go after my sons.” Female, 45-54, Rainbow Hill.
“I help an elderly neighbour - when I cook myself I do her a meal. I help family collect
grandchildren from school. I would help anyone who needed help.” Female, 65+, Rainbow
Hill,
“I work long hours to keep a roof over my family’s head. So don't have time for much. I do
put out neighbours bins and mow their grass when they are away but I should think most
neighbours do that sort of thing.” Male, Warndon.
“I listen to neighbours & friends problems & try & help”. Female, 65+, Gorse Hill.
“I visit a neighbour each morning & collect her shopping from shop. I visit another friend who
lives nearby daily. I put eye drops in for her & help with chores she cannot cope with.”
Female, 65+, Rainbow Hill.
4.6.4 Appetite for further community involvement
The findings are not very encouraging in terms of appetite for community involvement.
Nevertheless, a quarter of respondents do want to become more involved in the community, which
is hopeful.
This general reluctance to be involved could be linked to the way community is thought of as most
people are involved in their “small” community but don‟t volunteer in the wider, more formal version
of community. However, it could be due to other wider pressures on respondents, such as a lack of
time.
Whilst there are clear suggestions on ways some respondents can be encouraged to participate
that include raising awareness and making the process simple, overwhelmingly people do not want
to get involved and the people that are already involved generally feel at full capacity. The
importance of “no time” is useful to reflect on when considering the initiatives to make them realistic
to other pressures on people.
Table 51 Q. Would you like to be more involved in the community?
Answer
Percentage
Yes
24.4%
No
75.2%
Base: 314
55
Table 52 Reasons why people don‟t want to get involved/would make it easier to get
involved.
Reason
Percentage
Nothing, I do not want to get
64.8%
involved
Greater awareness of
10.6%
opportunities
Make it simpler to get involved 10.6%
Already involved enough
5.5%
Work too long hours/have no
5.1%
time
Broader range of roles
4.7%
Involve a wider range of
2.9%
people
Cover expenses
2.2%
Don‟t like the people around
2.1%
here
Percentages relate to respondents who answered that they would not like to be more involved in the community
4.6.5 Use of existing services
Most people have not visited any community services/local groups, and this figure is probably
higher for the general population throughout the study area as much of this research was conducted
in community settings.
When people have used services in the community, the difference this makes to them is positive
and again reinforces the theme that socialisation and being part of a support network enhances
mental health and general wellbeing:
Table 53 Q. In the past year, have you visited or used any services provided by local groups?
Answer
Percentage
Yes
39.5%
No
59.6%
Base: 314
56
Table 54 Top places visited
Name of centre
KGV community centre
Children‟s centres
Warndon Community Centre
Tolladine Community Centre
Fairfield Education Centre
Furness social club
Churches
Stop smoking services
Slimming clubs
Percentage
15.9%
11.5%
6.1%
4.8%
4.5%
3.8%
2.2%
1.9%
1.6%
Multi response. Base: 314
The following quotes illustrate some of the positive effects community and voluntary groups have
had:
Children‟s centres: “Chance to meet other parents & for the kids to play which is important
to mental health.” – Female, 25-34, Gorse Hill.
KGV: “Grandee club - as I have moved to the area recently I find it has helped me settle into
my new home & stopped my feeling isolated. I have made many friends at the club.” Female,
65+, Warndon.
“KGV Slimming world - I did lose weight but put it back on, I made friends. Looked forward to
a morning out” Female, 45-54, Gorse Hill.
Homeless provision: “Helps to make me more confident & perhaps helps to take my anger
away.” Male, 18-24, homeless.
Churches “I go to church there .I have lots of friends. It's my faith it's the centre of my world.
I feel part of a family.” Female, 45-54, Gorse Hill.
Support groups “My group of friends/ buddies who are all in the same boat as me, we
experience same difficulties in life.”Male, 45-54, Warndon.
Fairfield Education Centre: “Somewhere to go if you are short of money, I like being
social.” Female, 25-34, Warndon.
57
The following case study is an example of someone who is struggling with physical and mental
health issues but reports the benefit of being engaged in the community. Please note, all case
studies have been anonymised:
Jackie – female, over 65, White British, living in nexus sheltered housing, retired
Jackie is a frequent visitor to the GP and as an inpatient and outpatient at WRH. She finds
the outpatients service at the hospital the hardest service to access and the A&E
department the easiest. She finds the main problem with her GP surgery is the amount of
time she has to wait for an appointment. “You can sometimes be waiting hours for a call
back and then you never get an appointment with who you want, when you want.” Jackie
describes her physical health as fair and her mental health as very good, she regularly
exercises and eats three to four portions of fruit and vegetables a day.
