A Rapid Health Impact Assessment of Canolfan Dewi Sant in Rhyl
SEPTEMBER 2005
Report by Sian Bennett
Contributing authors
Ruth Cole Manager of Canolfan Dewi Sant
Liz Green Health Impact Assessment Development Officer,
Welsh Health Impact Assessment Support Unit
Sian Bennett Health Policy Officer, Denbighshire County Council
John Wetton Substance Misuse Coordinator, Denbighshire.
Lindsay Haveland Health, Social Care and Well-being Facilitator, Denbighshire Voluntary Service Council
Delyth Wyn Jones Principal Public Health Practitioner,
National Public Health Service
Acknowledgements
Thank you to all the stakeholders and facilitators who gave their time to attend and contribute to the participatory stakeholder workshop.
Contents Page
1.0 INTRODUCTION
1.1 Health Impact Assessment 4 1.2 Canolfan Dewi Sant, Rhyl 5-6
1.3 Welsh Health Impact Assessment Support Unit 7
2.0 METHODOLOGY
2.1 Why a “rapid” Health Impact Assessment? 7
2.2 Participatory stakeholder workshop 8
2.2.1 The workshop 8
2.2.2 Participants 8
2.2.3 Format of the day 8
2.3 Producing the report 8
3.0 THE RAPID HEALTH IMPACT ASSESSMENT
3.1 Identifying potentially affected groups 8-9
3.2 Impacts upon health of the local population 9
3.3 Summary of impacts 10-16
3.4 Summary of recommendations
3.4.1 Lifestyles 17
3.4.2 Social and community influences on health 17-18
3.4.3 Living/ environmental conditions affecting health 18
3.4.4 Economic conditions affecting health 19
3.4.5 Access and quality of services 19
4.0 Evaluation 19-20
5.0 Conclusion 20
6.0 Appendices 21-51
Appendix 1 21-45
Appendix 2 46
Appendix 3 47
Appendix 4 48
Appendix 5 49
Appendix 6 50-51
1.0 INTRODUCTION
1.1 Health Impact Assessment
“Health Impact Assessment is a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” 1
Therefore health impact assessment (hia) allows us to explore all the future potential health and wellbeing impacts (both positive and negative) of a project or programme, identify affected parties, and modify and enhance project delivery in order to maximise the positive health and wellbeing impacts and minimise or remove the harmful effects.
A recent guide to hia published in Wales states that the Welsh Assembly Government is “committed to developing the use of health impact assessment in Wales as part of its strategy to improve health and well-being and to reduce health inequalities.” 2
For the purpose of health impact assessment, the term “health” must be considered in its broadest possible sense, with awareness given to the wider determinants of health, including environment, housing, income, employment, crime, and transport. Therefore, for the purpose of hia it is usual to adopt the World Health Organization definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 3
Health Impact Assessment is an inclusive, participatory approach, involving key stakeholders at all stages in the process. These stakeholders range from key decision makers, to service users and members of the community likely to be affected by the policy or programme.
Canolfan Dewi Sant in Rhyl resolved in April 2005 to commit itself to carrying out a Health Impact Assessment in order to support its search for longer term funding. Further, an evidence base would exist influencing and enabling future planning and service development to progress according to identified priority thus improving the health and well-being of service users, service providers and the locality as a whole.”
Health Impact Assessment: Main concepts and suggested approach. World Health Organization. December 1999
2 Improving Health and Reducing Inequalities: A practical guide to health impact assessment. Welsh Assembly Government. September 2004
3 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p.100) and entered into force on 7 April 1948
1.2 Canolfan Dewi Sant
Canolfan Dewi Sant officially opened its doors on 24th June 2003. The centre is located in Rhyl West Ward, which is ranked 1 on the England and Wales Index of Deprivation, and is funded by the Denbighshire Drug and Alcohol Forum (DDAF) and European Social Funding Objective 1.
