VOL: 96, ISSUE: 42, PAGE NO: 37
Dorothy Paley, SRN, SCM, RHV, is public health practitioner, Bradford health visitor and member of Nursing Innovation Fund Leadership Team, Bradford Health AuthorityIn 1990 residents of the Buttershaw (council) estate in Bradford became increasingly discontented about their living conditions. Around the same time another large housing estate in Bradford was being renovated after successfully attracting central government funding and Buttershaw residents were beginning to feel that their situation was being ignored. Their houses were cold and in poor repair, many with only one gas fire to heat a three- or four-bedroom property. Empty properties were vandalised, drug dealing was an everyday occurrence and unemployment was high. A sense of hopelessness and abandonment gripped the area.
In 1990 residents of the Buttershaw (council) estate in Bradford became increasingly discontented about their living conditions. Around the same time another large housing estate in Bradford was being renovated after successfully attracting central government funding and Buttershaw residents were beginning to feel that their situation was being ignored. Their houses were cold and in poor repair, many with only one gas fire to heat a three- or four-bedroom property. Empty properties were vandalised, drug dealing was an everyday occurrence and unemployment was high. A sense of hopelessness and abandonment gripped the area.
A residents' group raised its concerns to the local authority and the response was an extensive study called The Get Buttershaw Heard Report (Buttershaw Advice and Social Centre et al, 1992). The document brought about two important initiatives. The first was the development of a local regeneration organisation (Royd's Community Association). Managed by residents of the estate, its objective is to look at ways of regenerating not only the Buttershaw housing estate, but also two other council estates in south Bradford. The second initiative was to set up a GP surgery on the estate.
Setting up the surgery
In 1994 a GP agreed to create a practice on the estate. She was offered rooms in the local clinic, which occupied the ground floor of a derelict block of flats. As this was a new practice, the GP had to develop a list of patients. She did this by consulting residents to find out more specifically what kind of services they felt would be most useful. By the end of the first year the GP had more than 1,000 patients.
Almost half the practice population was under 16; many of whom could be classed as 'children in need' (Carr-Hill et al, 1997). The GP employed two part-time practice nurses, a part-time practice manager and a receptionist. A district nurse from another team outside the area provided district nursing services as required. Health visiting service needs were met by a number of health visitors. Since the practice was in the developmental stage and the practice population was drawn from the immediate locality, the GP felt that a named health visitor should be a member of the practice team.
Developing the team
- The GP began to meet weekly with the local school nurses and a room was turned into a play/health promotion room. A nursery nurse was employed to involve children and carers in health promotion activities while they waited to see the doctor.
- People who lived or worked on the estate or had a special interest in improving the health of local people were invited to meet and become the Health Needs Assessment Group. Its role was to identify and prioritise the health needs of the area. It reported that local school children had poor dental health, which resulted in a community dentist being available in the health centre for two sessions a week.
- A case was made to the community health trust and the health authority for a full-time health visitor to be appointed to address the family health needs of the practice population in close collaboration with the school nurses and the practice staff. This post was created on a yearly, fixed-contract basis from 1995. However, by mid 1997 the post had become permanent, with 30-hours per week allocated to the GP practice and a further 7.5 hours per week towards community development work on the estate.
- In June 1997, a family support worker, employed and managed by a social services family centre, was seconded to work alongside the health visitor and school nurse for two-and-a-half days a week.
Initially, residents on the estate had a poor opinion of social services. It was felt that any support offered to residents should be dependent upon agencies working in partnership with the local community, and that some work was necessary to improve the relationship between social services and the community. The appointment of the family support worker allowed a local response to be given to clients requesting social support, group work and some community development work.
This project was piloted in collaboration with community health workers for six months and by mid-1998 the agencies involved agreed that the work should continue. The project became known as the 'Reevy Hill' project. Monitoring and evaluation of the project is carried out jointly between the agencies involved.
Collaborative working is about everyone working together to address long-standing issues in new ways. It involves taking the time to build networks of trust, and requires the resilience and flexibility to work for local improvement of health and well-being in partnership with the community. For nurses and family support workers it means demonstrating the ability to maintain professional integrity while being prepared to cross traditional role boundaries to meet local need (Department of Health, 1999). The basis for public health working has been developed over the last decade. Perhaps in this decade the hope of the children will be realised and Buttershaw will be known as a 'healthy and happy' place to live.