Evidence from Aneurin Bevan University Health Board to the Welsh Government Equality, Local Government and Communities Committee consultation on local approaches to poverty, WbFGA and Public Service Boards
Dr Sarah Aitken, Executive Director of Public Health, Aneurin Bevan University Health Board
13:06:18
1. ABUHB welcomes the opportunity to provide evidence on poverty reduction in the context of the Well-being of Future Generations (Wales) (WFG) Act 2015 and Public Services Boards. Aneurin Bevan University Health Board (ABUHB) is responsible for promoting wellness, preventing disease and injury, and providing health care to a population of approximately six hundred thousand people who live in the areas of Blaenau Gwent, Caerphilly, Monmouthshire, Newport, Torfaen and South Powys. ABUHB covers diverse geographical areas with a mix of rural, urban and valley communities. The valley areas experience high levels of social deprivation, including low incomes, poor housing stock and high unemployment.
2. Aneurin Bevan University Health Board (ABUHB) serves the five Public Service Boards (PSBs) in Gwent, namely:
Blaenau Gwent
Caerphilly
Monmouthshire
Newport
Torfaen
3. The Chair and the Chief Executive of ABUHB are statutory members of all five PSBs in Gwent, and they are represented by an Executive Director and Non Executive Director on each PSB. The Executive Director of Public Health sits on four PSBs, with the Deputy Director of Public Health sitting on the Caerphilly PSB. In addition, to providing representation on the PSB itself, ABUHB also provides representatives for the committees that support the PSBs.
4. To gain an understanding of the structure and functions of the Public Services Boards: The Well-being of Future Generations Act establishes Public Service Boards (PSB) in each Local Authority area in Wales. The four statutory members of each PSB are the Local Authority, the Local Health Board, the Fire and Rescue Authority for the area, and Natural Resources Wales.
5. Statutory members are collectively responsible for fulfilling the board’s statutory duties. This means unanimous agreement of the statutory members is needed in relation to fulfilling these duties (e.g. to publish assessments of local well-being, local well-being plans and annual progress reports).
6. ABUHB has established clear governance mechanisms for its duties under The Well-being of Future Generations Act. The Public Partnerships and Well-being Committee (a Board Sub-Committee) provides governance and oversight of ABUHB’s collaborative work through PSBs and the interface with the ABUHB Integrated Medium Term Plan. To provide a clear focus for ABUHB PSB members, the Public Partnerships & Well-being Committee identified 4 of ABUHB’s 10 Wellbeing Objectives which can only be taken forward in partnership through the Well-being Plans of the five Gwent PSBs, which are:
· To provide children and young people with the best possible start in life.
· To achieve impact on preventable heart disease, stroke, diabetes, cancer, respiratory and liver disease.
· To improve Community & Personal Resilience, Mental Health and Wellbeing.
· To enable people to age well and for those that need care to receive it in their home or as close to their home as possible.
7. To explore the effectiveness of PSBs, resourcing and capacity: The focus of the five Gwent PSBs business to date has been on developing Well-being Assessments and high level Well-being Plans in line with the requirements of the WBFGA. Within the Well-being Assessments and the Well-being Plans of all the five Gwent PSBs it is recognised that the broader social determinants of health play a much bigger role in shaping health outcomes than healthcare services, and addressing the causes of poverty calls for both targeted and universal actions across the social gradient of health. Action to tackle poverty feature throughout a range of commitments within the PSB Wellbeing Plans, including employment programmes, quality housing and access to quality childcare.
8. ABUHB membership of PSBs has created an opportunity for ABUHB PSB members to maximise the Health Board’s influence on the causes of ill health and health inequalities by exercising an important system leadership role to influence PSB partners to take collective action to address the six aspects of peoples’ lives that the evidence suggests are critical for tackling health inequalities, which are:
· giving every child the best start in life;
· enabling all children, young people and adults to maximize their capabilities and have control over their lives;
· creating fair employment and good work for all;
· ensuring a healthy standard of living for all;
· creating and developing sustainable places and communities;
· strengthening the role and impact of ill-health prevention.
9. All five PSBs in Gwent have acknowledged within theirWell-being Plans the need to improve public services in order to support their most deprived communities. Some of the PSBs have specifically agreed a focus on specific geographical areas of socio-economic disadvantage (e.g. a place-based approach in Blaenavon in Torfaen, the ‘Deep Place’ approach being adopted in Lansbury Park in Caerphilly and Newport PSB have agreed a joined up approach to capital investment and regeneration in Ringland). However, ABUHB recognizes that it will be important for PSBs not to focus just on the most disadvantaged areas as this will not reduce inequalities sufficiently. Reducing health inequalities will require both universal action and action that is of the scale and intensity proportionate to the level of disadvantage, known as proportionate universalism, and ABUHB representatives at the Gwent PSBs are strongly advocating for this approach.
10. Only Monmouthshire PSB explicitly mentions rural poverty within its Well-being Plan which acknowledges the impact of market failure within a rural context and how this impacts on the lives of those living in a rural setting. Opportunities for accessing investment through the City Deal and advances in technology, such as automated vehicles, have been identified as possible ways to mitigate against the impact of limited public transport in rural communities, as has the need for improved Broadband coverage and speed in some areas of the county. Action also includes developing a better understanding of the future of work in the area and identification of the skills required in the workforce and exploring the potential for specialist centres of excellence in Monmouthshire e.g. food/hospital, agriculture, tourism and technology.
11. All PSBs in Gwent have included Adverse Childhood Experiences as a priority for action and this is a clear example of where public services, led by Gwent Police, are collaborating to address socio-economic disadvantage.
12. To gather evidence of issues or barriers that may impact on effective working, and examples of good practice and innovation: there is some evidence that having new public services partners involved in PSBs is helping to develop some new approaches, for example Blaenau Gwent PSB has supported a funding proposal to Natural Resources Wales to develop Green and Active Spaces, and Tai Calon Housing Association are leading the PSB work-stream ‘Working together on Universal Credit’.
13. On a regional basis, there is recognition that the Gwent Strategic Well-being Assessment Group has enabled some effective collaboration amongst public service organisations. During the summer of 2017 the Gwent Strategic Well-being Assessment Group (G-SWAG) commissioned the development of a Well Being Planner to facilitate a collaborative process by which a set of regional well-being priorities for Gwent could be developed. The following 6 regional well-being priorities were subsequently identified as Gwent wide issues that would benefit from a consistent approach across Gwent:
· Make the best use of our natural resources to promote well-being- to be led by Natural Resources Wales.
· Work towards climate resilience and reduce the regions carbon emissions- to be led by Natural Resources Wales.
· Reduce Cancer Inequities, to be led by ABUHB
· An ACE informed approach to public service delivery and community safety, to be led by Gwent Police.
· Maximise the city deal benefits for Gwent, with a particular focus on improving regional transport, to be led by Monmouthshire Council.
· Gwent Green Energy project, to be led by Torfaen Council.
14. ABUHB, along with other Regional and National organisations that sit on the five Gwent PSBs, has considerable challenge in staffing the partnerships structures for all five PSBs.
15. ABUHB is one of the largest employers in Gwent, and is working towards being recognised as an exemplar public sector organisation by providing apprenticeship, training and employment opportunities and by promoting good employee health and well-being, reducing sickness rates and leading the way on pay equality and providing good-quality and stimulating work.