How do you improve the health of an entire town? That was the question facing the former fishing port of Fleetwood, in Lancashire.
It’s a place where lives have been blighted by illness and people were dying younger.
So, in 2016, a local GP began to lead efforts to turn things around, helping people take control of their health.
Since then, there have been ups and downs with the progress of what’s known as the Healthier Fleetwood initiative.
Initial enthusiasm was replaced by the stark realisation of just how big a task it would be to bring about lasting improvement in people’s physical and mental health.
But now there are some signs things might changing for better.
What was making Fleetwood ill?
Fleetwood – a small town on the end of the Fylde peninsula, north of Blackpool – was once a prosperous place.
The grand buildings on Queen’s Terrace that look out over Morecambe Bay, and the imposing North Euston Hotel, are testament to the money that once flowed through the town.
But its wealth was largely built on the fishing industry. And when that collapsed in the 1970s and 1980s, so did the local economy.
A further blow was the closure of the local ICI chemical plant, in the late 1990s.
There’s a powerful link between unemployment, poverty and a lack of opportunity and poor health.
And sure enough, rates of cancer, heart and lung disease among the population of Fleetwood soared.
There was an increase in addiction to drink and drugs and an explosion in mental health problems.
GP Dr Mark Spencer says: “I feel the town has been through a bereavement with the loss of the fishing industry, it’s been like a death in the family.
“And that bereavement process, that feeling of loss, that feeling of hopelessness and helplessness that everybody goes through with a bereavement – that’s lasted maybe 40 years.”
Dr Spencer knew his patients were getting sicker and dying younger than in other, more affluent, parts of the country.
Life expectancy in parts of Fleetwood was several years lower than in neighbouring villages and towns.
Something had to be done.
The answer to a health crisis?
By the spring of 2016, Dr Spencer had seen enough.
He was fed up with patching patients up, only to see them pitch up again at his surgery a few weeks later.
He believed the only way to tackle Fleetwood’s health problems was to start from the bottom up – not by dictating what needed to happen but by encouraging and supporting residents to take control of their own health, and in doing so, their own lives.
It would be for residents to decide how best to improve their health, what would work and what would not.
This is the key to what became known as Healthier Fleetwood, a movement that offered people the chance to empower themselves and start making positive decisions about their healthcare.
It started in the summer of 2016, with community meetings to try to bring together the various groups already operating in the town – the local football club, Fleetwood Town, residents’ associations, gardening clubs, sports groups that helped those trying to beat addiction.
Before too long, under the Healthier Fleetwood umbrella, there was an art therapy group, yoga classes, and the well attended Harmony and Health singing group.
Pauline Kennedy is a regular at Harmony and Health.
She has the lung condition COPD (Chronic Obstructive Pulmonary Disease) – and singing is recommended as a way of helping ease some of the symptoms.
But her first involvement with Healthier Fleetwood came earlier, when she realised she needed to make some changes to her life.
“I was morbidly obese. I had several medical problems that were causing me issues. I was a full time carer. I had turned 60,” she says.
“And quite honestly, I was ready to lie down and die. I just thought, ‘Well, this is it. I’ll just carry on to the day they cart me out in a wooden box.’
“But the more I started going, it started me thinking. And if you are at a meeting that is ‘Healthier Anything’ and you are the fattest person in that room, it is a bit of a shock.
“I went home and cried and had a think and realised that it was about time I did something and I accepted responsibility for my own health, for my own wellbeing.”
Pauline has now lost a lot of weight. She’s rediscovered her confidence and is getting out and about a lot more.
“I used to say Healthier Fleetwood has changed my life but on reflection Healthier Fleetwood has empowered me to change my life and I will be forever grateful for that,” she says.
An alternative to pills
One of the key strategies that has helped people such as Pauline is the use of what is known as “social prescribing”.
Dr Spencer was fed up with giving his patients pills, particularly for their mental health.
One alternative is to find an activity that can help build confidence, reduce anxiety and give people an objective or aim in life.
So instead of a drug, patients might find they have been prescribed a series of sessions in the gym at the local YMCA, or be referred to a local gardening project.
This is how Chris Eyre found himself punching a bag at a boxing class on a Thursday morning.
It was set up for those battling addiction – people such as Chris, who had to re-appraise his life after being admitted to hospital
“I was locked away in my house drinking, not doing a lot, smoking too much, never sober, watching television,” he says.
A frightening episode where his blood pressure went haywire led to Chris winding up in the accident and emergency department at Blackpool Victoria Hospital.
Chris was lucky – a conversation with a specialist alcohol nurse helped him turn things round.
Now, he is boxing and attending abstinence groups.
Chris says if he hadn’t made the changes, he would “probably back in hospital for another session with high blood pressure, and then again, and again, until finally it got me”.
“All the activities I’m now doing have improved my life, not beyond my wildest dreams but in such a positive manner that there’s no way I want to go back to where I was before,” he says.
“I am happy with my life now and how it is.”
Has it worked?
It is early days still.
Realistically, transforming the health of the entire community where ill health has been so deeply rooted is the work of generations.
But there are encouraging signs things might be starting to improve.
For example, there has been a significant reduction in the number of Fleetwood residents – people like Chris – turning up at Blackpool’s A&E, down by 11.5% in a year.
And there’s been a reduction of 9.4% in the number being admitted to hospital in an emergency.
The Fleetwood experiment is attracting national interest.
After all, there are lots of communities that face problems similar to those of the Lancashire town.
Anna Charles, a senior policy adviser at the King’s Fund health charity, says: “As people live longer, with lots of very complex conditions, we can’t just keep giving people more and more medicines and more and more appointments.
“There’s not enough money and not enough staff to do it, so finding different ways of tackling those problems is going to be absolutely critical – otherwise the NHS would fall over.”
Transforming the health of an entire community is not easy and there is still a long way to go.
But what is happening in Fleetwood could hold lessons for those communities across the UK that face similar problems.