Transcript: Assets-based approaches to intervention

Podcast Episode: Assets-based approaches to intervention

What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

LP - Lisa Pattoni
PM - Paul Morin
FG - Fiona Garven
JM - Jennifer McLean

I’m Lisa Pattoni, a Project Manager with the Iriss Innovation and Improvement Team. In this episode I will be looking at asset based approaches. An asset based approach means shifting the balance away from doing things to people in favour of doing things with people. Assets, or social assets, are things like personal skills, inner strength, knowledge and lived experiences - so things that people already possess that can be harnessed to help them deal with crisis, trauma or problems. Doing things with people means emphasising strengths rather than them focusing solely on their deficits. The theory is that an asset based approach in a community setting can tap into and can mobilise the human capital that exists here to create strong social and community networks. For the last few years Iriss has been working with various groups to explore and promote this approach and the feedback has been positive. To bring an international perspective this work, in September 2012 we invited Professor Paul Morin of Sherbrook University in Canada to present his findings of research in Trieste in Italy and also in two neighbourhoods in Canada. After Paul’s talk, Fiona Garven of the Scottish Community Development Centre and Jennifer McLean of the Glasgow Centre for Population Health joined me for a discussion about what Paul’s research might mean for us and for our work in Scotland. First, here’s Paul on the importance of place based social work, partnership with housing agencies and also the benefits of social workers being embedded within micro communities.

PM Even though we have integrated health and social services since more than thirty years in the public frontline, first line public institution, we got many silos and the idea is can we have a system, a holistic system, a collective system, can we make the system. And the idea is to put at the centre the territory as really the setting of services. So the public institution, but all the services are in the proximity of the inhabitant and the territory really is becoming the setting of the service and the idea is taking care of people, but also taking care especially of places who act on what is going on in these places.

LP He then went on to talk about the pivotal role of the third sector and bridging the community and statutory sectors. Community organisations also confirmed that the approach helped to build a cultural cohesion and participation, and altogether this led to a feeling of “we are all in this together”.

PM About the effect on the third sector partner, it does strengthen links with partners - support the action, mobilisation. In terms of challenge, the idea of meet, reinforce with partner… What is important to understand about the third sector in Sherbrook, we are talking about small organisation that is not much well-funded, so the big public institution is not really … not always well received - and to have the public institution more in proximity to them, they have found generally helpful to being more part of a community of providers, if I can say.

LP The analysis of the impact of the neighbourhood interventions showed recurring effects across all three neighbourhoods, including participating in the creation of social networks, fostering social support, improving access to institutional and community resources and also encouraging social participation.

PM We are talking about the creation of a neighbourhood dynamic for people working together, a better quality of life, and a feeling of security. For us, it is very important that that idea of quality of life, because that is one, if may, I make the link with the capability approach. What we want is that the people … the people being poor and seeing in the word of the capability approach - being poor is living in the absence of liberty. So we must try to break that cycle.

LP Two different types of group were created - open groups fostering social participation and information sharing, and also closed groups focused more on support, therapy or education.

PM Before the project, these groups were not existing, so if we take a classical separation between open groups - meaning by that, open to everybody in the community, and closed group meaning by that, it’s a kind of selection. You have, for example, in Jardin de Fleurie the group or everyone in the community can go there, make a soup, make a collective dinner and things like that. There was a walking group, it doesn’t exist anymore, but for instance the Bhutanese people, they are about 200-250 people, quite regrouped in their community - and the idea was to take a walk with them, with other people in the community, to discover the community. Also an open group with the African community, the Afghan community - for example, the police, the youth protection was invited to speak about what is the law in Quebec, because like here for instance, it’s a family is dysfunctional and is a problem, danger for the children. The children can be put out of the family so, for people coming, for instance, from Afghanistan or Africa to have a social worker go in there, you have the possibility to take the children, make a lot of reaction. So again the police, for example, the police - these people don’t have, maybe when they were in their country, maybe good relation - they were afraid of the police. So the idea is to discover the community, to have these people speaking to the community. In Jardin de Fleurie there is a mixed group of people having mental health problems with people that are so-called “normal” taking part in community art.

LP The effects on the healthcare system and also the social determinants of health were documented and it was found that there was better access to health services, less mistrust of the services, as well as crisis reduction after the intervention had been implemented.

