A Prospective HIA of ‘Towards 2010’ Programme in Sandwell and West Birmingham Shaukat Ali Vicky O’Callaghan Dr John Middleton 7 th International Health Impact Assessment Conference Cardiff, 4-6 th April 2006

Context  National NHS Plan Our health, our care, our say  Local Old dilapidated buildings Unsuitable working environments Services that do not meet peoples needs Outdated healthcare system

Strategic Outline Case  Secretary of State for Health July 2004  Improved physical, mental and social wellbeing of the population in Sandwell and West Birmingham  £750 million capital investment Exchequer, LIFT, PFI  Probably largest partnership of its kind

Towards 2010 Programme  24 wards in Sandwell and 7 wards in HoB  3 Acute Hospitals  430,000 population  1 SHA  5 PCT’s  2 Local Authorities Population Profile

HIA Aims  Aid and inform decision makers  Identifies indirect paths by which decisions could affect health of people  Informs trade offs between positive and negative consequences  Enables maximisation of positive and minimisation of negative impacts  Involves stakeholders in the process

Four Options  Option 1 No change in current building provision in primary care, only essential refurbishment to City and Sandwell Hospitals  Option 2 A range of community facilities, City and Sandwell hospitals refurbished. A&E on one site  Option 3 A range of new community facilities, City and Sandwell Hospitals replaced by new larger hospital  Option 4 A wide range of new community facilities, City and Sandwell Hospital replaced by new smaller hospital

Broad Determinants of Health  Employment and economy  Education  Transport  Housing  Visual Amenity (Environment)  Access to services  Crime  Lifestyle  Pollution  Family and Social Cohesion  Health Inequalities

1 st stage  Steering Group Framework  Merseyside & Birmingham Guidelines  Desk top exercise Over 600 positive & negative impacts identified  Summarised main impacts

2 nd stage  6oo impacts were summarised to 174  Searched for evidence Published information  Quantification  Expert Opinion Gathering evidence  Workshops

Quantification Degree of certaintyDefinition UnchangedNo change to current impact SpeculativeLittle evidence ProbableSome evidence DefinitiveStrong evidence

Expert Opinion GroupDeterminants considered Regeneration Group11 determinants of health Capacity and Activity GroupAccess to services Estates and Technical GroupLifestyle, Pollution, Visual Amenity Workforce and Development GroupEducation, Employment Wider Stakeholder Engagement (WiSE) Group 11 determinants of health Sandwell Public Health Policy Group11 determinants of health Tackling Health Inequalities in Sandwell (THIS) Group Health Inequalities

Regeneration Group Workshop  Reviewed each health determinant criteria for each of the 3 options  Impact Positive Negative  Likelihood of impact High Low

Assessment of Potential Impacts Impact No.Description of impact Level of importance NatureSignificanceMitigation/ comments 1. Education 1.1Expansion of health and social care workforce L/DLTLowWith option A there is little opportunity to expand existing workforce Level of importance: I = International, N = National, R = Regional, D = District, L = Local Nature: ST = Short term, LT = Long term Significance: Low, High

Lessons for HIA - 1  Complexity Scale of project 4 options & ever changing definitions Difficulty in disentangling impacts between options Sites unknown Political drivers & public expectations

Lessons for HIA - 2  Timetable Tight deadlines Functionality of steering group  Stakeholder involvement Expectation that HIA would absolve decision makers of their responsibilities

Lessons for HIA - 3  Resources 2 people Core public health responsibility Meetings Reports

General Issues  Systematic Vs unsystematic approach  Predictable nature of HIA (added value?)  Involve local scrutiny committee at early stage  Expectation on what HIA could deliver

Implications for Stakeholders  Maxwell Criteria Access Equity Relevance to need Social acceptability Efficiency Effectiveness  Providers/stakeholders  Cultural issue of acceptance of new services/models

Outcomes  Towards 2010 programme temporarily on hold  Findings included in the public consultation document  Approved by Joint Birmingham and Sandwell Scrutiny Committee Stakeholder engagement  Approved by 2010 Agency Board  LSP shown interest in using HIA around regeneration  Raised HIA profile locally Integrated Health, Social Care and Leisure Centre HIA (£15 million PFI)

Acknowledgements  Towards 2010 Agency and all its subgroups  Dr Jayne Parry, Director HIAU, The University of Birmingham  Dr John Kemm, Director, West Midlands Public Health Observatory

Contact Shaukat Ali Tel: Vicky O’Callaghan Tel: