Community Health Projects
The final item of business is a members' business debate on motion S2M-5045, in the name of Mark Ballard, on community health projects. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises the great importance of community health projects in tackling the health problems that our nation faces; believes that community, independent and voluntary sector organisations addressing health inequalities play a crucial role in meeting the Scottish Executive's targets on health improvement; in particular, congratulates the Edinburgh Community Food Initiative on 10 years of working to remove barriers to a healthy diet by consistently developing innovative and effective programmes such as the Snack Attack project; notes that the future of this project, like many others, depends on its ability to continue to identify, secure and manage a wide variety of short-term funding sources; notes with concern the sense of fragility across the sector due to the uncertainty inherent in the funding system, and considers that the Executive should show much greater support to community health projects and act to reduce the financial insecurity that they are forced to face.
We all know that Scotland faces some major health problems and that the big killers such as heart disease, cancer and stroke and new threats such as obesity, diabetes and stress are all chronic, lifestyle-associated conditions. However, throughout the country, hundreds of voluntary and community health projects are, along with community nurses, health visitors and others, working to improve our health. They work locally as part of their community in response to pressing needs and they address underlying causes of ill health and health inequalities such as unequal access to knowledge, resources and support, which our conventional health services are simply not equipped to challenge.
Tonight, I welcome to the Parliament members of those voluntary and community health groups. We should all celebrate their work. In particular, I pay tribute to the Edinburgh Community Food Initiative, which I know well and which, this year, celebrates a decade of working to improve the diet of communities throughout Edinburgh.
Recognising that systemic, external factors and a lack of information prevent people from eating healthy foods, the initiative sees its role as promoting healthy eating and positive lifestyle choices, as well as providing access to healthier foods. It supports food co-operatives and educational events and provides more than 40,000 pieces of fruit a week to primary, nursery and special schools across Edinburgh. Community health projects such as the ECFI play a key role not only in addressing Scotland's health problems but in dealing with issues such as employment, equality and education. However, even such long-lasting and successful projects face problems with future core funding.
I have been heartened by the fact that, since the Parliament was established, the importance of community health has been increasingly recognised in a string of Scottish Executive policy documents. For example, in "Delivering for Health", which was produced in 2005, the Executive stated:
"there needs to be a shift towards preventive medicine, towards more continuous care in the community, with targeting of resources and anticipatory care to reach out to those at greatest risk."
Such sentiments are welcome and I am sure that the minister will give us a long list of other positive commitments that the Executive has made. However, words are not enough. Despite all the policy support, the community health sector is under immense financial strain—79 per cent of voluntary health providers are struggling with shortfalls or are seriously concerned about their future finance.
The reorganisation of funding for the delivery of health services through community health partnerships has not led to an improvement in the situation. According to the community health exchange, core funding has significantly diminished over the past year. It estimates that in the area now covered by the Greater Glasgow and Clyde NHS Board, core funding has decreased by 50 per cent. There has been a 50 per cent reduction in funding at a time when voluntary and community health projects are increasingly being relied on to deliver Executive policy in tackling ill health.
Projects are being forced to spend their time chasing funding and dealing with massive job insecurity. They are unable to plan effectively because funding streams are constantly shifting and being reduced. I congratulate the Executive on having a policy that is going in the right direction, but it is not doing enough to ensure that the policy is being implemented properly by local authorities and health boards.
The time has come for a national strategy on community health, which would give the sector the standing that it deserves. I draw the minister's attention to the suggestions in that direction in the community health exchange's briefing. It sees the need for health boards and local authorities to be required to produce a clear statement—including strategies and targets—on how they will support community-led and voluntary sector health initiatives.
Health boards and local authorities are allocated large amounts of money by the Executive specifically to support community-led and voluntary sector health initiatives. That is welcome and the policy is moving in the right direction, but the minister should ask those bodies to account for the funds that they have been given. I have tried to get information from health boards and local authorities to establish how they spend the money that the Executive—the Parliament, in fact—gives them, but the information is not there. Health boards, local authorities and other publicly funded agencies should commit themselves to the national standards for community engagement and should agree voluntary sector compacts, as the Executive has done.