PM They have access to all things, food security, social support, support for social participation. Health is also the idea of offering people in the neighbourhood an opportunity to take action, give people the confidence to get involved in taking responsibility - again the issue of empowerment.

LP Fiona, have you any broad reflections from Paul’s presentation that you would like to share today?

FG Yes, I mean I found Paul’s presentation really interesting - it’s really current in terms of the issues that they are trying to research in relation to what we are facing in Scotland around how we reshape public services. I think one of the slight differences around the research for Paul though, is that in the areas that they were working, they seem to be working in very deprived areas with quite high immigrant populations, and part of the research was to try and enable people to engage people with public services so they could take up the kind of services that were on offer, to try and help them achieve better outcomes, particularly in the area of mental health. Part of the debate around us looking at asset based approaches and building services around people in communities is both to help achieve better outcomes from services when people are in systems, but also to try and mitigate people actually having to access public services in the first place. So while there were some broad similarities, there were also some real differences, and I think we are trying to do a bit of both here in Scotland.

LP He talked about a neighbourhood approach, particularly in small localities, which he called micro-territories, and there was some discussion actually at the event from people saying that local authorities don’t currently have resources to work in really small areas. And I was wondering about what the implications are for Scotland for that - about how do you work in very small areas and make sure that there is not a postcode lottery and that there is equality, I guess?

FG I actually think … I am not sure I agree with we don’t have the resources to work in small pockets or small localities. I think there is a resource issue generally in terms of working at local authority level, working across all different agencies. We know that public spending is reducing. I think it is choices about how we apply the funds that we have got. I think one of the barriers that we have got at the moment in terms of micro-localities, if you like, is the fact that community planning is done at much more of a sort of higher level. So for example if you are doing community planning in Inverclyde or Aberdeen, it’s for the whole area rather than thinking about how you break those down - although of course there will be some thought about how you break that down into different areas and different themes and different priorities. But nonetheless, I think there is room to think about how we can really extract the data for the areas that are particularly impactful in terms of public services. And I think with the data that we have got in Scotland, you can drill down into areas, almost 2 or 3 streets, where you can see that the population there are much more likely to impact in terms of health services, justice services, police services and so on. And it is what we do with that - it is how we use that data to then plan an intervention … a collaborative intervention, but critically in relation to Paul’s work and the researching finding the importance of community in that, and how we engage and partner with communities in developing responses to those areas of extreme deprivation but also high impact - not just because it will help alleviate, you know, impact on the public purse, but because actually that will help to support people achieve better health and social outcomes in those areas.

LP In relation to the smaller areas, I think you have mentioned before, Fiona, that there is a lot of research in the community development perspective that suggests that smaller localities are better placed to kind of create social networks and to be more cohesive. So I guess my question is - how do we build on that and how do we share those lessons across each local authority in Scotland so that they can help to … well help communities to help themselves, I guess?

JM It’s really just about trying to identify where the work is going really well and where those connections are being made and where communities are working well together, and really trying to showcase that work or to highlight it through a range of different routes - whether that’s through research, whether that’s through publications, through media. But then it’s trying to draw the lessons out - well why is it so successful in that area? What is it about that area or that community that has made that really successful? Is it about the people who work there? Is it about investment that they have had? Is it about the kind of nature of the place that they live in? Is it about a common interest that they have that has really brought the community together and trying to kind of capitalise on that and really build on that, and trying to get the lessons out to other areas where some of that may be transferrable.

FG I think that is a really important point that Jennifer made actually, because I think that most communities would, if asked, look for the same kind of outcomes that we all look for at agency level, in terms of better health, better education, more employment, more wealth spread around the area and so on. But actually in terms of engaging them in either dialogue or action around those issues, it is going to be around issues that are really meaningful for them - that they experience in their everyday lives. Therefore, in terms of the kind of engagement that we see around planning processes, you can see why that could really put people off - because it is all at a kind of quite high level, it is outwith the communities and the territories that they actually inhabit and move around every day. So there is something about working right down at those localities to identify what are the issues that are impacting on people’s lives every day? But not only then so that people can start to influence how public services respond, but actually how they can be supported to engage in collective action to try and address those issues independently. And by investing in that kind of activity, what tends to happen, we know … well we know anecdotally, but we also know through various qualitative studies, that when investment is made in that, that people will experience much better outcomes in terms of them being in control of what happens to them, they have got a purpose, they have got a role, they work together with people, they are less isolated, they start to create better social networks, they start to identify common social bonds and so on, and actually that makes for a healthier individual and a healthier community.

