Final Evidence Summary 9th Feburary - 25th ... - Islington Council

www.islington.gov.uk/fairness
Evidence submitted to the Islington
Fairness Commission
A Summary of evidence submitted (9 Feb – 25 Mar)
1. The Islington Fairness Commission received 17 submissions in total between 9 February and
25 March 2011, the final deadline for submitting evidence to the Fairness Commission. All
submissions are available on the Fairness Commission website except for submissions which
relate to particular individuals which will be treated as case work. All submissions are read by
the Commission and its secretariat and suggestions to improve fairness in Islington will be taken
into consideration in agreeing the Commission’s final report.
2. Some submissions followed on from the ‘Health Inequalities’ meeting on 15 February by
addressing the issue of health inequalities in Islington. Other submissions focused on
environmental determinants of health, community integration and engagement of minority
groups, housing, education, and budgets.
3. The issues raised in the submissions have been organised into themes and summarised
below, with a quotation to illustrate the key points.
Health Inequalities – Referenced in 5 submissions
“There is a responsibility to examine health inequalities from the perspective of ethnicity,
alongside age, gender and social deprivation.”
4. The above quote is from a report about work to tackle health inequity in primary care in LB
Tower Hamlets. This report, along with four other submissions, raised the issue of inequalities in
health outcomes by gender, age and ethnicity.
5. The report on Tower Hamlets focused on three long term conditions, Cardiovascular Disease,
Diabetes and COPD (Chronic Obstructive Pulmonary Disease), and found that for disease
process and outcomes there were significant inequalities by gender, age and ethnicity. The

eport also highlighted that inequalities in service provision can be hidden and are not always
easy to identify.
6. Health equity audits were conducted to demonstrate the differences between experiences of
different groups and the data from the audits could then be used by primary care teams. The
report stated that although there were improvements across all local PCTs for most disease
indicators, health inequalities are persistent and need to be continually reviewed.
7. Two submissions highlighted the health inequalities experienced by Black and Minority Ethnic
(BME) communities in Islington. A report from the Women’s Association for African Networking
and Development (WAND UK) argued the need for targeted support for BME women and
cultural sensitivity on the part of health service providers. The report identified that some of the
key barriers to BME women accessing health services include financial constraints and a lack of
information about what services are available to them.
8. A report from the Islington Refugee Forum (IRF) made similar points that a lack of clear
information and a lack of cultural sensitivity can prevent refugees from accessing health
services. The report highlighted further barriers for refugees including language barriers and a
lack of interpreters in health service contexts, and the impact of the trauma and stress of coping
with a new environment and integrating into a new community.
9. Both reports stressed the importance of effective signposting and information and advice
from GPs, as GPs form the gateway to other services. The importance of having interpreters
and information in a range of languages at the GPs was also emphasised.
10. Two submissions argued that health services are not sufficiently tailored to address the
sometimes complex needs of elderly people and those with disabilities. One submission argued
that there is too strong a tendency for a ‘one size fits all’ approach in health and social care
services and that therefore the support and advice provided may be inappropriate. The
example given was that for someone who lives alone and on a low income the weight loss
advice they receive may often be tailored at couples and families, or the ingredients they are
recommended to use may be too expensive.
11. One submission argued similarly that health services are not sufficiently adapted to the
needs of elderly people wishing to live independently in their own homes, and that this failing is
likely to lead to more older people being admitted to hospital.
Health Determinants – Referenced in 4 submissions
“Local authorities can respond to the challenges and expectations placed upon them to
improve as far as possible local environmental conditions...to improve local housing
conditions; to improve workplace safety & promote healthy options and alternatives to the
community.”
12. The quote above is from a submission about the work of the Environmental Health teams
within Islington Council. The submission elaborates on the work of the team and provides
evidence on how the wider environment and individuals’ living and working conditions are key
determinants for their physical and mental health.