I welcome the work that has been undertaken throughout the country by the national task group on developing and supporting healthy communities. I look forward to the publication of its final report and I hope that the minister will endorse its recommendations and, most important, ensure that proper funding is available for their implementation.
Community health groups have been a Cinderella for far too long. I hope that the debate will ensure that the Parliament pays more attention to this vital aspect of delivering health care. It offers us unparalleled opportunities to tackle social exclusion, improve people's quality of life and—because money spent on prevention will always be more effective than money spent on a cure—reduce expenditure overall.
We must back words with action. We must support the community health projects that carry out work that is vital to tackling our nation's chronic ill health. We have heard positive words from the Executive and positive decisions have been made by the Parliament, but implementation is lacking. That is why we need real action and strategies to tackle chronic ill health through community-led projects. [Applause.]
I remind people in the gallery that it is not appropriate to applaud.
The motion is excellent. When I first became an MP, I was very excited by an organisation called Barri Grubb. Malcolm Chisholm will remember it because it was an active community co-operative in Pilton and Muirhouse. He and I shared representation of the area at Westminster for a while.
The briefing produced by Voluntary Health Scotland is one of the best that I have ever seen—it agrees with what I have been saying since the Parliament started. I hope that Voluntary Health Scotland has some effect, because nobody has ever paid attention to anything that I have said. It hits the nail on the head in saying that what we need is a better system of funding from the Government. We probably also need more funding.
However, if the funding were better directed in a continuous manner so that organisations could be sure that they would exist next year and the year after—as long as they kept on doing a decent job—and if there were core funding that enabled good projects to continue rather than new projects constantly having to be invented to match the latest flavour-of-the-month funding scheme, the groups would be able to do much better fundraising in commercial and charitable areas. That would enable them to bring together funding from many sources instead of living hand to mouth. The small number of staff in the organisations spend far too much time grovelling for money from here and there. What is needed is a steady stream of money that will support them as long as they are doing the kinds of things that the Executive and the local authority want them to do. All this seems to be desperately obvious, but common sense is the rarest quality in politics and government and we are yet to win this argument. However, I think that Malcolm Chisholm is pointing roughly in the right direction. We must push him along a bit, but I have more hope that he will do what is necessary than I have of many other ministers.
This is important across the voluntary sector, but especially for the organisations that are involved in matters relating to health. We must support them in a more intelligent way. I hope that, as a result of this debate and the efforts of many people who are saying the same things, we will achieve that. I say to the minister that the road to Damascus is open before him.
I can verify that Donald Gorrie is a broken record on this subject and I congratulate him for continuing to be so.
It is clear that the issues that face voluntary organisations, particularly in community health, are about core funding and the ability to sustain funding for projects that work quietly to provide services, rather than having to develop new, bigger and brighter projects. There are 1,600 voluntary sector organisations in Scotland that focus on health, with 14,000 employees and 72,000 volunteers. That meets a lot of need. How does that need get met when those organisations are facing cuts of 50 per cent?
Voluntary Health Scotland estimates that 45 per cent of voluntary health providers have a current funding gap or shortfall and that 34 per cent are concerned about their future funding. Who will meet the need if that funding is not available?
It is important for the minister to tell us how he is liaising with the Minister for Finance and Public Service Reform and the Minister for Health and Community Care about this issue, as it clearly spans departmental portfolios. Are they talking to each other in an attempt to ensure that they achieve their goals?
The issue is related to that of local government funding. Malcolm Chisholm knows that I have consistently raised the issue of funding equal pay. Glasgow City Council's failure to fund equal pay adequately has helped to lead to a situation in which its programme of budget cuts for 2006-07 has resulted in the scrapping of two thirds of its contributions to community health projects across the city, despite Steven Purcell's claims that there would be no cuts to frontline services. If ever there was an example of the need for joined-up government, this is it. There is no excuse for the Development Department, the Health Department and the Finance and Central Services Department not getting together to ensure that that need is met and that the successful voluntary health organisations that we are discussing can get on with their job of delivering services.
