Case study 1: Luton Borough Council
Interviews with Paul Adams, Environmental Health Service Manager, and Chimeme Egbutah, Health and Wellbeing Coordinator, of Luton Borough Council
The relationship between Luton Borough Council's Regulatory services and the public health directorate of the primary care trust (PCT) began some time ago. Health Action Zone funding was secured to build partnership links between the council and the NHS. Part of the work undertaken was the development of a health impact assessment (HIA) toolkit. This used the HIA of the local plan as an example on how to undertake HIAs on other projects.
At the same time, council regulatory service managers began asking themselves what more could they do to contribute to the health of their borough. They decided that a first step would be more effective coordination within their own services and throughout the council. The environmental health service manager and the director of public health agreed to jointly fund a post within the council. The post is line-managed by the director of public health and located in the council's offices, linking closely with regulatory services.
A post of health and wellbeing coordinator was set up and has been held since its inception in June 2004 by Chimeme Egbutah. The post comes with a small budget that she believes is sufficient to support strategic working.
One of the first pieces of work she undertook was to run a workshop for Environmental Health and Consumer services staff. They were encouraged to make the links between their work and the health aspects of the local area agreement (LAA). Egbutah is honest enough to admit that it took some time to see results from her input. She says:
“When starting to build a relationship it's hard work and you have to be prepared to put a lot of effort in.”
Paul Adams, the current Environmental Health Service Manager, is in no doubt about what the creation of this post has achieved. He says:
“Chimeme has been instrumental in encouraging regulatory services to look at how they can add value to health interventions through their enforcement work.”
An obvious example is the way Adams used the work on implementing smokefree legislation to tie in with an LAA target on smoking cessation. This has a focus on new ways to signpost smokers to the PCT provider, the Stop Smoking team.
Health MOTs for taxi drivers
Another innovative piece of work was to organise 'health MOTs' for taxi drivers, who were already engaged with the Licensing team during a taxi trade fair held locally. Many of the taxi drivers from Luton are from ethnic minority backgrounds. This provided an opportunity to raise awareness of their ‘culture-specific' personal health issues and enable them to take various health-related tests.
This work engaged with the PCT provider services - community health nurses - and the local sports trust - Active Luton. Working in partnership allowed cholesterol, sugar and blood pressure checks to be conducted on taxi drivers. In addition, fitness tests, health promotion advice and, if necessary, a GP referral letter were given to those at risk of diabetes or hypertension.
Another example is the work of the Environmental Health Food Control team with local businesses to help them provide healthy choices. This is part of the town's Obesity strategy. Adams says:
“A partnership approach is seen as the only way to tackle agendas such as this. And bringing together teams from different organisations with complementary skill-sets is a great way of delivering a better outcome.”
Bedfordshire and Hertfordshire Air Alert scheme
One initiative that the council is particularly proud of is its participation in the Bedfordshire and Hertfordshire Air Alert scheme. This is led by the Environmental Protection team and, uniquely in the two counties, has received £25,000 funding from the PCT to help get the project off the ground.
Adams points out that the negotiations with the PCT were made easier through Egbutah's presence. She was working both in the council and PCT offices to build links and help explain the work of regulatory services to the NHS. The council already has considerable information on air quality because it runs a monitoring station as part of a regional network. The team can use this information to send messages to the mobile number, home telephone and email of vulnerable people, such as those living with asthma or those who have a serious respiratory condition, whenever poor air quality is predicted.
To illustrate the added value of a corporate approach, the initiative has been able to use the council's housing role to include sheltered housing wardens. This enables them to warn their residents of expected temporary deterioration in air quality. Residents can then make plans for the day with this in mind. An external organisation has now been engaged to carry out evaluation of this scheme.
Engagement with elected members and across the council
Adams believes that Chimeme Egbutah's role of Health and Wellbeing Coordinator has been very valuable. It has shown regulatory service colleagues and staff throughout the council that that there is common ground to be explored in achieving healthier outcomes for Luton's people. There has been a concerted attempt to engage with elected members and other council services beyond Environmental Health. An example is ensuring that the 'Department of Public Health Annual Report' is presented to all elected members. There are now regular briefings with the portfolio holder with responsibility for health improvement.
This interest has been sustained through the presence of elected members on the Health and Wellbeing Partnership Board. There is increasing joint work between adult social care and the PCT. This is seen as vital. There is some input to this work from the health and wellbeing coordinator, partly so that she can draw on her knowledge of what is happening elsewhere in the council, but also so that she is ‘kept on the radar' for both the PCT and social services.
The health impact assessment tool that was originally developed for the Health Action Zone has evolved. The PCT has now funded some training for council staff to help them carry out rapid HIAs. For example, in relation to the new, extended GP surgery in an area of Luton where there is lower life expectancy than other areas of the town.
A major question for all those interviewed for this online resource has been how to ensure that the links and initiatives set up - often initially through the enthusiasm of a small number of individuals - remain sustainable. Also they need to remain embedded and ultimately independent of any one individual. In Luton, both Adams and Egbutah believe that the joint work between Regulatory services and Health is becoming more sustainable for a number of reasons.
The borough now has a joint director of public health who sits at the top tables of both the PCT and the council - a factor that was considered important by all interviewees.
Through the initiatives instigated by the head of Environmental Health and the health and wellbeing coordinator, other staff have begun to see the health links of their work and to establish their own relationships with the PCT. This presents to the PCT an increasingly consistent image of an organisation that recognises and is keen to increase its own contribution to health improvement. For example, the Air Alert scheme was initiated not by the health and wellbeing coordinator but by colleagues in Environmental Protection.
The NHS itself is currently going through a period of stability which enables relationships to be formed and developed. This is compared to previous structural changes and reconfigurations that have proved a real challenge in sustaining good working links.
24 February 2010