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Connecting Communities to tackle health inequalities

7th July 2023

To end this busy week of celebrations for the 75th anniversary of the NHS, we are delighted to publish a Voices Blog by Hazel Stuteley OBE that reflects on her distinguished career as a health visitor and leader of ‘place-based’ community development, long before it became the ‘buzz word’ that it is today. Anniversaries like #NHS75 provide a helpful opportunity to reflect on the past and learn from it to build a better future. They also provide an opportunity to recognise key individuals like Hazel who have made such an enormous contribution to the health visiting profession over so many years – we think that her energy, drive and innovation to make a difference are inspiring and hope you do too!

Following qualification as a nurse at King’s College Hospital and health visitor training, Hazel has worked with disadvantaged communities in a career that spans more than 50 years. In 1995, she led the multi-award winning Beacon Community Regeneration Partnership in Falmouth. Following secondment with the Department of Health in 2001, she became Neighbourhood Renewal Adviser to the Office of the Deputy Prime Minister before being granted a Senior Research Fellowship at University of Exeter where she co-founded Connecting Communities, known as C2, in 2004.

C2 is known nationally as a programme leading to the creation of community-led place-based partnerships between local people and providers and has a long track record of delivering lasting, transformative outcomes in diverse settings.

In 2013, the Health Service Journal listed Hazel in the top 10 most influential and innovative NHS clinical leaders in the country. Hazel was awarded an OBE in 2001 for services to the community of Falmouth.

Hazel Stuteley OBE, Founder: C2 National Network of Connected Communities (C2NN)

‘Health creation is the enhancement of health and wellbeing that occurs when an individual or community achieves a sense of hope, purpose, mastery & control over their own lives & immediate environment.’ (Hazel Stuteley OBE 2014)

In my 75th year, I was amazed to receive a lifetime achievement award at the Health Creation Alliance (formerly the NHS Alliance) ‘Coming of Age’ event in London last year.

I remember sitting there thinking ‘I wonder who’s got that this year?’ and the total shock that rendered me speechless when my name was announced. Doesn’t often happen!

Never one to get too ‘up myself’, I’ve since reflected it’s maybe what you get when you’re past your sell-by date! But it was a joy nevertheless.

It also nudged me to reflect on a very long career and the journey which led me to community-led health creation, most of it as a health visitor, so it was very timely when Alison contacted me to write a short blog for the iHV.

So here goes….

Since 2002, I’ve been leading a learning organisation, partnered with the University of Exeter, called C2 (short for Connecting Communities) that’s successfully brought transformative change and wellness to very low-income communities nationally.

But, it was very much my career as a health visitor through the 70s, 80s and 90s that shaped this.

The lifelong passion for finding ways to address health inequalities began in 1968 when, as a teenage student nurse at King’s College Hospital, I shadowed a health visitor for a day in her south London practice.

The difference in the health of mums and babies living at the bottom of the hill in Deptford, then described as a ‘deprived neighbourhood,’ contrasted starkly with those living literally just up the hill, in affluent Blackheath, and actually made me angry!

So health visiting seemed to offer the best route to:

a) understanding the root causes of health inequalities
b) finding ways to tackle and interrupt what was depressingly then called the ‘cycle of deprivation’
c) understanding the causes of wellness that could be applied to an entire community.

It certainly did. All through the 70s, 80s and 90s as a health visitor in Lewisham, where I’d first been inspired, and later in Cornwall, I was able to identify and put together the pieces of the health inequalities puzzle to truly understand what could bring wellness to an entire community.

Unsurprisingly, the answer for me lay far beyond the NHS with the broader determinants of health, especially housing, policing, education and employment, but I was always struck at how ‘disconnected’ these providers were from the communities they serve.

When it came to population health, the predominant narrative was that smoking, obesity, alcohol and substance abuse were the root causes of health inequality, but experientially I learnt that it was actually a collective sense of hopelessness, disconnectedness, powerlessness and passivity causing those harmful health behaviours. I also learnt the power of listening. We consult but we’ve forgotten how to simply ‘shut up and listen’! Yet more pieces of the health inequalities puzzle.

The chance to put them all together came when my fellow health visitor and I led the Beacon Project 1995-99 on a troubled estate of 6,000 people in Falmouth Cornwall, to form Beacon Community Regeneration Partnership (BCRP).

Against a backdrop of violence, poor housing and poor health, this place-based, community-led partnership between local people and providers delivered outcomes that dramatically impacted on postnatal depression, employment, educational attainment, child protection, all levels of crime, and much more. Those improvements have lasted to this day and the partnership’s still there.

So Beacon became the evidence base for C2 following 2 years of research and evaluation by the University of Exeter who also identified a major new piece of the jigsaw – that it was also new relationships between residents and service providers which led to such amazing outcomes. For the full Beacon story and national spread watch TEDx 2013.

So I left health visiting in 2002 to follow my vision to influence policy and embed community-led health creation as a way of tackling health inequalities at source within the NHS.

Memorably, we worked for some years with the inspirational Sir Harry Burns, CMO in Scotland, who taught us about the profound brain changes positively affecting every system in the body, that come with gaining a sense of influence and control. The final piece of the jigsaw was in place by 2010!

Where are we now? Despite the joy of being a major NHS influencer and watching many more communities transform and reverse health inequalities, all these years on I’m still angry.

So many opportunities lost due to successive government’s lack of political will to implement recommendations of great pioneers like Michael Marmot and Harry Burns, to name just two, resulting in vast numbers dying needlessly during COVID.

But I’m hopeful too, that at last the NHS is waking up to health creation.

There are many green shoots and many other fellow pioneers ‘out there’ including Lord Nigel Crisp, a globally respected influencer and former CEO of the NHS. His book, ‘Health is made at home; hospitals are for repairs’, is a great read – and not just because we’re in it!

We’ve also watched and been an early influencer in the exponential growth of the social prescribing movement, now mainstreamed, led by Michael Dixon.

Primary Care Networks, and more recently ICSs, have also seen emergence of many visionary clinicians like GP Dr Gill Orrow, who’s influenced Surrey County Council to adopt health creation practices across the county. This was supported by us and The Health Creation Alliance (TCHA), the only national cross-sector movement tackling health inequalities by health creation.

Do join – it’s free and they love health visitors!

Finally, you won’t be surprised to hear that C2’s common sense ‘how to’ programme to create health via place-based partnerships is called ‘It’s not Rocket Science’!

It’s something we’ve heard many times over from our brave communities who’ve achieved so much and taught us everything we know. They’re right – it really isn’t!!

Hazel Stuteley OBE, Founder: C2 National Network of Connected Communities (C2NN)

[email protected]





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