It is disgraceful that, for example, the Maryhill community health project lost half of its funding as a result of Glasgow City Council's cuts. It had been open for 10 years and had pioneered support for breastfeeding, which, as a midwife and a mother, is close to my heart. Many years ago, in Castlemilk, I started a voluntary support group for breastfeeding mothers, who were very much in the minority in Castlemilk at the time. I started that group with the help of my health visitor. She worked voluntarily and had no funding; indeed, the group sprang up from the grass roots and never received any funding. When initiative is shown at grass-roots level in communities, it really ought to be supported. Our group died a death when the health visitor could no longer afford to offer her time unpaid.
It is really sad that a project such as the Maryhill project, which was successful in supporting breastfeeding, had to close. That is just one example of a closure that completely flies in the face of the Executive's and the Minister for Health and Community Care's commitments to promoting breastfeeding. Where is the joined-up government that can sustain such services?
The Possil project in Glasgow is another that provided a range of services. One of its services was breakfast clubs, which the Executive promotes as an alternative to free school meals. However, the Possil project has had to close. Again, where is the joined-up government?
I have run out of time, but there were a number of questions there for the minister. I congratulate all the organisations that provide community health services in difficult times. I hope that they will be able to continue and that we will see a shift in the Executive's position.
Like other speakers, I congratulate Mark Ballard on securing the debate. The topic is close to my heart.
It is interesting to look back at the origins of the health service and at the aspects that characterised its early years. I was brought up in the 1950s and was aware of school doctors, dentists and audiology services, and of immunisation and radiography services going out to communities. In a range of ways, the health service moved away from the hospital and into the community. Many of the services were channelled through schools, but many were channelled through community organisations. There was a process of community engagement that, sadly, has become diluted in recent years as the health service has focused on hospitals on the one hand, and on primary care as delivered by general practitioners on the other. Both those things are obviously valuable, but health is not delivered exclusively by doctors or by technologically driven medicine. One could argue that society's health needs are increasingly to do with changing our lifestyles and shifting away from destructive patterns—in diets, in alcohol and drugs, or in poor exercise—and away from other ingrained behaviours. Only through a community process will we achieve such changes.
The minister will know—because I remember discussing it with him before we both became parliamentarians some eight years ago—that I was chair of Glasgow healthy cities. That was the umbrella organisation that dealt with many community health projects in Glasgow. The projects were highly successful. There were diet-based projects; lifestyle projects aimed at women, such as the maternity and child care projects that Carolyn Leckie mentioned; men's health projects; sexually transmitted diseases projects; and a whole range of other health improvement projects that were actually community projects as distinct from hospital-based projects.
I happen to think that in Glasgow we were at the forefront, not just of the United Kingdom but of Europe. Glasgow was part of a healthy cities network that covered most European countries. Interestingly, people would come to Glasgow not because we had wonderful health, but because we had wonderful community health practitioners who had relevant experience that others wanted to learn from. It is of some regret that Finland, for example, which had a lot to learn from Glasgow, has now put our health lessons into practice and appears to be driving further ahead than we are.
Priority needs to be given to a community focus on health, to community engagement and to linking health improvement with other forms of community involvement. In many deprived communities, the people's best health champions are not doctors and nurses, but other people who live in those communities. Many of the best professionals who work on community health projects understand that and act not as deliverers of services—professionals who do something about people's health—but as advisers or supporters who encourage people to stop smoking or drinking, or to change their diet. Such work is done collectively in a community context, not in doctor-patient relationships.
There is a great deal that we can do to improve our health by putting more emphasis on community health. Not just the Minister for Communities, but the Minister for Health and Community Care should take that on board.
I congratulate my colleague Mark Ballard on securing the debate and echo his welcome to the people who have joined us in the public gallery. Given that many community health organisations are under a great deal of pressure and are unsure about their futures, it speaks volumes that so many people have come to the Parliament to listen to the debate.
