Management: How partners bring change

Multi-agency working is becoming the key concept in the Government's drive to improve the nation's health. As well as getting health trusts and social services departments to co-operate, the Government wants to see a network of healthy-living centres established across the country, bringing together NHS trusts, councils, universities and community groups, funded by lottery money.

The Life Project in the Wirral is one of three examples quoted in The People's Lottery White Paper, where a multi-agency approach is already making an impact. It has focused on increasing equality in health-care provision, improving fitness levels among people with heart problems, and raising awareness of the connection between lifestyle and health.

Initially the project was funded for five years through city challenge funding, based on Birkenhead's poorest area of Citylands. The pilot scheme finished in March, but instead of allowing a successful project to collapse, the health authority and borough council have amended, expanded and financed it to continue across the whole of the Wirral. The council is putting in pounds 50,000 this year, and the health authority pounds 150,000, which it hopes to recoup from reductions in operations and prescribed drugs.

Liverpool University was closely involved with the pilot project, helping to analyse the health impact of large amounts of grant aid coming into the deprived area, particularly from the European Commission. Research found that while poorer people had the highest incidence of heart disease, it was richer patients who had more operations. The imbalance of treatment has now been redressed.

It was recognised that treatment, though, must not end on the operating table. The chances of rehabilitation were much increased if the patient could be persuaded to exercise more.

GPs were happy to co-operate in writing out "exercise prescriptions", giving patients an initial free use of the local leisure centre for six weeks, but few patients maintained their exercise regimes.

"We found the actual compliance rate was very low - about 20 per cent," explains David Brodie, professor of movement science and physical education at Liverpool University. "We changed that by organising the exercise for people. Compliance dramatically improved, to 70 per cent."

Life organised special courses for obese people, which enabled patients to feel comfortable in classes with others with similar problems. It had been difficult to challenge patients' diets, but the project has found that advice on food was accepted much more readily when incorporated into fitness classes.

While it is too soon to ascertain the impact on long-term mortality, morbidity and recovery, the indications are that patients' rehabilitation is greatly improved. Yearly examinations of post-operative patients have shown fitness improvements, and reductions in cholesterol levels and the number of people who now smoke.

With the rolling out of the Life Project across the whole of the Wirral, the focus has had to change. The emphasis is now on working with young people, to establish healthier lifestyles from an early age. Teachers, youth group leaders and young parents are all targeted to get them to instil on children and youths the need to learn healthy habits. The project's four campaigns are on smoking, sun safety, AIDS and being "active for life".

Tessa Jowell, the public health minister, will visit the Life Project in the near future, to endorse its approach. Sue Drew, manager of Life, says its approach fits in well with the minister's priorities. "Tessa Jowell has talked of using the public as health advocates - that is what we have been doing." A network of self-employed fitness trainers and stress counsellors has become established to take forward the work, operating in conjunction with the council's leisure centres.

Lottery funding for new healthy living centres will not become available until 2001, when the extra good cause, the New Opportunities Fund, will be running.

But Sue Drew can already advise others around the country about which approach is most likely to prove successful, both to win money and to produce real benefits. "It is about thinking wider and in partnership," she says. "Bids from just health authorities or local authorities would be less favourably received than partnership bids."

The results, it is already clear, are benefits all round.