Key issues and recommendations

In the course of producing this guide we worked with a number of different groups to identify a set of key issues about the way community cohesion is addressed by the NHS and to consider the kind of action programmes that would improve the NHS contribution to cohesion. Our findings are as follows:

Key issues

1. The issue of terminology

We found that the term 'community cohesion' is not widely used within the Health service and there is some confusion about what it means. Some people thought the work they were doing under the label of 'equality and diversity' was contributing to community cohesion but that was not always the case. Equality and diversity is mainly about how we identify and respond to the different needs of individuals and groups. Tackling inequalities is, of course, an important component of community cohesion too, but cohesion goes much further to break down the barriers between communities, developing interaction and mutual understanding to avoid conflict and taking a much more proactive approach to build a society based on trust and shared values. We think it is important to make that distinction clear and to be explicit about the objectives you are trying to achieve.

How can we encourage people to adopt the term 'community cohesion' where appropriate?

2. Not just race and faith

We found that there is a perception amongst many people in the Health service that community cohesion is about race and faith but there are other differences that divide communities (such as age, social class, disability, sexual orientation and ill health). Community cohesion is about promoting positive interactions across all such divisions. Nationally this has been recognised by the establishment of the Equalities and Human Rights Commission (EHRC) which brings together several different strands of equality and diversity. At a local level it means we need to promote more positive images of people who others perceive to be different (e.g. how old and young people perceive each other, how disabled people and people with long term illness or mental disorders are viewed by others). We need to promote positive interactions that break down barriers and challenge myths and stereotypes across all such divisions.

How can we ensure that all aspects of perceived difference are addressed in community cohesion programmes?

3. Priority and commitment

Everyone we talked to recognised that community cohesion is an important objective, but some felt that it is in competition with other policy initiatives which are given a higher priority. In many Trusts community cohesion is seen as an extra responsibility for specialist equality and diversity officers and not necessarily as something that needs to be owned and championed by leaders. In Part 4 we have suggested that a focus on community cohesion will help you to comply with several legal duties and to achieve some of your other NHS objectives. Community cohesion depends upon the creation of a stock of social capital and it is clear that positive interaction, with more people volunteering and looking out for each other, has huge health benefits.

Is local action sufficient to influence priorities at a local level or is there a need for community cohesion to be included as an indicator in the NHS performance framework to provide a more formal incentive?

4. Understanding how communities are changing

We know that many communities are changing rapidly but our information systems are rarely able to provide adequate measures of the scale and nature of that change. In some parts of the country local agencies are working in partnership to develop better systems of shared intelligence. In these areas the Local Strategic Partnerships (LSP) are able to adopt effective strategies to meet changing needs but in other areas there is still a silo mentality and people are reluctant to share data with others. There is scope for the NHS to play a much greater role in this aspect of partnership working. Records of GP registrations, for example, can be a rich source of data on demographic change when combined with other sources like the annual schools census.

How can we encourage a more fundamental commitment to improving shared intelligence systems through partnership working?

5. Building community cohesion into community engagement

As communities become more complex it is vital that methods of community engagement respond to that complexity. We found many examples of good community engagement including ways of engaging with 'seldom heard groups' about their health needs. However it appears to be rare for community engagement to include an exploration of how individuals and communities interact.

How can we ensure that we understand the way people with different characteristics feel about each other and the impact this may have on health?

6. Challenging the practice of single group funding

There is a longstanding practice in Health and Local Government of providing funding to particular community groups that may be vulnerable or in need of support. This practice has had many benefits in promoting equality, but it has recently been pointed out that it can also foster resentment, segregation, separate development and inhibit interaction between communities. In Part 6 (at question ii) we discuss this issue and suggest that, whilst funding policies should still recognise particular needs, they need to be applied in different ways and be based on a clear analysis of their impacts.

How can funding policies be designed to encourage integration whilst still addressing particular needs?

7. How does community cohesion fit with patient choice?

The Government's initiatives to increase patient choice should provide a stimulus for improved quality and make services more responsive to patients. However the benefits may not come automatically to all communities. Trusts will need to monitor how it is working to ensure that all sections of communities see the service as being 'for them'.

How can we ensure that service changes are having a positive effect on social interaction and community cohesion?

Recommendations