Jackie would like to do more exercise but has not approached any services for any help with
this. She worries that she cannot do exercise because of her arthritis and pain so would like
to find some exercise classes that would be suitable for her. She has previously attended a
slimming world group but stopped going after her friend who took her stopped going and
she found it difficult to get to and didn‟t want to go on her own.
Jackie has been diagnosed with asthma, diabetes, hypertension and arthritis. She feels that
she can manage these conditions successfully on her own by taking tablets and using
inhalers. She has only used the GP, nurses and pharmacists for help with her conditions but
admits that she only understands her conditions “a little”. Since these diagnoses, she has
changed her diet and stopped smoking. Jackie used to be a smoker but she gave up when
she was diagnosed with asthma. She gave up on her own without any help after suffering
from a bad chest infection.
Jackie attended A&E most recently after ringing 999 with chest pains. She was not admitted
and told to visit her GP to get her asthma checked out. Whilst she does not think that this
trip to hospital was directly related to her asthma, she does think that the trip could have
been prevented if she had more advice on what to do if her asthma was “getting bad”.
Jackie strongly feels part of her community and currently volunteers by helping her
sheltered housing group at lunches and coffee mornings. She feels that everyone in the
sheltered housing community helps each other out and it is a friendly place to live. She finds
out about what is going on locally through friends and family, housing services, the internet
and the “what‟s on” guide.
She feels the biggest issue affecting her general health and wellbeing is the lack of public
transport and is concerned about her grandchildren who she believes may be taking drugs.
58
4.6.6 Barriers to the use of voluntary and community groups
The following are the most frequent reasons for why people do not currently attend any
community/voluntary groups:
Table 55 Reasons why people do not attend groups
Reason
Percentage
No need
27.8%
Not enough time/other work/life 25.1%
commitments
Don‟t know about them
9.6%
No interest
9.6%
Don‟t feel able to due to health 5.3%
Nothing geared towards me
2.7%
Scared/fear
1.6%
Percentages relate to respondents who do not attend groups
Multi response question: base 187
The following quotes expand upon some of these reasons:
“Didn't realise what was or is on offer. Don’t always have time as I work part time, single
mum to two children and help a neighbour.”
“Lack of time, not really any services that are available are of my interest.”
“Don't feel up to it, not always in the right frame of mind.”
One of the Community Champions, Sanne, explains what she found surprising about the research:
“What surprised me most was that there are so many people living within the community that
would like to get more involved but either can’t because of working long hours or do not have
a great awareness of how to get involved. And others, who would like to live more healthily
but lack motivation in doing so – or keep putting things off for another day!”
The following case study illustrates one respondent‟s opinions towards her community and potential
reasons why she does not want to get further involved. Please note all case studies have been
anonymised.
59
Julie: Female, 35-44, White British, works full time and rents from WCH
Julie is positive about the GP service she receives and likes the fact that she can get to see her
GP on the same day if it is needed. However, she finds it difficult that the prescription service
takes 3 days and that it has to be done in person and she find it harder to see a nurse.
Julie rates her mental health as poor and attributes this to having an exhausting and stressful job
and a busy family life where she finds it hard to have “me time”. She is currently receiving
support from health services regarding her mental health and has been diagnosed with
depression, however, she has not changed her behaviour or lifestyle since this diagnosis.
Julie acknowledges that her diet is not very healthy and she is a bit overweight. She reports that
she eats one to two portions of fruit and vegetables a day but she does exercise frequently. In
particular, she would like to improve her diet and states that in the past she has used the GP,
nurses and pharmacists to help with this. She has also attended a slimming group. She feels the
main way her health and wellbeing could be improved would be to be able to afford the gym and
to afford healthier foods.
Julie used to smoke and has successfully given up. This was triggered by having bronchitis and
she used support from the local pharmacy to give up at this time. Julie has been smoke free for
5 years.
Julie has family members that have been affected by drug and alcohol misuse, including one
brother who died as a result of drug dependency and a father who suffered all his life with
addiction.
Whilst Julie does not volunteer in the community, she helps out and cares for a lot of family
members. She would like to be more involved in the community, in particular to have more of a
say regarding anti-social behaviour, housing, addiction and safe-guarding. She doesn‟t currently
access any local voluntary community groups or centres because she doesn‟t feel like it is for
her. She associates community centres with “unemployed and needy families and troublesome
families”.