My experience of voluntary sector health organisations relates to the field of sexual health, which Des McNulty mentioned. I am talking about the other side of the coin—not health services that have been moved out of clinical provision, but areas of health that were not identified until the community got involved and responded to them, with the result that they were subsequently picked up by the national health service and other providers.
Community-driven health activism alerted the rest of society to the problem of HIV and, later, to the specific needs of gay and bisexual men. That is not the only group in society whose needs were first recognised by the community health sector. Asylum seekers and refugees are another example of such a group. The people who live in those communities or who are connected with them are often the first to be able to respond; they can do so more quickly than policy makers and large service providers. When community health activism drives provision in a particular field, it helps to fill some of the gaps that the larger service providers have not been able to fill.
Clinical services are crucial to Government policy and targets, but they are not enough on their own. Community health can pull in the same direction. It is a matter of some regret that politicians, especially in the run-up to elections, focus on hospitals and doctors and nurses, and sometimes lose sight of the need to adopt a broader approach to responding to health problems.
It would not be an overstatement to call the present situation a national funding crisis. Des McNulty said that Glasgow had been at the forefront of community health provision, but in the space of one year, the Greater Glasgow and Clyde area has experienced a 50 per cent reduction in funding for community health. That is a huge change to cope with.
With the introduction of community health partnerships and the advent of changes in funding, the Glasgow healthy city partnership commissioned a review that mentioned the benefits that community health services provide. It said:
"Termination represents a radical departure from current policy and practice which point towards increased community and voluntary sector involvement in the health improvement agenda. In this context, termination presents a politically unacceptable option."
One year later, by the summer of this year, two out of the eight projects that were studied had been terminated and four others faced such drastic funding cuts that they were forced to consider merging. Even if they can pursue that option, they will not be able to provide the same level of service that they have done in the past.
I echo Mark Ballard's point that, if the Scottish Executive is to meet its policy priorities and put its agenda into practice, it must get a grip on the problem nationally and ensure that organisations that work hard to deliver health improvements through community projects in Scotland can continue to do so in the future with secure funding.
I, too, pay tribute to Mark Ballard for bringing an important motion to the Parliament. The motion is important for three reasons: first, because we often underestimate the important role that community health projects play in broader public health matters; secondly, because of the funding difficulties that Patrick Harvie and others have mentioned; and thirdly, because of the important role that volunteers and volunteering play in our society. I will touch on each of those issues.
To deal with the last one first, it was appropriate for Mark Ballard and other members to pay tribute to those who volunteer and give their time for nothing. The Parliament has made it more difficult to volunteer, although for the best of reasons. As a result of the provisions on disclosure for those who deal with children and a variety of other measures, we have introduced hurdles to volunteering. It is therefore appropriate for the Parliament to record its thanks to those who dedicate their time to volunteering. In the more complicated 21st century world in which we live, with a 24/7 society of split shifts and split and dislocated families, finding time to volunteer is arguably harder than it has been previously, yet it is ever more necessary. The Parliament should therefore pay tribute to those who volunteer. They do not ask for much and the least that we can do, given the difficulties that we have imposed, is to thank them.
Funding issues apply not only to community health projects, but to a variety of voluntary agencies. The Executive must, correctly, check against delivery, balance the books and ensure that funding is not given in perpetuity. However, that causes difficulties that result in many organisations being unable to continue—we have heard examples of that. The situation can also be fundamentally debilitating for organisations that are doing a difficult job in difficult circumstances, involving people who give their time voluntarily. They face not only the challenges and problems with which they are dealing, but the difficulties of managing and balancing the books. As a body politic, we must do more to address that. We must ensure that public funds are best used and not used wrongly, but we must also ensure that such organisations, which contribute immensely, can continue and are not undermined. As I said, organisations sometimes simply cease to exist or are undermined by the hassle and wear and tear and the anxiety that goes with that. We must address that.
Community health projects play an important role in addressing the difficulties that Scottish society faces. Modern medicine has resulted in a huge swathe of changes that we clearly welcome. We do not now simply have heart transplants; we have face transplants and a plethora of other wonderful procedures. However, at the end of the day, we must realise that some of the most significant changes that the Parliament and the Scottish people can make will come as a result not of the wonders of modern science, but of measures at the basic grass-roots level. Part of the issue is about improving affordability and accessibility and making services available and part is about changing attitudes, for example, in tackling smoking.
