Getting better all the time

The <em>New Statesman</em> and Fellows' Associates, with the support of Northgate Information Soluti

The "power of well-being", enshrined in the Local Government Act 2000, is designed to give local authorities the scope and impetus to improve the economic, social and environmental welfare of their areas. The concept, in keeping with new Labour's ideological commitment to civic engagement and renewal, encourages the development of partnerships between local authorities, other statutory agencies, and voluntary and community groups, in particular emphasising the involvement of communities in the formulation of strategy.

The Welsh have embraced the notion of well-being more enthusiastically than their counterparts in England. Since April 2003, local authorities and health boards in Wales have been required jointly to prepare and implement health, social care and well-being strategies, and in March this year a new health and social services department was established. This positive response to the legislation is perhaps not surprising, given that Wales continues to be dogged by a range of social and economic problems that undermine well-being: 26 per cent of those who are eligible to work are unemployed, compared with roughly 21 per cent in the rest of the UK, and the nation's gross domestic product stands at just 78 per cent of the UK's, compared with 85 per cent in 1989.

Wales is often described as a nation of villages, divided geographically by its varied, sweeping landscape. It should there-fore work well as a model for localised initiatives. Further- more, the power of well-being represents an excellent opportunity for the devolved Welsh Assembly to assert its independence from Westminster.

You might expect a debate on well-being in all its manifestations to be fairly wide-ranging, and you would not be wrong. The discussion touched on crime, unemployment, education, technology and the environment. However, the main focus was on provision of healthcare and social services, and the implications of policy for community justice more generally.

The round table kicked off with the participants attempting to pin down the meaning of the term "well-being", and explaining why they felt it was significant. The sociologist Gareth Williams drew attention to the disturbing increases since the 1980s in certain health problems in Wales, such as heart disease and cancer. The improvements in his field of academic study have helped to establish a firm link between social and economic inequalities and ill-health, and in particular have demonstrated the existence of "historic pathway effects" whereby the well-being of whole areas and communities is undermined by the almost predetermined life choices available to them. The NHS must respond to these social factors, Williams argued, rather than simply treat illness as and when it occurs.

Malgwyn Davies said that local authorities and their strategic partners must look at longer-term policies affecting education, environment, transport and employment. However, he pointed out that this is often secondary to the more pressing aim of alleviating ill-health and deprivation in the poorest areas. Jane Hutt agreed that a truly successful approach to tackling the inequality endemic in parts of Wales requires a cultural shift, and that progress will take time. She was none the less optimistic that policies are working - for example, the fruit tuck shops in primary schools, which supplement young people's diets in the hope that they need never use the NHS as a result of poor eating habits.

For Gloria Jones Powell, the involvement of the voluntary sector is crucial. Like Hutt, she felt she had seen doors that were once closed gradually opening during her time on the "fringes of health provision", and this was due to the widening of the debate to engage groups beyond local authorities. Well-being is not confined to health, Powell argued, but is more broadly about quality of life, and the challenge over the coming years is to gather the previously disparate strands of community groups, health boards, academics and local authorities to work in unison towards the same ends.

Professor Morton Warner said the impact of language was significant. The use of terms such as "well-being", "responsibility" and "community" had helped widen the parameters of debate and facilitate discussions of the broader question of how we want to live, rather than just how we address particular concerns. He pointed out that Wales has a strong tradition of tackling these issues, and said we should be encouraged by the progress the country has already made. At a recent seminar on the elderly in Singapore, the Welsh model was praised as an example to emulate.

Alun Michael MP, the minister for rural affairs and local environmental quality, said that lack of aspiration is the biggest factor limiting people's lives. In Wales, historic mass employment in the steelworks and manufacturing gave way to a period of widespread unemployment. Now, thanks partly to the New Deal, Michael claimed, there is a huge variety of career paths open to young people; making them aware of the opportunities and giving them the necessary skills, however, is a big challenge.

Superintendent Jon Burley said that the environment is one of the most crucial determining factors of well-being. Some areas are simply undesirable places in which to live and work, and residents therefore lose out from the start of their lives. In such areas, the challenge for the police is simply to keep a lid on crime and attempt to make the residents feel as safe as possible. The elderly are frequently too afraid to go out, because they feel threatened and therefore isolated from their community. Engaging young people continues to prove extremely difficult. But Burley made a strong case for opening dialogue with ordinary people. While professionals are promoted or move jobs, many people live in the same communities all their lives. It is these people who are in the position to know what is most needed and how that is best to be achieved.

How representative are individual instances of success in, say, a specific school or estate? Hutt and Michael agreed that examples of positive outcomes on a local level help to provide a model of "best practice" that can be drawn on and adapted. Jan Williams, meanwhile, argued that the role of "storytelling" is often overlooked: this has been an effective way of finding community champions and spreading the message from the bottom up.

David Meaden, representing Northgate Information Solutions, outlined the important role of technology. IT has helped to support partnerships between the various bodies involved in cultivating well-being, and the historical view of technology simply as a means of speeding up service provision is no longer valid. IT systems enable the tailoring of services to individuals, and help measure the success of policies at every step. The participants broadly saw technology as a positive mechanism for effective change, but it was pointed out that it can be dangerous to rely too much on data. Burley found that statistics on crime rates, for example, are deceptive. As Warner put it, the right questions have to be asked of the data in the first place.

Many of the participants were involved in and committed to government-led well-being initiatives, but there was one truly dissenting voice. For Neil Wooding, well-intentioned policy is often counter-productive because it does not acknowledge, from the outset, the ultimate goal of redressing inequalities - of race, gender, age, wealth and opportunity. A blanket level of services can serve to entrench inequality, he said, and the redistribution of resources to marginalised groups must come first. The question should not be "how can the community help public services?" but "how can public services help the community?".

Despite often opposing opinions on how best to approach and understand well-being in Wales, the round-table debate was marked by a sense of shared purpose. Improving the "well-being" of the country's communities requires incremental change based on dialogue with and the participation of residents, and on making maximum use of the advantages that IT brings to the process. Even when the chair, Sarah Dickins, raised the question of further constitutional change, there was little argument. It was agreed that the devolved powers of the Welsh Assembly, and in turn of individual local authorities, are enough to bring about real change. Leadership, civic engagement and the effective formation of partnerships will allow progress. The days of "silo-like" organisational structures are over in Wales, and the movers and shakers in Cardiff seemed optimistic about where this will lead.

Participants

Sarah Dickins (Facilitator) BBC Radio Wales
Jon BurleySuperintendent, Gwent Police
Malgwyn DaviesChief executive, Caerphilly County Borough Council
Jane HuttMinister for health and social services, Welsh Assembly
Gloria Jones PowellVice-chairman to the board, Powys Association of Voluntary Organisations (Pavo)
David MeadenManaging director, public services, Northgate Information Solutions
Alun MichaelMP for Cardiff South; minister for rural affairs and local environmental quality
Professor Morton WarnerDirector, Welsh Institute for Health and Social Care
Professor Gareth WilliamsSchool of Social Sciences, Cardiff University
Jan WilliamsChief executive, Centre for Health Leadership Wales
Neil WoodingStrategic director, NHS Centre for Equality and Human Rights, Wales; commissioner, Equal Opportunities Commission