The main things that are having an effect on Julie‟s health and wellbeing are; drugs and alcohol,
anti-social behaviour and money problems/debt. Julie is concerned for the future of her
grandchildren that they will not have any work when they are older.
4.6.7 Advertisement of local community and voluntary groups
It appears that the most effective ways of reaching people are through informal networks of friends
and family and word of mouth with a combination of using the newspaper and the internet.
However, this should be viewed in the context of the data about isolation or a lack of social support
being a factor towards poor health and wellbeing, so ways of informing people need to work on
other means rather than word of mouth. However, again, it does show that there are potentially
strong informal social networks in the community that could be tapped into.
60
Table 56 Q. How do you find out about what is going on locally?
Source
Percentage
Friends/family (or word of
62.4%
mouth)
Newspaper
47%
Internet
35.1%
Schools
13.4%
GP/health services
9.6%
„Our happy place‟ what‟s on
9.3%
guide
Housing services
5.4%
Leaflets
3.2%
I don‟t find out about things
2.6%
Multi-response question, base 314
One of the Community Champions, Becky, observed that services were not well known about:
“I was surprised at just how many facilities are accessible locally. Children, over 55s and
mums with younger children felt the area had a lot to offer if they went out to look for it –
advertisement is bad.”
 How can initiatives be structured to appeal to “small” definitions of „community‟ and informal
ways of helping, rather than formal community volunteering?
 How can the promotion of existing initiatives and services be more joined up and more effective
at engaging people by using influential and positive role models from within the community?
 How can we best use a variety of media to promote services based on the research findings?
61
5
Workshops
5.1
Community asset mapping
An asset mapping workshop was held on April 23 rd at the Tolladine Community Centre.
5.1.1 What is community asset mapping?
Community asset mapping is about identifying the assets and positive attributes of a neighbourhood
and viewing these as opportunities to do things differently.
The approach is part of what is known as Asset Based Community Development (ABCD)
techniques.
According to Foot and Hopkins (2010), ABCD is a set of values and principles which:
-
Identifies and makes visible the health enhancing assets of a community
Sees citizens and communities as the co-producers of health and wellbeing, rather than the
recipients of services
Promotes community networks, relationships and friendships that can provide caring, mutual
help and empowerment
Identifies what has the potential to improve health and wellbeing
Supports individuals health and wellbeing through self esteem, coping strategies, resilience
skills, relationships, friendships, knowledge and personal resources
Empower communities to control their futures and create tangible resources such as
services, funds and buildings.
For the purpose of the Strengthening Healthy Communities project, assets can be broken down into
four broad groups:
Physical assets – shops, buildings, community centres, libraries, health centres etc.
Structured Social assets – people, activities, groups, support groups, community, health
initiatives
Informal social assets – neighbours, support networks, peer support, local knowledge,
individual knowledge of illnesses, parenting, substance misuse, local history
Green space – parks, gardens, sports facilities, open spaces
5.1.2 Outcomes from the asset mapping workshop
Front-line stakeholders from the local community were invited to participate in the asset mapping
workshop (full list of delegates to be found in appendix 2). Delegates included:
Community Champions
Local health professionals
Local police and housing officers
Staff from Worcester Community Trust
Local education staff
62
Councillors
Representatives from Worcester Council
Participants mapped and logged the resources, skills, talents of individuals, community groups and
institutions.
The biggest assets
Transport – community transport, bus routes.
Vast amount of activities take place in each of the community centres.
Informal social assets are intangible and hard to draw up on a map but are recognised as
assets
“Internal” assets of people are key e.g. motivation, resilience, emotional intelligence,
aspirations, skills
All sports, play and arts and community activities available for free or low cost
Drugs=biggest problem, how to turn into positive: drug education, pathways and survivors
Us – the people!
The area is very close to the city centre and service assets
Ideas for initiatives
Cooking and skills – intergenerational skill sharing in cooking project and to help
ASB/dynamics of the community.
Professionals‟ notice board or chat room to share contacts and ideas.
Peer mentors to support those recently diagnosed with long term conditions.
Volunteer or paid gatekeepers, vcs contacts in GP practices to help support patients with low
level needs e.g. isolation.
Face to face – Use a trailer for information and to signpost to the community centres – let
people come to you and ask.
Understand the “culture” of Tolladine. Very close knit and loyal to its own identity.
Respect the people‟s perception of their neighbourhood – health services need to be local.
Continue employing the champions – don‟t let it fizzle out.