Other small nations reward and support those who volunteer by ensuring adequate funding. Des McNulty mentioned Finland, which, as a consequence of such measures, has moved from being the sick man of Europe to being the country that most of us in Scotland would emulate. I congratulate Mark Ballard on the motion.
I congratulate Mark Ballard on securing the debate. Community focused health provision is vital in building a healthy Scotland. I welcome the motion's recognition of independent and voluntary sector organisations, which are often somewhat overlooked by Government and whose work in providing services is essential in addressing health inequalities in our society. I also congratulate the Edinburgh Community Food Initiative on its 10 years of work throughout the Lothians, and especially on its efforts to improve the diet of many local people.
In north-east Scotland, which I represent, similar organisations, such as Gordon Rural Action, for which I will be sponsoring an exhibition in the garden lobby next week, are working to support and promote local voluntary action and services in central Aberdeenshire, including the provision of access to a wide range of community and self-help groups. I recently went along to one of Gordon Rural Action's drop-in days in Inverurie to see for myself the services that are on offer, which include not only information on health matters but access to money and debt advice, and to rural housing and local employment services. We must encourage such innovative and effective organisations and we must work to reduce and remove the barriers and red tape that often prevent community groups from starting out in the first place.
Often, the personal contact that comes with community, independent and voluntary services is as valuable as the service that they provide. I cite the example of the WRVS meals on wheels service. It provides our old folks—although not only old folks—with a healthy hot meal each day, but it also provides human contact. Many older people who live on their own, and adults who have mental health problems or physical, sensory or learning disabilities might lack that human contact. I suggest to the minister that it cannot be provided through weekly delivery of frozen ready meals which, I am sorry to say, many local authorities are moving towards.
Community based and focused groups provide invaluable assets but, as we have heard repeatedly this evening, many of them are bedevilled by the problem of future funding. Voluntary organisations throughout Scotland increasingly operate in what can be described only as a guillotine situation, in which they never know when vital funding will be cut off.
I know from my involvement over the years with different groups in Aberdeen and Aberdeenshire that day-to-day costs—or working capital—are a pressing issue. As the motion says, "the sense of fragility" that that brings often impacts on the services that such groups can provide.
The funding and support of community health organisations is an area that we as politicians must consider in order that we can provide the stability that is essential to forward planning in the community health sector. The difficulty in identifying and securing continued long-term funding and funding for existing services must be addressed so that the great work that we have heard much about this afternoon can continue and expand to reach more of our communities.
We need to develop and build a confident and well-informed society, which will help Scotland's parents to make the health choices that will enable their children to become healthy, well-educated and passionate young Scots. We must continue to educate community groups on health matters, promote good health and encourage individuals and communities to share health-improvement responsibilities and activities. To do that, community based and focused voluntary groups need to be free of Government interference, but financially secure. I—as other members would—would welcome a commitment from the Executive across portfolios to review funding of the voluntary sector, which plays such an important role in our communities, with a view to securing and sustaining its long-term viability.
I congratulate Mark Ballard on securing what I consider to be a very important debate. Community health is very important, given that the majority of health issues are dealt with in the community, which we forget. There is a lot of focus on the acute sector, but 98 per cent of health matters are dealt with in the community, so if we do not get it right, people will end up in hospital.
We thank all the people who work in our community; they include primary care workers such as general practitioners, nurses and allied health professionals, and independent and voluntary service organisations. It is important that we use many ways to address inequalities throughout communities, which is close to the Executive's heart—we want to eradicate inequalities.
It saddens me that projects such as the Edinburgh Community Food Initiative might be under threat because of the effort that they have to put into getting their funds together. We have heard about that problem and what we have heard is true—it is happening in my constituency. So much of the energy that should go into doing good work goes into finding funding. Local authorities and health boards should help to fund such organisations, but there has been a decline in support over time. As Des McNulty said, Glasgow was good at supporting projects, but the effort that we put into the community has decreased, probably partly because health boards have to try to get rid of their deficits—the millions that they owe—before they start their building programmes.
