GUEST BLOG: Dr John Middleton on Sandwell’s public health

Many of you will have read about John Middleton at Sandwell and his long public health career in The Guardian back in March 2014 – Public health is about making ordinary lives richer. We are delighted that he has written this blog for us:

My regional  director of public health at the time, Rod Griffiths, asked the fairly fundamental question  back in 1994, about how did we know all this partnership working was  doing any good?  It took nearly 20 years to start to answer any of this, especially on the housing front. The Health Action Zone gave us the first big chance to propose housing intervention for health and to test it prospectively. The repairs on prescription schemes gave health  visitors and  GPs  the opportunity to  refer children with  asthma and later mental health clients for a range of housing improvements around affordable warmth, asthma prevention and minor repairs for slips trips and falls. A controlled study testing intervention with waiting list households gave positive results on asthma symptoms reducing medication, and improved school results. I am afraid we didn’t run the study through the one more year which might have given us the statistical power to get a publishable result. Being simple service folk our two year unpublished data was enough for us. It would be another ten years before we had the chance to publish something more academically rigorous on affordable warmth. Repairs on prescription has continued on a shoe string through the 2000s if housing or health had non recurrent under spends we would get in there opportunistically. It was the 2009 housing and health strategy that once again enabled us to get mainstream funding and more importantly formal GP commissioner sign up.

Our housing and health strategies from 2000 onwards have considered housing issues as quantity, quality and situation:

  • Quantity going up
  • Quality improving more in public sector
  • Self build community centre
  • Situation
  • Designing out crime
  • Designing in food and green access
  • Key workers near the new hospital

After nearly five years of work in the collaboration for leadership on applied health research and care we have a result on energy efficiency and health.  We have a SAP rating for 2010 for 25,000 properties improved by the former arms length management organisation, (the ALMO – ‘‘Sandwell Homes” ). A ‘before improvement SAP rating’ was modeled for before 2005. This required the combined public health research and quantity surveying skills of our researcher Gavin Rudge. SAP improvements were in themselves an impressive achievement – most properties going from shiver range to thermally comfortable if not totally heat efficient. SAP improvements were correlated with excess winter deaths and cold – related hospital admissions.

The early results  suggest a strong effect on reducing winter deaths and cold related hospital admissions – although these  results will undergo peer scrutiny ahead of formal peer review on submission to a high ranking journal.

Much remains to be done to improve Sandwell health. The current threats of welfare reform, recession, food and energy insecurity, cuts in public services create new challenges – or old problems revisited.

In my last tour  of Sandwell for Guardian Society editor David Brindle, I was struck by the revolution in housing across Sandwell massive private sector development is redrawing the social map of the borough – the idea of Sandwell as a dormitory for Birmingham was once a  feed prophecy but is becoming a welcome reality – new people with money and demands for better public services schools and health are coming in and paying their council tax;  prospering Asian families want their children to go to university and then settle  in the area. They are forming a middle class. For the first time in Sandwell history the population has risen, and the death rates have gone down. The quality of housing is also improving mainly through innovative housing associations high energy efficient building and socially responsive building lifetime homes and mixed tenure. The Lyng estate which had been referenced in the Health action Zone is now prospering with new housing; concierge controlled high rise for older people, green and smart housing, combined heat and power developments and better served by the Lyng health centre, the new police station, metro station and bus stations and the newly overhauled West Brom town centre.


One thought on “GUEST BLOG: Dr John Middleton on Sandwell’s public health

  1. Encouraging news from Sandwell. I spent my student EHO years there over 30 years ago, and it would be fascinating to return and compare and contrast now and then. In those days, there was a huge investment in clearing “unfit” housing and building new; and in spending vast amounts of money on housing grants. But I remember most of all the semi-derelict commercial premises in which people struggled to sell safe food and the need for commercial, as well as residential, regeneration.

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