To tackle Health Equity we must get the Citizens Voice into Due North
In February there is a ‘one year on’ conference at the University of Chester to consider progress and next steps, since the launch of Due North the report that seeks to articulate a North of England analysis of how we tackle health inequalities.
One of the key points made by the original report is:
“The most disadvantaged members of society lack influence over how public resources are used”
Recommendation 3 of the report focusses on this area specifically:
“share power over resources and increase the influence the public has on how resources are used to improve the determinants of health”
Actions for bodies in the North of England include:
- Regionalism and government structures – bringing policy making a bit closer than Westminster and developing a stronger collective local government voice across the North of England
- Access to information – greater transparency of decision making at a local level
- Participatory Budgeting – more involvement for citizens in financial decisions
- Mutuals – create more collective forms of ownership
- Building capacity in communities – to strengthen engagement
There are also a set of actions that government should consider which include:
- Strengthening the role of local government – increase proportion of public expenditure spent locally, prioritising health equity spend, increase ability of local authority to raise funds
- Expand role of local healthwatch to hold govt to account for action and progress on health inequalities
- Co-produce national programmes with local government
There is nothing intrinsically wrong with these recommendations but I think they lack coherence and don’t sufficiently address the original challenge.
The actions feel as though their starting point is concerned with what local public sector bodies consider to be important, their role, their relationship with government; rather than challenging the way in which local public sector bodies relate to communities.
There is not enough about the lived experience of citizens and the relationship that the local state has with them. This means that this section (indeed the whole report) is weak on the role of the community and voluntary sector – especially grass roots community organisations.
So, while I support the calls for more regional government, greater access to information about need and services, and participatory budgeting I think the document over emphasises these at the expense of a weak section at the end (where else!) on community capability.
Regrettably this is reflected by the general lack of emphasis on the contribution of the voluntary and community sector as a whole.
We need more honest local debates about relationships with communities and citizens
If Due North is to achieve real change then I think it needs to revisit its approach to citizens and communities.
Lets face it the arguments articulated in Due North for localism are predicated on the belief that the strongest relationships with citizens happen best at a local level.
The credibility of any proposal to shift power from Westminster or to redress inequality rests on our ability to demonstrate that we can deliver these powerful relationships with citizens.
We have to recognise that we need to put our own house in order, a culture change is required at a local level too. The way Due North is written does not convince me that this is sufficiently recognised.
We need to recognise that there needs to be ongoing debate with citizens and community organisations to develop a shared view about how to strengthen engagement, involvement and yes…..solidarity.
There is plenty of hopeful stuff going on. I am impressed by the work of the Co-operative Councils who have been leading some of the work here. Local Authorities such as Lambeth are doing really interesting stuff – including developing their Competency Model for Co-operative Councils looking at how to change their relationship with local citizens. I suspect that some of this work is informed by seminal reports like “The Relational State” whose strap line calls calls for “recognising the importance of human relationships could revolutionise the role of the state”
There is a great deal out there – the challenge is to locate this promising activity within a broader analysis of why this is important, where current deficits are and what we need to be doing differently.
We need to avoid leaping into our usual behaviour of renewing neighbourhood committees, laying on a bit of community capacity building and providing some better information and then saying job done”
What do you think?