The energy that goes into organisations such as the ECFI should be used to encourage people to eat healthily and to exercise in order to help them to lose weight. It is extremely important to do that because it has been proved that to lose a modest amount of weight, such as 5kg to 10kg, has a significant effect on reducing the chance of type 2 diabetes, hypertension, atherosclerosis and raised cholesterol. I refer to what is known as the metabolic syndrome: the heavier we are, the greater is the cumulative effect of those factors, so it is important to get our diets right. Scottish intercollegiate guidelines network guidelines from 1996 say that if we get weight down into the low-risk range, we can reduce total mortality by between 20 per cent and 25 per cent, diabetes mortality by 30 per cent to 40 per cent and obesity-related cancers by 40 per cent to 50 per cent. That must be good. We need to inform people and prevent them from becoming overweight and we must target those who are at high risk.
How can we do that but by everybody working to keep people's weight down? It is extremely hard work to educate people about the important reasons why they should lose weight and to support them in doing it. I would like school nurses to be brought back—they exist, but there are not enough of them. It is important to get the waistline down. For a man, 37in is low risk and 40in is high risk. For women, the low risk figure is 32in and 35in is high risk.
At one meeting of the cross-party group on loss of consultant-led services in Scotland—solutions, Professor Colin Waine, who is connected with the National Obesity Forum, gave a presentation. He ended by saying that the metabolic syndrome is a public health time bomb. He also said that the report "The Cost of Doing Nothing—the economics of obesity in Scotland" shows that obesity is already costing as much as smoking but that smoking is, we hope, decreasing—it keeps going down—while obesity in the United Kingdom rises at a rate of 1 per cent per annum.
The status quo is not a viable option, and I would like the minister to address the issue. Some moneys are not available, such as the supporting people fund, which I have been told has been cut. Perhaps the minister could say something about that.
Other members have congratulated Mark Ballard on securing this important debate: I add my congratulations to theirs. It has been more than useful and I support the general terms of Mark Ballard's motion. As other members have said, it is important to welcome and celebrate the work of community health projects. The debate also provides an opportunity to thank volunteers—and paid staff—for their efforts and endeavours.
I regret that I am not intimate with the details of the Edinburgh Community Food Initiative, but it clearly has a distinguished track record and history and obviously fits well with the current raft of initiatives on better diet and healthy living. It seems to be complementary to national policies such as hungry for success, which is the programme to improve school meals. It and other such projects demonstrate how much value strong local community input can add to national policy initiatives. As Jean Turner said, 98 per cent of health contacts take place in the community. It is clear that community health projects add immense value to that input.
Mark Ballard rightly referred to the Scottish Executive's success in taking forward the community health agenda. He mentioned a number of initiatives and important policy documents. It is fair to say that we are much further ahead than we were eight years ago, but there is a risk of falling backwards: it is all a question of funding. The need for constant fundraising is a long-term problem because it is debilitating to the efforts of the sector and loss can result from it. The debate has rightly centred on continuity of funding. Core funding is critical to the work that is done at the local level.
The role of health boards is also key. They need to take greater responsibility and should place greater priority on funding community health projects. The Executive can provide better resources via health boards and councils, and it can give a strong lead to both types of organisation in supporting and valuing community health projects. It is not sensible to have micromanagement from Edinburgh; local input is immensely important.
I will mention a constituency example, as other members have done. The Dry Dock in Eyemouth in Berwickshire is a first-rate project that has been scaled down because of an inability to access core funding. The club is still there, but not in the way that it should be, in my view. It started off as a youth club with a dry bar and developed into an education and health project. I was there one day when a postman arrived with a parcel. One of the young people said, "Ah, our baby has arrived," which caused slight consternation on my part. It was in fact a full-size medical dummy, which is used to help young mums to understand how to cope with babies—there were pregnant teenagers there. The dummy was also used for another education and health project.