JM And I think going back to the point Fiona made earlier about working at neighbourhood level, and obviously building on what Paul said, I think there is kind of recognition now at, whether it’s Health Board level or higher than that, that actually there needs to be work at neighbourhood level as well for these impacts to really have a chance, and for the outcomes that we want to see actually be able to happen. I think that it is now being recognised that there needs to be work at kind of city level, as in the whole of Glasgow need kind of health promotion, public health work for the whole city - but then there is specific areas within this, at kind of community level, which needs more investment, more support. But then above that again, there are neighbourhoods which really need support intensively to actually help them get the outcomes that they need. So I think it is starting to kind of come down and it is being recognised that we need to be working at a range of different levels - there is not a kind of one size fits all.

LP It’s interesting the points you are both making, and I think Paul also highlighted in his presentation the idea of having buy-in from a kind of top down level and also grass roots up, and we do have quite a sympathetic policy context currently in Scotland, and there is a lot of will, I think, on the ground. So I guess a broad question is - how do we make more asset based approaches come to fruition, I guess?

FG I think you are right, I think communities are definitely becoming more and more prominent in public policy, probably less about “well actually how do we do this stuff”. I mean certainly one of the responses to Christie, or one of the Christie recommendations, and then the subsequent government response was around workforce development - how do we free people up to actually work in a different way, to engage with the people that they are there to serve, but to actually involve them then in terms of what those services look like, and actually help them, as I say, achieve better outcomes, regardless of whether those are justice outcomes, health outcomes or social outcomes. So there is something about skills and competencies here and how we do engage in workforce development around asset based approaches. But there is also, going back to the neighbourhood work, which Jennifer quite rightly pointed out the need for it, we have no one these days really working at neighbourhood level - it is something that has … there was never an awful lot of it happened in Scotland, but actually what was there, what used to happen in the community development part of social work has been almost eradicated. Therefore we don’t have people doing that neighbourhood work which is bringing people together, creating social networks, helping people collectivise around issues that affect them in their everyday lives. It doesn’t tend to exist anymore. So what we have got are a whole load of different services - going in and working with different groups or working with different community based organisations, but not necessarily joining those up. So for me there is something about going back to a community development approach, about having somebody there who creates that bridge between communities and public services, but also between community organisations and community organisations - so that there is much more of a kind of coherent approach to people working together collaboratively at a local level to try and achieve good outcomes.

JM And I would agree around the policy context - I think we are in quite a sympathetic policy context at the moment, where there is quite a lot of support for approaches such as asset based approaches from a fairly high level, and it’s getting backing by many of the people kind of very high up the chain, but also being recognised at a local level from Directors of Public Health into kind of Health Promotion departments and Public Health departments. So I think now does seem like the right time to really try to change the balance - moving very much away from a kind of treatment model and very much doing to people, to working alongside them. How we do that obviously brings its own challenges, but I think now is a good time to really try to embed these approaches and try to get the word out there about these approaches and what it can achieve for individuals, for communities and for wider society.

LP Well thanks for that, because I also think … I think there were a lot of questions after Paul’s presentation that focused on cost effectiveness and how you actually evaluate an asset based approach and what difference it does make to the individual, or the community or the group within the community. And I am wondering what needs to be done really to help evaluate asset based approaches as we go forward, and how do we then make the argument for preventative type models or more investment in the community?

JM I think we need to try to find the right kind of research methods for evaluating and monitoring these type of approaches - they might not be the very, kind of very top down methods that we are maybe used to in the past in terms of evaluating kind of community based work. We need to find the kind of model that fits within a community which allows them to continue to do more of the work that they know that happens and that works for their community.

LP I think you talked, both of you, both Jennifer and Fiona talked earlier on about how maybe an action research model might help to facilitate some of the evaluations so that individuals are determining what outcomes they want to achieve themselves and are continually sort of testing it out in practice. Does that …

