A health authority which won special funds to develop its most deprived districts has lessons for other bidders. Barbara Millar reports

Five years ago Teresa Edmans began working on a small community health project in Waltham Forest, on the north-eastern edge of London, covering two of the most deprived estates in the borough.

The two estates, with a population of around 3,000, had also been identified as the most poorly served by existing health facilities and designated a housing action trust area by the government. Redbridge and Waltham Forest health authority was particularly keen to link into the HAT initiative to develop new approaches to improving the health of local people.

This year, by building on the strengths of that small programme, Redbridge and Waltham Forest became the first HA to bid successfully for single regeneration budget funds to cover health inequalities across the board.

Although other HAs have won SRB money, this has been for specific programmes, such as drugs or crime.

'The SRB bid stemmed from the community health project work, where we started looking at the links between health and regeneration, ' Ms Edmans, the HA's community health co-ordinator, explains. 'We realised that this work could become much wider.'

Last year the HA put in a small SRB bid to fund partnership work. It was deemed 'interesting' by the Government Office for London but was not funded.

This time round the bid was successful and the HA's seven year,£20m programme has just begun. Some£8m has come from the SRB, the rest is 'matched funding' - in kind as well as in cash - which will come from the myriad partnership agencies involved with the HA, including local authorities, trusts, primary care groups, colleges and universities, community groups, voluntary sector organisations, other government departments, the private finance initiative and local businesses.

The programme is ambitious. 'By the end of our SRB programme we will have helped to break the cycle of no health, no wealth and no wealth, no health, ' says Ms Edmans.

The people who will benefit most are those at greatest risk of being denied healthcare and employment opportunities, particularly black and ethnic minority communities, refugees, homeless people, people living in temporary accommodation, under-25s and elderly people.

There are four 'streams' to the bid: improving access to jobs and training in the local health and social care industry, improving access to primary care services, coordinating the public health response and capacity building.

The HA also aims to create a culture, structures and practical support to 'glue' the SRB programme together and ensure its sustainability.

The bid specifically pledges to create or safeguard 115 jobs, ensure that 300 people are trained and obtain qualifications, help 10 new businesses to start up, support 50 voluntary or community groups and carry out 300 capacity-building initiatives.

Ten per cent of the SRB funding will go into capacity building, 15 per cent into the public health response, with the rest divided equally between jobs and training and access to primary care. In year one, the SRB will provide£750,000, with£1m in year two and£1.5m in years three and four. Funds will then taper off over the following three years.

'We will also be bringing in other programmes that will enhance what we are doing in the SRB programme, ' says Ms Edmans.

The programme is breaking a lot of new ground for health services. What is remarkable is that the bid was spearheaded by just two people, Teresa Edmans and Catherine Shaw, associate director of public health with the HA. They received a great deal of support from within their organisation and partner agencies, but admit that putting the bid together involved burning a lot of midnight oil.

After an initial expression of interest had been submitted - on three sides of A4 - to GOL, and been warmly received, the HA was invited to work up a full bid. 'It is very important to make your case well in the expression of interest, ' advises Ms Edmans. 'There were over 120 expressions of interest submitted to GOL and only 50 made it to the next round.'

Even when invited to present a full bid there is no guarantee that the funding has been secured. 'It is a risk, in terms of the amount of work you have to do. There has to be great commitment from the organisation.'

Ms Edmans and Ms Shaw researched and wrote the bid, in addition to carrying on with their normal work load .

'We were working most evenings and every weekend in the two months we had to produce the full bid, ' says Ms Edmans.

'We consulted 60 to 70 voluntary and community groups across both boroughs and had regular meetings with the local authorities, trusts, PCGs and so on. We wanted to engage people at this early stage, so we put time and effort into this work, in order that people had a voice and a role in how the bid was shaped.'

Even if the SRB money had not been forthcoming the work would have paid dividends. 'A major voluntary organisation has said this was the first piece of work they have ever felt fully involved with and properly consulted on - it has resulted in a better working relationship already.'

