Introduction to this guide

Purpose

This guide has been produced to help people working in the Health service to understand how their work can have an impact on community cohesion and, conversely, how community cohesion can impact on health, wellbeing and health inequalities. It offers practical advice on what types of policies and actions can help to improve relations between people from different backgrounds and indicates where tensions are likely to arise and the kind of actions that may increase competition between different communities. It is important to health practitioners and commissioners because there is plenty of evidence, referred to in part 4 of this guide, that cohesive communities are healthy communities and vice versa. Local Strategic Partnerships are strengthened where the health sector plays a major role, contributing to the wider vision for the area, in which diversity is valued, negative views are challenged and services meet the needs of the local population.  

What is 'community cohesion?'

Community cohesion is about building positive and harmonious relations between people of different backgrounds of ethnicity, faith, age, gender, disability, social class, education or sexual orientation. It is defined by the Government as follows:

Who the guide is for and how it can help you

The guide is aimed at managers, commissioners and practitioners responsible for making policy or for commissioning or delivering health services. It will also be useful to people involved in scrutinising decisions about health policy. 

• Strategic leaders (senior managers, nonexecutive directors, directors of public health, policy planners etc)
  It will help you to improve performance in line with the NHS performance framework by identifying and addressing community cohesion issues and ensuring that your plans are culturally sensitive and based on a clear understanding of the nature of local communities and their health and wellbeing needs. It will help you to contribute to "place shaping" through Joint Strategic Needs Assessments, Local Area Agreements, and Multi Area Agreements and it will help you to comply with anti-discrimination legislation and your duty to engage with communities.
• Commissioners
  It will help you to assess the health needs of different communities, assess the consequences for health and wellbeing of new proposals affecting health determinants and commission services that are sensitive to community needs and changing demographic profiles.
• HR managers and workforce planners
  It will help you to recruit and develop a workforce that is representative of, and sensitive to the needs of, all parts of your community.
• Practitioners (including GPs and other service providers) working directly with the public, patients and the voluntary and community sectors
  It will help you to ensure that your services are based on a clear understanding of the diversity and different needs of communities within your locality and of how those communities interact.
• Service users, members of Local Involvement Networks and Overview and Scrutiny Committees
  It will help you to make informed contributions to the debate about local health issues based on a clear understanding of the diversity of needs in your locality.

There are other resources available to help you with these areas of work but we believe this guide has a very specific focus on the relationship between health and community cohesion. Where appropriate we have provided references and links to other guides so this work complements rather than replaces previous guides.

How to use the guide

The guide uses a series of questions designed to help you think about the relationship between health and wellbeing and community cohesion in the particular communities you serve and to develop strategies that are appropriate to your circumstances. It provides you with links and references to information and documents that may help you and it draws on a number of case studies to show how different approaches have been used around the country but it comes with a "health warning". Whilst it identifies some key issues and suggests the kind of action you might take to improve your contribution to community cohesion, it is not a toolkit telling you exactly what to do. It is an aid to your thinking to help you develop your own approach.

How the guide has been developed

The guide was commissioned by the Department of Health and has been prepared by Andrew Lawrence, principal associate of the Institute of Community Cohesion (iCoCo). It draws on work that iCoCo has carried out across the country on all aspects of cohesion in which we have worked with health and other practitioners to assess local cohesion issues and to develop responses and longer term strategies and plans. A key part of the guide is a series of 'Ten challenging questions' which were developed by a group in the North West region led by Dominic Harrison and supported by Sabir Hussain, Gulab Singh and Dr Sheila Marsh. The group involved representatives from PCTs, Health Trusts, Local Authorities, Common Ground North West and Lancaster University. We worked with the North West group in the early stages of their work. The North West group will publish a report containing the ten questions soon; we have included them in this guide (at part 6) with a series of supplementary questions to help you assess how well your organisation is doing on community cohesion and to provide some pointers to help you develop your strategy.

We have illustrated many of the key points by referring to material gathered from experiences throughout the country. We have also suggested how you could build community cohesion into your management system, using the ten questions at the appropriate stages. We have been helped by a group of 'critical friends' who have provided constructive criticism of drafts and we have used the draft guide to identify key issues at a series of workshops, culminating in a national workshop hosted by Derby PCT on 28 October. As a result of this process we have been able to make recommendations on the kind of actions that NHS bodies could take to make a much greater contribution to community cohesion. The pioneering work carried out in the North West is currently being developed further by an action learning set approach which is being applied to a number of ground breaking projects in that region.