FG Yes, I think that is one way of doing it. I mean I think it is often … I think Jennifer is right - it seems the big challenge, but we also have got enough evidence out there that tells us that what we are currently doing isn’t always achieving impact. So basically how do we turn that on its head? It also depends a lot on what people constitute as evidence, you know, and working with communities - there has never been enough money going around communities to conduct a longitudinal bit of research that says “if you design an intervention based on an assets or community development approach it is going to lead to X saving as opposed to a service delivery approach with may lead XY saving”. So from that point of view it is really quite difficult to generate the evidence, although Glasgow Centre for Population Health has been doing a lot around that, particularly with case study work that Jennifer has been writing. But there is something for me around that question - we do need to be robust about monitoring, we do need to invest in supporting community based organisations and agencies and partnerships to work together in a collaborative evaluation model, whatever that may look like - but whatever it looks like, it should be participatory. Who’s evaluating? Because at the moment agencies go in and they say “well we have done this and we think this had led to this success or otherwise” - who is asking most of the time - service users or community themselves. So we need to think not just about participatory evaluation, but also actually participatory planning. So involve the communities and users from the outset about what they see as their vision, what they need to see … what they see as needing to be changed - and then how we work together to achieve that, and then, as I say, evaluate that in partnership.

JM Which I think is really interesting, Fiona, because that’s quite different from the approach Paul took. I think his presentation talked about his evaluation of asset based approaches, so as the researcher he was evaluating what was going on, and it wasn’t participatory from the start. And that was one of the things that I think came out in the discussion at the end, that he didn’t necessary have the answer to, or was still kind of at the forefront of his mind.

FG Yes, I think that’s right, although I did get the impression actually though, that that was part of the research findings that they were starting to be able to uncover - was actually “well we need to do this in a participatory way”. So they were kind of getting there. Although the kind of research was focused around “what are the barriers to people engaging with health services”, he did really concentrate, you know, sort of in his research finding, about the importance of community connectedness and all sorts of things - and actually within that, the importance of dialogue at a local level, you know, so that people felt as if they were in touch with one another and sort of less isolated, leading to better, stronger, social support networks and so on. So yes, I thought it was interesting from that point of view.

JM My take of Paul’s presentation, when he did speak about the kind of measurement and evaluation side of it, was they very much focused on the effect of the work they were doing, not on the impact, which was a kind of different position from maybe what we would take - and very much the kind of action research model, which you mentioned Fiona, with a kind of focus of “what’s going on in a community and let’s try and understand that, let’s try and see what the mechanisms are for why things work the way they do, and how can we change those”. So I thought that was really nice and it was maybe taking a slightly different perspective - and I didn’t feel they were too kind of bogged down the whole measurement in evaluation and monitoring processes, the way that we might be in Scotland sometimes if we were to do work in communities, especially in terms of trying to gather evidence in relation to this approach.

F GI thought one of the important things actually about the process, the way they conducted the research, was to have the researchers based in those communities - so that people weren’t flying in and flying out like it was a laboratory, and then they were coming out the other end. They were actually living and working in those areas at the same time as they were conducting this research, and attempting to involve groups and individuals in that. So from that point of view I thought that was a useful way, and that is why it kind of felt more like an action research approach rather than a sort of clinical research approach.

JM Uh huh, and that whole participatory approach is very much seen as one of the methods that can really be used to identify assets within communities, and it really builds on the kind of people working together, about building capacity and local communities, because the people who are trained to do the research are community residents. So once the research is finished, those skills and capacity are still there for future work. So it’s really building the kind of resources and skills that are located within that community.

LP One of the questions I asked Paul at the event was about what kind of skills and capacities were there for the worker and how did they recruit them? And he kind of … I was really interested in his response, because he said they needed to be young, energetic and resilient. And I am just wondering if anybody has any reflections on that, because I think … I was asking about the particular workers who were embedded in the community because they had lots of work to do as well as … it was … some of the community connection stuff was an add on to their already existing job. But what you were saying Jennifer, that has really struck me, is how do you kind of foster and develop those skills and capacities potentially within people in the community? And I am not sure … I don’t know what you would reflect on that or whether it is just youth, energy and resilience or …

FG Yes, but also a kind of certain value base, you know, around being passionate about these approaches and why investing in people is worthwhile. I mean I thought it was interesting that he said youth and energy, and I kind of took away a couple of things from that - one of them was, well actually maybe youth, because this is challenging, tiring work, it’s not particularly easy. So, you know, you need to have a certain amount of stamina about you. And maybe also, you know, and don’t bring any baggage with you - you know, so for older people who have maybe been in this field of work for a long time, do you know what I mean … they might be a wee bit more resistant to change … maybe a combination of things - been there, seen it, done it, didn’t work. Or actually, you know, just generally have that kind of resistance to working with people. So from that point of view I think that was interesting. But in terms of looking at how you then engage people locally to try and build that capacity - again, I think it goes back to finding actually what is closest to people’s hearts? You know, what is it they want for themselves and their families? What kind of life do they want to live? What kind of life do they want for their neighbours, their families? What do they want their communities to look like? And when you start engaging people in that kind of debate, it’s not just about what does a service look like, or what should the consulting times be, or how could the waiting room look better? It’s about a vision for life - a better life. And as soon as you start engaging people in that debate, they will come on board with it because it means something to them.

