King's Lynn was the first area to win a large grant from the New Opportunities Fund for its Healthy Living Centre. Brian Baker reports on an ambitious project which seeks to pull preventive health, community education and medical expertise together

When the New Opportunities Fund announced, last November, that the St Augustine's project in King's Lynn was the first Healthy Living Centre to receive a large grant, there was some surprise. King's Lynn is not top of many amateur ill-health lists, but, in fact, the North End and North Lynn areas of the Norfolk town qualified within the lottery board's priority targets. The area has had no primary health care facilities for well over a decade. With high levels of long-term unemployment and low incomes, health-related needs are acute.

The scheme will draw strength from six years of sustained community development, led by the North End and North Lynn Community Trust, which was formed in 1992. A 1996 survey carried out by the local people for the Trust revealed visits to Accident and Emergency facilities were the highest in East Anglia and accidents in the home averaged 350 a year in an area of 5,800 people. Trust Manager Lin Twell says:
"Whatever you looked at it was worse here." Morbidity and mortality rates are much higher than average. Despite the statistics, which convinced the health professionals, progress in securing resources was slow. However, the community trust was proving itself effective on the ground and its courses and projects have built self-confidence among residents and established a committed pool of largely local staff.

When the new government announced its Healthy Living Centres initiative in 1997, Lin Twell and her colleagues saw an opportunity to lift their game to a new level. Eventually, a capital grant was secured from the former Northwest Anglia Health Authority for £120,000 and the trust was able to have this held while lottery funding was sought. Premises had, similarly, to be put on hold. King's Lynn and West Norfolk Borough Council bought a former social club when it went into receivership and were persuaded to earmark it for a Healthy Living Centre, subject to funding. Success with the New Opportunities Fund means plans can now move forward.

Shape of things to come
The centre will be 100 per cent wheelchair accessible once the conversion, designed by Barry Fulford and built by R G Carter, is completed in November. It sits on a two-acre site, which will form a vital part of the Healthy Living Centre project. Part will be used as a demonstration garden where local people will be able to learn skills in growing food. A former bowling green, which had become overgrown, will be converted into an outdoor play area where children of all abilities will be able to play. There will also be an external area for the creche run by the Trust, which will move to the new building when it opens. While, at the insistence of the planning authority, much of the rest of the area around the building will be used for parking, it is likely there will be a space for the community café to expand outside in good weather.

Ms Twell hopes that the café, which will be near the main entrance, will use food grown on site. The shared main entrance, which will be reached along a covered walkway, was a crucial design decision. All the users of the Healthy Living Centre will access services through it.

Medical advice
Having succeeded in securing primary health care for the area, the trust is keen it should work holistically with its own activities. The GPs, Drs Ahmed and Suchak, were deliberately sought by the trust and persuaded to come to the centre. Ms Twell says: "We wanted them and won them over".

Within the building, which is being enlarged, the GPs' surgery will have a self-contained suite of rooms on the ground floor. Services will include chiropody and physiotherapy. The doctors have already established a working relationship with Lynn Sports Centre from their present practice. The community trust has run joint projects with them too. Exercise, when appropriate, is likely to be prescribed at the Healthy Living Centre. Lin Twell hopes co-operation with the surgery will go into more specific problems. "We will encourage the doctors to suggest to people who come and see them, to come to us and try our activities such as art therapy for depressed young mothers."

Other organisations which will be based at the St Augustine's Healthy Living Centre will be the Citizens Advice Bureau, West Norfolk Community Transport and People First of Norfolk, a disabled advocacy group.
Most of the upper floor will be a large hall, which will be available for hire. The New Opportunities Fund suggested acoustic screens so it can be used simultaneously by more than one group. There is also a flat for a resident caretaker. There will not be a pharmacy on the premises, so conflicts about levels of security between users should not arise.

All inclusive
Lin Twell only expected to stay two years when she was hired, initially as a sole community worker, in 1992 after a dowry from a former factory in North Lynn led to the establishment of the trust. She believes they have come so far by adopting an individual way of working. She is cautious about how to deliver nutrition and smoking information and will keep to the methods that have worked so far in the new centre. "We try, in our courses and projects, to bring nutrition in through the side door," she says.

The decision on smoking policy at St Augustine's has been delayed. Ms Twell says: "Although people are used to a complete ban in buildings like the centre now, we don't want to preclude the people who need us most". The demonstration garden will be a place of tranquillity as well as growing area for fruit and vegetables. There are plenty of unused allotments available in King's Lynn and the team hope that local people will be inspired to take them on and decide for themselves what food to grow and eat. Lin Twell says that the power of arts and creativity in regeneration and building self-confidence cannot be over-estimated and artistic activity will be prominent in the new Healthy Living Centre. There will also be several contributions by artists to the final detail of the conversion and its fit-out.

Funding the future
Most of the funding for St Augustine's is from the national lottery. The New Opportunities Fund (NOF) awarded £0.9m and the National Charities Board approved £0.5m. Lin Twell says: "Both boards gave us what we asked for. Part of the Charities' Board grant is for initial revenue costs." Even so, her primary task, and that of the Trust Board, which is chaired by the vicar of one of the local churches, is to secure core revenue funding.

They had previously secured £100,000 of money from the Arts Council in 1998, and the surgery is separately funded, but most of the staffing and project costs in recent years have come from the trust's involvement (along with the borough council) in a single regeneration budget funded programme. The NOF bid went against received wisdom on healthy living centre projects - both the Government and the lottery board had emphasised partnerships when the programme was launched and guidelines warn against bids which are necessarily building-based. But for the North End and North Lynn Trust, the buildings was crucial. They were in no doubt that they needed a substantial and central physical focus in order to deliver. Lin Twell says: "I've never really understood what they are thinking of by a kind of virtual healthy living centre." But she points out that the Trust will continue its level of outreach work, even when the centre is open.

The Trust didn't bid as a partnership either. "We didn't want our style and approach to be changed by working with a formal partner," explains Ms Twell. "If you are a relatively new organisation, you need the big players as partners. It's only because we'd been going for so long we could do it the way we have."

This isn't to say that Ms Twell is opposed to partnerships though, far from it, but it's clear she believes action speaks louder than words. "We think partnerships are about relationships, not heads of organisations signing a piece of paper," she says. "We have partnerships and relationships with individuals."

Lin Twell smiles and admits to being a bit surprised that they have pulled it off on their own terms. The centre is expected to open at the end of this year. Next year, they have the chance to start to deliver the health improvements King's Lynn needs so badly - doing things their way.

For more informaton on Health Living Centres, visit the DoH website: www.doh.gov.uk/hlc.htm