Introduction

Communities are groups of people joined together by a common interest, characteristic or experience. They can be defined by their experience of health, geographical location, race, age, faith, health need, or even by their involvement in online spaces. Over recent years there has been an increase in momentum nationally towards recognising the role that communities have to play in improving the health and wellbeing of their members. Factors related to where people are born, live, work and socialise have greater influence on health and wellbeing than health services. Evidence shows that social isolation and loneliness can impact negatively on health, and that there are many assets within communities that can be mobilised to promote health and wellbeing.

The purpose of this Joint Strategic Needs Assessment chapter is to create a shared local understanding of the evidence of effectiveness for working with communities to promote health and wellbeing, to support ongoing work and enable consistency across Nottinghamshire. It will also help to summarise what is known about the local picture, to inform recommendations for system partners as to how community-based assets can be drawn upon and utilised to maximise health and wellbeing across the county. The chapter will focus on geographical communities, defined by place.

The overall aim is for Nottinghamshire to be a place where communities and the individuals and families within them feel connected to each other, feel heard and valued by local organisations, and feel empowered and confident to make changes for their own health and that of their communities. 

Evidence of what works

Community-centred approaches are ways of working locally that focus on mobilising communities’ own resources, strengths and capabilities (assets), promoting equity (fairness) and increasing people’s control over their health and lives. These approaches focus on promoting health and wellbeing in community settings as opposed to health service settings, using non-clinical methods. Community-centred approaches can go some way to addressing health inequalities; by targeting areas most in need, work can be done to identify what matters most to those communities to attempt to bridge the gap and reduce some of these inequalities.

There is an increasing body of evidence that community-centred approaches can have positive effects on health and wellbeing and can help to reduce inequalities. Evidence suggests that this is particularly true when there is continuity and flexibility of funding, and devolved power leading to collective control and social cohesion, enabling and empowering community members to make their own decisions. The quality of the evidence in this area is variable, but what is clear is that local context is important as communities differ significantly, and therefore there is no one-size-fits-all approach. 

What do we know about communities in Nottinghamshire?

The ‘needs’ of different communities will vary greatly, and as indicated in the literature, are best defined by communities by themselves rather than external parties using proxy measures to illustrate needs. However, certain descriptive indicators might provide useful background/context to understand and consider the needs that different communities across Nottinghamshire might have. A few of these indicators are listed below, but it is important to remember that these show an average across the county, within which there is vast variation between individuals and communities.

Key indicators for Nottinghamshire:

• 60 years is the average age when females report not being healthy, which is worse than the England average of 63.9 years. The average age that males in Nottinghamshire report not being healthy is 62.4 years, which is similar to the England average of 63.1 years (2018-20).
• Nottinghamshire is ranked 101 out of 151 upper tier local authorities in England in the index of multiple deprivation, 1 being most deprived.
• 23% of adults report feeling lonely always, often or some of the time. This is similar to the England average of 22%.

Local surveys have shown that the average estimated life satisfaction scores for Nottinghamshire are below the national average, but residents recognised and appreciated a stronger sense of community during the COVID-19 pandemic and are keen to see this built upon.

Local insight

• Communities want to be supported and involved in their own development and feel organisations are working alongside them.
• Communities want creative and flexible solutions to services and funding that can adapt to the communities ongoing and changing needs.
• It is important to have consistent, trusted community figures, as well as physical assets and social infrastructure.
• Sense of belonging increases with sense of pride and cleanliness, and transport is important for combating loneliness and building connections.

Current activity and assets

Many organisations working in Nottinghamshire will have identified geographical areas where there is an opportunity to achieve better outcomes for individuals and communities, and which require a greater level of resource to address need. The areas identified, and the approach used to identify them, will depend on the nature of work planned by that organisation.

The voluntary, community and social enterprise (VCSE) sector is crucial to working closely with communities. In Nottinghamshire, 38% of such organisations are charities and 23% are registered as a community group. There are approximately 6,000 volunteers involved across Nottinghamshire with an average of 21 volunteers per organisation. 15% of organisations received funding from Nottinghamshire County Council, and 21% from Nottinghamshire district councils, but 23% of organisations have only up to 3 months funding reserves.

Examples of some of the ongoing community-centred initiatives across the county include volunteering schemes, community connectors and Local Area Coordination (see Case Studies).

What does this tell us?
Service gaps

• One of the key challenges experienced in this area is around funding. For community-centred initiatives, funding is not always long-term or sustainable.
• The importance of community voice is increasingly recognised across organisations, but some communities experience consultation fatigue.
• Not all communities feel that they have spaces or venues to meet, which could help with tackling loneliness and social isolation.

Knowledge gaps

• There is a lack of robust, high-quality evidence of community-centred approaches.
• There are limitations of data about communities, as this does not capture their felt need and is often only available for larger geographical areas so cannot show differences between individual communities.

Recommendations for consideration

The recommendations below are for any organisation working with communities, with key partners recognised. Whilst these recommendations have been developed with a focus on place-based communities, they may also be applicable for working with communities of different kinds. Other JSNA chapters have focused on some of these other communities, and we recommend that these are also drawn upon when working with any of the relevant communities.

* Other partner organisations can be any organisation working with communities, but examples include Primary Care Networks, Other NHS providers, the Integrated Care Board, Active Notts, Parish and town councils and local businesses that support communities. 

Dawn Jenkin                                                                   
Consultant in Public Health                                    
dawn.jenkin@nottscc.gov.uk

Kathryn McVicar                                                                   
Speciality Registrar in Public Health                                    
kathryn.mcvicar@nottscc.gov.uk