National policy and local research initially highlighted the need for a day centre in Rhyl West. The Government’s Social Inclusion Unit describes social exclusion as being “a shorthand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown”. It goes on to state that “we need to improve action to reduce social exclusion by producing joined-up solutions to joined-up problems”. It was clear from research undertaken in Rhyl[1], not least the Welsh Indices of Multiple Deprivation, that Rhyl suffered a number of the factors that are referred to above. As has already been noted, Rhyl West Ward ranks as first in the Index of the most deprived Wards in Wales, and Rhyl South-West ranks as 49th. These two wards jointly also account for 40% of the recorded levels of crime and disorder in Denbighshire[2].
Canolfan Dewi Sant Centre is a one-stop-shop and day centre, providing statutory and voluntary sector support, advice and guidance to people who are socially excluded, marginalised and vulnerable with a view to promoting, encouraging and assisting their access to appropriate services and resources in order to achieve life changing opportunities. The project is aimed principally at the residents of Rhyl West Ward, but does not exclude people from other wards in the area.
The Dewi Sant Centre offers open door access to people who require advice and support in stabilising what are often described as ‘chaotic lives/chaotic lifestyles’.
Although not exhaustive the main objectives of the centre are to achieve the following:
· Alleviate homelessness and its undoubted consequences by accessing appropriate quality accommodation for both single people and couples who are homeless.
· Actively seek to increase social and interpersonal skills necessary for daily living.
· Increase employability by offering training and by building those skills suitable for current employment opportunities
· To reduce the incidence of substance and alcohol misuse, to contribute to crime reduction and to encourage healthy lifestyles
· Encourage social engagement and promote the valued participation of those people currently socially excluded, marginalised and discriminated against.
· To provide a link and gateway with other service providers whether statutory, voluntary or private sector organisations.
· To provide, from a central base, a network of direct and appropriate support systems.
The primary means of engagement are hot food and refreshments and shower facilities.
The above has been taken from the 2004 – 2009 Business / Strategic Plan for the centre which can be seen in full in Appendix 1. 1
1. Canolfan Dewi Sant. Business / Strategic Plan 2004 – 2009. Documented by John Wetton (Research Officer) July 2004
1.3 Welsh Health Impact Assessment Support Unit
The Welsh Health Impact Assessment Support Unit (WHIASU) is funded by the Welsh Assembly Government, through the Wales Centre for Health. WHIASU is based in the Cardiff Institute of Society, Health and Ethics, which is part of Cardiff University’s School of Social Sciences, and is funded to cover North and South Wales.
The key roles of WHIASU are:
o To support the development and effective use of the health impact assessment approach in Wales through building partnerships and collaborations with key statutory, voluntary, community and private organisations in Wales.
o To provide direct information and advice to those who are in the process of conducting health impact assessments.
o To contribute to the provision of new research, and provide access to existing evidence, that will inform and improve judgements about the potential impacts of policies, programmes and projects.
The WHIASU can be contacted at:
Dr Alison Golby
Welsh Health Impact Assessment Support Unit, CISHE, School of Social Sciences, 53 Park Place, Cardiff
Tel: 02920 879161
E-mail:
Liz Green
Welsh Health Impact Assessment Support Unit, Croesnewydd Hall, Wrexham Technology Park, Wrexham
Tel: 01978 313664
E-mail:
2.0 METHODOLOGY
2.1 Why a “rapid” HIA?
HIAs can be categorised in two ways. Firstly, “in-depth” hia’s, which are conducted over a matter of weeks or months, and secondly “rapid” hia’s, which are completed in hours or days.
Rapid hia is clearly useful where a short period of time is available. A key element of rapid hia is usually a participatory stakeholder workshop where key individuals are brought together to examine the proposal.
2.2 Participatory stakeholder workshop
2.2.1 The workshop
The rapid hia was undertaken at a one-day participatory stakeholder workshop, held on Monday 13th June, at the Salvation Army Building, Windsor Street, Rhyl.
A copy of the letter sent out can be seen in Appendix 2.
2.2.2 Participants
There were 21 participants, from a variety of sectors and backgrounds, including representatives of the Council, Local Voluntary Council, the Police and service users of the centre.
A full list of participants and all those who were invited can be found in Appendix 3.
2.2.3 The format of the day
The day began at 9am and concluded at 4pm. During the morning there was a presentation on health impact assessment, then an introduction to the Centre and the workshop screening exercise. During the afternoon session, the evidence was appraised and recommendations were made.