Use a navigator for services.
The fundamental outcome from the workshop was identifying that there are many existing assets in
the area, including the provision of healthy lifestyle services and initiatives, however, there was a
recognition that these are not well accessed within the community and knowledge of how the assets
join up within the community with existing providers is low.
5.1.3 Subsequent workshops
It is envisaged that there will be further service design workshops held in order to develop the
initiatives. This will include inviting members who work in the local community, Community
Champions and local residents who indicated that they wished to be kept informed about the
development of new local initiatives as a response to the research. The workshops will enable the
initiatives to be developed as a response to the research findings and led by people working and
living in the community to ensure they are as relevant and successful as possible.
63
6
Recommendations to the Steering Group
The following recommendations are derived as a response to the research findings and are
intended to be considered by the steering group when looking at the development of initiatives.
The steering group should bear in mind that at least one initiative needs to be long term condition
specific and that there is a proposal that three initiatives are developed.
The steering group are reminded that the overall aims are to look at ways of reducing health
inequalities, ways for people to better manage long term conditions and to prevent long term
conditions from developing.
6.1
Recommendations
6.1.1 Objectives
These objectives have been generated in direct response to the research findings contained in this
report. The proto-type community projects should focus on one or more of following objectives:
To increase the use of appropriate health care provision and reduce the use of A&E.
To increase the amount of positive lifestyle changes for long term condition management
rather than reliance on medication.
To increase socialisation and co-dependency in the community.
To develop community capacity to learn from people who have lived experiences of long
term conditions, mental health, substance misuse and managing debt.
To increase people‟s perceptions of what a healthy lifestyle should be for them.
To promote better mental health – and higher expectations for mental health- for people of
all ages within the community.
6.1.2 Approaches
The proto-type community projects should take the following issues into consideration:
The Community Champions are a useful resource that bridge the gap between members of
the community and services which is unique compared to the way existing services are
currently structured. Look to include community champions where possible.
There are many existing services that tackle health management either directly or indirectly
but they are not widely used and appear not to be joined up. The initiatives could look at
ways to promote these existing assets better, how they might work together and ensure they
are relevant to the community and advertised to the community appropriately.
 In particular, this could focus on ways to increase the use of alternative health care
provision outside of the GP, pharmacist and A&E by looking into the way these are
advertised and promoted and the issues of when they are available.
64
 This could also include the promotion of cheap or free healthy lifestyles initiatives
focussed on diet and exercise to break the perception that people can‟t afford healthy
lifestyles.
The initiatives need to recognise the wider influences on health and lifestyle management
including stress, money problems and debt, substance misuse and mental health and
incorporate proposed outcomes of increased socialisation within the community.
The long term condition specific initiative could be based around asthma and/or heart
conditions as this was the most prevalent in the study and also accounted for reasons
presenting at A&E. This should focus on promoting lifestyle management above medication.
Promoting mental health and wellbeing should be direct and indirect outcomes for all
initiatives. This could be coupled with increasing the expectations people have for their
physical and mental health.
Consider using peer support and identifying community experts to foster increased
socialisation and community spirit together with promoting healthy lifestyles. This could
include members of the community who face similar issues to that in the research, rather
than being completely successful at managing their health.
Structure initiatives to appeal to a neighbourhood level and be relatively informal to ensure
that people feel connected to them and to foster co-dependency.
Promotion of the initiatives needs to be carefully looked at but should include elements of
word of mouth and use of informal social networks but also include a strategy to reach out to
the socially isolated.
Consider using pharmacies as hubs for the promotion of initiatives.
6.2
Next steps
6.2.1 Development of initiatives
The initiatives will be developed as a response to the recommendations in the report initially by the
steering group. These recommendations will then be taken forward to further development and
design by community members and front line staff, supported by Turning Point.
6.2.2 Design workshops
Design workshops for the proposed initiatives will be held with interested members of the local
community and front-line staff to ensure that the initiatives are responsive to the community. The
workshops will use the information within this report, including the recommendations to gather
feedback from the people living and working in the community. The format of the workshops will
include break-out groups where people will have the opportunity to directly feed into planning and
development.
65
6.2.3 Promotion at community events
Community Champions and members of the steering group will continue to promote the project and
the proposed initiatives throughout the community at appropriate events to gather feedback and
foster interest.
6.2.4 Piloting of initiatives
Once the initiatives have been developed, they will be piloted for a period of at least 3 months. This
will be followed by an evaluation and final report.
66

Worcester Strengthening Healthy Communities

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