Warm words are important, and it is right to thank people for their efforts, but that is not enough. We need to ensure that strong support is given to projects. It is important to emphasise community health, which I am sure will be expressed in a number of manifestos for next year's elections. I add my support to the motion, and I repeat my congratulations to Mark Ballard on securing the debate.
I add my congratulations to my colleague, Mark Ballard, on securing the debate. Mark has given us a good overview of the sort of projects that we are talking about and the problems that they face. It is clear from the briefing that we all received from Voluntary Health Scotland that organisations face real difficulties. The Executive has a stated commitment to work in partnership with voluntary and community-based groups. However, in practice, it is not an equal partnership. Groups face particular difficulty in securing the core funding that would give them a certain future and would allow them to plan their projects effectively.
We all have local examples and here is mine. In Scotland, we tend to think of deprivation as an urban or central-belt problem, but in 2003 the seventh most deprived ward in Scotland was Merkinch in Inverness. The community got a five-year lottery funding package to convert the janitor's house at Merkinch primary school into a healthy living centre, known—because we are down-to-earth folk in the Highlands—as the janny's hoose. The janny's hoose is led and managed by a user group from the community. It offers a variety of services, including education on diet and dental health, with a school toothbrushing programme; a variety of activities to promote good mental health, including stress management and counselling; support for parents; and joint work with the school and professionals in the community.
I will quote from a representative of the janny's hoose:
"At this stage it is uncertain whether we will continue. The Health Minister maintains that funding for these projects should come from local sources (Community Planning Partnership and Community Health Partnership). The CHP say they have only just over £2,000 for health promotion, the council have problems with us as we don't fit into their structure anywhere."
The project might get some funding from the regeneration fund, and possibly some from the community health partnership, but nothing is certain. An organisation cannot continue to be effective if it is on a continual funding knife edge. If the janny's hoose folds, the progress that has been made in tackling health inequalities in that deprived area will be lost.
I turn to another aspect of the partnership between the NHS and community groups in delivering community health projects. I understand that the Minister for Health and Community Care will publish the Executive's review of nursing in the community next week. It has become clear that the final report is likely to contain a proposal to move away from health visitors, district nurses and so on towards generic community nurses, but many professionals have deep concerns about that.
I remember working as a school doctor with triple-duty nurses, who combined the roles of health visitor, district nurse and school nurse. When the pressure of work meant that something had to give, as is always the case in the NHS, it was always the health promotion activity that went. Such activity is no less important than reactive health activity, but it is less immediately urgent. Whenever we had a single-duty school nurse who had no other duties and could do the health promotion work that was so necessary, that was always hailed as a huge benefit.
The national strategy that Mark Ballard proposes would ensure that health promotion and community health could not be allowed to slide off the bottom of budgets or be left on a funding knife edge. It is not enough to give money to local authorities and health boards in the hope that it will find its way down to such projects. Our communities need projects such as the janny's hoose and nurses whose specific role is to engage with the community. We must ensure that they get those.
I congratulate Mark Ballard on bringing this important debate to the Parliament and I welcome the representatives of voluntary and community health groups who are in the gallery.
The voluntary sector is vital to our communities and delivers responsive, innovative services such as the community health projects that we are discussing. Community projects arise from and are embedded in the communities that they serve. They can persuade people and engage with them in ways that statutory providers often find much more difficult. Last December, we published "A Vision for the Voluntary Sector: The Next Phase of Our Relationship", which recognised the sector's vital contribution to our joint policy aims and made it clear that we need to do much more to understand, build on and learn from best practice in the sector.
Seen from the perspective of "A Vision for the Voluntary Sector", community health projects make a substantial contribution to addressing the health issues that communities in Scotland face. We need the commitment of the independent, community and voluntary organisations that work with the statutory sector to meet the challenging targets that we set for improving the health of the people of Scotland and closing the health inequalities gap. Without those organisations, it might be impossible to achieve our objectives.
