The
importance of community participation in health and social care
has been recognised for some time. The declaration of Alma Ata
recognised "people have the right and duty to participate
individually and collectively in their health service" (the
Alma Ata Conference on Primary Healthcare 1978). The World Health
Organisation Strategy ‘Health for All by the Year 2000’
(1985), to which the UK Government is a signatory, gave further
prominence to the idea of community participation in health, where
it was highlighted as one of three key principles to promote health,
the others being equality and inter-sectoral working. Promoting
social inclusion has also been an important feature of European
Policy directives and initiatives eg the European Structural Fund
and the Special Support Programme for Peace and Reconciliation
which have emphasised the importance of social inclusion as a
major goal.
The
same themes are evidenced in more recent policy initiatives at
local level. The Government’s Targeting Social Need (TSN)
initiative aims to address disadvantage across a range of issues
by targeting resources to areas of greatest disadvantage, whilst
the Children (NI) Order 1995 aims to 'safeguard and promote the
welfare of children'. The Department of Health and Social Services
Regional Strategy 1997-2002 Health and Wellbeing: Into the Next
Millennium, places clear priority on the goal of addressing inequalities
in health and wellbeing. In this regard community development
and community sensitive approaches to the commissioning of health
and social care are highlighted as important mechanisms. More
recently in December 1997 the present Government reaffirmed and
renewed this commitment in ‘Well Into 2000’ which further
highlighted the need to tackle inequalities and promote health
and social wellbeing. The Government’s Targeting Health
and Social Need Initiative was re-launched in March 1998 and highlights
the need to target social need and promote social inclusion in
Northern Ireland.
Promoting
social inclusion, addressing inequalities in health and wellbeing
and increasing community participation in health and social care
demands new approaches. Communities require support if they are
to be able to truly participate actively as partners in shaping
health and social care issues. Community development is one important
method of promoting health. It is a way of tackling a community’s
problem using the energy and leadership of the people who live
there (Thomas, 1995). The empowerment which results is a fundamental
building block for health and increases the likelihood of people
actively participating in matters relating to their own health.
This promotes self reliance, rather than compliance, and is based
on a commitment to change, a redistribution of power and the clear
goal of empowerment (Black, 1998).
The
Board’s mission requires a locally sensitive approach to
commissioning. Its mission is to:
§
"promote the health and social wellbeing of its resident
population;
§
inform people of the challenges and issues that health and personal
social services have to face in the maintenance and development
of services and the allocation of resources;
§
involve local people in discussion on health and social services
matters so that their views can be taken into account when the
Board makes policy and planning decisions;
§
secure a balanced range of health and social care services to
the highest standard within available resources, taking account
of the professional guidance and best practice to meet the specific
needs of the community".
The
views of service users have been acknowledged by the Board as
an essential element to service development. However, there is
a need to broaden such involvement and to develop mechanisms whereby
local views and opinions can be used to shape the pattern overall
of services developed to meet needs on a local basis. In developing
such approaches emphasis must be placed on partnerships –
with local people, communities, and the voluntary and statutory
sectors where there is greatest potential influence on health
and wellbeing.
The
health service reforms initiated in 1989 and introduced in Northern
Ireland in 1992, required Boards to act as ‘purchaser’
of services from Trusts, as ‘providers’ to meet the
needs of its resident population. In 1994 Circular HSS/PPRD5
7/94 clarified the role of Boards in relation to their local communities
"Boards must continue to develop locally sensitive purchasing
agreements … be able to demonstrate that they are taking
systematic action to seek and act on the views of Health and Social
Services Councils, GPs, voluntary organisations, the wider public
and their representatives throughout the purchasing process …
involving trying to establish local legitimacy for Board priorities
and purchasing intentions .. to go that extra mile to explain
their proposals, to take account of people’s concerns and
to carry the public with them". This guidance remains extant
and the new Government has reiterated the need to maintain a separation
between commissioning and providing, though in a much more collaborative
than market-based relationship. It is within this Policy environment
that the Community Commissioning Partnership was established in
1998. Alongside this has been the development of the Northern
Health and Social Services Board’s community development
strategy. Together with Provider Trusts, the aim of the strategy
is to support and expand community development initiatives within
the Board’s area. In addition, is the development of the
Children Services Planning process which places emphasis on the
active participation of community, voluntary and other statutory
sectors in developing an effective Children Services Plan which
aims to address the needs of those young people most vulnerable
and in greatest need.