The full programme can be found in Appendix 4.
The workshops were run in two groups. One workshop was facilitated by Liz Green (Welsh Health Impact Assessment Support Unit) and the other was facilitated by Delyth Wyn Jones (National Public Health Service). The number of participants attending each workshop was roughly even.
2.3 Producing the report
Information was gathered from the workshops to compile this comprehensive report.
3.0 THE RAPID HEALTH IMPACT ASSESSMENT
3.1 Identifying potentially affected groups.
At the beginning of the screening session, participants were asked to identify vulnerable and/or disadvantaged groups who may be affected by Canolfan Dewi Sant. Participants chose from a list of population groups particularly vulnerable to the cause of ill health. The list is included as Appendix 5.
Groups that participants felt may be affected by Canolfan Dewi Sant were:
· Service users
· Staff at the centre
· Local residents
· Families
· Friends
· Social support networks
· Staff of other services
· Volunteers
· Tourists
· Large statutory organisations (County Council, LHB)
· Local businesses
3.2 Impacts upon health of the local population
The vulnerable and/or disadvantaged groups identified would be considered in terms of positive or negative health-related impacts upon their:
· Lifestyles
· Social and community influences on health
· Living/environmental conditions affecting health
· Economic conditions affecting health
· Access and quality to services
Participants used a health and well-being determinants checklist (see Appendix 6) in order to assist them in focusing their thought, and to help them to make a judgement as to the likely impacts of the Centre upon the different health determinants.
3.3 Summary of impacts
The following tables describes the potential impacts of elements of Canolfan Dewi Sant, the adverse effects, the positive effects and the recommendations which emerged following discussions of the issues.
24
Issue / Positive impacts – beneficial effects / Negative impacts – adverse effects / RecommendationsLifestyles
DIET / Balanced meals are provided at the centre / There is no meal provision at the weekends currently, so some users will have a meal on the Friday, and then potentially not eat again until the centre opens on the Monday morning. / To support the development of a Church food drop-in service.
Explore other agencies cooking / preparing food / distribution.
Explore food voucher scheme.
Give service users a packed lunch on Friday.
PHYSICAL ACTIVITIES / The centre encourages physical activity e.g. football / Lack of resources / Look to encourage and develop further sports activities.
SUBSTANCE MISUSE IN THE BUILDING / Cigarettes, alcohol or drugs are not permitted within the centre.
The centre will provide help in accessing identified services to help users address substance misuse. / Drug dealers target the centre.
Sometimes users misuse the facilities. / Better locking system to control access.
Report dealers.
Monitor use of toilets.
Ban trouble makers, after a warning has been given.
Medical presence at centre.
Plans for smoking yard.
SEXUAL ACTIVITIES / Sign posting to other services / Substance misuse is linked with the occurrence of sexually transmitted disease / Expand the harm reduction programme
OTHER RISK TAKING ACTIVITIES / Staff trained in diffusing potentially difficult situations / Potentially volatile / dangerous situations / Panic alarm system
Further training for staff in restraint and communication techniques
Issue / Positive impacts – beneficial effects / Negative effects – adverse effects / Recommendations
Social and Community influences on health
FAMILY ORGANISATION AND ROLES / Staff are able to offer advice to families adding reconciliation. / Lack of suitable facilities for consultation
Impacts on the family, who themselves have no support. Partners exposed to violence. / Plans for 2 consultation rooms.
Family support will be provided through the Criminal Justice Intervention Team programme
NEIGHBOURLINESS / COMMUNITY / It is a local service for local people.
Is a needed service.
Recorded crime has fallen by a substantial percentage in the locality since the centre was opened. / Not on my doorstep attitude from some of the local residents.
Fear factor of groups
congregating.
Cannot engage with community, due to inaccurate perceptions.
Community not able to empathise.
Community opposition / Promote, advocate and engage with community.
Work more closely with town, parish, county council representatives and community leaders.
Community education needed. Produce a leaflet.
Team requires expansion for liaison.
Increase volunteer base.
Workshops – community leaders / press.
Positive images in promotion of current provision.
Be welcoming / promote inclusively.
Support volunteers and wider networks.
Encourage reciprocal community activities.