Like Mark Ballard, I pay tribute to the Edinburgh Community Food Initiative's remarkable achievements in the past 10 years. They are a tribute to the energy, commitment and vision of the staff and volunteers who have contributed so much over the years to make the initiative such a great success. I hold up the Edinburgh Community Food Initiative as an exemplar of how a community health project can work successfully with and within the communities that it serves to identify where positive change can be brought about in community health and well-being. The initiative demonstrates how a community health project can respond and adapt to the changing priorities in health improvement—and to changes in community and partnership demands—and ensure that it remains sustainable.
There are, of course, many other examples, and I will mention just one. Just around the corner from the Edinburgh Community Food Initiative, which is based in my constituency, is the FareShare project, which is run by the Cyrenians. It distributes food to more than 40 hostels and day centres for the homeless. A film about the project will be shown in the Parliament two weeks today and speakers will describe the project's work. I hope that members will attend to hear about its important work on health and homelessness.
I recognise that achieving sustainability remains a major concern for community health initiatives. A key principle in the Executive's approach to improving community health and well-being is to allow community partners to agree on local priorities and to target their resources accordingly. Therefore, it is important that community health initiatives are able to work with the statutory sector to identify the priorities and decide how they can best be met. The Edinburgh Community Food Initiative can act as a model for others in that respect. It has secured a wide range of funding partners as well as generating its own income as a social enterprise.
Among its deliverables are activities that clearly link to enabling its partners' objectives to be met. An example is the snack attack initiative, which delivers on the Scottish Executive's free fresh fruit for primary 1 and 2s initiative and provides free fruit for children who are eligible for free school meals and subsidised fruit for primary 3 to 7s. That is joined-up delivery and true partnership working, and I believe that much can be learned from it.
I welcome the minister's positive comments, particularly about the Edinburgh Community Food Initiative. He has talked a lot about partnership working, but the examples given by my colleague Patrick Harvie indicate that partnership working does not seem to be happening in Glasgow and Clyde. Despite the large amounts of money that the Executive has given to support community health and health promotion, it is still impossible to hold local authorities and health boards to account for how much of the money gets to the bodies. I have tried using freedom of information legislation, but the information does not exist. Does the minister share my concern that, despite positive words from the Executive, implementation is still not working?
I was about to say that decisions about funding for the projects that we are discussing are made by local agencies and partners, and members cannot really suggest that it would be right for the Executive to take steps that would constrain community partnerships in their funding decisions on individual projects. However, I acknowledge the problem that Mark Ballard described in both his intervention and earlier speech.
We are determined to expand the role of the voluntary sector and, as part of that, we are working on ways of supporting the continued sustainability of community health initiatives. One important development is the work of the community-led supporting and developing healthy communities task group. The group has been examining ways of enabling statutory and voluntary community organisations to deliver better on community-based health priorities. It has been considering issues such as sharing best practice, ensuring adequate stakeholder engagement, developing support for building capacity to deliver effectively, and gathering evidence of what works and, equally important, does not work in improving health and well-being through community-led initiatives.
The task group is due to launch its report before the end of the year and its findings will be of great interest and importance. The Executive will work with the relevant stakeholders to consider how its recommendations can be translated into actions that will provide support and reassurance for community health initiatives.
Returning to resources, I point out that the Executive already provides the voluntary sector directly with a significant level of funding—some £656 million in the current year, based on three-year funding packages that can be renewed. However, it is not possible or appropriate to fund all of Scotland's 50,000 voluntary organisations from the centre. Most of the locally based organisations rightly seek funding from strategic agencies in their areas, since their work is about determining local need and local solutions for local people.
However, as a priority the Executive will promote the further use of and support for the voluntary sector. We will encourage local authorities, health boards, enterprise companies and other agencies to work with the voluntary sector in their area to meet the needs of communities in the most appropriate way.
Understanding those needs and demands is a central ambition of "A Vision for the Voluntary Sector". The vision means new working methods and new partnership approaches based on working together. That is what communities are about, and we have seen real successes all over Scotland. Putting the power of the community to the challenge of health may be the way to a truly healthy population. The challenge is there, and the community undoubtedly has both the strength and potential.
Meeting closed at 17:59.