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About this guide

Many communities in Britain, as in other countries, are experiencing rapid change. Traditional industries have been replaced by new types of employment; women play a much more active role in the workforce and we live in much smaller family units than we did a generation ago. Our horizons have been widened by the internet, private motor cars and cheap air travel and many of us choose to move from our homes to seek work, new experiences or a better environment. So places change. As some people move away and new people replace them the nature of places may become more diverse in culture, faith, ethnicity and needs. This opens up new opportunities which can enrich people's lives but it also presents new challenges as old social networks break down and new ones develop.

Community cohesion occurs where there are strong and positive interactions between people from different backgrounds but sometimes it needs a helping hand. This guide suggests that the Health service could, and should do more to provide that helping hand - and that it will improve health outcomes.

Key points

  • Part 2 sets out the key issues that have emerged in the course of producing this guide, and contains a number of recommendations about the kind of actions that NHS bodies could take to make a major contribution to community cohesion.
  • In Part 3 (the introduction), we outline the purpose of the guide and say how it can help different people. We give a definition of community cohesion, suggest how you might use the guide and describe the process we used to develop it.  
  • In Part 4 we explain why community cohesion should be a major issue for people working in the Health service. The NHS is required by law to engage with communities, to comply with a range of anti-discrimination legislation and to work in strategic partnerships to achieve agreed public policy outcomes (which increasingly include community cohesion). The activities covered by these legal requirements lie at the heart of community cohesion.
  • Community cohesion is part of an area's stock of social capital. Where it is strong there is a positive impact on health with improved life expectancy and reduced health inequalities. Where it is weak, the reverse tends to be true. By addressing community cohesion issues Health bodies and their partners have a positive impact on health determinants.
  • Whilst community cohesion contributes to health it is also true that health contributes to community cohesion. When people are fit and well they play a more active role in their community's life.
  • In most parts of the country Local Government leads partnership work on community cohesion but Health is a sleeping giant with the potential to play a much bigger role because of the huge impact it has on most peoples' lives.
  • There is also a pragmatic reason why it makes sense for Health bodies to address community cohesion. By doing so, you will strengthen and enrich your approach to several key NHS priorities: World class and practice based commissioning, joint strategic needs assessment and local area agreements, improving wellbeing, promoting equality and diversity, reducing health inequalities, engaging with and empowering communities, implementing the Darzi report recommendations, tackling issues of mental health, community safety and the harm caused by abuse of drugs and alcohol.
  • In Part 5 of the guide we trace the development of ideas about community cohesion and discuss some of the elements which define the concept. We consider how to measure community cohesion and suggest a basket of measures including the national indicators for PSA 21 (about how people feel about the state of social interaction in their community) and various local indicators relating to local issues. In 2008, 92 Local Strategic Partnerships selected one or more of the four national PSA indicators on community cohesion thus making a partnership commitment to cohesion.
  • Part 5 also considers what we mean by 'community' and suggests that we need to engage with seldom heard groups such as young people, disabled people and their carers, people with mental health problems, new migrants and BME communities. Some examples of how this has been done well are included in Part 6 under question iv.
  • We examine the causes of tensions within and between communities and consider a set of principles that are needed to underpin community cohesion strategies. This includes a discussion of the Government's recent proposals to combat violent extremism.
  • Part 6 focuses on ten key activities through which you can have the greatest impact on community cohesion and sets out a series of ten challenging questions to help you work out how you can adapt your approach to that activity to improve the impact. For each of the ten sets of questions we have explained why they are important and we have given some examples of good practice. The questions cover leadership and partnership, promoting positive relationships, achieving positive interactions, engaging with all communities, locating services where they are accessible and encourage interaction, involving suppliers, communicating effectively and countering myths, using information to understand your communities, investing in your people and promoting NHS jobs to all communities.
  • In part 7 we discuss some different ways of developing your community cohesion strategy (e.g. developing a bespoke community cohesion strategy, building cohesion into your equality and diversity strategy or building it into your overall service strategy) and we suggest which approach might be appropriate for different circumstances.
  • In the course of producing this guide we have worked with several groups, using the ten challenging questions to identify a number of key issues and the kind of action programmes that will address those issues (as set out in Part 2). In Part 7 we emphasise the importance of adopting a similar approach in the way you develop your plans and strategies for your local area.
  • We refer to a range of existing guides that provide help and examples of good practice in community cohesion. Many of the case studies described in these guides are from Local Government experience but there are plenty of examples that can be adapted to a health environment.
  • We describe a range of tools that can be used to assess the needs of different communities and to assess the impact of new policies and developments on different communities. These are key tools in understanding and responding to different community needs and are fundamental to the process of improving community cohesion.
  • In part 8 we identify seven key processes that are common to most effective management systems and we suggest how the ten sets of questions from part 6 can be used to build community cohesion into the appropriate management processes. The key processes are: developing vision, values and strategy, developing partnerships, engaging with communities and understanding their needs, planning and commissioning your programmes, managing resources (finance, information, people and other resources), delivering services and evaluating performance and learning from results.
  • Finally there are two appendices with notes on the case studies and pointers to where you might look for further help.