13. Another submission came from the Local Involvement Network (LINk) about the relationship
between housing and health and it made many similar arguments to the environmental health
submission.
14. Both submissions evidenced the range of physical and mental health issues that can result
from living in poor housing conditions and in a physical environment with very little green space,
poor air quality, noise pollution, crime, litter etc.
15. The LINk report specifically details the impacts that poor housing conditions have been
found to have on health, and references calculations done by the Building Research
Establishment which estimated that poor housing costs the NHS at least £600 million per year.
16. The report identified eight hazards of poor housing that can cause ill health: damp and
mould, cold homes and fuel poverty, exposure to house dust mites and other allergens,
overcrowding, rodent and other pest infestations, prevalence to slips, trips, falls and other
accidents, and a lack of housing aids and adaptations for independent living. These hazards
can lead to a range of conditions including asthma and respiratory problems, eczema and
conjunctivitis, infectious diseases such as TB, accidents, injuries and fatalities (through
accidents or excess winter deaths). With all these conditions, it is often children who are the
most susceptible and at risk.
17. The submission also referenced a report by the British Medical Association which argued
that it is often the most vulnerable people (the very young and the very old, people with long
term illness etc) who are the most likely to be affected worst by the hazards associated with
poor housing because of the long periods of time they spend in their homes.
18. According to LINk’s report the highest rates of non-decent housing are generally found in
the private-rented sector and within that some of the worst housing conditions are found in
housing in multiple occupation (HMOs). Those who are homeless or in temporary
accommodation have the worst health outcomes; the life expectancy of someone sleeping
rough in the UK is about forty years.
19. The report included 2007 survey data for Islington which estimated that 15,899 households
in Islington (18.1%) were living in unsuitable housing with the main reasons being overcrowding,
special needs and need for repairs. The rate of overcrowding in Islington was estimated at
6.9%, mostly concentrated in the social rented sector. The key argument is that to reach a state
of equality in health outcomes, all housing in Islington must be of a decent standard that is
conducive to a healthy lifestyle.
20. One submission came from the Seasonal Health Interventions Network (SHINE) and
outlined the fact that hundreds of Islington residents are admitted to hospital or die every year
due to health problems associated with extreme cold and hot weather. SHINE is a partnership
between The Council and the NHS in Islington, established in December 2010, and aiming to
tackle fuel poverty and reduce excess seasonal deaths and hospital admissions in Islington.
The submission asked that Commissioners note SHINE as an effective partnership in bringing
together different agencies and improving the health and wellbeing of vulnerable residents.
21. Another submission came from a national project called the Health Empowerment Leverage
Project (HELP) that supports residents to transform the conditions of their neighbourhood in
conjunction with the full engagement of the different agencies. The submission advocated for
the opportunities presented by localised health commissioning for greater investment at the
neighbourhood level as a way of tackling spacial inequalities. The project does not currently

work in Islington but the submission suggested that an area like the Bemerton Estate would be
a good candidate for their initiative.
Housing – Referenced in 1 submission
“These changes will enable residents to make more informed decisions about their housing
earlier, and will enable the HfI and LBI to deliver a better service to those with a high level of
need.”
22. The quote above is from a submission about a Joint Efficiency Review (JER) undertaken of
the housing process by HFI and the Council’s Housing Team. The submission states that on
the basis of the Review’s findings the service plans to introduce a face-to-face and telephone
assessment and advice service, change the verification process, and review and amend the
lettings process.
23. The submission argued that these changes would enable better communication, quicker
decisions and make the service more responsive to need, and would bring about the benefits
highlighted in the quote above.
Minority Groups – Referenced in 2 submissions
“The situation of BME women and children in Islington is largely characterised by: Poverty,
income inequality, violence against women, housing difficulties, inequality in access to
health services, invisibility to local decision making and under representation in public sector
employment”
24. Two submissions focused on the disadvantage experienced by minority groups in Islington,
specifically refugees and those from Black and Minority Ethnic communities. Some of these
issues and how they relate to health are covered above, but the submissions referred to a wide
range of areas of disadvantage.
25. The report from the Women’s Association for African Networking and Development (WAND
UK) focused on the position of BME women in Islington and argued that the lives of BME
women and children in the borough are largely characterised by poverty, income inequality,
violence against women, housing difficulties, inequality in access to health services, and an
invisibility in local decision making.
26. The submission reported high instances of domestic violence and sexual violence in
Islington, and argued that BME women have the worst experiences of housing in the Borough,
are overrepresented among the homeless in Islington, and are less likely to interact with
Councillors and elected officials to have their views heard.
27. The report recommended that BME women be empowered and have greater access to
training and education to overcome language barriers, social isolation and all barriers to
integration, and emphasized the fact that the key to reducing child poverty is empowering
women who may not have the financial support of a partner.
28. The submission from the Islington Refugee Forum went through evidence on the
experiences of refugees in the key areas in the Refugee Integration Strategy: community