GOL and the NHS Executive London regional office, which was one of the advisers on health-related bids, were supportive and helpful, but Ms Edmans says working with an organisation which has experience and expertise in putting together SRB bids is crucial.

Redbridge and Waltham Forest HA used a private, not for-profit organisation, the Stratford Development Partnership, to help write the bid. This organisation will also project manage the SRB on behalf of the HA, setting up the administrative procedures and financial systems and helping to recruit a partnership board.

'Working with an agency with a proven record of success with SRB bids has been very important as HAs have no track record in this area, ' says Ms Edmans.

But she adds: 'You do need to be careful who you employ to manage the bid because, at the end of the day, the HA is the accountable body - the buck stops here.'

A nerve-wracking six weeks passed before the HA learned it had got the funds it sought, with no conditions.

'Success breeds success, ' says Ms Edmans. 'People now want to partner us for pieces of work in other areas. You start making a lot more linkages and getting better value for your communities.'

Redbridge and Waltham Forest HA chief executive Laura Noel urges HAs to go for SRB six, the next funding round.

'Even when mainstream resources are tight, this gives you ringfenced money to pursue exciting developmental work which it would otherwise be difficult to do, ' she says.

'It also takes you into new areas where health has not previously been involved.'

Bid for improvement The Redbridge and Waltham Forest HA bid area is made up of 19 electoral wards, 14 of them in Leyton, Leytonstone and Walthamstow in the London borough of Waltham Forest and five in the south of Redbridge.

Approximately 215,000 people live in the bid area. Nearly two-thirds (71 per cent) of the population is aged under 45, compared with 62 per cent for England and 70 per cent for inner London. More than one third (36 per cent) is under 25.

Over the next 10 years the greatest increase in the bid area population will be in the 5-24 age group.

The proportion of residents from black and ethnic minority groups exceeds that for London as a whole.

The 1991 census recorded 30 per cent of the Waltham Forest bid area as being from black and ethnic minority communities, compared with 20 per cent for the whole of London. In the Redbridge bid area 34 per cent of the population is from black and ethnic minority communities.

There are around 9,500 refugees and asylum seekers of more than 49 nationalities, speaking 42 different languages in the two boroughs, many of whom live in the bid area.

At the beginning of 1999 the average male unemployment rate in the Redbridge bid area was 10 per cent, compared with a borough level of 6 per cent and an outer London average of 5.9 per cent. In the Waltham Forest bid area the average male unemployment rate was 15.5 per cent, compared with a borough level of 9.2 per cent.

A high number of children in the area qualify for free school meals - up to 60 per cent in some schools, compared with a national average of 27 per cent.

The most recent data suggests that up to 8,500 people are homeless in Redbridge and Waltham Forest.

A significant proportion of the bid area population suffers, on average, poorer health than the boroughs' population as a whole, as illustrated by the standardised mortality ratio.

Indices of mental health needs show that 16 out of 19 wards in the bid area have an increased need for mental health services.

Reversing the causes of social and economic decline The single regeneration budget is a major part of the government's strategy to reverse the causes of social and economic decline - unemployment, bad housing, crime, poor health and a degraded environment.

It is co-ordinated by the Department of the Environment, Transport and the Regions and is based on funding transfers from a wide range of departments, including the Home Office and the Department of Trade and Industry, as well as DETR. In each region, the regional development agency (in London, the Government Office for London and the London Development Partnership) plays a leading role in assessing the final bids submitted. SRB rounds one to five have, so far, funded more than 600 schemes which stand to receive over£3.4bn of SRB money.

The projected results from the first four rounds are: 670,000 jobs created or safeguarded; over 650,000 people trained and obtaining qualifications; over 83,000 business start-ups; 330,000 dwellings built or improved and 53,000 voluntary groups supported. SRB round five awarded 160 partnerships£1.04bn to spend over the next seven years. This is expected to create or safeguard 118,000 jobs.

Further information from Carole Dawson, DETR, Zone 4/G5, Eland House, Bressenden Place, London SW1E 5DU.

Phone: 0171-890 3772 or www.detr.gov.uk