Feature

When people won’t take ‘closed’ for an answer

Does the new, user-friendly healthy service take any more notice of local people than it ever did? Judith Emanuel describes how people in Ancoats fought for the services they wanted — and got them

In early 1987 North Manchester Health Authority announced that they would be closing the Ancoats casualty department. In previous years local people had lost a lot of facilities, such as play areas, shops, the library and swimming pool and they were not going to lose the casualty department without a fight.

On the day the casualty department was due to close local people decided, rather impulsively, to sit-in at the casualty department. The sit-in was unusual in attracting local people in a wholly working class area, who maintained control throughout. It was never dominated by trade unionists or political activists.

In September, the health authority agreed to set up a community clinic that would provide walk-in facilities for people with minor injuries. While this was not what people had been campaigning for, some did see it as a victory.

According to Phil Burke, of the Ancoats Action Group: ‘We won that fight because we complained and made our protest felt by taking over the casualty department...If we had sat round a big table and tried to talk things through at the beginning, we would have been beaten right at the start, basically because we didn’t have the know-how or the knowledge to be able to argue our case.’

‘But by taking action, by refusing to move from the casualty, we gained strength to argue, and also gave ourselves the time to find out exactly what was going on and how things worked, and so I feel that we won...in terms of getting a clinic which would not have been there. I’m sure of that.’

The action group were centrally involved in influencing the services which would be offered at the clinic and to a large extent they got the services they wanted.

North Manchester has a women’s health team which already had experience of working with groups of local women to plan, develop and run well women centres. The action group decided that they wanted a well woman clinic and worked with a member of the women’s health team to set up services. The well women centre is a particularly good example of a new type of partnership between local people and professionals.

‘I went to the first meeting and decided to get involved,’ said Jennifer Thompson, a volunteer. ‘The training was good, there was no “us” and “them”, we all sat down together and worked out some basic agreements on what happened to women, although we all had different experiences and outlooks. I used to look forward to it all week because it was social and supportive as well as work. And we all had a say in what the training was about, which was good because it was the first time that I felt that I could relate to health professionals and feel like an equal.’

The circumstances which led to the establishment of Ancoats Community Clinic demanded that workers reviewed how they did their jobs and established new ways of working.

A local health visitor explained: ‘Several aspects of health visiting needed to be addressed: the first was that local participation in the service...and this was achieved by developing a “contract of care” where families were given the chance to determine what, if any, involvement with the service they required.

‘Secondly, working alongside local women in the women’s health group and a child health group meant that we tried to provide a service that local women would find acceptable.

‘Finally, sharing information about health statistics and listening to what the local people felt were barriers to their health potential being achieved has raised our awareness of local need, which we were then able to represent to the health authority and other agencies.’

There appears to be a much stronger sense that Ancoats community clinic belongs to Ancoats people than exists between other clinics and their local areas. Over time, as the confidence of local activists has developed, professionals, activists and policy makers have increasingly worked together to tackle local issues.

When the Manchester Health for All (HFA) working party won funding for a consultation project, Ancoats was an obvious choice for one of the areas. The project worked by training local people and professionals to do the consultation. After the consultation they organised an exhibition to report back what they had found out.

Cathy Jackson, of the Ancoats HFA group, said: ‘I think the key thing that came out of the HFA project was a raising of awareness. All these people in the health authority had known all these statistics about health for years, and after the consultation and the exhibition, people were really shocked. That project really brought home to people about life chances and inequalities in health, linked with the area in which you live.’

After the consultation, volunteers who were involved took action on some of the issues raised - especially drugs, refuse and play areas for children.

‘I went to Lifeline and arranged for somebody from there to go to a local school to talk about discarded needles,’ said Winnie Amir, of the HFA group. ‘We tried to get a leaflet put in with the needles at the needle exchange to ask people to take used needles back. Cleansing were very helpful - they sent wagons out to clean up the area.’

Health workers have also supported local initiatives outside the NHS, such as a men’s drop in centre held at a local advice centre.

Now the campaigners have published a book — Stitched up! Action for health in Ancoats: voices of struggle, hope and vision - as a guide for all community groups concerned about health in their local area.

It should certainly be read by health authority members and those concerned with community participation in health services. It describes the complexities of what happens once the community are really involved in identifying needs, planning, developing and running health services.

I was a health promotion officer, manager and health authority member at the time of the events described in the book. I think that the opportunities presented by the high level of community activity have contributed enormously to moving towards some of the objectives of Health for All in Manchester and to developing our understanding of community-based and community development work.

As Joyce Leeson, former director of public health in North Manchester, says in her excellent introduction to the book: ‘Ordinary Ancoats folk came together in various ways that are valuable and important for physical, mental and social health. If, in similar communities elsewhere, local potential can be empowered too, then impressive forces to improve health and well being will be released.’

There are many lessons to be learnt from the experience in Ancoats. Perhaps they could help to resolve differences between the campaigners and authorities who are currently engaged in battles over the future of local services in many other parts of the country.

Stitched up! Action for health in Ancoats is available from Church Action on Poverty, Central Buildings, Oldham St, Manchester M1 1JT. £5.00.