integration, health, housing, employment and education and argued that refugees experience
significant disadvantage in all these areas.
29. Language barrier was identified as one of the biggest barriers that limits refugees in terms of
their access and outcomes in all these areas. The lack of appropriate and accessible ESOL was
raised as a very big issue, with a stress on the need for more entry-level and pre- entry-level
classes, and a need to reduce the prohibitive waiting lists.
Family Support and Community Integration – Referenced in 3 submissions
“Community Centres are often in the centre of housing estates, perhaps there should be an
emphasis on re-generating to become the 'hub' of the community. People from the
surrounding area could be encouraged to take a very active part in running and maintaining
'their' centres enabling sustainability and growth.”
30. The above quote is from a submission that called for the regeneration of Islington’s
community centres which, it was argued, are underused. The submission argued that
community centres are often well placed to reach the most disadvantaged because very often
they are on large estates.
31. It was suggested that if the centres were regenerated they could form very successful hubs
that could incorporate cafes, community gardens, exercise and cooking classes, and a range of
other activities. The submission argued that the centre could improve local employment by
employing local young people as volunteers, and could create a greater sense of community
cohesion and integration.
32. One submission stressed that in existing work to support families and young people and
encourage healthy development there has not been enough work on the role of men in families,
or on concepts of masculinity. The submission asked that these factors be considered further in
future work.
33. Another submission that focused on strengthening community integration in Islington came
from Rowan Arts, an organisation that aims to act as a catalyst for social change through the arts
and to use their projects to create spaces for exchanges and experiences that improve lives and
enhance a sense of place.
34. The submission argued that the arts offer unique opportunities for learning and enjoyment as
well as employment. The submission specifically referenced two current projects that speak to
issues of fairness. The first is their goal to open a charity shop in Holloway that would offer entry
level volunteering opportunities to help local people get into employment and earn new skills, the
second is a project called ‘Holloway online’ that would allow local people to connect with each other
and with local services and events online.
Funding and Budgets – Referenced in 3 submissions
“Given long-term contractual commitments and service costs that are statutory, what
proportion of the Council annual budget remains discretionary (i.e. available to be cut)?”
35. The above quote is from a submission that asked about Council budgets and about which
areas of the Council’s work are vulnerable to cuts. The submission also asked whether the cost

of servicing of political and democratic processes, in terms of paperwork and admin work, were
considered alongside the costs of other services when considering the budget.
36. Another submission stated that Disability Action in Islington (DAII) and Islington People’s
Rights (IPR) had both received money from the Government’s Transition Fund. The submission
asked whether these organisations were representative of all Islington’s residents.
37. One submission suggested that the Council look to use the pupil premium to help schools
provide services that would help to tackle child poverty. The evidence on services needed came
from some of the work that has been done interviewing parents in the borough about the
difficulties they face.
38. Key issues highlighted in the submission include: affordable before and after school
childcare to help parents who are looking for a job, internet access for children who don’t have it
at home, homework clubs, free additional activities and lessons in music and sport, holiday
provision for working parents and free or affordable indoor facilities after school and during
holidays.
39. The submission highlighted that many of these activities complement each other and could
be provided together (for example, after school childcare or homework clubs could be combined
with giving children access to computers and the internet). The submission also proposed that
a group of schools in an area could look to share services so that even if every school could not
provide everything, there would be a range of services available in a local area. The submission
suggested that the Commission look to encourage the Council to use the pupil premium to
provide these types of affordable provision consistently across the borough.
Education – Referenced in 1 submission
“There are only two ways of people moving from poverty and exclusion to social mobility: of
narrowing the Spirit Level gap: these are employment and education and training; the one
leading to the other.”
40. The quote above is from a submission that asked why the Commission has not given more
specific attention to the issue of education and training during the Fairness Commission
process.
41. The submission suggested that education is one of the most important tools for increasing
social mobility and asks whether the complexity and challenging nature of raising educational
performance and attainment has deterred the Commission from fully tackling it. .
42. The submission did praise the work of the Commission so far but expressed disappointment
that there had not been an individual meeting for education and argued that it was a disservice
to the residents of Islington not to give due attention to education.