LP With that in mind then, what do you think generally are the implications of Paul’s research and what we have just said for community organisations that currently are existing in Scotland? It’s a big question, I know.

FG I think we need to be looking at research, you know, from across the globe on this stuff. And actually what was quite striking is that some of the things that Paul was finding and some of the issues that they faced were so similar - and yet in a different culture, different kinds of communities, as so on. So there are definitely kind of broad similarities there. So I think the more we can do to try and make sense of that kind of research and look at how we can apply it to a Scottish context, I think that is really important. But one of the biggest things for me is that at the moment what we tend to do in Scotland across different policy areas, are chase the same kind of outcomes. So we really risk maintaining some kind of silo based approach - when actually I think we need to get much better at collaborative working. You know, you can’t address a health outcome in isolation of a social outcome or a community safety outcome or a regeneration outcome - it’s got to be a collaborative approach. So from that point of view I think those are the kind of things that we need to learn how to get better about - at policy level and at practice level.

LP And I think Paul touched on … actually a big strong theme that came through was partnership working in the research that he said, particularly with housing was one of the key elements. I don’t know if anyone has any reflections on integrating, you know, working together with housing on these, or any examples of working with housing?

JM No I think I would just reflect and agree with everything Fiona said there about the need to not work in silo’s, it is about cross-cutting, it is about collaborative work at different kind of policy levels - but it is also about getting that buy in at regional level or local authority level so the research and the approach that is being taken does kind of get that backing. And it is about recognising the kind of social determinants of health and how everything is related - you can’t look at one thing in isolation. And we need to remember that - that you can’t just go in and tackle one issue without tackling the issues that surround that within the community.

LP For me, I think one of the barriers to partnership working or cross-sectoral working, making sure that people don’t work in silo’s is the issue of language, which we talked about and we continue to talk about in Scotland - about how you define an asset based approach. What does it mean for health? What does it mean for social services? What does it mean for communities? Do you think we are getting too bogged down in descriptions, or do you think there is still a lot of work to be done to define exactly what we mean?

JM In terms of asset based approaches I would say that we have kind of got enough evidence now of what it means, what the theory of it is, what the principals of an asset based approach are. We have got the theory there - what we are now lacking is the kind of evidence to really back it up, so that when people do see something they can say “ah they are taking an assets based approach”, and remembering it is not just an approach that you go in and you do with somebody. It’s very much a way of looking at the world … it’s a perspective that you take when you are working with individuals - it is not a kind of top down approach. It is very much bottom up. But I think the theory is there now and there is kind of generally common agreement, especially from a health perspective, about what the theory is for asset based approaches - why it’s a good thing and why we should potentially move down that line. But I think what we need to do now is start to try to build the evidence base.

LP So you think people are currently working in an asset based way?

FG Some people … can I go back to the language thing though, because I do think it is quite important. Because I think you are right, and I think … but I think sometimes language can be a distraction. And we do often see new terms invented … well not ‘invented’ but new terms brought into the arena that sometimes describe what people think they do already. And that can be frustrating for some people and it can be positive for others, because they realise it’s another side to them engaging with the kind of work that they are interested in. But nonetheless, I think there is a wee bit of a tendency sometimes to let the language obfuscate actually what is actually about a values based approach. And I think one of the things that we need to do on top of gathering the evidence is actually looking at what some of the effective … sorry, rather fundamental underpinning principals are needed to be able to implement this approach. And they can be written in very basic, very accessible language that nobody could pretend not to know what it meant. But I just think that we need to get down as basic as that - while we have got a theory base and an evidence base to back that up. So from that point of view I think there is probably quite a lot of work that they could do around that. I think community development has been quite guilty in the past about, you know, sort of using, you know, technical terms - when actually, as I say, I think it is down to a set of effective practice principles.

LP That cross cut lots of different … overlap with lots of different styles.

JM Yes, I think I would probably agree with that. In the case study work that we did, we spoke to 19 different types of community based projects, and maybe 2 out of the 19 had actually heard of an assets based approach - none of the rest of them had. They were all projects that were working predominantly at a very local level, with direct community - and as soon as you said “this is what we mean by an assets based approach, it’s about people, it’s about individuals building their skills, their confidence, their self-esteem”. “Uh huh, that’s what we do - that’s what we do, that’s what we’ve always done. That’s the way you treat people, that’s the way you work with people”. So they were just coming at it from a different angle from what we are. As researchers we come from very much theory base, principles, definitions - but actually at a local level that’s what they are doing, that is what they have always done, and that is what they know works for their local community.

LP I have shared that experience I would say in social services, people talking about strength based practice or recovery based practice in mental health and saying that that’s an asset based approach and the principles of that practice seems to cross over with what we talk about with an asset based approach. And maybe it is just about saying it up front.

F GOf course there is always the danger, on the other side of the coin, that people will say they are doing an asset based approach because the language is current - and that is what will sort of get attention or maybe get funding through the door for them. So there is something around, although there is a set of kind of effective, fundamental principles, there is something about having some kind of rigour around making sure that if people are saying they are working in an asset based way, then they actually are. But again, I think that can be done fairly simply, in terms of making sure that there are just checks and balances in place.

JM But I think because, at the moment is quite a kind of hot topic, if that’s what you want to call it, we are getting lots of requests from people who are saying “we want to do work with a community and we are going to take an assets based approach - we are going to work with them in an assets based way”. You are thinking “you don’t really understand what you are talking about - it’s not about an approach that you parachute in and you do with somebody”. It’s again reminding them it’s about a way of working, it’s a way you view the world and it’s about people working together. It’s becoming very much “we’ll just do it in an asset based way”, because that’s the kind of current buzz word.

FG You can’t do assets approaches to people, the same as you can’t do outcomes to people.

LP Exactly, and I think we touched on it earlier about the different levels of working in an asset based way - and I think for Iriss we have been trying to help practitioners to be more assets for strength based - and certainly the work that we have been doing has not been about community development, and it is about trying to focus practitioners on what is important to the people that they are working with. And similarly, I would say lots of social workers who work in a strength based way - that’s how they work. And maybe it’s about how we extract the lessons from each of the different levels as well, so that we can understand what an asset based approach means at those levels and what you would be able to do to work in that kind of way.

FG I think, as you said Lisa, I think there is a sympathetic policy environment at the moment and I think we have got to basically exploit that in some way. And I think we are also at a time where we realise in Scotland there has got to be a change, as we have talked about. There’s real pressures on the public purse and there is a real recognition that the current ways of doing things don’t always work for people. And that’s not to say that some public services aren’t very, very good - some of them are very, very good. But there are different ways of working, and part of those new ways of working are about, you know, increasing the independence of communities and the ability and capacity of communities to be able to respond locally and deliver their own local solutions. So from that point of view I think we are at a bit of a tipping point in Scotland in terms of what we do with this stuff - so I think it is important to keep generating the kind of evidence that we are all … kind of all of our respective organisations are working on and use that to influence that policy debate. And I think that is where Paul’s research comes in to be very useful as well, because again it’s not just Scotland that is thinking in this way - we are thinking about this way in Italy and Canada - and I think we could all look across various countries in the world that say “when you deliver something in this kind of way, then it actually does lead to positive change”. So from that point of view, as I say, yes, I think the time is current, I think we have got the language right, we have got the policy environment right. We just need to actually get on with the implementation and actually start to think about actually delivering change solutions, rather than maybe just talking about them. I think we need to actually get on and try it out and do it.

JM And I would agree with that - we know that health is improving for everybody, but the health … the gap in health inequalities is getting wider because the people at the top end are … their health is improving faster than those in more deprived areas. So I think really any approach which can really try to tackle that gap in health inequalities by building on the skills, the resources, the capabilities of people - can be no bad thing. What we need to do is just try to redress that balance between services which are constantly delivering and which are under huge demand, to try to just re-orientate them to give people a place within that system, so they too have a role to play and it’s not just about all what services can do for them - it’s about giving back them some responsibility for the way that they are treated within the system. So I think it can be no bad thing - it’s not going to give us all the answers, it might not tackle the issue, but it is going to be a good thing in the long run I think.

LP Excellent thank you very much, both of you.

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